PPP IN HEALTH SECTOR: POLICY FRAMEWORK & INSTITUTIONAL CAPACITY

A.VENKAT RAMAN

FACULTY OF MANAGEMENT STUDIES

UNIVERSITY OF DELHI

avr@fms.edu

A.VENKAT RAMAN FMS-DU 1

14th Arab Conference7th Dec, 2015, Amman

A.Venkat Raman, FMS-DU 2

PPP MODELS IN HEALTH SECTOR(Venkatraman, 2012)

INFRASTRUCTURE PPPs

Variants of Design, Build, Finance, Own, Operate, Lease, Transfer Models

(DBF, BOO, BOOT, BOLT)Joint Ventures

Financing (PFI, VGF)Land/ Tax Concessions

SERVICE DELIVERY PPPs(Clinical/ Non Clinical Services)

Contracting ('in' & 'out')Management Contract

Co-locationFranchising

FINANCING / PURCHASING PPPs

DSF (Vouchers/ Health Cards/ CouponsConditional Cash)

SSF (Incentive) Community Based Insurance

Social Insurance/ Illness Assistance fund

OTHER PARTNERSHIP OPTIONS

Public Private MixTechnology Demo. (e,g. Telemedicine)

Social Marketing Drug Research

Capacity Building/ Human ResourceSelf Regulation (Networks/ Alliances)

PPP MODELS

E

PPP: Ideal Strategy(Venkatraman,2012)

PPP(Infra, Delivery,

Financing)Institutional System (Policy, Unit, Capacity-M&S, Payment)

Accreditation& Quality

A.Venkat Raman, FMS-DU 3

KEY STAKEHOLDERS IN PPP

A.Venkat Raman, FMS-Delhi Univ 4

(Poor) Patients

Political

Bureaucracy

Public Health System

Private Sector

Civil Society

Regulator/ Legal

DEVT. PARTNERS

PPP Policy: A Template

• Background to the country’s health system• Past Efforts and Present Situation• Problems and Challenges• Need for a New Policy• Vision, Mission and Objectives• Strategy and Working Models• Institutional Structure• Financial Aspect• Legal Aspect• Monitoring and Evaluation• Risk• Policy revision

• Annexure: Governing principles of PPP in health sector• Annexure: Types of PPP in health sector• Annexure: PPP policy framework• Annexure: SNP Evaluation Framework Model

Process:

A Draft Policy

Consultation process

Delineation of Infra to Service delivery

Steering group

Cabinet approval

Responsibilities of PPP Unit in the MoH

Policy, Scoping, Advisory

Capacity Building

Dialogue/

Gather Evidence Disseminate

Monitor / Evaluate/ VfM Analysis

Conceive, Structure, Implement- Manage

Main functions of the PPP unit is:

I. Development of PPP Policy and Guidelines

II. Project Conceptualisation/ Planning

III. Designing individual projects

IV. Transaction

V. Contract Management

VI. Monitoring and Evaluation

ToR for PPP Cell: Overall MandateDevelop and execute a pipeline of PPP projects that will contribute to improvements in the health of the population of the province.

Overall mandate :

• Function as a nodal agency for all private sector engagement initiatives in health sector in the state/ province;

• Identify, design, negotiate, contract, monitor, manage and evaluate PPP schemes/ projects, in accordance with the PPP policy

• Develop systems and SOPs to facilitate private sector engagement / PPP in health sector

• Generate and deploy appropriate resources for effective management of PPP

• Liaison with key stakeholders, create awareness and promote an eco system

• Monitor and evaluate the outcomes of any private sector engagement initiative

What kind of capacity

PPP enabling framework

Develop PPP policies, guidelines, fiscal

rules

Draft PPP-related legal / regulatory

framework

Streamline PPP institutional set-up

Rules on fiscal impact, VGF, and

risk-sharing mechanisms

Financing & Risk guarantee mechanisms

Protocols of setting up & utilizing

guarantee fund to cover risks

Develop policy, regulatory measures on long-term health investment financing

Build Capacity on financing

mechanisms and norms

PPP best practices

Conduct training of PPP staff and other departments and

agencies

Analyze PPP models ( successes and

failures) at national and local level; -Identify lessons , best practices a

PPP Unit: Staffing Options

Hire

• Quickly appointed

• Challenge of selecting effective consultants

• May be be expensive

• Risk of possible conflicts of interest.

• Civil service rules restricts autonomy of the consultants

Train and/ or Hire staff

• Builds Capacity

• Time and resource intensive;

• Outside consultants may still be needed to start.

• Govt. staff may not want to or lack incentives or background to learn new subjects

Govt Staff

• Can look after the entire PPP project cycle

• Reassure private sector that there is a dedicated unit and continuity

• But PPP projects are likely to be less frequent -may not justify dedicated unit;

Consultant: Planning and Transaction ManagementDuties & Responsibilities (Competencies)

PLANNING:• Assess the demand for health services and identify service delivery

gaps across the province based on demographic and epidemiological profile of the population;

• Identify and map health sector resources (both public and private sectors) across the province; identify alternative and innovative models in service delivery mechanisms to overcome problems of access to quality services

• Identify and develop proposals for appropriate models of engaging the private sector that are contextually appropriate to address service delivery gaps, including scope of services, scale of partnership, budgetary and financial outlays for such partnership ; coordinate with officials of health directorate and the secretariat and other experts / consultants in PPP cell in the design, implementation and evaluation of PPP transactions.

• Facilitate Private sector consultation / dialogue, support development of policy guidelines and plans

• Create awareness and disseminate PPP programs/ Schemes to the beneficiary population

TRANSACTION MANAGEMENT

• Work closely with the procurement team of the directorate to support in preparing transaction documents and support in transaction process, including identification and appointment of transaction consultants, monitoring of contract design, verification of proposals, and in shortlisting of private partners.

• Undertake and / or support pre-feasibility/ feasibility studies on PPP projects; develop concept notes (case briefs) for new PPP projects and prepare detailed project plan / proposal

• Compile evidence on appropriateness and merits of various PPP models and lead the process of documenting PPP models to help in developing locally appropriate PPP model

• Prepare guidelines and standard operating procedures under the project as required by the concerned authorities

• Prepare bid/ transaction/ contract documents (EoI, RfP, RfQ, MoUand Contract) and liaise with procurement cell, legal cell, transaction advisor).

• Prepare periodic report regarding the overall functioning of PPP planning system and its outcomes.

• Hold stakeholders consultation on PPP policy, guidelines, design, and implementation of PPP Projects

• Undertake assessment of financial sustainability, identify relevant parameters for financial modelling and help in evaluating value-for-money in PPP projects.

• Support the procurement officer in defining criteria for the pre-selection procedure and other PPP procurement process

• Contract Period (Contractual Post)

• Key Competencies: • Demonstrated experience in program design, project

planning, developing feasibility report, proposal development in health sector.

• Experience in design and management of public-private partnership (PPP) projects in health sector including planning, contract design, proposal development, contract management, etc.

• Experience in conducting population based studies, needs assessment and complex program modelling for health sector projects, experience working on the development of health plans.

• Experience in organizing and facilitating stakeholder / private sector consultations

• Proficiency in office / data base software. Knowledge of project management software applications

THANK YOU !!!

DISCUSSION……….