In recent decades, large infrastructure projects such as ports, roads and public services including health have been financed through public private partnerships (PPPs). States are pressured to implement fiscal reforms to support the emergence of PPPs as a means of choice for development projects and channel investment finance, thereby locking in State debt. PPPs have been touted as the investment model that will help in developing and upgrading infrastructure to improve effectiveness of public services along with up- skilling human resources if the business environment is right. PPPs are a type of contract under which private companies build and operate public services and infrastructure but much of the financial risk remains with the public body concerned.
Two hospitals in Fiji will undergo a change in healthcare operations as they are transformed from a public to a PPP provided service under a concessional agreement. The Lautoka and newly built Ba Subregional Hospital will provide healthcare to 337, 041 people in the Western Division (Bureau of Statistics, 2018), which is a quarter of Fiji’s population. The Lautoka Hospital will be extended with an additional wing of 305 beds.
Luxury Destination
Join Alisi in her journey to make sure her daughter Mereoni receives prenatal care in Lautoka, the second largest city in Fiji.
In a country now promoting medical tourism, healthcare is far from reach, and these hard-working women find themselves travelling for hours to get to healthcare facilities now that the hospital in their neighbourhood, once publicly funded, has been turned into a public-private partnership-managed facility.
Fiji entered into its first Public-Private Partnership (PPP) with an Australian medical firm, Aspen Medical, in order to re-develop the Ba Hospital, and construct a new wing in the Lautoka Hospital.
The International Finance Corporation (IFC), the private sector arm of the World Bank, played a key advisory role to the Fijian government and facilitated the establishment of the first PPP in a Pacific Island country.
“Now, how will people like us
manage to access basic healthcare?”
“Luxury Destination” unveils how neoliberal global trends in healthcare financing are impacting women’s lives even in a country that once had a strong public healthcare system.
The Podcast
Let’s dive into the impacts of public-private partnerships in Fiji’s health system with researcher and activist Lice Cokanasiga, author of the case study that inspired the film “Luxury Destination”.
Lice Cokanasiga has been a researcher and campaign assistant with the Pacific Network on Globalisation (PANG). Her work has revolved around monitoring, tracking and critiquing the blue economy agenda in the region and its impact on indigenous peoples’ environment in the Pacific Islands.
In this thought-provoking interview conducted by feminist economist Corina Rodríguez Enríquez and international development expert Sue Godt, Lice talks about how Fiji has been portrayed as a leader among the Pacific Island countries, with growing economic capacity and influence beyond its borders, supposedly because it has been restructuring its public system and embraced the neoliberal prescriptions for development.
Theoretically, the aim is to alleviate poverty and promote economic growth in the Pacific region. But what Lice shows clearly is how financially powerful actors can effectively influence and steer the direction of policymaking, culminating in initiatives such as the health PPP for Ba and Lautoka hospitals.
Her research denounces the lack of transparency in this process and examines the impacts of the new investment model adopted to fund the two hospitals. “We need to support those public systems that are working right now, instead of jumping into something that will just cost the country more money, which really should be used to improve the public health systems that we already have that’s working”, says the activist.
What impact are these PPPs having on the foundational health system that has successfully integrated community health care, primary health care, and health promotion?
Connect The Dots
In recent decades, large infrastructure projects such as ports, roads and public services including health have been financed through public private partnerships (PPPs). States are pressured to implement fiscal reforms to support the emergence of PPPs as a means of choice for development projects and channel investment finance, thereby locking in State debt. PPPs have been touted as the investment model that will help in developing and upgrading infrastructure to improve effectiveness of public services along with up- skilling human resources if the business environment is right. PPPs are a type of contract under which private companies build and operate public services and infrastructure but much of the financial risk remains with the public body concerned.
Two hospitals in Fiji will undergo a change in healthcare operations as they are transformed from a public to a PPP provided service under a concessional agreement. The Lautoka and newly built Ba Subregional Hospital will provide healthcare to 337, 041 people in the Western Division (Bureau of Statistics, 2018), which is a quarter of Fiji’s population. The Lautoka Hospital will be extended with an additional wing of 305 beds.
This paper develops a case study analysis of a Public Private Partnership in Fiji’s health sector that attempts to bring together both relevant evidence to study the gender and human rights consequences of PPPs, as well as critical elements for strengthening a feminist approach to PPPs.
Read now Public Private Partnerships: Are they a healthy investment model? Lautoka and Ba Hospitals – Fiji A Case Study by Lice Cokanasiga