Skip to main content

Financing Development Through PPPs: What Does This Mean for Inequalities

  • Chapter
  • First Online:
The Political Economy of Global Manufacturing, Business and Finance

Abstract

Public–Private Partnerships (PPPs) are promoted by international development donors as a means of financing the Sustainable Development Goals. In the health sector, PPPs have been used for a range of purposes including financing the building of new healthcare infrastructure and the delivery of healthcare services. Yet despite the growth of health PPPs across the Global South, little attention has been given to their ability to address health inequalities. Critics argue that given their commercial imperative, health PPPs can potentially undermine the right to health and entrench existing inequalities. The chapter reflects on the potential challenges and opportunities offered by health PPPs in Latin America, before focusing on the case of Peru and asks how far PPPs can address the major challenges faced by a health system characterised by fragmentation and inequalities.

This chapter draws on a larger project focused on Health PPPs in Peru and I would like to acknowledge the work of Kate Bayliss, Océane Blavot, Rosella Falco, Camila Gianella, Ma José Romero, and Ruth Iguñiz Romero that enabled me to write this piece.

This is a preview of subscription content, log in via an institution to check access.

Access this chapter

eBook
USD 16.99
Price excludes VAT (USA)
  • Available as EPUB and PDF
  • Read on any device
  • Instant download
  • Own it forever
Softcover Book
USD 129.99
Price excludes VAT (USA)
  • Compact, lightweight edition
  • Free shipping worldwide - see info
Hardcover Book
USD 129.99
Price excludes VAT (USA)
  • Durable hardcover edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info

Tax calculation will be finalised at checkout

Purchases are for personal use only

Institutional subscriptions

References

  • Adamou, M., N. Kyriakidou, and J. Connolly. 2021. Evolution of public-private partnership: The UK perspective through a case study approach. International Journal of Organizational Analysis 29 (6): 1455–1466.

    Article  Google Scholar 

  • Alston, P. 2020. The parlous state of poverty eradication (Report of the Special Rapporteur on extreme poverty and human rights). Human Rights Council Forty-fourth session 15 June–3 July 2020.

    Google Scholar 

  • Amorim Filho, M.H., Leite, L.W.C., and Chambarelli, M.A.P.P. 2015. Parcerias público-privadas: uma classe de ativos para investimentos. Brazil: Banco Nacional de Desenvolvimento Econômico e Social.

    Google Scholar 

  • Anker, T. 2016. A PPP Encore in Brazil: Two healthcare partnerships boost Bahia’s ability to care for citizens. Washington DC: World Bank.

    Google Scholar 

  • Arrieta, A. 2011. Health reform and caesarean sections in the private sector: The experience of Peru. Health Policy 99 (2): 124–130.

    Article  Google Scholar 

  • Atun, R., L.O.M. de Andrade, G. Almeida, D. Cotlear, T. Dmytraczenko, P. Frenz, P. Garcia, O. Gómez-Dantés, F.M. Knaul, C. Muntaner, J.B. de Paula, F. Rígoli, P.C.F. Serrate, and A. Wagstaff. 2015. Health-system reform and universal health coverage in Latin America. The Lancet 385 (9974): 1230–1247.

    Article  Google Scholar 

  • Babacan, H. 2021. Public–private partnerships for global health: Benefits, enabling factors, and challenges. In Handbook of global health, ed. R. Haring, I. Kickbusch, D. Ganten, and M. Moeti, 2755–2788. Cham: Springer.

    Chapter  Google Scholar 

  • Barrios-Ipenza, F., A. Calvo-Mora, F. Criado-García, and W.H. Curioso. 2021. Quality evaluation of health services using the Kano model in two hospitals in Peru. International Journal of Environmental Research and Public Health 18 (11): 6159.

    Article  Google Scholar 

  • Baru, R., and M. Nundy. 2020. History and characteristics of public-private partnerships (PPPs) in the health service system in India. In Critical Reflections on PPPs, ed. J. Gideon and E. Unterhalter, 179–213. London: Routledge.

    Google Scholar 

  • Basu, S., J. Andrews, S. Kishore, R. Panjabi, and D. Stuckler. 2012. Comparative performance of private and public healthcare systems in low-and middle-income countries: A systematic review. PLOS Medicine 9: 6.

    Article  Google Scholar 

  • Bayliss, K., M.J. Romero, and E. Van Waeyenberge. 2021. Uneven outcomes from private infrastructure finance: Evidence from two case studies. Development in Practice 31 (7): 934–945.

    Article  Google Scholar 

  • Bhatia, M., L.K. Dwivedi, K. Banerjee, and P. Dixit. 2020. An epidemic of avoidable caesarean deliveries in the private sector in India: Is physician-induced demand at play? Social Science & Medicine 265: 113511.

    Article  Google Scholar 

  • Birn, A.-E., and N. Krementsov. 2018. ‘Socialising’ primary care? The Soviet Union, WHO and the 1978 Alma-Ata Conference. BMJ Global Health 3 (Supp 3): 1–15.

    Google Scholar 

  • Birn, A.-E., L. Nervi, and E. Siqueira. 2016. Neoliberalism redux: The global health policy agenda and the politics of co-optation in Latin America and beyond. Development and Change 47 (4): 734–759.

    Article  Google Scholar 

  • Bustamante, A.V., and C.A. Méndez. 2014. Health care privatization in Latin America: Comparing divergent privatization approaches in Chile, Colombia, and Mexico. Journal of Health Politics, Policy and Law 39 (4): 841–886.

    Article  Google Scholar 

  • Carrasco-Escobar, G., Manrique, E., Tello-Lizarraga, K., and Miranda, J.J. 2020. Travel time to health facilities as a marker of geographical accessibility across heterogeneous land coverage in Peru. Frontiers in Public Health. 16th September 2020.

    Google Scholar 

  • Carrillo-Larco, R.M., W.C. Guzman-Vilca, F. Leon-Velarde, A. Bernabe-Ortiz, M.M. Jimenez, M.E. Penny, C. Gianella, et al. 2022. Peru-Progress in health and sciences in 200 years of independence. The Lancet Regional Health-Americas 7: 100148.

    Article  Google Scholar 

  • Chiriboga, D., P. Buss, A.-E. Birn, J. Garay, C. Muntaner, and L. Nervi. 2014. Investing in health. The Lancet 383 (9921): 949.

    Article  Google Scholar 

  • Contraloría General de la República. 2018. Informe del Operativo de Visita Preventiva N 634–2018/CG/SALUD-OCS. Lima: Contraloría General de la República. https://doc.contraloria.gob.pe/documentos/operativos/OPERATIVO_POR_UNA_SALUD_DE_CALIDAD.pdf.

  • Coviello, M. Gollán, J., and Pérez, M. 2012. Public-private partnerships in renewable energy in Latin America and the Caribbean (Project document). Santiago: Economic Commission for Latin America and the Caribbean.

    Google Scholar 

  • Crabtree, J., and F. Durand. 2017. Elite power and political capture. London: Bloomsbury Publishing.

    Book  Google Scholar 

  • Cueto, M., S. Palmer, and S.P. Palmer. 2015. Medicine and public health in Latin America. London: Cambridge University Press.

    Google Scholar 

  • Diario Médico. 2018. MINSA planea 12 proyectos vía APP para hospitales de Lima. 12th December 2018.

    Google Scholar 

  • e Neto, D.D.C S., Cruz, C.O., and Sarmento, J.M. 2019. Renegotiation of transport public private partnerships: Policy implications of the Brazilian experience in the Latin American context. Case Studies on Transport Policy 7 (3): 554–561.

    Google Scholar 

  • ESRC-H and CHRGJ. 2021. Wrong prescription: The impact of privatizing health care in Kenya. New York: The Economic and Social Rights Centre-Hakijamii, Kenya and the Center for Human Rights and Global Justice.

    Google Scholar 

  • El Peruano. 2019. Plan Nacional de Competitividad y Productividad, 28th July 2019.

    Google Scholar 

  • Ferreira, D.C., and R.C. Marques. 2021. Public-private partnerships in health care services: Do they outperform public hospitals regarding quality and access? Evidence from Portugal. Socio-Economic Planning Sciences 73: 100798.

    Article  Google Scholar 

  • Fine, B. 2020. Situating PPPs. In Critical reflections on public private partnerships, ed. J. Gideon and E. Unterhalter, 26–38. London: Routledge.

    Chapter  Google Scholar 

  • Franzoni, J.M., and D.S. Ancochea. 2018. Undoing segmentation? Latin American health care policy during the economic boom. Social Policy and Administration 52 (6): 1181–1200.

    Google Scholar 

  • Gabor, D. 2021. The Wall Street consensus. Development and Change 52 (3): 429–459.

    Article  Google Scholar 

  • Ganguly, P., K. Jehan, A. de Costa, D. Mavalankar, and H. Smith. 2014. Considerations of private sector obstetricians on participation in the state led “Chiranjeevi Yojana” scheme to promote institutional delivery in Gujarat, India: A qualitative study. BMC Pregnancy and Childbirth 14 (1): 1–13.

    Article  Google Scholar 

  • Gianella, C., J. Gideon, and M.J. Romero. 2021. What does COVID-19 tell us about the Peruvian health system? Canadian Journal of Development Studies 42 (1–2): 55–67.

    Article  Google Scholar 

  • Gideon, J., and E. Unterhalter. 2017. Exploring public private partnerships in health and education: A critique. Journal of International and Comparative Social Policy 33 (2): 136–141.

    Article  Google Scholar 

  • Gideon, J., and E. Unterhalter, eds. 2020. Critical reflections on public private partnerships. London: Routledge.

    Google Scholar 

  • Gobierno del Perú and CEPLAN. 2020. Informe Nacional: Perú a mayo 2020. La Protección de la Vida en la Emergencia y Después CEPLAN.

    Google Scholar 

  • Gonzales, G.F., V.L. Tapia, A. Fort, and A.P. Betran. 2013. Pregnancy outcomes associated with caesarean deliveries in Peruvian public health facilities. International Journal of Women’s Health 5: 637–645.

    Article  Google Scholar 

  • Göttems, L., B. Donato, and M.L. Rollemberg Mollo. 2020. Neoliberalism in Latin America: Effects on health system reforms. Revista De Saude Publica 54: 74.

    Article  Google Scholar 

  • Grugel, J., and P. Riggirozzi. 2012. Post-neoliberalism in Latin America: Rebuilding and reclaiming the state after crisis. Development and Change 43 (1): 1–21.

    Article  Google Scholar 

  • Guasch, J.L., D. Benitez, I. Portabales, and L. Flor. 2016. The renegotiation of public private partnerships contracts (PPP): An overview of its recent evolution in Latin America. Revista Chilena De Economía y Sociedad 10 (1): 42–63.

    Google Scholar 

  • Hellowell, M. 2019. Are public–private partnerships the future of healthcare delivery in sub-Saharan Africa? Lessons from Lesotho. BMJ Glob Health 4 (2): 1–6.

    Google Scholar 

  • Hernández-Vásquez, A., H. Chacón-Torrico, and G. Bendezu-Quispe. 2020. Differences in the prevalence of caesarean section and associated factors in private and public healthcare systems in Peru. Sexual and Reproductive Healthcare 26: 100570.

    Article  Google Scholar 

  • Hodge, G.A., and C. Greve. 2022. A research agenda for public private partnerships and the governance of infrastructure. Cheltenham: Edward Elgar.

    Book  Google Scholar 

  • Homedes, N., and A. Ugalde. 2005. Why neoliberal health reforms have failed in Latin America. Health Policy 71 (1): 83–96.

    Article  Google Scholar 

  • Hunter, B.M., and S.F. Murray. 2019. Deconstructing the financialization of healthcare. Development and Change 50 (5): 1263–1287.

    Article  Google Scholar 

  • IBT Group. n/d. IBT Group Peru is the new logistics arm of MINSA in Lima. www.ibtgroup.com/en/news/.

  • Iguiniz-Romero, R., Cahuana, L. and Bartolini, L. 2021. Evidence available about Health PPP´s in Peru: a scoping review of studies about PPP. unpublished mimeo.

    Google Scholar 

  • Irwin, M.T.C., S. Mazraani, and M.S. Saxena. 2018. How to control the fiscal costs of public-private partnerships. Washington DC: International Monetary Fund.

    Google Scholar 

  • Jamison, D.T., et al. 2013. Global health 2035: A world converging within a generation. The Lancet 382 (9908): 1898–1955.

    Article  Google Scholar 

  • Joudyian, N., L. Doshmangir, M. Mahdavi, J.S. Tabrizi, and V. Sergeevich Gordeev. 2021. Public-private partnerships in primary health care: A scoping review. BMC Health Services Research 21 (1): 1–18.

    Article  Google Scholar 

  • Kotecha, V. 2018. Dealing with the legacy of PFI: Options for policymakers (Report). London: Centre for Health and the Public Interest.

    Google Scholar 

  • Lethbridge, J., and Gallop, P. 2020 Why public-private partnerships (PPPs) are still not delivering. Brussels: Eurodad/European Federation of Public Service Unions.

    Google Scholar 

  • Mawdsley, E. 2018. ‘From billions to trillions’: Financing the SDGs in a world ‘beyond aid. Dialogues in Human Geography 8 (2): 191–195.

    Article  Google Scholar 

  • Mesa-Lago, C. 2008. Reassembling social security: A survey of pensions and health care reforms in Latin America. Oxford: Oxford University Press:

    Google Scholar 

  • MINSA. 2018. Resolución ministerial, 1st August 2018. Lima: Ministerio de Salud.

    Google Scholar 

  • MINSA. 2020. REUNIS—Repositorio Único Nacional de Información en Salud. Lima: Ministerio de Salud.

    Google Scholar 

  • MINSA. 2021. Diagnóstico de Brechas de Infraestructura y Equipamiento del Sector Salud. Lima: Ministerio de Salud.

    Google Scholar 

  • Minteguiaga, A., and G. Ubasart-González. 2021. Reviewing Exclusionary Welfare Regimes: Andean Countries (Bolivia, Ecuador, and Peru). In Latin American social policy developments in the twenty-first century, ed. N. Sátyro, E. del Pino, and C. Midaglia, 101–133. Cham: Palgrave Macmillan.

    Chapter  Google Scholar 

  • Miraftab, F. 2004. Public-private partnerships: The Trojan Horse of neoliberal development? Journal of Planning Education and Research 24 (1): 89–101.

    Article  Google Scholar 

  • Molyneux, M. 2008. The ‘neoliberal turn’ and the new social policy in Latin America: How neoliberal, how new? Development and Change 39 (5): 775–797.

    Article  Google Scholar 

  • Mukherjee, J., M. Lindeborg, S. Wijayaratne, C. Mitnick, P. Farmer, and S. Satti. 2020. Global cash flows for sustainable development: A case study of accountability and health systems strengthening in lesotho. Journal of Health Care for the Poor and Underserved 31 (1): 56–74.

    Article  Google Scholar 

  • Murillo, J.P., L. Bellido-Boza, P. Huamani-Ñahuinlla, G. Garnica-Pinazo, O. Munares-García, and J. Del-Carmen. 2019. Satisfacción y tiempo de espera de usuarios de establecimientos de salud peruanos: Análisis secundario de ENSUSALUD 2014–2016. Anales De La Facultad De Medicina 80 (3): 288–297.

    Article  Google Scholar 

  • Nandi, S., V. Prasad, D. Joshi, I. Chakravarthi, G. Murugan, S. Khan, M. Allam Ashraf, P. Gupta, and C. Kumar. 2021. Public-Private Partnerships in Healthcare: Evidence from India. Economic and Political Weekly 56 (36): 29–36.

    Google Scholar 

  • Nuhu, S., C.J. Mpambije, and K. Ngussa. 2020. Challenges in health service delivery under public-private partnership in Tanzania: Stakeholders’ views from Dar es Salaam region. BMC Health Services Research 20 (1): 1–12.

    Article  Google Scholar 

  • Nunnenkamp, P., and R. Thiele. 2013. Financing for development: The gap between words and deeds since Monterrey. Development Policy Review 31 (1): 75–98.

    Article  Google Scholar 

  • Ocampo, J.A. 2015. Uncertain times. Finance and Development 52 (3): 6–11.

    Google Scholar 

  • PAHO. 2017. Health financing in the Americas. Washington DC: Pan American Health Organization.

    Google Scholar 

  • Parker, L., G. Zaragoza, and I. Hernández-Aguado. 2019. Promoting population health with public private partnerships: Where’s the evidence? BMC Public Health 19: 1438.

    Article  Google Scholar 

  • Patouillard, E., Goodman, C.A., Hanson, K.G., and Mills, A.J. 2007. Can working with the private for-profit sector improve utilization of quality health services by the poor? A systematic review of the literature. International Journal for Equity in Health 6–17.

    Google Scholar 

  • Pérez, B. 2021. PPPs and women’s human rights feminist analysis from the global south. DAWN Informs www.dawnet.org.

  • ProInversión. n/d. Cartera de Proyectos—accessed from ProInversión—APP—Cartera de Proyectos de ProInversión. https://www.investinperu.pe/.

  • PWC (Price Waterhouse Cooper). 2015. Lessons from Latin America: The early landscape of healthcare public-private partnerships (Healthcare public-private partnerships series No. 2).

    Google Scholar 

  • Ravindran, T.K., and N.E. Philip. 2021. Towards universal health coverage? Taking stock of two decades of health reforms in India. In India’s economy and society: Lateral expectations, ed. S. Mani and C.G. Iyer, 253–285. Singapore: Springer.

    Chapter  Google Scholar 

  • Roerich, J.K., M.A. Lewis, and G. George. 2014. Are public private partnerships a healthy option? A systematic literature review. Social Science and Medicine 113: 110–119.

    Article  Google Scholar 

  • Romero, M.J. 2015. What lies beneath? A critical assessment of PPPs and their impact on sustainable development. Brussels: Eurodad.

    Google Scholar 

  • Romero, M.J., and J. Gideon. 2020. Health PPPs in Latin America: A Review. In Critical reflections on public private partnerships, ed. J. Gideon and E. Unterhalter, 160–178. London: Routledge.

    Chapter  Google Scholar 

  • Romero, M.J., and E. Van Waeyenberge. 2020. Beyond Typologies: What is a Public Private Partnership? In Critical reflections on public private partnerships, ed. J. Gideon and E. Unterhalter, 39–63. London: Routledge.

    Chapter  Google Scholar 

  • Rotarou, E.S., and D. Sakellariou. 2017. Neoliberal reforms in health systems and the construction of long-lasting inequalities in health care: A case study from Chile. Health Policy 121 (5): 495–503.

    Article  Google Scholar 

  • Saha, S., R. Panda, and G. Kumar. 2018. Public-private partnership in health care of India: A review of governance and stewardship issues. Journal of Comprehensive Health 6 (1): 1–8.

    Article  Google Scholar 

  • Sharma, S., and S. Soederberg. 2019. Redesigning the business of development: The case of the World Economic Forum and global risk management. Review of International Political Economy 27 (4): 828–854.

    Article  Google Scholar 

  • Smithers, D., and H. Waitzkin. 2022. Universal health coverage as hegemonic health policy in low-and middle-income countries: A mixed-methods analysis. Social Science and Medicine 302: 114961.

    Article  Google Scholar 

  • Stafford, A., and P. Stapleton. 2017. Examining the use of corporate governance mechanisms in public–private partnerships: Why do they not deliver public accountability? Australian Journal of Public Administration 76 (3): 378–391.

    Article  Google Scholar 

  • Tabrizi, J.S., Azami-Aghdash, S., and Gharaee, H. 2020. Public-private partnership policy: A scoping review. Journal of Primary Care and Community Health. January–December.

    Google Scholar 

  • Trebilcock, M., and M. Rosenstock. 2015. Infrastructure public–private partnerships in the developing world: Lessons from recent experience. Journal of Development Studies 51 (4): 335–354.

    Article  Google Scholar 

  • United Nations. 2003. Monterrey consensus on the international conference on financing for development. A/CONF.198/11 Monterrey Consensus of the International Conference on Financing for Development. https://www.un.org/.

  • United Nations. 2022a. The 17 goals—sustainable development. New York: United Nations Department of Economic and Social Affairs. https://sdgs.un.org/goals.

  • United Nations. 2022b. Transforming our world: the 2030 agenda for sustainable development. New York: United Nations Department of Economic and Social Affairs. www.un.org.

  • Vasquez, E.E., A. Perez-Brumer, and R.G. Parker. 2019. Social inequities and contemporary struggles for collective health in Latin America. Global Public Health 14 (6–7): 777–790.

    Article  Google Scholar 

  • Webster, P. 2015. Lesotho’s controversial public–private partnership project. The Lancet 386 (10007): 1929–1931.

    Article  Google Scholar 

  • WHO. 2020. Private sector landscape in mixed health systems. Geneva: World Health Organisation.

    Google Scholar 

  • World Bank. 1987. Financing health services in developing countries. Washington DC: World Bank.

    Book  Google Scholar 

  • World Bank. 1993. World development report 1993: Investing in health. Washington DC: World Bank.

    Book  Google Scholar 

  • World Bank. 2016. A PPP Encore in Brazil: Two healthcare partnerships boost Bahia’s ability to care for citizens. Washington DC: World Bank.

    Google Scholar 

  • World Bank. 2021. Private participation in infrastructure (PPI) half year report 2021. Washington DC: World Bank.

    Google Scholar 

  • World Bank. 2022. PE- (APL2) Health reform program (second phase adaptable program loan (APL) of the health reform program for Peru). Washington DC: World Bank.

    Google Scholar 

Download references

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to Jasmine Gideon .

Editor information

Editors and Affiliations

Rights and permissions

Reprints and permissions

Copyright information

© 2023 The Author(s), under exclusive license to Springer Nature Switzerland AG

About this chapter

Check for updates. Verify currency and authenticity via CrossMark

Cite this chapter

Gideon, J. (2023). Financing Development Through PPPs: What Does This Mean for Inequalities. In: Tribe, M., Kararach, G. (eds) The Political Economy of Global Manufacturing, Business and Finance . International Political Economy Series. Palgrave Macmillan, Cham. https://doi.org/10.1007/978-3-031-25832-9_11

Download citation

Publish with us

Policies and ethics