Today’s ministries of health face a host of complex, costly challenges. Around the world non-communicable diseases, aging populations, and COVID-19 threaten to strain existing healthcare structures, overwhelm national healthcare budgets, and outpace existing infrastructural capacity. These crises have pushed healthcare systems to a breaking point, and—with the possible exception of COVID-19—only stand to become more dire with time. 

Governments have struggled to keep up. The challenges are too costly, too complex, and they are growing too quickly. But, with cash-strapped ministries of health struggling to manage these crises, one thing has become clear: neither governments nor the private sector have the resources—financial, operational, and human—to address them alone. Increasingly, public-private partnerships (PPPs) have been used to combine the relative strengths of both the public and private sectors, enabling overextended governments to do more with less. Not only can PPPs save money, they can also serve as highly effective management structures, spurring innovation and fostering efficiency. But while their advantages are many, PPPs can also be challenging. Solutions must be negotiated, and conflicts of interest must be managed. Successful PPPs require cross-sector collaboration and interdisciplinary skillsets, and professionals who are equipped with these skillsets are—currently—few and far between. Simply put, the future of healthcare lies in PPPs, but if public- and private-sector executives are to be prepared for that future, they will need to be armed with certain skills and frameworks that they need to succeed.

Enter the Joint Centre for Global Infrastructure Policy, an ambitious new Joint Centre to be established by the PPP Initiative and the Bartlett Faculty of the Built Environment at University College London. Motivated by a desire to combine the Bartlett’s world-renowned emphasis on interdisciplinary study with the PPP Initiative’s economics-driven approach to healthcare issues, the Joint Centre will develop a new healthcare curriculum for graduate and executive education courses emphasizing the frameworks, skills, motivations and incentives that underpin successful healthcare PPPs. This curriculum—rooted in the foundational PPP courses pioneered by Professor Alan M. Trager at Harvard Kennedy School and Johns Hopkins SAIS—will use the research and teaching methods associated with healthcare PPPs, combining The Bartlett’s studies of infrastructure investment, finance, and governance with healthcare issues. Further, the Centre will act as a convening mechanism, bringing together high-level executives from across borders and across sectors, including public and private sector executives, graduate students, and constituent donor organizations. Together, they will address the world’s most pressing healthcare challenges: non-communicable diseases, aging populations, and Covid-19. In the process, the Joint Centre will seek to change the way we think about healthcare to include not only medical, scientific, and public health concerns, but also infrastructural and economic ones as well.

The Centre will attract top-level talent not just from within the UK, but from around the world. Drawing from the worlds of investment, planning, finance, and management, the Centre’s potential reach extends far beyond that of a conventional school of public health. With the potential addition of a public service fellowship program, top-tier graduate students could be encouraged to apply PPP knowledge to careers in the public sector, ensuring that—over the long run—PPP expertise would pervade the public sector as well as the private sector. 

The Joint Centre for Global Infrastructure Policy enjoys support from a diverse group of public, private, and multilateral stakeholders. Potential donors include governments; NGOs specializing in international public health; multinational biopharmaceutical companies; global infrastructure developers and asset managers; and government-backed, institutional investors. This diverse set of supporters would allow the Joint Centre to address the medical, policy, development, investment, and management considerations associated with delivering effective and sustainable healthcare PPPs.

Key Questions

The Centre will seek to address several key questions, including: 

1. In what ways are our current health systems insufficient, and, if they must be changed, what form should they take going forward? What needs to be done and how will it be accomplished?

2. How can health systems be made more resilient? How can they be strengthened to address inequality?

3. How can low- and middle-income countries “skip steps” in the development of health systems and their treatment of individuals?

4. What is health as an investment? How can governments work across sectors and ministries to leverage their investments most effectively?

5. How can multilateral organizations add government capacity in cross-sector healthcare partnerships?

COVID-19 has presented institutions of higher learning with a difficult challenge: how to educate students from a distance. With all the videoconferencing tools at our disposal these days, this might seem—at first—like an easy task. But as I have learned through years of experience in graduate and executive education, the intimacy and interactivity of the classroom are among an educator’s most valuable assets. So back in May, with COVID-19 social distancing mandates in place throughout much of the world, the PPP Initiative (PPPI) found itself facing a difficult challenge: without a classroom, how would we educate graduate students and public- and private-sector executives on something so subtle, so complex, and so interdisciplinary as public-private partnerships?

From July 13th to July 24, PPPI and the National University of Singapore’s School of Public Health (NUSSPH) set out to answer this very question, offering—for the first time in our history—a 100% digital workshop. “Introduction to Healthcare PPPs,” a pilot program that engaged a diverse and talented group of healthcare professionals and executives, demonstrated a compelling proof of concept for distance learning, and offered a glimpse of what the future might hold for distance-based healthcare PPP executive education.

Co-taught with Professor Kee Seng Chia, NUSSPH’s founding dean, the workshop took place over six sessions, each about three to four hours, spanning two weeks. Conducted entirely over Zoom, thanks in no small part to NUS’s excellent technology platform and support staff, the program combined lectures, Q&A sessions, and two participatory group projects in which students gained experience with the skills and frameworks that underpin successful PPPs. Learning directly from PPPI’s newest core curriculum, the 135-page PPP Government Guide, participants engaged with eleven carefully-selected case studies, which allowed them to gain hands-on experience with real-world PPP examples. 

Participants were recruited from a wide variety of institutions, including public-sector entities like Singapore’s Ministry of Health, National Kidney Foundation, and the Health Promotion Board; private-sector companies like Fitbit, GlaxoSmithKline, and Apple; and academic institutions like NUS. Productive interaction between sectors is a key element of any successful PPP, and as such, project groups were sorted specifically to encourage cross-sector engagement. As one participant wrote, “I enjoyed the diverse perspectives from different partners: public, private, and academic.”

Of course, executing a successful program via Zoom was no easy task. Without a classroom dynamic, our ability to “read the room” and make adjustments “on the fly” was significantly compromised. To compensate, PPPI engaged in extensive preparation. For each one-hour lecture, PPPI prepared a detailed slide deck—usually 40-50 slides—with content that was closely tied to the Guide and relevant case studies. These decks were distributed 24 hours in advance to give participants the opportunity to familiarize themselves with the content before attending each session. Lectures emphasized repetition and “re-capping” of previous lectures to ensure that participants had a strong foundation in the fundamentals before moving on to more advanced concepts.

A significant time difference also presented unique challenges. Each class began at 8am in Singapore, which is 8pm in New York. Between lectures, group projects, and presentations, the sessions would often continue late into the night, EST. The time difference necessitated a “hand-off” between Professor Trager, who delivered the lecture/Q&A, and Professor Chia, who—along with a group of highly-competent teaching assistants—directed the participatory group projects. Both professors’ extensive experience in healthcare executive education enabled them to execute this transition seamlessly; though each offered a unique perspective on the workshop’s content, the program maintained a smooth flow and a clear forward thrust. 

Students were consistently engaged and insightful, and frequently pushed the discussion far beyond what we would have thought possible over video-conference. In fact, over the run of the course, we devoted approximately one third of our total lecture time to answering over forty distinct participant questions, which were—without exception—challenging, thoughtful and creative. This was no doubt due partly to the high caliber of our participants, but also to the consistently high attendance rates, which were regularly perfect or near-perfect. By the time participants were asked to present their final projects, in which they applied what they had learned to a real-world healthcare challenge in Singapore, they were able to demonstrate a clear facility with the frameworks and skills that underpin successful PPPs. 

In their anonymous course evaluations, participants consistently praised the course’s “balanced approach” between hands-on work and lectures, and cited the “discussions” and “group projects” as among the most beneficial parts of the class. “The lectures were insightful and organized, clear and concise,” wrote one participant, while another felt that “the group work segment was the most enjoyable, as it allowed us to bounce ideas off one another and think about different perspectives.”

Thanks to the generous support of Amgen, PPPI will continue to expand our programming at NUS and beyond over the next year. By refining our curriculum materials and improving our distance-learning methodologies, PPPI is eager to lead the way in distance-based executive education for healthcare PPPs—both within Southeast Asia, and around the world.