1. Public Private
Partnership in Health
Dr. Purna Chandra Dash
Date: 05-06-2007

2. 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
Developing
Countries
Avg
Developed
Countries
Avg
65
78
Developing
Countries
Avg
Developed
Countries
Avg
56
6
Developing
Countries
Avg
Developed
Countries
Avg
256
119
64
37
India
2000
India
1951
70
146
India
2000
India
1951
274
339
India
2000
India
1951
DALYs per ‘000 population
Infant
mortality
Life
expectancy
Source: ICRA Indian Healthcare Industry 2003, Report by CII-
Mckinsey: Healthcare in India

3. 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

4. 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!

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

6. ...and the rural areas are not left
far behind
Most rural Indians go to
private providers for
their healthcare needs

7. The trend is seen in almost
all States

8. Better utilisation of public
services for immunisation…
….but definitely not for hospitalisation and outpatient care

9. 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

10. PPP needed in UP also
….with poor ranking for ANC care

11. …and institutional deliveries

12. The Benefits of PPP
Creating competition
Economies of Scale
Utilising Existing Capacity
Create Synergy
Targeting the Poor
Flexibility in Action
Resource Mobilisation
Technical Upgradation
Better Services Better Health

13. 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

14. 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

15. Models of Public Private
Partnerships in Health
1. Social Franchising
2. Branded Clinics
3. Contracting
4. Social Marketing
5. 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

16. 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

17. Model for Social Franchising

18. 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

19. 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

20. Branded Clinics
 Chain of Clinics – Same
Organisation
 Cater to better-off clients –
Market Segmentation
 More Income More
Sustainable

21. 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

22. 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

23. 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

24. 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

25. 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).

26. 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

27. Donations From Individuals
Donations from
 rich philanthropists
 institutions
 Need for simple and
transparent mechanisms to
encourage donations

28. 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

29. Involving the Corporate Sector
Organised Corporate Sector through
• CII
• FICCI
E.g.s Indo-Gulf Fertilisers’ Health
Initiative and recent Health Conclave
by CII

30. Partnerships with Professional
Associations
Expert Pool
• FOGSI – Janani Suraksha
Yojana
•IMA – Aao Gaon Chalein
•TNAI
•Pharmacists Associations
Protocols/ Quality
Assurance/
Accreditation

31. 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

32. 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

33. 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

34. Partnering the Public
and the Private for a
Healthier India!