in the profitmaximization by the private sector, but whether the minimum standard of qualitywill be maintained. In long-term equitable access can change value for moneyconsiderations (Rosenau 2000), therefore affecting viability of the project.Moreover, not providing equitable access in healthcare PPPs may also affect thereputation of the project. According to Benoit & Pang (cited in Tricia et al. 2007), projects reputation is usually threatenedwhen it is held accountable for an undesirable event.Evaluating The Suburban Hospitalin SalvadorBased on the evaluationframework developed and justified above, this section critiques the Hospital doSuburbio PPP in Brazil, pointing strengths and weaknesses of the project aswell as evidences some areas of improvement. Despite the fact that theHospital do Suburbio PPP was chosen as one of the worlds most innovativeprojects (Infrastructure 100: world cities edition 2012), perfection is not theright word to describe this initiative. With the objective of providingequitable access to quality health services for the poor people from the localcommunity in Salvador, in Brazil, this PPP has been facing some issues such as innumerouscomplaints from the patients regarding the difficult access to the Hospital dueto the lack of public transport in the area; high rates of absenteeism; andovercrowding. Although corruption and fraud are considered tobe constraints on governments activities in Brazil (Changing the rules of the game: adiagnosis of corruption in Brazil 2011), surprisingly transparency and accountabilityare pointed as strengths of this PPP, while, controversially, stakeholdersengagement seems weak. Procedures have been executed in open manner, andmonitoring of services shows efficiency by assessing performance tobenchmarking against best practices. However, external stakeholders could bemore involved in planning, and internal stakeholders could be more committed inpromoting equitable access to quality health services for the local community,by helping to speed up treatment and reduce the length of stays, clearlyaffected by the high rates of absenteeism. Further, it also calls for moregovernment support, as the lack of public transport in the area has beenrecognized as the main cause of absenteeism and difficult access. Consequently,the Brazilian society started questioning the Government about the realintention of this PPP, since without public transport, the poor people, who donot have own vehicle, are unable to access the hospital, raising doubts aboutequity and access considerations in this project. Hence, social, political andreputational risks appear to be poorly explored.In fact, the holistic appreciation of risks,highly recommended for this type of PPP, seems inefficient, considering thesocial and political sensitivity of the project, wherein only financial risksappear to be taken into account, even thought ignoring operating costs in the caseof increasing demand. It is worth mentioning that this analysis, made by aproud Brazilian, does not consider the possibility of hidden risks in order toreduce bids price which follows the principle that the public sector cannotallow this type of project to fail, regardless their contractualresponsibilities. As mention above, this project has beenregarded as very successful, however problems with increased demand have beenraising debates around quality. The Government, worried about the maintenanceof quality, has been making contractual adjustments to increase payments forthe private sector, but it may affect the expected value for money. The privatesector, on the other hand, having its payment associated