PPP Models - Prepared for Kanpur Workshop
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Transcript of PPP Models - Prepared for Kanpur Workshop
Public Private Partnership in Health
Dr. Purna Chandra DashDate: 05-06-2007
India has shown progress in all the basic health indicators…
Morbidity
Expectancy at birth in yrs
Deaths per ‘000 births
Still India has a significant distance to traverse in achieving global standards of healthcare
DevelopingCountries
Avg
DevelopedCountries
Avg
65 78
DevelopingCountries
Avg
DevelopedCountries
Avg
56
6
DevelopingCountries
Avg
DevelopedCountries
Avg
256119
64
37
India2000
India1951
70
146
India2000
India1951
274339
India2000
India1951
DALYs per ‘000 population
Infant mortality
Life expectancy
Source: ICRA Indian Healthcare Industry 2003, Report by CII-Mckinsey: Healthcare in India
Even though in terms of % GDP India compares well, Indian spends on a per capita basis need improvement…
13
3.5
8.6
8.3
8.8
3.7
5.3
4.9
United States
Sinagapore
Argentina
Brazil
South Africa
Thailand
China
India
4499
814
658
267
255
71
45
23
Per capita healthcare has to increase many fold to reach the level of even other developing countries
Healthcare spend in USD per capita, 2000Healthcare spend as % of GDP 2000
Source: ICRA Indian Healthcare Industry 2003
Public Spending on Health is only 1% of GDP
Expenditure on Health
Private-Out of Pocket, 85%
Government, 15%
Distribution of Public Expenditures in India on Curative Care by Income
Quintile 1995-96
…..and that too on the rich!
There is a lack of community ownership of public health programs leading to Lack of efficiency, accountability and effectiveness
...and the rural areas are not left far behind
Most rural Indians go to private providers for
their healthcare needs
The trend is seen in almost all States
Better utilisation of public services for immunisation…
….but definitely not for hospitalisation and outpatient care
Therefore, the need for Public and Private to work together
Private Sector
• Good Market Presence•Viable Enterprise•Efficiency higher •Flexibility to respond
Public Sector
• Economies of Scale•Technical and Professional Expertise•Presence in Rural Areas•More Equitable
PPP leverages the benefits of both
PPP needed in UP also
….with poor ranking for ANC care
…and institutional deliveries
The Benefits of PPPCreating competition
Economies of Scale
Utilising Existing Capacity
Create Synergy
Targeting the Poor
Flexibility in Action
Resource Mobilisation
Technical Upgradation
Better Services Better Health
Public Private Partnerships in Health
Definition:Public-Private Partnerships (PPP) are collaborative efforts, between private and public sectors, with clearly identified partnership structures, shared objectives, and specified performance indicators for delivery of a set of health services
Objectives of Public Private Partnerships in Health
Improving access to essential RCH services
Improving the quality of RCH services available
Exchange of expertise
Mobilize additional resources for RCH activities
Improve efficiency
Better Management of Health services
Increasing scope and scale of services
Increasing community ownership RCH program.
Ensuring optimal utilization of govt. investment and infrastructure
Models of Public Private Partnerships in Health1. Social Franchising 2. Branded Clinics 3. Contracting 4. Social Marketing5. Build, Operate and
Transfer 6. Joint Venture
Companies 7. Voucher System 8. Donations from
individuals
9. Partnerships with Social Clubs and Groups (e.g. Rotary Club)
10. Involvement of Corporate sector
11. Partnership with Professional Associations
12. Capacity Building of Private Providers
13. Autonomous Institutions
14. Mobile Health Vans 15. Health 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
Model for Social Franchising
Types of Social Franchising
Partial Franchising Full Franchising
Challenges•Controlling Quality of Services
•Positioning on Price/ Quality – Trade off between Social goals and Provider Satisfaction
•Understanding motivation of Clients for Accessing Services
Social Franchising - Criteria for Initiation
Revitalising present Government structure is slow Resources required to expand public health
infrastructure is enormous. High demand but poor supply from government
health institutions Availability of vast network of private hospitals in
places needed When 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 Clinics
Chain of Clinics – Same Organisation
Cater to better-off clients – Market Segmentation
More Income More
Sustainable
Branded Clinics – Criteria for initiation Need to expand services rapidly Need to provide high visibility to
services available Offer a package of services selected
for the purpose Provide high quality services at
comparatively affordable prices
Contracting – Contracting-in and Contracting-out
Legally enforceable Contract
-Defined Set of healthcare services
-Quantity of services
-Quality of services
-Duration of Service Provisioning
Public Private
Criteria for initiating Contracting-out Difficult 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-in Improve efficiency levels of services
provided Make management of services more
effective Conserve scarce resources by cutting
costs Try out innovative approaches to
improve efficiency and effectiveness
Voucher System/ Demand Side Financing
A voucher is a document that can be exchanged for defined goods or services as a token of payment (tied-cash).
Voucher System – Criteria for Initiation
Improve access to services and provide choice Where costs act as a major barrier to services Existing public healthcare service delivery points do not
have provision for all types of services Inadequate knowledge about the value of services (e.g.
importance of antenatal care) Need to generate demand for healthcare services Possible to do regular monitoring for ensuring quality
standards Training of providers and network with the people to
ensure proper use of vouchers is possible
Donations From Individuals
Donations from rich philanthropists institutions
Need for simple and transparent mechanisms to encourage donations
Partnerships with Social Clubs and Groups
Social Clubs like• Rotary• Lions’• JCs
They have been proven to be useful in: Popularising reformed healthcare service delivery
outlets In communication campaigns Management of camps on a large scale Providing additional resources and technical
expertise Advocacy efforts
Involving the Corporate Sector
Organised Corporate Sector through• CII• FICCI
E.g.s Indo-Gulf Fertilisers’ Health Initiative and recent Health Conclave by CII
Partnerships with Professional Associations
Expert Pool
• FOGSI – Janani Suraksha Yojana
•IMA – Aao Gaon Chalein
•TNAI
•Pharmacists Associations
Protocols/ Quality Assurance/
Accreditation
Mobile Health Vans
Already implemented in inaccessible areas
Comprehensive Health Services Fixed Journey Plans Public Sector contribution Medical
Officers and Medicines Private Sector for Purchase and
Management of Vans These vans are useful in:
Provide access to services people living in inaccessible terrain
Make services available at central location to reduce travel time and costs of clients
Initiating Public Private Partnerships in Health
Prioritizing needs
Evaluating and analyzing the ground realities
Selecting the appropriate model
Piloting the model
Evaluating the pilot
Scaling up
Initiating Public Private Partnerships in Health - Vital Components: STRAIGHT
Identifying the SCOPE of partnership Identifying the appropriate TARGET POPULATION Selecting the RIGHT PARTNERS and the RIGHT
MODEL of PPP Ensuring ACCOUNTABILITY of private providers Ensure active INVOLVEMENT of the government GENERATE SUPPORT of all the key stakeholders
through IEC, advocacy and rapport building HIGHLIGHT ACHIEVEMENTS of the partnerships Build TRUST of all the partners and clients
Partnering the Public and the Private for a Healthier India!