Mapping Health PPPs in Brazil: key actors and shifts in public provision

Health Public Private Partnerships (PPPs) are advocated by governments and development actors as a means of bringing financial resources and skills to deteriorating public healthcare services. However, although PPPs bring much needed resources in the short-term, the long-term effects of these contracts on the health system as a whole raise some concerns. There is evidence of high contract costs, regulatory challenges and the risks of PPPs for health inequalities. For example, PPPs can divert public health budgets away from primary and secondary care and studies reveal that PPP hospitals sometimes exclude users requiring more costly treatments. Despite these concerns, Brazil, which has one of the largest public health systems in the world, has seen a rapid expansion of health PPPs. Brazil’s first health PPP contract was signed in 2010 to construct a hospital in Bahia but to date this remains under-researched. In 2022 there were 118 health PPPs with more planned after a change in the PPP law in 2023. Yet there is a lack of publicly accessible knowledge and understanding of this process. Moreover, anecdotal evidence highlights the importance of PPP policy diffusion from the UK to Brazil despite the acknowledged failure of the UK Private Finance Initiative in healthcare. Thus, our project has three objectives: to comprehensively map all of the health PPPs, identifying the key actors and their strategies behind each contract; to create a publicly accessible database of Brazilian health PPPs to monitor their impact; to understand the role of UK support in the PPP expansion.