Global Healthcare “Public-Private-Partnerships (PPP)” Focus on Fiji- LMIC.

The COVID-19 pandemic unearthed gross inequities and inequalities in global healthcare delivery.Currently, all 32 Health targets of the Sustainable Development Goals (SDG) will not be met by the charted strategic directions. In fact, World Health Organization (WHO) has now mobilized a division to access, review and recommend to STATE parties, the important measures to addressing Global Health inequity and inequality by the release of the Progression Pathway Research analysis. This follows its analysis of consolidated reports from the African, Mediterranean and European regions. These WHO studies have been released and widely circulated. The outcomes have indicated the need for greater Public-Private-Partnership (PPP) in State healthcare with their individualized health priorities.

 The need to cost efficiency, closely monitored with tailored PPP has been recommended, based on the increasing role of the private sector in primary, secondary and tertiary healthcare. As knowledge of public healthcare remains allusive to both public and private primary healthcare teams, much work needs to be undertaken to overcome this new nascence, develop strategy with policy directives which will enable sustainable partnerships to be nurtured with improved relations, establishing a unified healthcare system for all citizens. 

The Fijian government’s response to the COVID-19 pandemic has played out in many other jurisdictions with unique overtones, impacts and outcomes. The disjoint in non-sharing of personal protective equipment (PPE) to non-involving of the private public system initially, in supporting the fragile public health system has been documented. However, a tipping point arose with all “Intensive Care Unit” (ICU) patients invariably ending in the mortuary and health facilities running out of medication, consumables and bed space.

 The politician animal in governance hastily juggled a select group of General Practitioners (GP) under a micro-economic PPP schedule. The aim was to keep the fragile public health system from collapse, on one hand. An ill-conceived macro-economic PPP was also implemented with an overseas hospital recruitment group for political mileage, as election fever dawned. There remained no national stakeholder dialogue prior to this agreement, even in Governmental circles. Unfortunately, the national superannuation scheme was instructed to fork out a progressive fiscal ratio of 80% for this deal.  The overseas based hospital recruitment company was to provide the concurrent 20% fiscal equity to run two major western hospitals. This was at great fiscal loss to the taxpayer’s retirement entitlements now estimated at $10 x 10⁶/monthly becoming apparent. The Fiji College of General Practitioners (FCGP) was not collectively engaged as its individual members were hand-picked by the Ministry of Economy’s bureaucrats under closed shop directives.  Attempts by FCGP to raise interjections were throttled with Ministry of Health and Medical Services (MOHMS) and with senior economy bureaucrats. The camel’s back broke, when the ill-defined/unresearched PPP delivery system was reviewed, misused by the select private sector. A major redefinition was inevitable and still is.

 Conclusion.The need for transparency and clarity by the administrators in Economy and Health inclusive of the private sector viz a viz FCGP and others is now warranted. The need to identify priority areas, policy, strategy and programmatic applications reviewed in the interests of patients, communities and society is fiscally important and responsibility of the Coalition government. The fiscally compromised healthcare system needs redirection. The current WHO technical support to STATES inclusive of Fiji should be considered “High Priority”. Fiji will benefit from a strengthened governance mechanism, developing innovative approaches in primary healthcare with this shared information. Results in policy and strategic directives with “Health of All, by All” being nurtured and implemented within the remaining 6 years to 2030. Health inequity and inequalities needs an open cross-cultural mind with Fijis evolving demography and differing ethnic health seeking behaviors in light of accruing scientific evidence of future pandemic forecasts.

Neil Sharma,

2rd August, 2024

nsharma2@connect.com.fj