May 22, 2020

Africa’s Public-Private Partnerships in Health Campaign: Improving accountability and transparency

PPP, health, accountability, transparency

By Wofai Ibiang

African leaders have consistently neglected their country’s health sector despite several pledges to improve it.

A Brookings Institute report highlighted that as of 2015, Africa accounted for one percent of the global health spending, even though the continent bore 23 percent of the world’s disease burden. In 2001 the leaders of 52 African countries met in Abuja, Nigeria’s capital, and committed to dedicating 15 percent of their annual domestic budget on health through a Millennium Declaration.

However, according to the WHO, only Botswana, Rwanda, Tanzania, and Zambia have met this target. Reports such as that from CNN with the news headline Africa’s leaders forced to confront healthcare systems they neglected for years, gives most Africans a ray of hope.

Hope that the wake of the COVID-19 pandemic will nudge African governments to realise the importance of investing in national healthcare and that the wakeup call will have them prioritise the healthcare system of their respective countries. Most health and civil society enthusiasts are advocating that public-private partnerships, PPPs, are the way to go to achieve better healthcare in Africa. After all, the business of health is attractive, with estimates that Africa’s healthcare and wellness sector has the potential of $259 billion in business opportunities and creating 16 million jobs by the year 2030.

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I highlight here that transparency and accountability need to improve if the gains of designing PPPs are to be achieved in Sub-Saharan Africa’s health system.

Captions such as ‘Africa’s $66B health financing gap requires private sector power, experts say’, from Devex, affirm the gusto in PPPs for Africa’s healthcare. Like any other PPPs, many factors have to be critically considered for PPPs in health projects to be successful.

As I browsed through tons of research on infrastructure and PPPs in Africa, transparency and accountability were a common feature. Poor governance and a lack of transparency have the ability to undermine success in other vital elements of PPPs in healthcare. Corruption has long been identified as one of the major impediments to Africa’s structural transformation, and it trickles down to nearly every facet of society in majority of Sub-Saharan African countries.

To realise the gains of PPP projects in the health system, the issue of corruption in public and private procurement needs to be addressed. This has been done in other regions such as South America and the Caribbean, where Inter-American Development Bank with other partners introduced a platform called InvestmentMap. It is a tool that links the State and citizens by giving citizens a means to track public investments in all economic and social sectors. This management tool has increased transparency and accountability and information dissemination of public financing for all audiences in the countries where it is introduced.

What if the African Union and indeed African Development Bank introduced a similar tool which is, of course, adapted to the African context? An impact assessment paper in 2019 confirmed that after the launch of the InvestmentMap or MapaRegalias in Columbia, the efficiency of physical execution increased by an estimated 8 percentage points for public investment projects financed by royalties.

Introducing a tool such as the InvestmentMap has the potential to facilitate the effectiveness of PPP projects in Africa by curbing corruption through its transparency and accountability property. This is achievable considering that mobile phone penetration across Sub-Saharan Africa has increased in the past decade.

According to a ZDNet report, the number of mobile internet subscribers in Sub-Saharan Africa quadrupled since the start of the last decade. In Nigeria alone, there are 97.5 million unique mobile subscribers and a projection that this statistic will grow to 135 million by the year 2025. This milestone is already being harnessed to achieve gains in areas such as digital financial services.

At the end of 2017, there were 135 live mobile money services found in 39 countries across Sub-Saharan Africa. This data is indicative of the potential that mobile phone penetration can be exploited to increase transparency and accountability of infrastructure projects in the region.

Upgraded digital infrastructure and better e-government services can unlock Africa’s PPP potential further, although more developed digital skills are necessary.

But any government wishing to make effective use of PPPs must establish effective institutions as the baseline for their development; the resources available to governments today, place this goal within their reach, provided there is political will and determination to implement them effectively.

Ibiang is of The Johns Hopkins University School of Advanced International Studies, Washington DC, USA.