Dr Deoki Nandan

PUBLIC PRIVATE PARTNERSHIP IN HEALTH SECTOR: MODELS & THE AGRA EXPERIENCEProf. Deoki NandanDirectorNational Institute of Health & Family Welfare, New Delhi

Public Private Partnership in HealthDefinition:Public-Private Partnership (PPP) is a collaborative effort, between private and public sector, with clearly identified partnership structures, shared objectives, and specified performance indicators for delivery of a set of health services (MOHFW,GOI)

Objectives of Public Private Partnership in HealthImproving access to essential services Improving the quality of services availableExchange of expertiseMobilize additional resourcesfor activitiesImprove efficiencyBetter Managementof Health servicesIncreasing scope and scale of services Increasing community ownership of programs.Ensuring optimal utilization of govt. investment and infrastructure

Economies of ScaleEconomies of ScaleUtilising Existing CapacityUtilising Existing CapacityCreate SynergyCreate SynergyBetter ServicesBetter ServicesBetter HealthTargeting the PoorTargeting the PoorFlexibility in ActionFlexibility in ActionResource MobilisationResource MobilisationTechnical UpgradationTechnical UpgradationThe Benefits of PPP are

Models of Public Private Partnerships in HealthSocial Franchising Branded Clinics Contracting Social MarketingBuild, Operate and Transfer Joint Venture Voucher System Donations from individualsPartnerships with Social Clubs and Groups (e.g. Rotary Club)Involvement of Corporate sectorPartnership with Professional AssociationsCapacity Building of Private ProvidersAutonomous InstitutionsMobile Health VansHealth 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

The Merrygold Network (USAID, SIFPSA & HLFPPT), Uttar PradeshProvides high quality MCH services at affordable prices. Network comprises of seventy - 20-bed Merrygold Hospitals, 350 - Merrysilver clinics and 10,500 - Merrytarang Ayush partners. The franchisees of this network are being provided training, marketing and quality assurance support

Controlling Quality of Services

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

Understanding motivation of Clients for Accessing ServicesChallenges

Social Franchising - Criteria for InitiationRevitalising present Government structure is slowResources required to expand public health infrastructure is enormous. High demand but poor supply from government health institutionsAvailability of vast network of private hospitals in places neededWhen 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 ClinicsChain of Clinics – Same OrganisationCater to better-off clients – Market SegmentationMore Income More SustainableEg. Butterfly clinics, titli centres in Bihar,MP

Example With the support of States, an NGO Janani set up a network of more than 21,000 Titli (butterfly) centres and more than 500 Surya (sun) clinics in Bihar, Jharkhand and Madhya Pradesh. Surya clinics are referral clinics run by formally qualified, state-registered doctors in the towns.Titli centres are situated in villages and run by RHPs who have been trained to provide family planning counselling and sell non-clinical contraceptives.

Branded Clinics – Criteria for initiationNeed to expand services rapidlyNeed to provide high visibility to services availableOffer a package of services selected for the purposeProvide high quality services at comparatively affordable prices

Contracting – Contracting-in and Contracting-outLegally enforceable ContractDefined Set of healthcare services

Duration of Service ProvisioningPrivatePublicRemuneration

Contracting Out & InExamplesContracting outState Govts. Has contracted out few PHCs in Karnataka, Arunachal Pradesh to by Karuna Trust, VHAI Subcentres in Uttarakhand to NGOsContracting in Human resources by almost all states under NRHM -Radiology, drug stores etc.eg. SMS Hospital, Jaipur -Diet, cleaning, laundry etc. in almost all states

Criteria for initiating Contracting-outDifficult 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-inImprove efficiency levels of services providedMake management of services more effectiveConserve scarce resources by cutting costs Try out innovative approaches to improve efficiency and effectiveness

Voucher System/ Demand Side FinancingA voucher is a document that can be exchanged for defined goods or services as a token of payment (tied-cash).Eg: AGRA, Hardwar

Voucher System – Criteria for InitiationImprove access to services and provide choiceWhere costs act as a major barrier to servicesExisting public healthcare service delivery points do not have provision for all types of servicesInadequate knowledge about the value of services (e.g. importance of antenatal care)Need to generate demand for healthcare servicesPossible to do regular monitoring for ensuring quality standardsTraining of providers and network with the people to ensure proper use of vouchers is possible

Donations From IndividualsDonations from rich philanthropistsinstitutions Need for simple and transparent mechanisms to encourage donations

Partnerships with Social Clubs and GroupsSocial Clubs likeRotaryLions’They have been proven to be useful in:Popularising reformed healthcare service delivery outletsIn communication campaigns Management of camps on a large scaleProviding additional resources and technical expertise Advocacy efforts

Involving the Corporate SectorOrganised Corporate Sector throughCIIFICCIE.g. Indo-Gulf Fertilisers’ Health Initiative and recent Health Conclave by CIIAdoption of Villages for providing primary health care services – TVS -in Karnataka

Partnerships with Professional AssociationsExpert Pool IAPSM, IPHA

Pharmacists AssociationsProtocols/ Quality Assurance/ Accreditation

Mobile Health VansAlready implemented in inaccessible areasComprehensive Health ServicesFixed Journey Plans Public Sector contribution Medical Officers and MedicinesPrivate Sector for Purchase and Management of VansThese vans are useful in:Provide access to services people living in inaccessible terrainMake services available at central location to reduce travel time and costs of clientsUnder NRHM many states have introduced this scheme

Health Insurance CGHS – Tie up with private hospitals RSBY – Empanelled private hospitals ESIS - Panel of private hospitals & empanelment of private doctors

Initiating Public Private Partnerships in HealthPrioritizing needsEvaluating and analyzing the ground realitiesSelecting the appropriate modelPiloting the modelEvaluating the pilotScaling up

Initiating PPP in Health - Vital Components: STRAIGHTIdentifying the SCOPE of partnershipIdentifying the appropriate TARGET POPULATIONSelecting the RIGHT PARTNERSand theRIGHT MODELof PPPEnsuring ACCOUNTABILITY of private providersEnsure active INVOLVEMENTof the governmentGENERATE SUPPORT of all the key stakeholders through IEC, advocacy and rapport buildingHIGHLIGHT ACHIEVEMENTS of the partnershipsBuild TRUST of all the partners and clients

Initiating Vouchers scheme for MCH care for BPL in Agra

The task was to bring government health sector, private health care providers,NGOs work together on one platformand Policy makers To accept PPP in health as an implementable issue

Key policy makers were:State GovernmentHealth Department Bureaucracy-Principal Secy M&HSenior technocrats at state HQ

Existing Rules were……..It cannot be done!

Principal viewpoints against scheme were…Government-Why should we give government money to private providers?Private providers are profiteers, so why link with them? It has not been done before so how can we do it now?Health department Technocrats-We give services for free! why should they get money for it We will lose our constituency and control on public healthPrivate health care providers-Government is corrupt, we will not work with them

Key supporters wereNONEExcept the funding agency

SignalsWe compiled a data bank onExisting health indicators in the district

Comparative cost of treatment to patients in Govt. vs Private sector

Percentages of un-served BPL patients in the state

Comparative reach of private sector

Increasing inclination of population towards private health careConsultation and Formulation Step-1Called on the key government representatives to share data

Discussed successful models to remove doubts

Discussed the pro poor spectrum of this scheme

Shared experiences from the other states/developing countries

Tried to convince that this is cost effective Step-2Called a consultative meeting of all stakeholders at AgraThis included- Bureaucrats, Senior government officials,Nursing home Associations, IMA, Nursing council, Civil Society reps, Senior reform advocates and subject specialistsHad discussions, did documentation, developed models and presented findings to government with a draft plan recommendationAggressionFollowed up with fostering pressure groups inside state bureaucracy. Also aggressively advocated with senior technocrats in health directorateSent the proposal to Government for ratification

Dr Deoki Nandan

More Related Content

What's hot

Similar to Dr Deoki Nandan

More from IAPSMUPUKCON2010

Recently uploaded

Dr Deoki Nandan