This synthesis paper builds on previous IEG work on PPPs and on private sector involvement in health, notably the 2009 Health, Nutrition, and Population Evaluation and the 2013 World Bank Group Support to Public-Private Partnerships: Lessons from Experience in Client Countries FY02– 12. The 2009 Health, Nutrition, and Population Evaluation was intended to inform the implementation of HNP strategies so as to make future support more effective. Although the HNP Evaluation was broader in scope some of its findings were relevant to World Bank and IFC health, and echoed the findings of the 2013 PPP evaluation.
For example, to strengthen the Bank Group’s ability to help countries to improve the efficiency of health systems, the IFC should: (i) support PPPs through Advisory Services (AS) to government and industry and through its investments, and expand investments in health insurance; and (ii) improve collaboration and joint sector work across the Bank Group, leveraging World Bank sector dialogue on health regulatory frameworks to engage new private actors and more systematically coordinate with the World Bank’s policy interventions in private sector participation in health. The more recent 2014 IEG review of Bank Group support to health financing over FY03–12, found that 70 percent of all IFC AS in health was dedicated to PPP projects, and highlighted the role of the Bank Group’s Health in Africa Initiative in fostering private sector participation in publicly funded health.
Lessons Learned
As the development community and the World Bank Group increasingly partner with the private sector to enhance the delivery of health services, this review stresses five lessons:
- When advising governments on the various models for providing health services, both the IFC and the World Bank should act as one Bank Group and discuss the whole range of options, from the public and mixed options to the other possible types of PPPs, in the context of the country’s state of reform, overall maturity, and track record in using PPPs.
- To be better positioned to deliver such strategic advice, the Bank Group should better integrate its sector reform and policy work with its structuring and financing of PPPs.
- Access for the poor and affordability need not only be systematically considered at the design stage, but also tracked to ensure that the poor actually benefit from PPPs.
- The recently developed Bank Group–IMF PFRAM tool for assessing fiscal implications should be systematically applied to structuring PPPs that have substantial fiscal implications.
- The new practice of preparing post-completion reports after the PPPs have gone into operations should be mainstreamed so that post-completion reports are conducted after sufficient time, given the long contractual life of PPPs.
