Public Private Partnership

Hope this Presentation on Public Private Partnership would be giving gist of it. Happy Learning!

1. IN HEALTHCARE SERVICES Dr. VINOTHINI. J Junior Resident Dept. of Community Medicine Banaras Hindu University

2. Characterized by sharing of; Resources Risks Rewards Responsibilities for the mutual benefit of both parties What is PPP? Partnership between the government and the private sector ( Profit, Non-Profit, Private Service Provider) Principal objective: Providing Public infrastructure, community needs and other related services that were traditionally provided by the public sector

3. Policy formulation Planning Implementation Monitoring Evaluation Training & Research DEFINING PUBLIC PRIVATE PARTNERSHIP IN HEALTH Main objective of any PPP mechanism related to health services: Universal coverage and equity for primary health care Partnership in PPP in health sector is an instrument for improving the health of the population PPP is viewing the whole medical sector as a national asset with health promotion as goal of all health providers, private or public. Private and Non-profit sectors are also accountable to health systems and services of the country

4. Objectives of PPP To ensure government services are delivered in an economical, effective and efficient manner To create opportunities for private sector growth and to contribute to the overall economic development of the district/state/country through the stimulation of competitiveness and initiative To ensure the best interests of the public, the private sector and the community are served through an appropriate allocation of risks and returns between partners.

5. Why do we need PPP in Health Sector? The key to establishing an effective and efficient healthcare delivery system in any country is to ensure the three ‘A’s : The WHO recommendation on Doctor- Population ratio - 1:1000 India’s Doctor-Population ratio – 1:1,404 ( National Health Profile 2019) Rural India Doctor-Population ratio – 1:10,926 ( National Health Profile 2019) Availability Accessibility Affordability Availability (Recommendation vs Reality)

6. A shortfall of 86.5% of Surgeons, 74.1% of Obstetricians & Gynecologists, 84.6% of Physicians and 81% of Pediatricians. Overall, there was a shortfall of 81.6% specialists at the CHCs as compared to the requirement for existing CHCs. Public health facilities continue to face staff shortage as over 85% specialist doctors, 75% doctors, 80% lab technicians, 53% nursing and 52% ANM posts are vacant across States. The density of health professionals is also more in urban areas compared rural areas. According to WHO, India‟s ranking is 52nd out of 57 countries facing crisis in human resources in health.

7. 74% of doctors in India and 75% of healthcare structure are in urban areas Accessibility Urban area: only 27% of Indian population resides Affordability NHP-2017 recommends govt. expenditure on health to be increased by 2.5% to 3% of GDP by 2025 But between 2015-16 to 2020-21 there’s only a mere increase of 0.02% in the health budget INDIA SPENDS JUST 1.26% OF GDP ON PUBLIC HEALTHCARE The national policy also recommended that expenditure on health by states should be increased to 8% or more of their budget by 2020, but none of the states have allocated 8% of their budget towards health in 2020-21. On an average, the state governments have just allocated 5.4% of their total budget towards public health care systems.

8. The Economic Survey 2020-21 has strongly recommended an increase in public spending on healthcare services from 1% to 2.5-3% of GDP , as envisaged in the National Health Policy 2017. The Union Minister for Finance & Corporate Affairs, Smt Nirmala Sitharaman tabled the Economic Survey 2020-21 in Parliament ( JAN 29 TH 2021) Out-of-Pocket-Expenditure from 65% to 35% of the overall healthcare spend

9. Over the years the private health sector in India has grown remarkably At independence the private sector in India had only 8% of health care facilities but recent estimates indicate that 93% of all hospitals, 64% of beds, 85% of doctors, 80% of outpatients and 57% of inpatients are in the private sector. Given the overwhelming presence of the private sector in health, various state governments in India have been exploring the option of involving the private sector and creating partnerships with it in order to meet the growing health care needs of the population There is huge growth in private sector with its large number of private companies (for profit ) becoming multinational from being national

10. Advocates argue that the public and private sectors can potentially gain from one another in the form of resources, technology, knowledge and skills, management practices, cost efficiency and even a make-over of their respective images. It is assumed that collaboration with the private sector in the form of Public-Private Partnership would improve Equity, Efficiency, Accountability, Quality and Accessibility of the entire health system.

11. Infrastructure Development Management and Operations Capacity Building and Training Financing Mechanism IT Infrastructure Materials Management PRIVATE SECTOR Cost-effectiveness Higher Productivity Accelerated Delivery Clear Customer Focus Enhanced Social Service Recovery of User Charges PPP BENEFICIAL ASPECTS

12. Under the Tenth Five Year Plan (2002-2007), initiatives have been taken to define the role of the government, private and voluntary organizations in meeting the growing needs for health care services including RCH and other national health programme ; Family welfare services TB control program Leprosy control program Trachoma & Blindness control program National AIDS control program INTRODUCTION TO PPP IN HEALTH SECTOR PPP has emerged as one of the options to influence the growth of private sector with public goals in mind

13. National Rural Health Mission (NRHM 2005-2012) also proposes to support the development and effective implementation of regulating mechanism for the private health sector to ensure Equity, Transparency and Accountability in achieving the public health goals. In order to tap the resources available in the private sector and to conceptualize the strategies, Government of India has constituted a Technical Advisory Group for this purpose, consisting of officials of GOI, development partners and other stakeholders.

14. The responsibility for delivery and funding a particular service rests with the private sector. Full retention of responsibility by the government for providing the service Ownership rights are sold to the private sector along with associated benefits and costs May continue to retain the legal ownership of assets by the public sector Determined by the private provider Contractually determined between the two parties All the risks inherent in the business rest with the private sector Shared between the government (public) and the private sector PPP PRIVATIZATION Responsibility: Ownership : Nature of service: Risk & Reward : (vs)

15. Partnerships in health financing through health insurance Contracting-in and contracting-out of service delivery Outsourcing of operations & management of public health facilities Build-operate-transfer model Concession model FORMS OF PUBLIC – PRIVATE PARTNERSHIP IN HEALTH IN INDIA Build Operate Transfer

16. Joint venture model Social franchisee model Voucher schemes Corporate social responsibility

17. Partnerships in health financing through health insurance The National Health Insurance Programme known as RSBY was launched by the GOI in October 2007 to provide BPL families State Health Insurance programme for tertiary health care – the Rajiv Aarogyasri programme Yeshasvini Health Scheme in Karnataka Arogyaraksha scheme in ANDRA PRADESH

18. Contracting-in and contracting-out of service delivery It is becoming a well-established form of PPP that many state governments are trying out with varying degrees of success, especially under NRHM. In one of the good-performing models in the state of Odisha, an NGO contracted out some PHCs along with the sub- centres reporting to them It is a contracted-out model and one of the most successful PPP models in India Chiranjeevi Yojana Scheme The public-sector hospital invites private doctors to undertake normal and caesarean deliveries to increase patient volumes at an institution The contracting-out of PHCs EMRI 108

19. Outsourcing of operations and management of public health facilities Non-clinical hospital services such as laundry, catering, security ( Bhagajatin hospital) the contracting-out of kitchen, cleaning and laundry services Clinical services such as radiology and laboratory services, the directly-observed therapy programme for antitubercular therapy Private management of primary healthcare centres in Tamil Nadu and the Rajiv Gandhi Gram in Mobile Medical Centre in Rajasthan

20. The Rajiv Gandhi super- speciality hospital in Raichur Karnataka is a joint venture of the Govt. of Karnataka and Apollo Hospital Group, with financial support from OPEC. Joint venture model Social franchisee model The MGHN project was implemented in 35 districts of Uttar Pradesh (a network of franchised hospitals offering quality RCH services at pre-fixed prices) The private partner takes complete responsibility for marketing and distribution of low-cost health products (contraceptives, insecticidal bed nets, etc.).

21. Partnership between the Government and the for Profit sector Contracting in Sawai Man Singh Hospital, Jaipur The Uttaranchal Mobile Hospital and Research Center (UMHRC) is three-way partnership. The motive behind the partnership was to provide health care and diagnostic facilities to poor and rural people at their doorstep in the difficult hilly terrains Contracting out of IEC services to the private sector by the State Malaria Control Society in Gujarat is underway in order to control malaria in the state

22. 4. Contracting in of services like cleaning and maintenance of buildings, security, waste management, scavenging, laundry, diet, etc. to the private sector has been tried in states like Himachal Pradesh; Karnataka; Orissa (cleaning work of Capital Hospital by Sulabh International); Punjab; Tripura (contracting Sulabh International for upkeep, cleaning and maintenance of the G.B. Hospital and the surrounding area); Uttaranchal, etc. 5. The Government of Andhra Pradesh has initiated the Arogya Raksha Scheme in collaboration with the New India Assurance Company and with private clinics

23. Family Welfare Programme Partnership between the Government and the non-profit sector Involvement of NGOs SEWA-Rural Govt. of Gujarat has provided grants to SEWA-Rural for managing one PHC and three CHCs. The NGO provides rural health, medical services and manages the public health institutions in the same pattern as the Government Emergency Ambulance Services Government of Tamil Nadu has initiated the scheme in Theni district in order to reduce the maternal mortality rate in its rural area Urban Slum Health Care Project Andhra Pradesh Ministry of Health and Family Welfare contracts NGOs to manage health centers in the slums of Adilabad

24. Collaboration Management of Primary Health Centers in Gumballi and Sugganahalli was contracted out by the Government of Karnataka to Karuna Trust in 1996 to serve the tribal community in the hilly areas. 90% of the cost is borne by the Govt . and 10% by the trust Between Govt. of Arunachal Pradesh, VHAI & Karuna Trust in managing number of PHCs

25. Partnership between the Government and a private sector and/or the non-profit sector and/or a private service provider and/or multilateral agencies National Malaria Control Programme National Blindness Control Programme National AIDS Control Programme RNTCP Involved private practitioners and NGOs for rapid expansion of the DOTS strategy Involved both the voluntary and private sector for outreaching the target population through Targeted Interventions District Blindness Control Societies have been formulated, which are represented by the Government, non-government and private sectors. The NGOs have been involved for providing a package of services Involved the NGOs, private practitioners at the district level for the distribution of medicated mosquito nets

26. Govt. of Karnataka, the Narayana Hrudalaya hospital in Bangalore and ISRO initiated an experimental tele-medicine Rajiv Gandhi Super-specialty Hospital Community health insurance scheme Karnataka Integrated Tele-medicine and Tele-health Project Yeshasvini Health Insurance Scheme Rogi Kalyan Samiti Public Private Mix DOTS Chiranjeevi experiment Joint venture of the Government of Karnataka and the Apollo hospitals Group, with financial support from OPEC Karuna Trust in collaboration with the National Health Insurance Company and Government of Karnataka Formed in Jai Prakash Governement Hospital to manage & maintain it with public cooperation A public/private DOTS model was established in Hyderabad at Mahavir Trust Hospital, which is a private non-profit hospital. This partnership also involves private service providers (doctors and nursing homes)

27. CASE STUDIES Chiranjeevi Yojana Scheme Rashtriya Swasthya Bima Yojana The Rajiv Aarogyasri Programme National AIDS Control Program Contracting –Out PHC – Orissa PPP Initiatives In Bihar Outsourcing Of Hospital Maintenance Operationalization And Management State and District Data Centre Radiology Services Pathology Services Mobile Medical Units

28. Best PPP Should be built up on the following tenets PPP as a part of social responsibility of the public sector Transparency Impartiality between public & private sectors Value for money Integration of healthcare services Financially workable

29. REFERENCES

30. REFERENCES

31. REFERENCES

32. THANK YOU P P