Exporting public–private partnerships in healthcare: export strategy and policy transfer

The literature on policy transfer has paid insufficient attention to the role of commercial interests in the transfer of policy. The British government has developed a healthcare industrial strategy that includes an attempt to export Public Private Partnership (PPP) services. This article analyses the application of the strategy to export PPP services in healthcare to developing and eastern European countries through a review of ‘scoping reports’. The analysis reveals that the strategy involves an attempt to utilize the UK Department for International Development, international financial institutions such as the World Bank, and private sector consultancies to influence developing country governments towards adopting the British Private Finance Initiative (PFI) model, in order to lay the basis for the winning of consultancy, construction and other contracts by British firms. The debate concerning the suitability of PPP/PFI arrangements for the financing of healthcare facilities in Britain is considered in terms of its implications for the adoption of such arrangements by developing and eastern European countries. The purported efficiency gains of PPP/PFI in the UK are unproven, yet the drawbacks of the model may be even more problematic for public health service organizations in developing and eastern European countries, where the expertise to negotiate, monitor and enforce robust contracts with the private sector may be more limited. The article concludes that the attempt to export PPP services entails a strategy of trying to ‘export’ the policy itself, despite the fact that the public sector technical capacity needed to make the policy effective may be lacking in the target countries.