Gwenael Dhaene, PhD Health Systems Governance and Financing Department. PPP: French Snapshot. PPP en et CSU AfHEA_

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1 Gwenae Dhaene, PhD Heath Systems Governance and Financing Department PPP: French Snapshot 1

2 Something s stirring up Traditiona PPPs encompass ease, concession, provision of services PPP have ong been invoded in heath services deivery Deegation of responsibiity : Lease (DBO) mode Concession (deivery of heath care with charges evied on users) Purey private heath services deivery with HIF reimbursements BOOT / DBFO mode has been copied and pasted for just above 13 years 2

3 Pubic sector prominent roe Pubic sector is not an average contractor case aw said for 200 years Uncertainty Power of terminating the contract Power of substantiay changing the contract Compex tender process Pubic sector benefits from dedicated PPP units 3

4 How we does it work? Once mistrust is overcome and risk assessment better managed, sweating the asset yieds positive resuts BOOT - DBFO 76 Signed BOOT and DBFO) up to date (September 2016) Energy Unit Roanne hospita Provision and deivery of energy and water Aes hospita New edery care & housing faciity Douai hospita Technica support centre Nancy Regiona teaching hospita 4

5 Findings Tender notices generate between 5 and 8 EOI with on average 3 candidates shortisted For two projects above sq. meters, competition is more imited: ony the major buiding companies have the capacity to appy Advisory services (technica/financia/ega) shoud be more often required. Length of seection and finaisation is party due to ack of expertise Advisory services requested % of projects Lega counci ony 20% Technica and ega councis ony 40% Technica, financia and ega councis 40% 5

6 Findings - 3 Daunting negotiations Negotiation phases range from 7 to 18 months whie finaisation can ead to cose to 24 month overa bidding process! A project has a 6-month finaisation phase meaning that specs were acking carity (on financia issues mainy) Lack of anticipation Ony 70% BOOT projects have contracts which provision the possibiity of transferring asset/ capita, sae! 20% projects have no provisons regarding M&E nor supervision during conception/impementation phases Ony 50% have provision re reguar feedback from contractors during construction phase 20% have no provisions re the ending of the contract 6

7 Cost structures - sampes Costs % Costs % Construction 74% Construction 79,1% Conception 12% Conception 13,6% Taxes 1% Insurances 2,8% Fees & insurance 13% Management fees 2,1% Tota 100% Price adjustment provision 2,4% Tota 100% è 10% project do not provide information as to whether prices are w/o VAT è 10% project amount to 100% without providing an amount for insurances è Prices and costs can ack sufficient detais 7

8 Said behind their backs. Pubic about private Private about pubic Members of consortia ack interna coherence ToR are rigid and don t fit PPP purpose (merey provision of goods) Finaisation phase can prove to be probematic when candidates want an opportunity to renegotiate conditions 40% say environmenta considerations have not been seriousy taken into account by pubic sector Lenders change their conditions given the ength of the bidding process and detais provided during finaisation Bidding process with competitive diaogue is too ong, exchanges too poor, pubic partners too many and sometimes irreevant 8

9 Prospect è Diversification of PPP areas (drug, edery care, deivery of anciary and heath services as we, energy and environmenta norms more synergies) è More effective competitive diaogue going on fostering innovation è More private stakehoders meaning more diverse contract/services offer è Lega framework is aso adapting and earning 9