Triage – the sorting of and allocation of treatment to patients and especially battle and disaster victims according to a system of priorities designed to maximize the number of survivors (Merriam-Webster Dictionary)
An Unprecedented Battle
The Covid-19 pandemic has caught almost all government agencies (at all levels of government) off-guard and ill-equipped to address the immediate and long-term impacts to their national PPP initiatives. The massive and sudden onset of the pandemic’s onslaught has been similar to an unexpected military onslaught where front-line defences (institutions) have faced unprecedented damage, the loss of ability to provide counter-manoeuvres, and a breakdown in a coordinated counter-attack.
At the moment many governments; international banking organizations; and development and donor institutions are looking at ways to assess the onslaught’s impacts on PPP projects and national programs (i.e. national and sub-national pipelines). While I agree with this the necessary first step for the development of recovery strategies, we already know that the impacts are enormous and dire. What we need more is a focus on decision points, much like those adopted by doctors and nurses on how to respond to treatments for patients during a massive onslaught that could lead to a breakdown of services if a triage approach if not undertaken.
Medical triages include a screening process (determination of health status) of patients to determine their relative priority for treatment. This includes the separation of casualties into three groups – those who cannot be expected to survive even with treatment; those who will recover without treatment, and those who will not survive without treatment (Fairfax Free Dictionary).
When a “determination of health status” assessment is carried out, each patient is labelled with certain objectives in mind (Wikipedia) that decide forward actions. They include –
- Identifying the patient
- Developing a record of assessment findings
- Identifying the priority of the patient’s need for medical treatment and transport from the emergency scene
- Tracking the patients’ progress through the triage process
- Identify additional hazards such as contamination.
Over time medical triage approaches have been adopted by the business sector as well when determining prioritized mitigations for businesses enterprises that are suffering catastrophic stress failures.
Wikipedia states the following regarding business triage-
Business triage is a decision-making system that provides a framework for business decision making, outcome goal prioritization, and resource allocation in many business environments. Business triage involves categorizing desired outcomes and goals and the processes that support them based on their relative importance to achieving a stated measurable goal or outcome. Using the same triage categories employed by military medical and disaster medical services, business processes are categorized as essential/critical (red) important/urgent (yellow), or optional/supportive (green).
In a business triage model, resources are allocated based on the outcome/goal and process category/rank, with resources first dedicated to red, then yellow, and finally green categories. In the event that resources become limited, resources are first withheld from green, then yellow categories. Resources are only withheld from red categories if failure to achieve outcomes/goals is acceptable.
PPP Initiative Triage
In the current world of public-private-partnerships (PPPs), we are faced with the difficult and unenviable task where governments will have to carry out a PPP triage on PPP projects so that they can maximize their survival as essential tools that will kickstart national recovery efforts. This means that a rapid assessment will need to be made of the “current health” of PPP projects to determine if they are in a terminal downward trajectory or show signs of resuscitation and recovery. Government institutions (i.e PPP Units, Ministries of Finance, Treasury Units, and line ministries) are finding themselves in almost in the same situation as hospital Intensive Care Units (ICUs) that have nearly collapsed due to limited medical and personal resources. Government agencies have become the ICUs of the PPP world where they are facing critical shortages of funding, financing, and material resources to keep their projects functioning.
PPP Triage Strategy
I suggest the following to remedy the critical situation –
- Separating of current PPP projects into (and candidate projects) into three groups – projects that cannot be expected to survive even with an economic stimulus treatment; those who will recover without an economic stimulus treatment, and those who will not survive without an economic stimulus treatment
- Labelling each patient by – Identifying the project (sector and specific service offered); developing a record of assessment findings (immediate action carried out collaboratively between the public and private sector partners); identifying the priority of the project’s need for economic mitigation; tracking the project’s progress through the triage process, and identifying additional risks that can cause economic contamination and failure
- Developing a PPP sophisticated and objective triage decision-making system that provides a framework for decision-making, outcome goal prioritization, and resource allocation
- Categorizing desired outcomes and goals and the processes that will support essential PPP projects based on their relative importance (merits) to achieving national recovery goals
- Using triage categories similar to those employed by military medical and disaster medical services where business processes are categorized as essential/critical (red) important/urgent (yellow), or optional/supportive (green).
- Adopting a PPP triage model where resources are allocated based on the outcome/goal and process category/rank, with resources first dedicated to red, then yellow, and finally green categories.
- Realizing that if public and private sector resources become limited, resources will first be withheld from green, then yellow categories. Resources should only be withheld from red categories if failure to achieve outcomes/goals is acceptable (to national recovery goals)
Other Considerations Behind PPP Triage Actions
As we move away from emergencies resuscitation actions, long term goals will need to be identified for the next two years (or more) which will allow the judicious allocation of economic resources to national PPP project pipeline priorities. Resources will remain scarce and international cooperation for them will be fierce. If PPP national initiatives continue to consider PPPs as tools for recovery, it will be cortical that elements of sustainability, resilience, and regeneration are considered. It will also be important that the private sector is included in this process, as the resources of both the public and private sectors will need to be mobilized and leveraged for the common good.
The following is recommended for a harmonized PPP recovery response –
- Avoiding quick fixes that are based on political decisions rather than economic and commercial reasons – in other words, do not mortgage your futures for ill-conceived short-term recovery actions that look good on paper. This includes the cancellation of prestige PPP projects so that resources can be directed to critical projects
- Not allowing competition between government institutions that compete for limited resources
- Avoiding “strangers that approach you from the dark” who offer “Ideal PPP deals” that suck up future national resources and which result in national strategic initiatives being subverted by geopolitical priorities of other nations
- Revisiting commitments to the SDG, see how the pandemic has affected them, recalibrate your national development strategies accordingly and then decide if your PPP triage priorities have changed – if they have, use new goals and objectives to determine what triage label a project will have
- Value for Money (VfM) assessments, Public Sector Comparators (PSCs) and other PPP project screening tools might have to be revisited and recalibrated
- Giving other factors such as “People First PPP” considerations; project sustainability; and resilience added weight when deciding on rescuing current PPP projects and reprioritizing procurements for future PPP projects.
- Adopting recovery decisions that are pragmatic and not emotional
As I wrote at the beginning of this article, we know what is happening. We now need to carry out an extensive triage that will encourage the recovery of projects that have merit. Keeping projects alive that have no merit, will unfortunately only cause valuable resources to be expended that will not bear fruit. Hard and decisive decisions will need to be made as we systematically move towards economic national recovery using PPPs as a tool. We will need to be future forward-looking and not trapped in past decision metrics as we move into an unknown “new normal” in the post-COVID-19 world. We must face the reality that events like this pandemic have a high probability of reoccurring. Let’s not repeat mistakes in the search for PPPs of the future which is sustainable and resilient.
If you enjoyed reading this article, you might also be interested in reading “Bridging the African Infrastructure Gap“