Multilateral Investment Fund (MIF) Inter-American Development Bank (IDB) 2015 PPP Americas Conference Session 2B: How PPPs Can Satisfy Demand in the Health Sector - The Trinidad and Tobago Health Perspective Stewart Smith, Senior Health Systems Adviser Ministry of Health April 14, 2015

Health PPP Initiatives in TNT National Dialysis Centres – On-going – Design-Build-Finance-Operate-Maintain (BDFOM) National Diagnostic Centres – Business Case being developed Design-Build-Finance-Operate-Maintain (BDFOM) Hospital Contract Management – Hospital construction being completed – Operations and Maintenance

Benefits of PPP to the TNT Health Sector … the practical side Build health infrastructure and replace ageing and obsolete hospital plant and biomedical equipment Address the challenges of government capital funding by incentivising the private sector Satisfy the increased demand for improved healthcare services by the citizenry and the need for new and improved health care services Strengthen the management and operations of hospitals to improve efficiency and care and service quality Attract, build and retain a skilled, experienced and competent health workforce Infuse modern governance, organization management and ICT systems into the health sector Resulting in a strengthened health system

Challenges of PPP in the Caribbean The concept is new…No developed cadre of government subject- experts with the know-how to lead and manage the process The constant need for support from international organizations International foreign subject-expertise is very costly The PPP development process itself is very costly Local private sector market is risk averse and still wants Government guarantees - no clear understanding of the concept of the transfer of risk to the private sector PPP procurement strategy is in competition with traditional procurement approach – a comfort issue High developmental PPP costs with high recurrent PPP costs in LMIC with high imports and resource constrained economies Significant and heavy long-term commitment on foreign exchange outflows - with possible limited inflows

Lessons Learnt and Way Forward Need for a long term government commitment to the PPP procurement model and modification to existing procurement legislation Need to strengthen the local talent pool for PPP support Establish a dedicated unit of subject experts and train-up that group to the level of “advisers”… all professionals Need for more private sector sensitization as well as more private sector financial institution sensitization As there is till limited, partial or completely wrong understanding of the PPP concept The thinking and expectation are still too government-centric Need for more thought-leadership and idea generation by the private sector (particularly in health delivery) One hopeful outcome