Heart of the matter
‡ No country in the world has healthcare financed entirely by the government. ‡ While the provision of health is recognised as the responsibility of government, private capital and expertise are viewed as welcome sources to induce efficiency and innovation. ‡ The balance of public to private resources in financing and managing health is unclear. ‡ Discussion on various structures to ensure the best returns for both taxpayers and private sector. ‡ One of these is PPP

good quality services ‡ notion that the public sector must reorient its dual role of financing and provision of services because of its increasing inability on both fronts .Assumptions ‡ belief that public sector bureaucracies are inefficient and unresponsive ‡ that market mechanisms will promote efficiency and ensure cost effective.

± mutual commitment to agreed objectives. ± mutual benefit for the stakeholders involved in the partnership. but ‡ Three fundamental themes ± relative sense of equality between the partners. .What is PPP ‡ Many definitions.

facility. skills etc) New Healthcare facility or service Assets (`.Private Healthcare Provider Contract State Department of Health Assets (facility. Land. etc) .

Possible PPP Approaches ‡ ‡ ‡ ‡ ‡ ‡ ‡ ‡ ‡ ‡ ‡ ‡ Contracting out Contracting in Joint Ventures Involvement of professional associations Involvement of corporate sector Social marketing Franchising Capacity building for providers Autonomous institutions Management and technical support Grants-in-aid Campaigns with private partners .

‡ Vouchers can be used to target the population receiving the services. ‡ Agencies that are contracted out can be for-profit or notfor-profit. ‡ In the health sector. ‡ Such partnerships can be with nongovernmental organizations or community-based organizations to provide services in remote and rural areas.Contracting out ‡ Agreement between one or more parties specifying provision of services by one party against payment by the other in exchange for the services provided. . services can be both clinical and non-clinical. salary or capitation. ‡ The payment to providers can be based on fees for services.

transport. provision of meals. diagnostic facilities. security and communications in major hospitals. ‡ Hiring of medical specialists for certain days of the week also forms part of such arrangements. housekeeping.Contracting in ‡ Hiring of one or more agencies or individuals to provide services. . including maintenance of buildings and utilities. medicine stores.

Joint Venture ‡ Legal entity: as a society or joint stock company. ‡ The participation of the government might be in the form of land or other contributions in kind. ‡ The equitable proportion of each partner can vary. with equitable participation of government and the private sector. ‡ Companies are usually formed for a specific purpose and for a specific time. .

such as the IMA. accreditation or certification and payment structures in PPP¶s such as the Chiranjeevi scheme. FOGSI and nurses¶ associations. and promoting new programmes such as the Vande Mataram scheme.Involvement of professional associations ‡ Involving professional associations. in selfregulation to ensure quality. . ‡ An association of global partners could also be involved. the Gaon Chalo project and immunization programmes.

corporate sector funding of public health programmes.Involvement of the corporate sector ‡ As part of corporate social responsibility (CSR). advocacy campaigns or opening and running hospitals and clinics for the community .

Social Marketing ‡ Application of marketing techniques to achieve a social objective. social marketing has been associated with expanding access to contraceptives. ‡ In India. ‡ The trend is now to increase the available products. including oral rehydration solution. . iron and folic acid tablets and other health products to make marketing more self-sustaining.

knowledge and strategies. ‡ The franchisees contribute resources to set up a clinic and pay membership fees to the franchiser. the franchiser has specialized skills.Franchising ‡ A business model in which a manufacturer or marketer of a product or service (the franchiser) grants exclusive rights to local independent agency (franchisees) to conduct business in a prescribed manner in a certain place over a specified period. ‡ Typically. .

Capacity building for providers ‡ Initiatives taken by the government to improve the technical and counselling skills of medical practitioners. . particularly in rural areas. to improve the quality of their services.

improving morale and encouraging the workforce. efficient services. high-quality.Autonomous institutions ‡ Granting complete autonomy to a public institution by incorporating it as a separate legal entity. accountable. such as a society or company. . ‡ This ensures greater involvement and ownership by the institution. and forming a partnership for the provision of equitable.

Management & technical support ‡ Agencies acting on behalf of the government as their management partner to undertake a certain set of activities .

Grants-in-aid ‡ Schemes to provide direct financial support for recurring expenditures to nonstate institutions or transfer of public resources. . vaccines and contraceptives. including subsidized or free commodities such as medicines.

.Campaigns with private partners ‡ Special campaigns in partnership with the private sector to generate demand for a refurbished. revitalized public sector and promotion of generic health products ‡ e.g. life-saving oral rehydration solution and menstrual hygiene with sanitary napkins.

cutting corners ± Effect on employee wages and benefits ± Conflict of interests .Criticism ‡ Benefits ± Timeliness ± Sharing of expertise ± Cost savings (eg PFI in UK) ± Performance related penalties ‡ Harms ± Quality.

‡ World Bank. Public±Private Partnerships: Managing contracting arrangements to strengthen the Reproductive and Child Health Programme in India Lessons and implications from three case studies. WHO. Somen Saha . Dileep Mavalankar.Further Reading ‡ World Health Organization 2007. IIM case studies ‡ Ramesh Bhat. ‡ A Venkat Raman and James Warner Björkman. Public/private partnership in health care Services in India.

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