Posts Tagged ‘PPP in Health’

PPP helps meet target to halt malaria spread

The Philippine Star, 10 April 2014

 

MANILA, Philippines – An overlooked area of potential for harnessing public-private partnerships (PPP) in the Philippines is healthcare. Proof of success and sustainability of PPPs in this sector is the current National Malaria Control Program (NMCP), a concerted effort of the Department of Health and local government units (LGUs), together with private enterprises, non-profit organizations and benefactors.

The NMCP has successfully reduced sickness and deaths due to malaria by 83 percent and 93 percent, respectively, as of end-2013 compared to 2005 figures.

These reductions were achieved ahead of the 2015 deadline set by the sixth UN Millennium Development Goal (MDG), which is to halt and reverse the spread of malaria by 50 percent.

From 46,342 confirmed cases recorded in 2005, malaria cases were down to only 7,720 in 2013. Over the past four years, five more provinces have been declared malaria-free: Camarines Sur, Batanes, Dinagat Islands, Romblon, and Batangas, bringing the total to 27.

There are 10 other provinces that have not registered any malaria case for three or more consecutive years, and are now primary candidates for attaining a malaria-free status.

While malaria continues to be a health burden in 53 provinces across the country, putting an estimated six million Filipinos at most risk for contracting the infection, especially children, indigenous peoples, and residents of far-flung areas, the strides that the NMCP has achieved are nothing less than remarkable and impactful. The program’s underlying PPP framework is considered pivotal to its enduring success.

The Movement Against Malaria (MAM) is the country’s current campaign toward malaria elimination. It showcases the viability of PPP in healthcare, and is supported by the grant for malaria of the Global Fund to Fight AIDS, TB, and Malaria.

Pilipinas Shell Foundation Inc. (PSFI) – the social development arm of the Shell companies in the Philippines (SciP) – is the principal recipient of the Global Fund grant, which manages MAM in partnership with the DOH, LGUs, community health workers, and volunteers.

The DOH provides technical expertise and overall direction to MAM, while LGUs have been tapped to provide additional resources for the program, including human resources, coordination, transportation, allowances for health workers, and other logistics.

Shell’s involvement in malaria control could be traced back in Palawan as far back as 1999. While the construction of the Malampaya gas-to-power project was underway, Shell Philippines Exploration B.V. (SPEX) and its joint venture partners, the Philippine National Oil Co.–Exploration Corp. and Chevron Malampaya Llc., simultaneously launched a grassroots campaign called Kilusan Ligtas Malaria (KLM).

KLM was the product of a broad stakeholder consultation led by the SPEX joint venture partners, PSFI, and the provincial government of Palawan. Local leaders and residents had identified malaria as a major burden in their community, causing almost 80,000 Palaweños to become sick, and hundreds to perish.

The success and effectiveness of KLM did not escape the attention of the Global Fund, which provided PSFI its first grant for a malaria control program covering five provinces (Palawan, Apayao, Quirino, Sulu, and Tawi-Tawi) from 2006 to 2009.

In 2010, PSFI received recognition for its outstanding management of the program, which also led to another grant by the Global Fund, expanding its coverage to 40 of the 53 malaria-endemic provinces in the country.

“Just as Shell has found its own unique role in the Philippines’ Malaria Control Program, I am certain other enterprises, big or small, have roles to play in malaria as well, not only in the Philippines but across the Asia-Pacific,” said SciP country chairman Edgar Chua to private sector players in support of malaria elimination during the Sixth Regional Meeting of the Asia-Pacific Malaria Elimination Network held recently in Makati City.

Shell has committed to MAM its expertise in community engagement, partnership building, financial management, and procurement and distribution of supplies and logistics, which include long-lasting insecticidal nets and malarial drugs. Religious use of the mosquito nets lined with insecticide remains to be the best way to prevent malaria.

 

Fear not the PPP for public hospitals

Malaya, 01 April 2014

By Ducky Paredes

 

IN the House of Representatives, two lawmakers filed a bill against the privatization of government hospitals to ensure that health care services are affordable and accessible to Filipino people.

Reps. Rufus Rodriguez (2nd District, Cagayan de Oro City) and Maximo Rodriguez Jr. (Partylist, Abante Mindanao) say House Bill 3994, to be known as Government Hospitals’ Privatization Act, prohibits the Secretary of the Department of Health to privatize, sell or offer for sale all government hospitals.

The lawmakers reacted to reports that the National Orthopedic Hospitals in Quezon City and other government hospitals were being offered for “privatization” under the Public-Private Partnership Scheme of the government.

“While it is true that the government is experiencing difficulty in infusing the much needed funds to continually upgrade and acquire sophisticated and advanced medical equipment, it is a reality that majority of the people rely on these government hospitals for their medical and health needs,” Rodriguez said.

Rodriguez said the corresponding increase in medical costs would ensue once the privatization of government hospitals is pursued and the increase in cost of hospitalization will be an additional burden to the poor.

Are the Congressmen Rodriguezes right? Is their HB necessary to stop this government from making health care so expensive to be beyond the ordinary citizen’s means?

 

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According to Health Secretary Enrique Ona, in fact, all 72 Department of Health (DOH)-run hospitals in the country are candidates for the public-private partnership (PPP) program of the government.

“All of our DOH hospitals are candidates for PPP. But we have a lot of options how to do this. For example, we can subject to PPP major equipment, such as CT (computed tomography) scans and MRI (magnetic resonance imaging), and even our oncology centers,” Ona says.

He stressed that the health department’s recourse to PPP, a flagship program of the Aquino administration, was a broad strategy to modernize the country’s public hospitals.

There are 72 DOH-run hospitals and more than 700 district and provincial hospitals across the country.

The tertiary 700-bed Philippine Orthopedic Center (POC) will be renamed “Center for Bone and Joint Diseases, Trauma and Rehabilitation Medicine,” and the build-operate-and-transfer (BOT) project awarded to Megawide Construction Corp. and World Citi Inc.

“We want to modernize the Philippine Orthopedic Center. How much will it cost us? Probably at least P3 (billion) to 5 billion to have a modern hospital,” he said.

Ona said he foresaw the new POC under the PPP to be the most modern orthopedic hospital not only in the country but in the entire Southeast Asia.

“We have already studied this based on the experience of others. We have looked into all the gaps and difficulties,” Ona says.

In describing the modernization of the POC through PPP, Ona says the country would have a modern hospital essentially without the difficulty of spending or borrowing money for it.

Under the BOT arrangement between the DOH and the private companies making up the consortium that was awarded the PPP project, the consortium will design, build, finance, operate and maintain the facility for 25 years. At the end of the 25-year concession period, the hospital is returned to the DOH.

During the 25-year program, there will still be free services for the poor even as the modernized hospital makes its money from other patients as a return on their investment.

There is nothing to fear about the government’s plan. It will modernize our hospitals without forgetting its public services for everyone, including the destitute.

 

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Here is an explanation from Atty. Sherry Ann N. Austria, the Director of Policy Formulation, Evaluation, and Monitoring Service (PFEMS) of the PPP Center:

“The private sector involvement in the delivery of public goods or services makes PPP indisputably and confusingly similar to privatization. Despite this similarity, both concepts differ in various ways.

“The vital distinction between PPP and privatization relates to ownership of an infrastructure asset or facility. When a publicly-owned asset or facility is privatized, the ownership is permanently transferred to the private sector together with the concomitant attributes thereof like operation and control. This asset or facility is viewed as better managed or owned by the private sector. However, regulatory control remains with the government. In PPP, ownership is retained by the government save in cases of Build-Own-and-Operate and Rehabilitate-Own-and-Operate contractual arrangements. In privatization, the ultimate objective is to shift the responsibilities to the private sector. This is not the case of PPP projects. Government retains ownership of the projects as well as defines the extent of private sector’s participation in a PPP project.

“The government remains accountable to its citizenry for the provision of a particular service in a PPP project. In privatization, accountability to provide service is oftentimes transferred to the private sector while the public sector gets paid for selling its assets. In the case of PPP, the private sector gets paid for delivering an asset or facility.

“Another difference between PPP and privatization is on how risks are being allocated to both the government and private sector. In PPP, risks are assumed by the party that is best able to manage and assume the consequences of the risk involved. The same does not apply in a privatized asset because the private sector assumes all risks associated with the project.

“The distinction between PPP and privatization is quite explicit: ownership. In the case of the Modernization of the Philippine Orthopedic Center (POC), this is clearly and distinctly a PPP project. What this means is that the POC is and will always remain as a government-owned hospital. It will however be built and operated by a private company who will bring in its vast expertise and resources to make POC a more reliable and efficient government hospital.

“By undertaking its modernization plans through PPP, the iconic Philippine Orthopedic Center will now have a new lease on life– reenergized by the private sector’s capital and competencies. Government undertakes PPP projects to make sure that our people will get the best possible service it deserves from its government at the least cost to the Filipinos. “

DOH: Poor patients to benefit from hospital modernization

Philippine Daily Inquirer, 24 February 2014

By Jocelyn R. Uy

 

MANILA, Philippines—The Department of Health (DOH) has assured charity patients that they would still be accommodated even if plans of the government to privatize the Philippine Orthopedic Center (POC) were to push through.

Health Secretary Enrique Ona said the hospital’s indigent patients would not be left out, stressing that 70 percent of its beds would be allotted for the sponsored programs of the state-owned Philippine Health Insurance Corp. (PhilHealth).

“This one is very clear-cut. Of the 700 beds, 70 percent or more than 400 shall be allocated for the [PhilHealth] sponsored programs,” Ona told reporters in a recent interview.

The health chief also clarified that under the PhilHealth program, patients would not be obliged to pay anything.

“Under the program, it is ‘no balance billing’ for all its members [so] that means everything will be taken care of by PhilHealth and patients will not be billed beyond what PhilHealth is required to pay by law,” Ona explained.

The P5.6-billion modernization program for the POC, the first government hospital to be privatized, is under the Aquino government’s public-private partnership scheme. The project was awarded to Megawide Construction Corp. and World Citi Consortium.

A multisectoral group earlier this month filed a petition in the Supreme Court, asking it to stop the government from pushing through with the project.

But Ona said the POC, which is the country’s only hospital specializing in orthopedic disorders, would not be privatized per se as the DOH would continue to oversee its management.

 

Public misconceptions on Orthopedic Center modernization

The Philippine Star, 22 February 2014

By Dr. Willie T. Ong

 

One of the controversial issues in health is the modernization of the Philippine Orthopedic Center (POC) under the Public Private Partnership (PPP) program of the government. Because of the complexity of the issue, the public has not been getting the correct information on the matter.

Facts concerning the new POC

POC will not be privatized. Some groups are claiming that POC will be privatized. This is simply not true. To explain briefly, privatization means that the government sells a property and lets the private group dictate the price and services rendered. For the new POC, government will retain ownership of the hospital, will continue to regulate services and will get majority of charity beds for the poor. Hence these three points make it very different from the old privatization scheme.

Government will retain ownership of hospital. This is the most important difference between privatization and PPP.

Government will regulate services given. The DOH will head a governing council that will oversee how the hospital is run. The government is not relinquishing control to the private sector.

Government is assured of 70% or 490 PhilHealth-Charity beds for the poor. This is written explicitly in the contract, which the private sector must follow. This is to correct false reports that only 10% will be devoted to charity.

How the private sector will benefit

Private sector has 30% or 210 private beds. The private sector can earn money from the private cases, without putting the poor at a disadvantage.

Private sector does not need to spend much for marketing. This is because it will get the Philippine Orthopedic Center branding already.

Orthopedic cases are on the rise because of the aging population. Hence, high technology surgeries, implants and treatments will now be offered to all Filipinos. Each of us can potentially benefit from having a modern orthopedic center.

Efficiency can give rise to profits. By performing operations quickly and safely, the new POC can serve an estimated four times more patients.

How the government and poor will benefit

New building and facilities built at no cost to the government and the people’s taxes.

New building and facilities built quickly in 2 years. Otherwise, Filipinos will have to wait 15-20 years if and when a modern POC would be built. With the present budget, there is no way P5.6 billion can be spent on one hospital alone.

Poor patients will get quality care and medical costs will be shouldered by PhilHealth.

Poor patients will now be operated on faster because of hospital efficiency. At present, patients at the old POC stay an average of 22 days in the hospital. In a world class and efficient facility, the average hospital turnover will be reduced to 4 to 5 days only. Thus, four times more poor patients can be served in the new hospital.

Why are some groups opposing?

The main reason for the opposition to the new POC is the fear of losing jobs. The DOH has repeatedly assured the thousands of POC employees that no one will lose their jobs.

However, DOH Secretary Enrique Ona explains that the employees will have three options. One, they can continue working as government employees in the new Philippine Rehabilitation Center (where the old POC is located). Two, for those of a certain age, they can opt for early retirement. Third, they can apply for a position in the new POC.

It is foremost in the DOH’s goal that poor patients will be guaranteed medical services and will not be turned away.

Secretary Ona says, “We have learned the lessons of PPP in other countries. We have studied this contract meticulously to ensure that the poor will not be disadvantaged. If we don’t go into this PPP project, I see no way for the POC to be modernized in the next 15 to 20 years. Are we willing to wait for that time and let our patients continue to suffer?”

In 25 years, the PPP contract will expire and the modernized POC will be returned to the government. By that time, in the year 2039, the government will have the option to continue the contract, or to manage it as a fully government-run facility.

“I believe that in 25 years, thousands of Filipinos would already have benefitted from the new POC. I will not be around to witness it anymore. But I want to assure everybody that I have tried my best, with the resources we have, to improve the delivery of health services for our people,” says the DOH Secretary.

 

Palace asked to answer plea vs privatization of orthopedic center

Inquirer.net, 19 February 2014

By Tetch Torres-Tupas

 

MANILA, Philippines – The Supreme Court ordered Malacañang to answer the petition to stop the government from pushing through with the privatization of the Philippine Orthopedic Center (POC).

High Court’s Information Chief Theodore Te said the high court gave Malacañang and other respondents 10 days to comment.

Aside from President Benigno Aquino III, other respondents include Health Secretary Enrique Ona, Health Undersecretary Teodoro Herbosa, Public Private Partnership Center, Jan Irish Villegas, project manager, Modernization of the Philippine Orthopedic Center, National Economic Development Authority, NEDA-Investment Coordinating Committee and Consortium of Megawide Construction Corporation and World City Medical Center.

Petitioners led by indigent patients and health workers and other organizations said the privatization violates the constitutionally guaranteed rights to health care and equitable access to health services.

The “Modernization of the Philippine Orthopedic Center” project is under the Public-Private Partnership scheme of the Aquino administration – the first government hospital to be privatized. The project costing P5.6 billion was awarded to Megawide Construction Corp. and World Citi Consortium.

The petitioners said the State’s responsibility to provide and ensure a basic social service “should not be relinquished to a private entity through privatization or commercialization of a government hospital to the prejudice of the poor and underprivileged.”

The POC is a DOH-retained hospital. It is the country‘s only hospital specializing inorthopedic disorders including cases of spinal cord injuries. It is being privatized as part of President Aquino’s Private Public Partnership (PPP) project of funding even social services.

Under the winning bid, the “modernized” POC is allowed to allocate only 70 beds for service (indigent) patients and 420 for sponsored (PhilHealth) patients – compared to the current 562 beds or 85 percent capacity for indigent patients. The new management would have an option not to accommodate non-paying patients if the 70 beds are already occupied.

POC employees also face the possibility of losing their jobs. The contract makes the workforce private, such that those who wish to remain in government service have to transfer to another DOH hospital. Those who choose to stay at POC are not assured that they will be absorbed.

Petitioners included doctors and nurses from the Network Opposed to Privatization of Public Hospitals and Health Services (NOP), Council for Health and Development (CHD), Nars ng Bayan Community Health Nurses’ Association, Alliance of Health Workers (AHW), Health Alliance for Human Rights (HAHR), People’s Health Movement, Community Medicine  Practitioners and Advocates Association (COMPASS); Head Alliance for Democracy (HEAD), leaders of citizens’ groups Makabayan, Gabriela, Kalipunan ng Damayan ng Mahihirap (KADAMAY), Kilusang Mayo Uno (KMU), and congressmen from Bayan Muna and Kabataan partylist.

 

Bidding for Fabella hospital canceled

Philippine Daily Inquirer, 18 February 2014

Niña P. Calleja

 

MANILA, Philippines—The bidding for the project to design and build a new government-run Dr. Fabella Memorial Hospital has been canceled for lack of a go-signal from the National Economic and Development Authority (Neda), health officials announced on Monday.

Health Undersecretary Teodoro Herbosa said Health Secretary Enrique Ona had ordered the bidding canceled after the Department of Health (DOH) was told that the approval of the Neda Investment Coordination Committee was needed for projects that cost upwards of P1 billion.

Herbosa said the budget allotted for the transfer and modernization of the state-run tertiary maternity hospital to its new site in Sta. Cruz, Manila, was pegged at P1.5 billion, which made it necessary for the agency to seek Neda approval.

In a memorandum circular dated Dec. 23, 2013, the Department of Budget and Management announced that the scope of the Investment Coordination Committee and the Neda Committee on Infrastructure will cover major capital projects costing P1 billion and above, instead of the P500 million project floor cost.

The winning bidder in the Fabella project, J. D. Legaspi Construction (JDLC), had submitted a bid of P742,888,888.88 to the DOH bids committee during the June 26 bidding. It later filed a case in the Makati Regional Trial Court to compel the DOH to honor the deal.

Herbosa said the DOH was back to doing a feasibility study on the project before it could submit a new proposal to the Neda.

“We were able to get the nod of the Neda technical board. At the Cabinet committee level, there was a suggestion that we pattern the project after the government’s classroom projects. The facility will be built by the private sector then we will pay them over time in tranches,” he explained.

Once the Neda, which is headed by President Aquino, gives the green light to the project, the DOH will start a new bidding process for the Fabella hospital, the third time it is doing so.

Asked to comment on the 13-page JDLC petition, Herbosa said: “They should compel Neda, not us.”

He added: “The secretary or the head of the procuring agency has the right to cancel the bidding for any purpose he sees fit.”

The aging Fabella Hospital, sometimes described as a “baby factory” for the sheer number of infants born there, is set to be transferred from the old Bilibid compound on Lope de Vega Street to the DOH’s San Lazaro compound on Rizal Avenue, Manila.

When the hospital is rebuilt under a public-private partnership (PPP) arrangement, it will no doubt provide modern delivery services to its mostly indigent patients, a prospect that would also jack up fees,  according to some groups.

“Experience tells us that PPP projects are bound to make the cost of public services higher, further disenfranchising the poor,” said Joms Salvador, secretary general of Gabriela, the militant party-list women’s group.

Fabella has always been the go-to maternity hospital for the poor. PhilHealth members do not have to pay a centavo, except in instances that exceed the agency’s case rate allocation. The Philippine Charity Sweepstakes Office has an office there to help indigents. Social welfare assistance is also available.

 

All 72 DOH-run hospitals candidate for PPP

Philippine Daily Inquirer, 15 February 2014

By Niña P. Calleja

 

MANILA, Philippines—All 72 Department of Health (DOH)-run hospitals in the country are candidates for the public-private partnership (PPP) program of the government, ostensibly aimed at reforming the country’s health system.

Health Secretary Enrique Ona said this on Friday as opposition grows to the privatization of the public health sector, which critics say is being done under the guise of PPP projects.

“All of our DOH hospitals are candidates for PPP. But we have a lot of options how to do this. For example, we can subject to PPP major equipment, such as CT (computed tomography) scans and MRI (magnetic resonance imaging), and even our oncology centers,” Ona told a media forum.

He stressed that the health department’s recourse to PPP, a flagship program of the Aquino administration, was a broad strategy to modernize the country’s public hospitals.

There are 72 DOH-run hospitals and more than 700 district and provincial hospitals across the country.

Ona defended the government’s move to privatize the tertiary 700-bed Philippine Orthopedic Center (POC) and award the build-operate-and-transfer (BOT) project to Megawide Construction Corp. and World Citi Inc.

“We want to modernize the Philippine Orthopedic Center. How much will it cost us? Probably at least P3 (billion) to 5 billion to have a modern hospital,” he said.

Ona said he foresaw the new POC under the PPP to be the most modern orthopedic hospital not only in the country but in the entire Southeast Asia.

“We have already studied this based on the experience of others. We have looked into all the gaps and difficulties,” Ona said.

In describing the modernization of the POC through PPP, the health chief said the country would have a modern hospital essentially without the difficulty for the government to spend for it or borrow money for it.

“If we are going to do this through mere government funds, we would need to borrow money,” Ona said.

Various groups, including the National Orthopedic Hospital Workers’ Union-Alliance of Health Workers, Network Opposed to the Privatization of Public Hospitals and Health Services, Kilusang Mayo Uno and Bayan Muna Rep. Neri Colmenares, have gone to the Supreme Court to stop the POC’s privatization.

Under the BOT arrangement between the DOH and the private companies making up the consortium that was awarded the PPP project, the consortium will design, build, finance, operate and maintain the facility until the end of the 25-year concession period, and then return the hospital to the DOH.