The importance of public, private and academia (PPA) collaboration in the health sector: A case study of the Western Cape.
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Introduction
 To face the global health challenges, a collaboration between stakeholders from the healthcare industry, academia, government, non-governmental organizations (NGO’s), regulators and patients’ organisations is essential. The success of multi-stakeholder collaborations in improving the healthcare system is often based on public-private, academia (PPA) model. Public and private actors leverage capital resources and knowledge to develop innovative solutions to healthcare challenges.
Interdisciplinary, translational and innovative research and development (R&D) is realized in PPAs by combining different ideas, skills, and expertise in technologically demanding areas. Also, sharing knowledge with competitors at the precompetitive and even at a competitive stage is increasingly considered to be relevant and viable. A shared objective is to translate basic biological research into therapies serving patients. Regardless of differences in short-term expectations that the different stakeholders may have, the essential elements for successful R&D PPAs are trust and a shared view on the PPA’s mission and long-term outcome.[1]
It is clear that the economic sustainability of our health systems South Africa is under threat. Whether one is talking about the affordability of medicines, lack of sufficient healthcare resources or society’s challenge in investing in prevention, all angles of the healthcare ecosystem are currently stretched.
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Economic opportunities through Private Public and Academia in the Western Cape.
Access to quality healthcare at affordable rates is an urgent challenge in South Africa. The private sector can innovate to create self-sustaining solutions to deliver quality healthcare in South Africa. Active participation by companies, both non-profit and for-profit, is critical to achieving the health-related Sustainable Development Goals. Through opportunities to engage directly in health service delivery, companies can contribute to improving health outcomes in South Africa whilst still focusing on their core competencies. Private investors are spurring innovations in telemedicine, delivery, operating room procedures, workforce training and the generation of new revenue streams.[2]
The Western Cape is one of the world’s most beautiful and iconic regions, and home to some of Africa’s most important educational institutions, healthcare facilities, business enterprises, centres of innovation, and cultural and historical sites. It has one of the best-performing regional economies in South Africa, and among the country’s best educational outcomes and health indicators.
The Western Cape is fast becoming the knowledge-sharing hub for South Africa and the wider continent. The Western Cape hosts one of the highest concentrations of medical device & healthcare companies, research institutes and research groups in South Africa.
Half of the top universities in Africa are in South Africa, with two of the top three universities located in the Western Cape. South Africa was also the largest African destination for foreign direct investment into research and development activity between 2003 and 2019, valued at USD345m, with 13 investment projects. The Western Cape has four major tertiary education institutions:
- University of Cape Town (highest QS World University Ranking among African universities)
- Stellenbosch University (third highest QS World University Ranking among African universities)
- University of the Western Cape (17thhighest QS World University Ranking among African universities)
- Cape Peninsula University of Technology
In 2019, approximately 76 015 students were enrolled in the four Western Cape universities in the science, engineering and technology fields.
Western Cape universities also attract a large number of top students from the rest of the continent, with 72% of international students coming from other African countries.
Training professionals, whether in medical, surgical techniques, management, population health, research, health economics or other important disciplines, will remain a vital source of healthcare expertise to the industry. Increasing importance will be assigned to teaching relevant cross-functional subjects, combining medicine and healthcare with diverse subjects like ethics, philosophy, research, technologies and business. With new scientific advances pushing our understanding of acceptable norms (areas like designer babies and commercial surrogacy for example), academia will play a key role in grooming healthcare leaders of the future and in shaping the role of medical ethics.[3]
The majority (43%) of the country’s medical device manufacturers are based in the Western Cape. Working with newly qualified doctors and experienced practitioners alike, there is no lack of talent and creativity within the medical field itself. Paired with entrepreneurial and technical skills from across the region. This collaboration will lead to the development of new firms and intellectual properties, which will establish the Western Cape region as a globally competitive centre of health innovation.
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Future of PPAs
South Africa has considerable experience of the public and private health-care sector, forming partnerships and collaborations. Still, there needs to be a more rigorous evaluation to inform future scaling-up options under the National Health Insurance.[4] Progress to achieving South Africa’s national health goals may be enhanced by improving government capacity to interact with the private sector in areas such as procurement, contracting and performance management. The private sector could play a bigger role in developing innovative use of technology, and innovations in service delivery but these require a close, transparent relationship with the government and public healthcare providers. More mechanisms and forums for engagement between the public and private healthcare stakeholders are needed.[5]
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Encouraging innovation and learning
The private sector can bring innovation and new technology to solve public health problems. This is particularly important for the Western Cape given the presence of a large number of globally successful corporate firms that are engaging in innovation. They also bring state-of-the-art business practices and systems to the destination. Despite Western Cape having a large and dynamic private higher education industry, the private sector is, to a large extent, barred from producing health-care professionals. Some hospital groups are involved in training nurses, but these efforts are not at a sufficient scale. A stronger partnership that rewards private-sector enterprises to help resolve public sector priorities could lead to significant win-wins not just for the Western Cape, but also for the continent and beyond.
Increasingly, governments are turning to the private sector to improve quality and deliver value for money, build infrastructure, provide staff and training, raise quality, improve productivity, undertake social marketing, and enhance procurement. Indeed, no health system is entirely public or private.
PPAs are effective models for development in part because of their ability to expand the reach and multiply impact. In the Western Cape, in particular, there is an opportunity to harness private sector investments and market reach to complement national goals. In this endeavour, the private and public sectors need to work to complement national efforts to attain the Sustainable Development Goals, including the health Sustainable Development Goals targets, at country and regional levels.
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[1] Public-Private Partnerships as Drivers of Innovation in Healthcare  by Remco L. A. de Vrueh , Jon S. B. de Vlieger and Daan J. A. Crommelin
[2] Health Policy and Planning, Volume 29, Issue 5, August 2014, Pages 560–569, https://doi.org/10.1093/heapol/czt042
[3] How Digital Technologies Will Change the Healthcare Jobs of our Future
[4] Healthcare and Economic Growth in Africa: Public-Private Partnerships
[5] Public–private interactions on health in South Africa: opportunities for scaling up by Nothemba Kula, Robert J Fryatt