PUBLIC PRIVATE PARTNERSHIP BY STUDENTS OF M.SC

Private sector is the most important source of healthcare services in India.
The private and non-profit sectors are very much accountable to overall health systems & services of the country.
75% of health-related expenses are out of pocket and occur at the point of service delivery.
Today the private sector provides 58% of hospitals, 29% of the beds in hospitals & 81% of the doctors (The report of task force on medical education, MoHFW).
The private providers in treatment of illness are 78% in the rural areas & 81% in the urban areas.

1. PUBLIC PRIVATE PUBLIC PRIVATE
PARTNERSHIPPARTNERSHIP
PRESENTED TOPRESENTED TO
Dr.(Mrs.)Sushma Saini MadamDr.(Mrs.)Sushma Saini Madam
Lecturer,N.I.N.E.Lecturer,N.I.N.E.
PRESENTED BYPRESENTED BY
Ms.MonikaMs.Monika
MSc. (N)1MSc. (N)1
stst
year year

2. IntroductionIntroduction
•Private sector is the most important source of
healthcare services in India.
•The private and non-profit sectors are very much
accountable to overall health systems & services of
the country.
•75% of health-related expenses are out of pocket
and occur at the point of service delivery.
•Today the private sector provides 58% of hospitals,
29% of the beds in hospitals & 81% of the doctors
(The report of task force on medical education,
MoHFW).
•The private providers in treatment of illness are
78% in the rural areas & 81% in the urban areas.

3. Introduction Cont..Introduction Cont..
•Reason to encourage private participation does not
appear to be a lack of funds but a lack of
managerial and technical ability.
•In a recent development, the Planning Commission
is actively looking at the prospects of
mainstreaming PPPs between the Govt., private
sector and the non-profit sector in healthcare
under the Eleventh Plan.
•In today’s world, the private sector is playing an
increasingly important role in shaping global
health agendas.
•PPPs to address emerging public health issues are
fast gaining acceptance as both the public and the
private sector recognise their individual inabilities

4. Introduction Cont..Introduction Cont..
•The use of public health care is lowest in U.P.
•77% of the OPD cases in rural areas & 80% in
urban areas are being serviced by the private
sector (National sample survey organisation-
NSSO report).
•Following documents have emphasized the need
of PPP:
-1Oth & 11
th
five year plan
-National health programs like RNTCP, NLEP, RCH,
NACP
-NRHM
-NHP-2002 & NPP

5. What is partnership?What is partnership?
•It is a joint ownership of a program/
proposal by two or more parties to achieve a
common goal.
•It is a higher level of collaboration

6. Meaning of PPPMeaning of PPP
•‘Public’ genarally refers to Govt. or
organizations functioning under state
budgets, ‘Private’ refers to the
profit/nonprofit/voluntary sector and
‘Partnership’ would mean a collaborative
effort & reciprocal relationship between two
parties with clear terms & conditions to
achieve mutually understood & agreed upon
objectives following certain mechanisms.

7. DefinitionDefinition
•Public-private partnership (PPP)
describes a government service or
private business venture which is
funded and operated through a
partnership of government and one or
more private sector companies.
•Also referred as PPP or P3.

8. Public Private Partnership in Public Private Partnership in
Health CareHealth Care
•PPP is Seeking collaboration with
private sector in the situations where
the public health system is not
immediately able to provide
guarantee.

9. AimAim
•It aims to harness the large pool of
private sector health care resources
and draw them into the process of
nation building.
•It is an initiative to improve efficiency,
effectiveness and equity in the
Provision of healthcare services.

10. ObjectivesObjectives
•Universal coverage & equity for private
health care.
•Improving quality, accessibility,
availability, acceptability & efficiency
of health services.
•Exchange of skills & expertise
between the public & private sector.
•Mobilisation of additional resources.

11. Objectives Cont..Objectives Cont..
•Improve the efficiency in allocation of
resources & additional resource
generation.
•Strengthening the existing health
system by improving the management
of health within the Govt.
infrastructure.
•Widening the range of services &
number of services providers.

12. Factors behind the Factors behind the
emergence of PPPemergence of PPP
•Limited reach of the public health
machinery
•The rapid pace of technology evolution
and lack of public funds have also
resulted in a need for the private
sector to commit funding towards
development of newer drugs and
diagnostics to combat these global
diseases.

13. PPP ModelsPPP Models
•Contracting:contracting out & contracting-in
•Franchising:
-Partial Franchising
-Full Franchising
-Branded clinics
•Social marketing
•Joint ventures
•Voucher scheme
•Hospital autonomy
•Partnership with corporate sector/industrial
houses
•Involving professional associations

14. PPP Models Contd..PPP Models Contd..
•Build, operate & transfer
•Donations & other contributions
•Involvement of social groups
•Partnership with corporative societies
•Partnership for capacity building
• Partnership with non-profit community-
based organizations.
•Running mobile health units
•Community- based health insurance

15. PPP at Global Level in HealthPPP at Global Level in Health
–Global Alliance for Vaccine and Immunization
–Global Polio Eradication Initiative
–European Partnership Project on Tobacco
Dependence
–UNAIDS/Industry Drug Access Initiative
–Stop TB Initiative
–Roll Back Malaria

16. Issues in PPP in Health CareIssues in PPP in Health Care
•Capacity of Private partner
•Advocacy
•Accreditation
•Regulation by the Government

17. Existing scenario of PPPExisting scenario of PPP
•PPP has emerged as one of the options
to influence the growth of private
sector with public goals in mind
•During the last few years, the Centre
as well as the state Govt. have
initiated a wide variety of PPP
arrangements to meet the growing
health care needs of population under
5 mechanisms in the health sector:

18. Existing scenario of PPP Existing scenario of PPP
Cont..Cont..
1.Contracting in-government hires individual on a
temporary basis to provide services.
2.Contracting out-government pays outside
individual to manage a specific function.
3.Subsidies-government gives funds to private
groups to provide specific services.
4.Leasing or rental-government offers the use of its
facilities to a private organisation.
5.Privatisation-government gives or sells a public
health facility to a private group.

19. Factors for effective PPPFactors for effective PPP
•Transparency :-PPPs should develop transparent
policy and procedural frameworks, towards
ensuring public interest.
•To ensure the smooth running of PPPs, all partners
should be accountable for the delivery of desired
results in an efficient manner.
•There should be established systems for
communication with reference to decision-making,
funding, and resource allocation with a provision
for documenting desired outcomes.
• High perceived pay-off to both parties
•Equal power with both parties
•Mutual Trust

20. Factors for effective PPP Factors for effective PPP
Cont..Cont..
•Partnership mechanism do not work
without quality assurance & an
enabling environment
•Govt. must ensure that providers are
accredited
•Essential standards are to be set and
followed
•Guidelines & protocols for diagnosis &
treatment are developed and used.

21. Factors for effective PPP Factors for effective PPP
Cont..Cont..
•Providers are kept updated through
continuing medical education
•System must monitor & correct such
important aspects of quality as
infection prevention, client
satisfaction & access to services.

22. Partnership between the Government Partnership between the Government
& the For-profit sector& the For-profit sector
•Contracting in Sawai Man Singh Hospital(SMS), Jaipur
• The Uttranchal Mobile Hospital & Research
Centre(UMHRC)
•Contracting out of IEC services to the private sector by
the state malaria control society in Gujarat
•Contracting in of services like cleaning , maintenance of
buildings, security laundry diet etc. to the private sector
has been tried in states like HP, Karnataka Orissa etc.
•The Govt. of Andhra Pradesh has initiated the Arogya
Raksha Scheme in collaboration with the New India
Assurance Company & with private clinics.

23. Partnership between the Government Partnership between the Government
& the Non-profit sector& the Non-profit sector
•Involvement of the NGOs in the Family welfare
program: The Mother NGO and Service NGO
schemes are being implemented by NGOs for
population stabilisation
•The Municipal Corporation of Delhi & the Arpana
Trust have developed a partnership to provide
comprehensive health services to the urban poor
in Delhi
•Management of PHCs in Gumballi &
Sugganahalli was contracted out by the Govt. of
Karnataka to Karuna trust

24. Partnership between the Government Partnership between the Government
& the Non-profit sector Cont..& the Non-profit sector Cont..
•Govt. of Tamil Nadu has initiated an
emergency ambulance service scheme in
10 districts of Tamil Nadu

25. Partnership between the Government Partnership between the Government
& a Private service provider& a Private service provider
•Partnership between the Department of Family
welfare & Private service providers:
The DFW has appointed 1 additional ANM on
contractual basis in the remote sub-centres to
ensure better emergency obstetric care under the
RCH programme.
Public health/Staff nurses have been appointed
on a contractual basis at PHCs/CHCs

26. Partnership between the Government Partnership between the Government
& a Private service provider Cont..& a Private service provider Cont..
At FRU states have been permitted to
engage the anesthetist from private sectors
on a payment of Rs.1000 per case at the
sub-district & CHC levels
In Haryana Urban RCH model, a private
health practitioner(PHP) has been identified
to provide comprehensive primary health
care service to a group of 1000-1500
targeted beneficiaries.

27. Partnership between Govt. & Private Partnership between Govt. & Private
sector & /or Nonprofit sector &/or sector & /or Nonprofit sector &/or
Private service provider &/or Private service provider &/or
Multilateral agenciesMultilateral agencies
•National malaria control program has involved
NGO’s & private practitioner at district level.
•Under the NBCP, the NGOs have been involved
for providing package of services.
•NACP has involved both voluntary & private
sector for outreaching target population
•RNTCP has involved the private practitioners &
NGOs for rapid expansion of DOTS strategy

28. Partnership between Govt. & Private Partnership between Govt. & Private
sector & /or Nonprofit sector &/or sector & /or Nonprofit sector &/or
Private service provider &/or Private service provider &/or
Multilateral agencies ContMultilateral agencies Cont....
•A Rogi Kalyan Samiti was formed in
Bhopal’s Jai Prakash Govt. Hospital to
manage & maintain it with public
cooperation
•Rajiv Gandhi super-speciality hospital in
Raichur Karnataka is a joint venture of the
Govt. of Karnataka & the Apollo Hospital
group.

29. •Michael JK Harper. A study on Public and
private partnerships advance contraceptive
research and development. Contraception
2008;78:S36-S41.
- The status of PPP’s for the resolution of global
health problems is briefly reviewed, and the
application of the concept to the field of maternal
health and especially contraceptive research and
development is discussed. It is concluded that
greater efforts must be made to reenergize the
field and encourage all funders to reengage in
this area of need.

30. Challenges faced in Challenges faced in
OperationalizatioIn of PPPOperationalizatioIn of PPP
•Lack of resources remains a big concern
•Great disparity in services & remuneration
•Lack of effective governance mechanism for
accountability
•Non transparent mechanism
•Lack of appropriate monitoring & governance
system
•Lack of institutionalised management structures
to handle the task
• Resource mobilization

31. •Public-private
partnership (PPP)-
RCH II

32. Types of PPP in RCH IITypes of PPP in RCH II
•3 key types of PPP will be strengthened in
RCH II
1.The current national social marketing program
will be expanded & diversified & new social
franchising initiatives will be developed.
2.Current contracting-out approaches (of both
health & non –health professional) will be
developed and expanded.
3. Current contracting-out approaches (for clinical
services and non-clinical services, BCC &
management) will be further developed &
expanded.

33. New approaches for PPPs in New approaches for PPPs in
RCH IIRCH II
•Improve the quality & equity of access
to private sector RCH services.
•Ensure affordable & equitable access
to quality pharmaceutical &
diagnostic testing services.

34. •Public-private partnership
(PPP)-
NVBDCP

35. Schemes under NVBDCP & Schemes under NVBDCP &
PPPPPP
1.Early diagnosis & prompt treatment:
-provision of outreach services; drug
distribution centre, fever treatment
depot
-provision of microscopy & treatment
services
-hospital based treatment & care of
severe & complicated malaria cases

36. Schemes under NVBDCP & Schemes under NVBDCP &
PPP Cont..PPP Cont..
2. Promotion of insecticides treated
bednets & distribution of bednets in
selected areas
3. Indoor residual spraying(IRS)

37. •Public-private partnership
(PPP)-
•NLEP

38. Involvement of NGO’sInvolvement of NGO’s
•NGO’s are involved in leprosy elimination
activities for many decades and their
contribution has been a positive impact in
reducing the prevalence of leprosy.
•There are 290 NGO’s working in the field of
leprosy throughout the country and 54
NGO’s are getting grant-in-aid from Govt. of
India for survey education treatment in
leprosy.

39. Involvement of NGO’sInvolvement of NGO’s
•Beside routine activities, some are also
providing facilities for hospitalization &
disability and ulcer care.
•Few NGO’s are involved in conducting
reconstruction surgeries and Govt. is giving
@ Rs.2500 per surgery & supply of a pair of
microcellular rubber(MCR) Chappal @
Rs.160 & for MCR insole @ Rs.40 per sheet.

40. •Public-private partnership
(PPP)-
RNTCP

41. Public Private mix in RNTCPPublic Private mix in RNTCP
•PPM is a strategy to diagnose and
treat TB patients reporting to all
sectors of health care under RNTCP.
•A total of 2200 NGO’s have formal
agreements with the RNTCP.
•Some examples are World vision
mission, hospitals like Christian
medical association of India, RK
mission.

42. Schemes for NGO’s under Schemes for NGO’s under
RNTCPRNTCP
•Sheme-1
Health education & community outreach:
Train volunteers, disseminate information,
counsel families, & patients, & retrieve
treatment who have stopped treatment.
•Scheme-2
Provision of directly observed
treatment:Identify, train & supervise
volunteers for providing directly observed
treatment.

43. Schemes for NGO’s under Schemes for NGO’s under
RNTCP Cont..RNTCP Cont..
•Scheme-3
In hospital care for tuberculosis
disease:Provide smear microscopy for
outpatients & hospital care for those who
require it & ensure adherence to diagnostic
& treatment policies, & follow-up & record
keeping.
•Scheme-4
Microscopy & treatment centre:NGO operates
a designated microscopy & treatment centre
as per RNTCP policy.

44. Schemes for NGO’s under Schemes for NGO’s under
RNTCP Cont..RNTCP Cont..
•Scheme-5
TB Unit model: Provides all RNTCP
services for diagnosis, treatment,
direct observation, defaulter retrieval,
recording & registration, &
supervision for a TB Unit(5 lakh
population).

45. PPM PROGRAMME IMPACT IN ZONE 4 (OCT. 01 - MAR. 04)
703
813
883
1030
1063
1223
1167
10601060
1157
0% 0%
6%
12%
17%
21%
17% 17%
13%
17%
0
200
400
600
800
1000
1200
1400
Q4-01 Q1-02 Q2-02 Q3-02 Q4-02 Q1-03 Q2-03 Q3-03 Q4-03 Q1-04
T
B

P
A
T
I
E
N
T
S

R
E
G
I
S
T
E
R
E
D
PPM RNTCP WITHOUT PPM PPM AS % OF TOTAL REGISTRATIONS
PPM start on April 02
Total coverage of Zone
4 completed (36 HP)

46. THANK YOU