How to Enhance Private Sector Participation in Achieving Public Health Goals: What We Can Learn from India

Suneeta Sharma, PhD, MHAAugust 26, 2010

Outline• Context: challenges and

opportunities

• Building public private partnerships: a policy approach

• Three examples

• Voucher system

• Mobile health clinic

• ASHA Plus scheme

• Equitable policy reform

Photo by Suneeta Sharma

Challenges• High maternal mortality, infant

mortality, and total fertility rates

• Use of FP methods and institutional facilities for deliveries is the lowest among poor

• Out-of-pocket expenditure on reproductive and child health (RCH) services in both government and private facilities is high

• Enormous access barriers to the poor

• Health expenditure – major cause of poverty

• Staff vacancies, lack of trained staff

• Difficult geographic terrain, remote populations

Photo by Michael Foley

Opportunities• Enabling environment under

National Rural Health Mission

• Emphasis on reducing inequities and improving access to MH and FP services

• Capitalize on private sector market presence

• Private sector is preferred provider of choice in both urban and rural areas

• Increased demand for high-quality healthcare services

Photos by Suneeta Sharma (top) and Meena Kadri (bottom)

Both Public and Private Sectors Have Important Roles to Play

Public-private partnerships provide opportunities for:

Creating Competition Achieving

Economies of Scale

Using Existing Capacity

Expanding ServiceDelivery Network

Targeting The Poor

Capitalizing on Strengths

Mobilizing Resources

Building Public-Private Partnerships: A Policy Framework

Balance public-private sector roles

Create an enabling environment

Share information, foster dialogue, and develop a common understanding of

health system goals

Understand the market and

policy environment

Build public-private partnerships

Using a Systematic Process of Building PPP Models

Develop strategicoptions

Develop strategicoptions

Ensure sustainablefinancing

Ensure sustainablefinancing

Establish links withpolicy framework

Establish links withpolicy framework

Develop costed scale up strategy

Develop costed scale up strategy

Evaluate impactEvaluate impact

GovernmentLeadership and

Ownership

Design and testappropriate

models

Design and testappropriate

models

Prioritize needsPrioritize needs

Determine shared goals

Determine shared goals

Engage right partners

Engage right partners

Effective Public-Private Models to Achieve Health Equity Goals

• Voucher system

• Social marketing

• Social franchising

• Mobile health vans

• ASHA Plus program

• Contracting out

Photo by Suneeta Sharma