Public-Private Partnerships for Health: Opportunities in Cabo Delgado, Mozambique

Abstract

The government of Mozambique faces tremendous challenges in improving population health outcomes – first due to a heavy burden of disease, and second due to insufficient resources for the health sector. The mining and natural gas firms operating in Cabo Delgado province face a challenge in maintaining a productive workforce – first because the burden of disease decreases labor productivity, and second because the current health care infrastructure is of low quality. The firms solve their problem by paying high prices for private health care contractors, but this SYPA argues that this funding could be spent more efficiently if aligned with the government health system through one of several possible public-private partnerships. This paper describes four potential options. Two target prevention of disease, specifically malaria, one with primarily state implementation and another with primarily NGO-led implementation. These partnerships would be likely to reduce the prevalence of malaria, which should reduce absenteeism and improve labor productivity while improving population health outcomes. Two other options target treatment services, one with an up-front investment in improving a public hospital, and another that adds a long-term contract between the firms and government with quality monitoring. This last, most ambitious partnership is the most technically correct in its ability to improve services and demonstrate cost savings for the firm, but involves the most risk and most difficult implementation. The analysis contained in this SYPA leads to three recommendations: 1. Until trust is established between partners, a long-term curative partnership is unlikely. The more limited partnerships should be pursued first to prove the state’s ability to implement higher quality services when their resource constraint is lifted. 2. Because establishing trust is a key goal, NGO implementation should be ruled out unless a state-implemented program is unsuccessful. 3. A preventative and curative partnership are not mutually exclusive, so the state should recruit a mining firm for the preventative partnership (their workforce is more likely to benefit from malaria reduction) while continuing to pursue a curative partnership with natural gas firms targeting stabilization services prior to medical evacuation.