Measuring success in lives saved: A pioneering health partnership in Bangladesh

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Photo: Abir Abdullah/ADB

For millions of people throughout the world, a diagnosis of Chronic Kidney Disease ushers in a lifetime of dialysis treatments.  A dialysis session lasts four hours, and is required two to three times a week – so these treatments are often just as logistically challenging as they are physically difficult.  But the trials of treatment pale in comparison to no treatment at all, which was often the case for citizens of Bangladesh prior to 2015.  That was the year the government offered its citizens dialysis services through a pioneering public-private partnership (PPP) that increased the number of dialysis machines and broadened dialysis services by adding new capacity into existing public hospitals.
I’ve worked in the area of health PPPs for many years, and have seen first-hand how patients benefit from well-structured partnerships. At IFC, our goal is to work with governments with pressing health sector needs and help them develop the right kind of partnership to deliver improved health facilities and services. Like infrastructure PPPs, health PPPs are complicated, long-term deals—but unlike infrastructure PPPs, we have the opportunity to measure results in lives. This makes our work in the field of health PPPs especially important – and rewarding.

The dialysis PPP in Bangladesh is a great example of this. Until this pioneering PPP (the first in the country’s health sector) took effect, treatment options were limited, due to the limited supply of dialysis services. For example, before the PPP there were fewer than 90 dialysis centers in Bangladesh, treating only 10,000 patients.  However, there are 18 million Chronic Kidney Disease patients in the country, and the number of those affected is growing at five percent per year.
For End Stage Renal Disease patients in Bangladesh, the prognosis was even worse. Of the 160,000 End Stage Renal Disease patients, only 8 percent could be treated – which led to related mortality numbers of about 40,000 per year across the country. Expanding dialysis services at the public hospitals will make treatment more accessible to all of these patients, most of whom are unable to afford overseas or local private medical treatment.
IFC and the Government of Bangladesh launched the pilot PPP in two existing dialysis centers in government hospitals: the National Institute of Kidney Disease in Dhaka, and Chittagong Medical College in Chittagong.  The private partner will finance, refurbish and install 110 machines at these facilities – a 13 percent increase in the number of dialysis machines in the country. Apart from this, the private partner will staff, operate, and maintain the facilities for a period of ten years.
The partnership will make it possible for these hospitals to increase the number of dialysis sessions to more than eight times, maintain the affordability of the treatment for the poorest patients, and improve services on a regular basis, assuring upgrades and reliability. Equally important, the PPP introduces standard operating procedures based on international best practice, while decreasing the out of pocket expenditure for treatment by more than half for poor patients.
In terms of scope, impact, and replicability, this project breaks new ground – not just for the nation, but also for the health sector.  The PPP was recognized in KPMG Infrastructure 100 World Markets Report 2015 as one of the top 100 projects across the globe in 2015, and is also featured as one of the two “Pioneering projects” in the report. But the real winners are Bangladesh’s kidney patients – present and future –whose improved quality of life offers possibilities denied to previous generations.

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