1. Public-Private Partnerships in Health Keerti Bhusan Pradhan keerti@aravind.org

2. Overview of the Paper Definition of Public-Private Partnership (PPP) in Health Evolution of PPP in Health Current Focus of PPP in Health Successful Models Challenges to overcome Conclusion

3. Public Private Partnerships (PPP) in Health PPP in health is an approach to addressing public health problems through the combined efforts of public, private and development organisations complimenting each other by contributing or sharing their core competency This synergy leads to better outcome of goals

4. Evolution of PPP in Health Government/Public Sector –Government sector finds it difficult to support health Eg. 1.1% of GSDP was the health expenditure in 1993-94 in 14 States in India 70% of budget allocation is spent on resource maintenance like Human Resources Has to lead to decreased capital investment

5. Evolution of PPP in Health Private Sector –80% of well qualified medical professionals work in private sector –State-of-the-art facilities –Private health care expenditure is around 4.25% of the GDP; increase @ 12.5% per annum –Private Sector Share is significant: Hospitals - 57% & Beds - 32%

6. Current PPP in India Contracting out to manage clinical and non-clinical services; health projects Joint ventures; private capital to set up hospitals Incentives system to influence desired geographic distribution of health facilities – qualified providers through contract mechanisms in rural areas

7. Current Focus of PPP in Health Develop strategies to utilise untapped resources and strengths of the private sector Enhance the capacity to meet growing health needs Reducing financial burden of government expenditure on tertiary care Reducing geographical disparity in provision of services and its access Reaching remote areas; target specific group of populations Improving efficiency through evolving new management structures

8. Some options & examples Partnership in disease surveillance (CMC- Kerala) Partnership in pharmaceutical procurement & supply (TNSMC) Partnership in managing high-risk pregnancies Partnership in promotive care (IEC- HIV/AIDS) Partnership with communities & industries

9. Models…Government’s initiatives Rajasthan –Acknowledged the inability to develop service delivery systems to tackle chronic diseases –Categorization of medical institutions and awarding benefits accordingly –Subsidised initial set up costs in rural areas (offering land at a lesser cost) –Fiscal incentives in acquiring medical equipment and machinery - sizable tax exemptions

10. Presence of a catalyst-A catalyst can bring partners together and offer expertise Public sector backing-reassurance to private sector Existence of a vibrant private sector Commitment of private sector decision-makers Road Map Ownership Understanding roles, responsibilities, expectations Critical Success Factors from Others

11. NGO’s contribution Aravind Eye Hospitals, a private trust contributes to the State by performing high volume, a staggering 42% of total surgeries in the State relieving its burden

12. Issues Involvement of private sector will improve efficiency; however no concrete steps have been taken to initiate this Clarity in policies to effect the partnerships is still evolving Lack of appropriate regulatory and monitoring mechanisms have raised doubts about PPP in health – still poor are not taken care of…

13. Policy constraints Weak regulatory regimes to monitor private health sector Weak capacity of Government Lack of a research and information base on the dynamics of private sector Lack of a policy framework for promoting private health sector

14. PUBLIC SECTOR PRIVATE SECTOR  Free Provision of Products and Services Unsustainable for Government & Donors Unsustainable for Consumers Profit Maximization Break Even      Goal is to create financially sustainable system

15. Challenges Ahead Involving private providers in managing various components of health sector programmes Developing joint ventures or inviting private capital to set up hospitals Contracting out services (Catering, Cleaning, Security, Laboratory…..) Consumer Protection Act (Safeguarding the interest of consumers) Regulation and Accreditation of private providers by Government

16. Conclusion Public-Private partnerships in health are at very early stages Will need significant institutional development work in terms of financial analysis capabilities, monitoring and evaluations systems Appropriate regulations to check the unintended outcomes of private sector growth in health