Challenges and Opportunities of Public-Private Partnerships: Perspectives from HealthRise and Dr. Saúde

The following article was written by Ronaldo J. Pineda Wieselberg, a member of the IDF Young Leaders in Diabetes Program, based in São Paulo, Brazil.

The Forum on Intersectoral Efforts to Fight NCDs in Brazil (Forum Intersetorial para Combate as DCNTs no Brasil) is an initiative of Global Health Leaders’ (GHL) Public Private Competency Building strategy. Led by GHL Fellow and Medtronic Foundation Associate Dr. Mark Barone, the initiative aims to build cross-sector competencies with local, national, and regional public, private and NGO stakeholders in Brazil, and foster intersectoral partnerships to address NCDs. Dr. Barone hosted the first event for the newly created Forum on October 25, 2017 in São Paulo, Brazil. The event was attended by Esther Tahrir, Global Health Leaders Director at the Public Health Institue (PHI) in Oakland, California, USA, as well as Andrew Pines, a PHI board member, both of whom presented on PHI’s leadership development capacity in non-communicable diseases and the role PHI can play in fostering more intersectoral partnerships in Brazil.

On October 25th, 2017, at the Legislative Assembly of São Paulo State, the Public Health Institute (PHI), in partnership with Medtronic Foundation, hosted the launch of the Forum on Intersectoral Efforts to Fight Non-Communicable Diseases (NCDs) in Brazil. Representatives from the Brazilian Ministry of Health, São Paulo Municipal Health Secretary, private companies and non-governmental organizations (NGOs) had a fruitful discussion on what makes public-private partnerships (PPPs) successful.

According to Andrew Pines, member of the Board of Directors of the Public Health Institute, PPPs are very useful in developing healthy communities in which every individual reaches their full potential. Given that NCDs have multiple common risk factors, developing PPPs can be valuable for many different communities struggling with how to best treat and prevent diseases such as diabetes, hypertension, and heart disease.

In Brazil, despite the universal health coverage offered to all citizens, not everyone can access good services due to regional socio-economic and demographic factors. Health problems in a country the size of Brazil are multifaceted, and a single nationwide strategy is simply not possible. Therefore, programs should be customized or developed specifically for each region, in order to provide the best, most targeted solutions.

Two examples of PPPs with these features, presented during the Intersectoral Forum to Fight NDCs in Brazil, are the HealthRise program in Brazil, supported by Medtronic Foundation and implemented by Abt Associates, and Dr. Saúde (“Dr. Health”), a program of CIES Global, both of which have a collaborative method of implementing public health services. Representatives from HealthRise and Dr. Saude presented on the opportunities and challenges of not only implementing partnerships, but getting buy-in from the regions in which they are working.

Doctor Davi Rumel, from Sirio-Libanês Hospital, shared that HealthRise is a program implemented simultaneously in four different countries – Brazil, India, South Africa and the USA – focusing mainly on strengthening frontline health workers and mobilizing the communities to improve access to quality healthcare for people with diabetes and hypertension. In Brazil, HealthRise has been implemented in the cities of Vitória da Conquista (State of Bahia) and Teófilo Otoni (State of Minas Gerais). These cities were chosen mainly due to the fact that most of their population depends exclusively on the public health system and are underserved and underprivileged. Some of the obstacles faced in these cities include the frequent change of government administrators due to elections every four years, low popular participation mostly due to economic pressures, lack of knowledge/education and the cultural challenge of treating someone who does not present symptoms, since NCDs are often asymptomatic until harming the organism.

According to Dr. Rumel, the HealthRise program also found huge difficulties due to the geographic inaccessibility within the region. The lack of patient registries and unified information in both cities were significant obstacles that delayed the launch of the program but also offered an interesting opportunity to implement electronic registration with tablets. Knowing that Medtronic Foundation would fund the program for two years only, the program was designed to merge with the public health system based on contributions from the federal, state and municipal governments. The implementation of both projects was transferred to the federal universities of Bahia, Vale do Jequitinhonha e Mucuri, and Minas Gerais.

Dr. Saúde, of CIES Global, has existed since 2008 and is based on the same pillars of the Brazilian Unified Health System (SUS). According to Doctor Roberto Kikawa, CIES founder and CEO, the modules of Dr. Saúde made it possible to build a secondary hospital in sixty days, with an average cost of two million Reais. He also explained that its cost is 30% less than of any other similar service, and they are all covered by the public health system with its regular budget.

The Dr. Saúde program refers people from the basic public health facilities to the CIES Global modular facilities. There, these people receive image exams and specialized care and are then sent back to basic public health facilities. Data is also collected to generate information about the epidemiologic profiles and assist in the development of more efficient local public policies. Dr. Kikawa also explained that the program helped in the Corujão da Saúde (“Late-Night Health”) program, São Paulo’s municipal program that reduced the waiting time in image and laboratory exams, and found that only 29.1% of the requested exams were really needed, evidencing a critical point in health financing.

HealthRise and Dr. Saude share the belief that providing better access to continuous care allows for a better quality of life. As Dr. Kikawa says, “NGOs are the bridges between the public and the private sectors, given the long term plans of the public sector, and the additional funds for innovation and efficiency from the private sector.”

The Intersectoral Forum to Fight NDCs in Brazil promises to continue fostering this multi-sector dialogue to co-design and implement effective solutions to fight NCDs and improve health throughout the country.

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