et al 2009).In healthcare PPP projects, internal stakeholders commitment to public good andexternal stakeholders involvement in planning and monitoring of services seemessential considerations in such social and political sensitive projects(Rosenau 200).Risk SharingEnglish (cited in Hodge & Greve 2005)suggests that social infrastructure PPPs are usually considered safe for theprivate sector, based on the idea that the state is always prepared tointerfere in these projects to protect them to fail, as in some cases the costsfor replacing the consortium, in social sensitive PPPs, can be higher thanpolitical costs. Indeed, in healthcare PPPs there is a great chance of publicsector intervention, including financial renegotiation (Akintove & Beck2008), requiring a deliberate risk analysis to guarantee their viability.Hence, the anticipation of the governmentsupport, regardless contractual arrangements, may promote unrealistic bids, assumingthat the risks, not specified in the proposal, will be absorbed by the publicsector (Hodge& Greve 2007).Thus, PPPs in health call for effective appreciation of risks in order to findthe proper balance of its stakeholders interests.In fact, risk sharing is often pointed as one ofthe major benefits in PPPs, but if inappropriate managed it can result ininsufficient risks transferred to the sector that can better deal with them,therefore affecting PPPs outcomes (Flinders 2005). Costs and QualityThe quality of public services in Brazil istraditionally very poor. Many hospitals provide low quality services, wherelack of accountability, inadequate supervision of staff, inadequacy ofequipment, lack of drugs and materials, and excess of bureaucracy, are clearly evident.On the other hand, private hospitals in Brazil are known for excellent qualitybut unfortunately they serve only the minority.Health care costs in Brazilare abusive. Although some improvement can be expected due to recent regulationsenforcement (Public-PrivatePartnership 2013),health services costs are associated with technology improvements andpopulation growth. Thus, some relief from increasing costs may rely onefficiency improvements brought by PPP projects, by which quality needs to bealso guaranteed. In fact, providing quality services and offering costadvantages are not only objectives of PPPs in health, but also challenges inachieving value for money (McKee etal. 2006).Notwithstanding,governments increasingly use PPPs to pursue value for money. A PPP projectachieves value for money when it costs less than the best realistic proposal inproviding the same services (Infrastructure Australia 2008). According to Trafford & Proctor (2006) an effective assess of value for money depends onsimultaneous considerations of qualitative and quantitative aspects, notindependently. Qualitative aspects are related to operations requirements,service delivery, and project management, while quantitative aspects involve coststhat can be measured using Public Sector Comparator (Quiggin 2004).Equitable Access to quality healthservices for the poor peopleThere is a broad understanding that governmentsare to provide health services to poor people that cannot pay for them. Povertyin Brazil is common and there are wide disparities in both income and healthamong the wealthiest and poorest parts of the society. Promoting equitableaccess is one of the biggest challenges for PPPs in health, since the privatesector concentrated in maximizing profit is normally less concerned with issuesof equitable access for poor people (Mills 1998). In PPPs projects maximizing profit means cost reduction, which mayaffect performance and quality (McKee et al. 2006). Notwithstanding, whenestablishing a PPP in health, the concerns remain not