Public-private partnerships can help improve healthcare in Africa

http://www.theguardian.com/world/2014/apr/09/public-private-partnerships-improve-healthcare-africa

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It is shocking, but perhaps not surprising, to read of the impact of the public-private partnership between the Lesotho government and Netcare on healthcare across Lesotho (Finance deal threatens Lesotho's hospitals, says Oxfam, 7 April). However, public-private partnership can work in an African healthcare setting, and this has been demonstrated over the last six years by the success of the Health Improvement Project Zanzibar (HIPZ) in transforming services on the island.

Since 2006, an innovative model of collaboration between HIPZ and the Zanzibar government has seen a huge improvement in care at Makunduchi and Kivunge hospitals. This partnership improves healthcare provision without commercial gain for individuals or corporations, or the accruement of debt, with an ultimate aim of long-term sustainability.

The success of this model has required a number of crucial factors: a commitment to fully understand local needs, an open-minded and pragmatic approach by the HIPZ team (recognising the importance of listening to local staff), consistent investment in local staff, and transparent monitoring of outcomes, but with the acceptance that improvement is slow and often difficult to demonstrate in the short term. This largely unknown model of collaboration demonstrates a stark contrast to that seen in Lesotho.Dr Jon Rees, Mr Ru MacDonagh, Roma Walker, Dr Nick CampainOn behalf of the HIPZ Trustees

• Your article rightly raised concerns about healthcare costs in Lesotho. The World Bank Group is working closely with the government to identify cost-effective solutions to improve health for the people of Lesotho.

We would like to clarify a few key points. The public-private partnership health network – which serves a quarter of the population – accounted for nearly 35% of the total health budget. While this is a significant allocation of the budget, it is about the same percentage spent on the facilities under the old system. Most important, the network is delivering better results.

As the article noted, maternal and infant mortality rates have declined and the quality of care provided has improved at the new health facilities. These important achievements have driven greater-than-expected demand at the network – which includes four primary clinics and the only referral hospital open to all citizens.

We are working in several areas to help the government of Lesotho to further expand access to high-quality health services for women and children, especially those living in remote areas. We welcome the opportunity to work with all stakeholders so that everyone in Lesotho, especially the poorest, is able to access the essential health services they deserve.Laurence CarterDirector, PPP transaction advisory services, International Finance Corporation

• The letter you published referring to the Tony Blair Africa Governance Initiative (9 April) is misleading. We are an independent UK-registered charity and Mr Blair, as our founder and patron, carries out his work in Rwanda on a pro-bono basis. As such he is well placed to comment on the country – its progress and its challenges. AGI derives no profit from its partnership with the government of Rwanda. A quick look at our website (www.africagovernance.org) will tell you that we work with several African governments to help them drive the development that lifts their people out of poverty.Nick ThompsonChief executive, Tony Blair Africa Governance Initiative