Transcript A SUMMURY OF THE BUGDGET PROCESS.

Namibia Health PPP Conference
Infrastructure: Equipment and
Medical Technology
PRESENTER: Sithembiso Mkwanazi
08 - 09 December 2014
OVERVIEW OF PRESENTATION
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Introduction
Motivation to manage medical equipment through PPP
Roles of Government and Private Partner
Medical Equipment to special vehicle services
– Fleet Management
– Specialised Vehicles
– Lessons Learnt
Medical Equipment directly
– Types of PPP Contracts with Medical Equipment
– Medical Technology
– Refurbishment, Maintenance and Replacement
– Hand over
– Lessons Learn
Conclusion
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INTRODUCTION
• When designed well and implemented in a balanced regulatory environment,
PPPs can bring greater efficiency and sustainability to the provision of such
public services as water, sanitation, energy, transport, telecommunications,
health care and education. PPPs also allow for the better allocation of risk
between public and private entities, taking into account their capacity to
manage those risks. (The World Bank)
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MOTIVATION TO MANAGE MEDICAL EQUIPMENT
THOUGH PPP
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Quality of service improvement
Attracting public funding
Attract skills required to manage medical equipment
Lowering cost of service
Better monitoring: through output/outcome
Risk transferred to a party best suited to manage it
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MOTIVATION TO MANAGE MEDICAL EQUIPMENT
THOUGH PPP: PRIVATE PARTY
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Experts/specialists in a field of medical equipment
Brand specialists as well
Wider market network
Their core business
Profit made through operation
Better and shorter procurement processes
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ROLES OF BOTH PARTIES: GOVERNMENT
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Regulator and Technical Advisory
Principal and contracting party
Define main objectives of public service (output specification)
Plan public service budget (feasibility study)
Select management model (feasibility study recommendation)
Ensure value for money, risk transfer and affordability
Performance monitoring and evaluation
– Risk management
– Quality assurance
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ROLES OF BOTH PARTIES: PRIVATE PARTY
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Fund, build, operate, maintain and hand over
Manage the facility on behalf of the institution
Ensure continuous service
Provide support to the institution
Ensure risk transferred, value for money and affordability is maintained
Take full control of risk assigned to them
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MEDICAL EQUIPMENT TO SPECIAL VEHICLE SERVICE:
FLEET MANAGEMENT
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Specialized vehicles being part of the general fleet
Specification as per Nation Department of Health Specification
Operated by department of health personnel
Fully equipped at all times
Penalties imposed for non-availability
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MEDICAL EQUIPMENT TO SPECIAL VEHICLE SERVICE:
LESSONS LEARNT
• Improved availability of specialised vehicles
• Specialised vehicles always equipped
• Better turnaround times in terms of repairs and replacements
• Minimum kilometers of about 2500 per month
• Additional charges based on extra km
• Vehicles treated similar to general fleet
• If considered specialised vehicle should have its own PPP contract
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MEDICAL EQUIPMENT DIRECTLY TO HOSPITAL: TYPES
OF PPP CONTRACTS WITH MEDICAL EQUIPMENT
• Full operational PPP (Inkosi Albert Luthuli and Lentegeur and Rehabilitation
Centre) None core
– Existing building
– Conditional Survey, upgrade and equip (IALCH)
– Upgrade and Refurbishment (L&RH)
• Co-location Hospitals (Hummansdorp, Settlers and Port Alfred and Universitas
and Pelonomi)
– Public and Private medical care within the same facility
– Upgrade, refurbishment and equip
• Specialised unit (Renal Dialysis)
– Renovate and equip
• Concession PPP (Phalaborwa Hospital) full Private use
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MEDICAL EQUIPMENT DIRECTLY TO HOSPITAL:
MEDICAL TECHNOLOGY
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State of the art technology
Full risk of technological changes
End User Training
Adhere to conditions and hospital needs
Most medical equipment carries high penalties with very short response and
restore times
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MEDICAL EQUIPMENT DIRECTLY TO HOSPITAL: ICT
SUPPORT
• ICT Infrastructure with proper capacity
• Medical ICT interphase with Institutional ICT
• ICT services provided:
– Medical Records
– Graphic images:
• Radiology services, Nuclear Medicine, Cardiology Services,
Physiotherapy, Obs and Gyn etc
– Telemedicine infrastructure available but not fully utilised
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MEDICAL EQUIPMENT DIRECTLY TO HOSPITAL:
OPERATIONAL
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Technology refreshment
Obsolescence replacement
Purchase cost including exchange and taxation risks
Equipment performance/availability
Maintenance costs
Life of Equipment Responsible for periodic planned preventive maintenance
Repairs and or change of equipment due to equipment breakdown
Cost of repairs borne by the institution/government incase abuse and
negligence has been proved beyond reasonable doubt
• Reactive maintenance due to equipment failure or poor performance normally
results into penalties
• Periodic equipment replacement as per the PPP agreement
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MEDICAL EQUIPMENT DIRECTLY TO HOSPITAL:
HANDOVER
• Conditional survey conducted towards the end of the PPP contract
• Joint appointment of the inspector
• Medical Equipment to be handed over in a condition specified within the PPP
agreement
• I terms of the PPP regulations the ownership of the equipment returns to the
Government at the end of the period.
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LESSONS LEARNT
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Advantages
– Efficiency
– Quality of service
– Quick response and restore time
– Readily available services
– Free from government procurement processes
• Disadvantages
– Loss of opportunities to use transversal contracts
– Single or limited suppliers utilised
– Equipment subjected to limited preferred brands
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CONCLUSION
• SA PPP medical Technology at institutional level at this stage
• Requires stringent:
– Contract management with:
• Strict monitoring system
• Fault reporting system (Help Desk)
• Stringent penalty model
• Risk management plan
• Financial Management
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Sithembiso Mkwanazi
Senior Project Advisor
PPP Division, GTAC
+27 12 315 5255
Private Bag X115
Pretoria 0001
Republic of South Africa
www.ppp.gov.za
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