Public Private Partnership in Health

Dr. Purna Chandra DashDate: 05-06-2007

India has shown progress in all the basic health indicators…

Morbidity

Expectancy at birth in yrs

Deaths per ‘000 births

Still India has a significant distance to traverse in achieving global standards of healthcare

DevelopingCountries

Avg

DevelopedCountries

Avg

65 78

DevelopingCountries

Avg

DevelopedCountries

Avg

56

6

DevelopingCountries

Avg

DevelopedCountries

Avg

256119

64

37

India2000

India1951

70

146

India2000

India1951

274339

India2000

India1951

DALYs per ‘000 population

Infant mortality

Life expectancy

Source: ICRA Indian Healthcare Industry 2003, Report by CII-Mckinsey: Healthcare in India

Even though in terms of % GDP India compares well, Indian spends on a per capita basis need improvement…

13

3.5

8.6

8.3

8.8

3.7

5.3

4.9

United States

Sinagapore

Argentina

Brazil

South Africa

Thailand

China

India

4499

814

658

267

255

71

45

23

Per capita healthcare has to increase many fold to reach the level of even other developing countries

Healthcare spend in USD per capita, 2000Healthcare spend as % of GDP 2000

Source: ICRA Indian Healthcare Industry 2003

Public Spending on Health is only 1% of GDP

Expenditure on Health

Private-Out of Pocket, 85%

Government, 15%

Distribution of Public Expenditures in India on Curative Care by Income

Quintile 1995-96

…..and that too on the rich!

There is a lack of community ownership of public health programs leading to Lack of efficiency, accountability and effectiveness

...and the rural areas are not left far behind

Most rural Indians go to private providers for

their healthcare needs

The trend is seen in almost all States

Better utilisation of public services for immunisation…

….but definitely not for hospitalisation and outpatient care

Therefore, the need for Public and Private to work together

Private Sector

• Good Market Presence•Viable Enterprise•Efficiency higher •Flexibility to respond

Public Sector

• Economies of Scale•Technical and Professional Expertise•Presence in Rural Areas•More Equitable

PPP leverages the benefits of both

PPP needed in UP also

….with poor ranking for ANC care

…and institutional deliveries

The Benefits of PPPCreating competition

Economies of Scale

Utilising Existing Capacity

Create Synergy

Targeting the Poor

Flexibility in Action

Resource Mobilisation

Technical Upgradation

Better Services Better Health

Public Private Partnerships in Health

Definition:Public-Private Partnerships (PPP) are collaborative efforts, between private and public sectors, with clearly identified partnership structures, shared objectives, and specified performance indicators for delivery of a set of health services

Objectives of Public Private Partnerships in Health

Improving access to essential RCH services

Improving the quality of RCH services available

Exchange of expertise

Mobilize additional resources for RCH activities

Improve efficiency

Better Management of Health services

Increasing scope and scale of services

Increasing community ownership RCH program.

Ensuring optimal utilization of govt. investment and infrastructure

Models of Public Private Partnerships in Health1. Social Franchising 2. Branded Clinics 3. Contracting 4. Social Marketing5. Build, Operate and

Transfer 6. Joint Venture

Companies 7. Voucher System 8. Donations from

individuals

9. Partnerships with Social Clubs and Groups (e.g. Rotary Club)

10. Involvement of Corporate sector

11. Partnership with Professional Associations

12. Capacity Building of Private Providers

13. Autonomous Institutions

14. Mobile Health Vans 15. Health Insurance

Social Franchising

“ A franchise is a contractual relationship between the franchiser and franchisee in which the

franchiser offers or is obliged to maintain a continuing interest in the business of the

franchisee in such areas as know-how and training; wherein the franchisee operates under a common trade-name, format and/ or procedure

owned and controlled by the franchiser and in which the franchisee has or will make a

substantial capital investment in his business from his own resources”

-International Franchise Association

Model for Social Franchising

Types of Social Franchising

Partial Franchising Full Franchising

Challenges•Controlling Quality of Services

•Positioning on Price/ Quality – Trade off between Social goals and Provider Satisfaction

•Understanding motivation of Clients for Accessing Services

Social Franchising - Criteria for Initiation

Revitalising present Government structure is slow Resources required to expand public health

infrastructure is enormous. High demand but poor supply from government

health institutions Availability of vast network of private hospitals in

places needed When objective is to improve access to services

on immediate basis. Improve quality standards of private sector and

provide high quality care at affordable prices

Branded Clinics

Chain of Clinics – Same Organisation

Cater to better-off clients – Market Segmentation

More Income More

Sustainable

Branded Clinics – Criteria for initiation Need to expand services rapidly Need to provide high visibility to

services available Offer a package of services selected

for the purpose Provide high quality services at

comparatively affordable prices

Contracting – Contracting-in and Contracting-out

Legally enforceable Contract

-Defined Set of healthcare services

-Quantity of services

-Quality of services

-Duration of Service Provisioning

Public Private

Criteria for initiating Contracting-out Difficult to manage government health

units in remote and inaccessible areas Utilization of services and performance

levels are consistently low due to non-availability of staff

Aim is to put government health facilities to optimum use

Increase responsiveness of government health facilities to local needs through community involvement

Criteria for initiating Contracting-in Improve efficiency levels of services

provided Make management of services more

effective Conserve scarce resources by cutting

costs Try out innovative approaches to

improve efficiency and effectiveness

Voucher System/ Demand Side Financing

A voucher is a document that can be exchanged for defined goods or services as a token of payment (tied-cash).

Voucher System – Criteria for Initiation

Improve access to services and provide choice Where costs act as a major barrier to services Existing public healthcare service delivery points do not

have provision for all types of services Inadequate knowledge about the value of services (e.g.

importance of antenatal care) Need to generate demand for healthcare services Possible to do regular monitoring for ensuring quality

standards Training of providers and network with the people to

ensure proper use of vouchers is possible

Donations From Individuals

Donations from rich philanthropists institutions

Need for simple and transparent mechanisms to encourage donations

Partnerships with Social Clubs and Groups

Social Clubs like• Rotary• Lions’• JCs

They have been proven to be useful in: Popularising reformed healthcare service delivery

outlets In communication campaigns Management of camps on a large scale Providing additional resources and technical

expertise Advocacy efforts

Involving the Corporate Sector

Organised Corporate Sector through• CII• FICCI

E.g.s Indo-Gulf Fertilisers’ Health Initiative and recent Health Conclave by CII

Partnerships with Professional Associations

Expert Pool

• FOGSI – Janani Suraksha Yojana

•IMA – Aao Gaon Chalein

•TNAI

•Pharmacists Associations

Protocols/ Quality Assurance/

Accreditation

Mobile Health Vans

Already implemented in inaccessible areas

Comprehensive Health Services Fixed Journey Plans Public Sector contribution Medical

Officers and Medicines Private Sector for Purchase and

Management of Vans These vans are useful in:

Provide access to services people living in inaccessible terrain

Make services available at central location to reduce travel time and costs of clients

Initiating Public Private Partnerships in Health

Prioritizing needs

Evaluating and analyzing the ground realities

Selecting the appropriate model

Piloting the model

Evaluating the pilot

Scaling up

Initiating Public Private Partnerships in Health - Vital Components: STRAIGHT

Identifying the SCOPE of partnership Identifying the appropriate TARGET POPULATION Selecting the RIGHT PARTNERS and the RIGHT

MODEL of PPP Ensuring ACCOUNTABILITY of private providers Ensure active INVOLVEMENT of the government GENERATE SUPPORT of all the key stakeholders

through IEC, advocacy and rapport building HIGHLIGHT ACHIEVEMENTS of the partnerships Build TRUST of all the partners and clients

Partnering the Public and the Private for a Healthier India!