Non-standard public-private partnership does not exist

Ana Pavlovska-Daneva

I usually spend my mornings reading the news, columns, analysis, checking my mail and social media. These last few days, as soon as I wake up I get scared to turn on my computer or phone, so I allow myself a few more minutes with my eyes closed, prolong the start of the day, putting off any subsequent stress, disappointment, excitement and bitterness that I must endure after reading the morning news coming from my country and Italy. After a short reconsideration, I encourage myself to enter reality because there is no escaping from it. After every morning “bomb’, there is an even greater shock from the derogatory and degrading statements of the actors in these so-called “bombs” whose voices or names we have heard, and all of these are interspersed with the most terrifying silence produced by those who are most called upon to say something (and take some kind of action).

The easiest way to fool myself into thinking that I can get away from this dirt that we have to live with is my consolation that these events are the work of politicians and “criminals”. And I should try to take care of “my” part of the law. Of course, viewing things this way doesn’t make it any easier for me, but I have always thought that everyone has to deal with what he/she is skilled in, both in science and politics and in analytics. By some objective criteria, I should be more skilled in the area of administrative contracts as they are the subject of my doctoral dissertation. And so we come to public-private partnerships (which is, not just public-private partnerships) in children’s cardiac surgery, since public-private partnership agreements are administrative arrangements.

And suddenly there is a problem. Public-private partnerships, according to all scientific theories, do not exist without a contract. And, in this particular case with the Macedonian public-private partnership in children’s cardiac surgery, there is no such agreement at all! At least the public has not heard about it, there was no public call for reaching such a contract, and we do not see or feel the protective clauses for the state (public interest) common to these agreements. Hence, without a contract, there is no public-private partnership. The contract is a legal act that contains legal norms that regulate the rights and obligations of both entities – the state and the private entity. Without a contract, there is no law. Without law there is anarchy and chaos. In such conditions the losers are usually the citizens, the public interest is damaged.

What am I actually talking about? The same thing that I was talking about in January when the media was campaigning for a supposed public-private partnership whereby children’s cardiac surgery, an activity that is the responsibility of the state (it is obliged to provide its citizens with services), was transferred to a private health facility? I’m talking about one big nothing! I am talking about the fact that state-run healthcare cannot be transferred to the private entity without a contract, with TV press conferences and the most usual sale of public-sector doctors to the private sector. I speak of the fact that such “deals” cannot be made without a legal procedure, without concluding a comprehensive, general, precise and full of protective clauses public-private partnership agreement.

One cannot even expect such legal finesse to be known by a health minister, an excellent doctor, a surgeon, a specialist, and equally ignorant of the way law works. How is it possible that there is not a single lawyer the entire health sector, in the whole government service, who will knock on the minister’s door and tell him that no matter how good the idea is, a (legal) procedure is needed to implement it. And he didn’t. It cannot be that after the fiasco this venture, a self-proclaimed “public-private partnership”, was exposed to the public by some “PRs of lawyers” from the Ministry of Health with a scanty statement to claim that this was a “non-standard” model of public-private partnership. Instead, there should be responsibility. For all non-professionals. Both disciplinary and material, and, if necessary, political as well.

Due to the “non-standard” ways of policymaking, the largest public-private partnership project in healthcare is about to fail after only six months. We witnessed the only surgeon with a certain type of license in the country to be out of public health (and that was part of it prior to the “non-standard” invention of the Ministry of Health) and not be a scientific staff at the Skopje State Medical Faculty (and, was before the “non-standard” project) and become part of the private healthcare business that our citizens will continue to use, but with the payment of their own private funds. Previously, they had used him as an employee of a state clinic and as an assistant in the selection phase at the Faculty of Medicine. On the other hand, funds from the Health Insurance Fund for Children’s Heart Surgery will continue to flow into a private hospital, but it will no longer operate the only licensed Macedonian cardiac surgeon, as it will no longer work in Macedonian public healthcare. He is now going to another private hospital where he will only operate on those who can afford such an operation, and he could leave the country in the future. I don’t understand, who gains, and who loses with this “non-standard” public-private partnership model?

Ah, I can hardly wait for my next column. For the sake of the hope that justice will speak, that I will have the pleasure of writing praise and affirmative criticism. That thieves will get what they deserve, no matter what positions they are or have been, and then that justice will turn around and ask for accountability from both the unskilled and the unprofessional, because they are the soil that allows the greedy and deceitful to thrive.

Views expressed in this article are personal views of the author and do not represent the editorial policy of Nezavisen Vesnik