Public Private Partnership in Health Service Delivery: Experiences & Lessons A.Venkat Raman Faculty...
-
Upload
lucy-murphy -
Category
Documents
-
view
215 -
download
1
Transcript of Public Private Partnership in Health Service Delivery: Experiences & Lessons A.Venkat Raman Faculty...
![Page 1: Public Private Partnership in Health Service Delivery: Experiences & Lessons A.Venkat Raman Faculty of Management Studies University of Delhi.](https://reader030.fdocuments.in/reader030/viewer/2022032523/56649d825503460f94a678cc/html5/thumbnails/1.jpg)
Public Private Partnership in Health Service Delivery: Experiences & Lessons
A.Venkat RamanFaculty of Management Studies
University of Delhi
![Page 2: Public Private Partnership in Health Service Delivery: Experiences & Lessons A.Venkat Raman Faculty of Management Studies University of Delhi.](https://reader030.fdocuments.in/reader030/viewer/2022032523/56649d825503460f94a678cc/html5/thumbnails/2.jpg)
WHY PARTNER WITH THE PRIVATE SECTOR?
2A.VENKAT RAMAN FMS-DU
![Page 3: Public Private Partnership in Health Service Delivery: Experiences & Lessons A.Venkat Raman Faculty of Management Studies University of Delhi.](https://reader030.fdocuments.in/reader030/viewer/2022032523/56649d825503460f94a678cc/html5/thumbnails/3.jpg)
Omnipresence of the Private Sector
93% of all hospitals64% of all beds80% doctors80% of OP and 57% of IP ….are in the Pvt. Sector• (World Bank 2001)
Estimated at Rs. 1,56,000 Cr. in 2012 +Rs. 39,000Cr.. for health insurance (NCMH 2005)
A.VENKAT RAMAN FMS-DU 3
![Page 4: Public Private Partnership in Health Service Delivery: Experiences & Lessons A.Venkat Raman Faculty of Management Studies University of Delhi.](https://reader030.fdocuments.in/reader030/viewer/2022032523/56649d825503460f94a678cc/html5/thumbnails/4.jpg)
Share of Pvt. Sector- Non- Hospitalized care (60th NSS-2004)
A.VENKAT RAMAN FMS-DU 4
![Page 5: Public Private Partnership in Health Service Delivery: Experiences & Lessons A.Venkat Raman Faculty of Management Studies University of Delhi.](https://reader030.fdocuments.in/reader030/viewer/2022032523/56649d825503460f94a678cc/html5/thumbnails/5.jpg)
Share of Pvt. Sector- Hospitalized care (60(60thth NSS-2004) NSS-2004)
A.VENKAT RAMAN FMS-DU 5
![Page 6: Public Private Partnership in Health Service Delivery: Experiences & Lessons A.Venkat Raman Faculty of Management Studies University of Delhi.](https://reader030.fdocuments.in/reader030/viewer/2022032523/56649d825503460f94a678cc/html5/thumbnails/6.jpg)
Share of Private Sector in Rural Areas (NCMH,2005)
A.VENKAT RAMAN FMS-DU 6
![Page 7: Public Private Partnership in Health Service Delivery: Experiences & Lessons A.Venkat Raman Faculty of Management Studies University of Delhi.](https://reader030.fdocuments.in/reader030/viewer/2022032523/56649d825503460f94a678cc/html5/thumbnails/7.jpg)
Relative expenditure in the private sector - in Rural Areas (NCMH,2005)
A.VENKAT RAMAN FMS-DU 7
![Page 8: Public Private Partnership in Health Service Delivery: Experiences & Lessons A.Venkat Raman Faculty of Management Studies University of Delhi.](https://reader030.fdocuments.in/reader030/viewer/2022032523/56649d825503460f94a678cc/html5/thumbnails/8.jpg)
Who Pays for the Services?Percentage of Private Expenditure
(NHA-2004-05)
A.VENKAT RAMAN FMS-DU 8
![Page 9: Public Private Partnership in Health Service Delivery: Experiences & Lessons A.Venkat Raman Faculty of Management Studies University of Delhi.](https://reader030.fdocuments.in/reader030/viewer/2022032523/56649d825503460f94a678cc/html5/thumbnails/9.jpg)
Implications
>80% of health expenditure is out-of-pocket. (NSS 2005; NHA,2004-05)
Debilitating Effects on the poor: Liquidation of assets,
indebtedness. 40% of hospitalized & 2% in the country every year end
up BPL (World Bank, 2001).
Compounded by poor regulation of private sector
A.VENKAT RAMAN FMS-DU 9
![Page 10: Public Private Partnership in Health Service Delivery: Experiences & Lessons A.Venkat Raman Faculty of Management Studies University of Delhi.](https://reader030.fdocuments.in/reader030/viewer/2022032523/56649d825503460f94a678cc/html5/thumbnails/10.jpg)
Private sector is needed because....
India needs an additional750,000 beds520,000 doctors overall investment of Rs 1,50,000Cr.
80% likely to come from the private sector (NMCH,2005)
A.VENKAT RAMAN FMS-DU 10
![Page 11: Public Private Partnership in Health Service Delivery: Experiences & Lessons A.Venkat Raman Faculty of Management Studies University of Delhi.](https://reader030.fdocuments.in/reader030/viewer/2022032523/56649d825503460f94a678cc/html5/thumbnails/11.jpg)
PPP MODELS & TYPES
A.VENKAT RAMAN FMS-DU 11
![Page 12: Public Private Partnership in Health Service Delivery: Experiences & Lessons A.Venkat Raman Faculty of Management Studies University of Delhi.](https://reader030.fdocuments.in/reader030/viewer/2022032523/56649d825503460f94a678cc/html5/thumbnails/12.jpg)
Not all interactions between the Government and Private sector are PPPs
A.VENKAT RAMAN FMS-DU 12
![Page 13: Public Private Partnership in Health Service Delivery: Experiences & Lessons A.Venkat Raman Faculty of Management Studies University of Delhi.](https://reader030.fdocuments.in/reader030/viewer/2022032523/56649d825503460f94a678cc/html5/thumbnails/13.jpg)
Financing vs Delivery:Public vs Private modes
(Bloom, 2001)
Public Provision Private Provision
Public Financing
Public Hospitals?????
VoucherContracting??????
Private Financing
User Fee Hospital Autonomy
????????
Private Hospitals??????
A.VENKAT RAMAN FMS-DU 13
![Page 14: Public Private Partnership in Health Service Delivery: Experiences & Lessons A.Venkat Raman Faculty of Management Studies University of Delhi.](https://reader030.fdocuments.in/reader030/viewer/2022032523/56649d825503460f94a678cc/html5/thumbnails/14.jpg)
Common PPP Models
Contracting (‘in’ and ‘out’)Joint VenturesBuild/ Rehabilitate, Operate, Transfer Health Financing (Vouchers, CBHI, Illness fund) Mobile Health UnitsFranchisingSocial MarketingTechnology demos (e.g. Telemedicine)Public-Private Mix
A.VENKAT RAMAN FMS-DU 14
![Page 15: Public Private Partnership in Health Service Delivery: Experiences & Lessons A.Venkat Raman Faculty of Management Studies University of Delhi.](https://reader030.fdocuments.in/reader030/viewer/2022032523/56649d825503460f94a678cc/html5/thumbnails/15.jpg)
Core Principles of Partnership
True partnerships entail◦Relative Equality between partners◦Mutual Commitment to Public Health
objectives◦Benefits for the Stakeholders◦Autonomy for each partner◦Shared decision-making and accountability◦Equitable Returns / Outcomes
A.VENKAT RAMAN FMS-DU 15
![Page 16: Public Private Partnership in Health Service Delivery: Experiences & Lessons A.Venkat Raman Faculty of Management Studies University of Delhi.](https://reader030.fdocuments.in/reader030/viewer/2022032523/56649d825503460f94a678cc/html5/thumbnails/16.jpg)
PPP Models in Practice:
A.VENKAT RAMAN FMS-DU 16
![Page 17: Public Private Partnership in Health Service Delivery: Experiences & Lessons A.Venkat Raman Faculty of Management Studies University of Delhi.](https://reader030.fdocuments.in/reader030/viewer/2022032523/56649d825503460f94a678cc/html5/thumbnails/17.jpg)
A.VENKAT RAMAN FMS-DU 17
Uttaranchal Mobile Health and Research Clinic
Clinical & Radio diagnostics through health camps, lab tests
Free to all BPL cardholders.
![Page 18: Public Private Partnership in Health Service Delivery: Experiences & Lessons A.Venkat Raman Faculty of Management Studies University of Delhi.](https://reader030.fdocuments.in/reader030/viewer/2022032523/56649d825503460f94a678cc/html5/thumbnails/18.jpg)
A.VENKAT RAMAN FMS-DU 18
Mobile (Boat) Health Service in Sunderbans, WB
Diagnostics; Consultation- health clinics; Drugs; Health promotion
All services are free; All beneficiaries are assumed to be BPL
![Page 19: Public Private Partnership in Health Service Delivery: Experiences & Lessons A.Venkat Raman Faculty of Management Studies University of Delhi.](https://reader030.fdocuments.in/reader030/viewer/2022032523/56649d825503460f94a678cc/html5/thumbnails/19.jpg)
SMS Hospital Jaipur Rajasthan
Radiological (CT/MRI Scan) Diagnostics
Free for all BPL Patients; Subsidized rate for others
A.VENKAT RAMAN FMS-DU 19
![Page 20: Public Private Partnership in Health Service Delivery: Experiences & Lessons A.Venkat Raman Faculty of Management Studies University of Delhi.](https://reader030.fdocuments.in/reader030/viewer/2022032523/56649d825503460f94a678cc/html5/thumbnails/20.jpg)
A.VENKAT RAMAN FMS-DU 20
Karuna Trust, Karnataka
Management of PHCs and sub-centers; 24-hrs clinical services
Free services- diagnosis, consultation, treatment and drugs.
![Page 21: Public Private Partnership in Health Service Delivery: Experiences & Lessons A.Venkat Raman Faculty of Management Studies University of Delhi.](https://reader030.fdocuments.in/reader030/viewer/2022032523/56649d825503460f94a678cc/html5/thumbnails/21.jpg)
Shamlaji Hospital, Sabarkantha, Gujarat
Management of a government built CHC; 24-hrs services
Except select surgeries all services are free for poor patients
A.VENKAT RAMAN FMS-DU 21
![Page 22: Public Private Partnership in Health Service Delivery: Experiences & Lessons A.Venkat Raman Faculty of Management Studies University of Delhi.](https://reader030.fdocuments.in/reader030/viewer/2022032523/56649d825503460f94a678cc/html5/thumbnails/22.jpg)
A.VENKAT RAMAN FMS-DU 22
Arpana Swasthya Kendra, Delhi(CO)
Management of Maternity health center under RCH
Free Lab Tests, ANCs, select surgeries, community health services, sanitation, IEC
![Page 23: Public Private Partnership in Health Service Delivery: Experiences & Lessons A.Venkat Raman Faculty of Management Studies University of Delhi.](https://reader030.fdocuments.in/reader030/viewer/2022032523/56649d825503460f94a678cc/html5/thumbnails/23.jpg)
A.VENKAT RAMAN FMS-DU 23
Rajiv Gandhi Hospital, Raichur Karnataka
Super-specialty clinical and surgical services
40% beds are for BPL patients; Free OPD services to poor.
![Page 24: Public Private Partnership in Health Service Delivery: Experiences & Lessons A.Venkat Raman Faculty of Management Studies University of Delhi.](https://reader030.fdocuments.in/reader030/viewer/2022032523/56649d825503460f94a678cc/html5/thumbnails/24.jpg)
A.VENKAT RAMAN FMS-DU 24
Karnataka Integrated Tele-medicine & Tele-health, Chamrajnagar
Tele-diagnosis and consultation in cardiac care and specialist care
Free diagnosis, medicines and treatment for the BPL patients
![Page 25: Public Private Partnership in Health Service Delivery: Experiences & Lessons A.Venkat Raman Faculty of Management Studies University of Delhi.](https://reader030.fdocuments.in/reader030/viewer/2022032523/56649d825503460f94a678cc/html5/thumbnails/25.jpg)
Yeshasvini Health Insurance SchemeKarnataka
Hospitalization and care for more than 1600 surgeries
Only for the members of farmers’ co-operatives and their dependents
A.VENKAT RAMAN FMS-DU 25
![Page 26: Public Private Partnership in Health Service Delivery: Experiences & Lessons A.Venkat Raman Faculty of Management Studies University of Delhi.](https://reader030.fdocuments.in/reader030/viewer/2022032523/56649d825503460f94a678cc/html5/thumbnails/26.jpg)
Chiranjeevi Yojana, Gujarat
Institutional deliveries through private obstetricians and gynecologists
Scheme is primarily for women from poor families, with prior ANCs from a govt. hospital
A.VENKAT RAMAN FMS-DU 26
![Page 27: Public Private Partnership in Health Service Delivery: Experiences & Lessons A.Venkat Raman Faculty of Management Studies University of Delhi.](https://reader030.fdocuments.in/reader030/viewer/2022032523/56649d825503460f94a678cc/html5/thumbnails/27.jpg)
Voucher Scheme, Haridwar, Uttarakhand
ANC, PNC Institutional Deliveries
Primarily for BPL women
A.VENKAT RAMAN FMS-DU 27
![Page 28: Public Private Partnership in Health Service Delivery: Experiences & Lessons A.Venkat Raman Faculty of Management Studies University of Delhi.](https://reader030.fdocuments.in/reader030/viewer/2022032523/56649d825503460f94a678cc/html5/thumbnails/28.jpg)
A.VENKAT RAMAN FMS-DU 28
OTHER MODELS IN OPERATION
![Page 29: Public Private Partnership in Health Service Delivery: Experiences & Lessons A.Venkat Raman Faculty of Management Studies University of Delhi.](https://reader030.fdocuments.in/reader030/viewer/2022032523/56649d825503460f94a678cc/html5/thumbnails/29.jpg)
A.VENKAT RAMAN FMS-DU 29
Arogyasri Scheme, Andhra Pradesh
Hospitalization & Surgical Procedures (more than 800 procedures)
Free Hospitalization/ Medicines/Follow-up
![Page 30: Public Private Partnership in Health Service Delivery: Experiences & Lessons A.Venkat Raman Faculty of Management Studies University of Delhi.](https://reader030.fdocuments.in/reader030/viewer/2022032523/56649d825503460f94a678cc/html5/thumbnails/30.jpg)
Franchising / Social Marketing
A.VENKAT RAMAN FMS-DU 30
![Page 31: Public Private Partnership in Health Service Delivery: Experiences & Lessons A.Venkat Raman Faculty of Management Studies University of Delhi.](https://reader030.fdocuments.in/reader030/viewer/2022032523/56649d825503460f94a678cc/html5/thumbnails/31.jpg)
A.VENKAT RAMAN FMS-DU 31
EMRI/ HMRI Hyderabad/ Ahmedabad……..Call 108
Emergency, Accident/ Trauma servicesALS / BLS
![Page 32: Public Private Partnership in Health Service Delivery: Experiences & Lessons A.Venkat Raman Faculty of Management Studies University of Delhi.](https://reader030.fdocuments.in/reader030/viewer/2022032523/56649d825503460f94a678cc/html5/thumbnails/32.jpg)
Regional Diagnostic Centres- Hub/SpokeMedicityCo-location of Specialty servicesDistrict Hospital + Medical College (Hub)Franchised /Accredited Health UnitsRBF – Incentive Contracts
A.VENKAT RAMAN FMS-DU 32
EMERGING MODELS
![Page 33: Public Private Partnership in Health Service Delivery: Experiences & Lessons A.Venkat Raman Faculty of Management Studies University of Delhi.](https://reader030.fdocuments.in/reader030/viewer/2022032523/56649d825503460f94a678cc/html5/thumbnails/33.jpg)
Key Lessons & Challenges in PPP: Indian Experience
A.VENKAT RAMAN FMS-DU 33
![Page 34: Public Private Partnership in Health Service Delivery: Experiences & Lessons A.Venkat Raman Faculty of Management Studies University of Delhi.](https://reader030.fdocuments.in/reader030/viewer/2022032523/56649d825503460f94a678cc/html5/thumbnails/34.jpg)
Political and Administrative Commitment
Half hearted support for PPPTop officials are enthusiastic, but
success takes them away- leadership vacuum;
Lower level officials suspect PPP as ‘privatization’ or show disdain towards the private provider
A.VENKAT RAMAN FMS-DU 34
![Page 35: Public Private Partnership in Health Service Delivery: Experiences & Lessons A.Venkat Raman Faculty of Management Studies University of Delhi.](https://reader030.fdocuments.in/reader030/viewer/2022032523/56649d825503460f94a678cc/html5/thumbnails/35.jpg)
Institutional Capacity Need for technical / managerial skills for
designing, negotiating, implementing and monitoring PPP contracts
Develop institutional capacity at all levels, including oversight role.
A.VENKAT RAMAN FMS-DU 35
![Page 36: Public Private Partnership in Health Service Delivery: Experiences & Lessons A.Venkat Raman Faculty of Management Studies University of Delhi.](https://reader030.fdocuments.in/reader030/viewer/2022032523/56649d825503460f94a678cc/html5/thumbnails/36.jpg)
Policy and Institutional Framework
Lack of policy driven strategy towards PPP in health sector. Need for a PPP policy.
Lack of information on Private sector thus poor regulatory leverage.
No institutional structures to manage PPP contracts. Need for specialized PPP cell in Health Dept.
A.VENKAT RAMAN FMS-DU 36
![Page 37: Public Private Partnership in Health Service Delivery: Experiences & Lessons A.Venkat Raman Faculty of Management Studies University of Delhi.](https://reader030.fdocuments.in/reader030/viewer/2022032523/56649d825503460f94a678cc/html5/thumbnails/37.jpg)
Social Context of PPPAntipathy or suspicion towards the
private sector and govt’s failure to regulate -raise suspicion.
Unwillingness of ‘civil society’ organisations to explore PPP as an option.
‘Squeamishness’ about profit making in services meant for poor patients
A.VENKAT RAMAN FMS-DU 37
![Page 38: Public Private Partnership in Health Service Delivery: Experiences & Lessons A.Venkat Raman Faculty of Management Studies University of Delhi.](https://reader030.fdocuments.in/reader030/viewer/2022032523/56649d825503460f94a678cc/html5/thumbnails/38.jpg)
Diversity and Complexity of Private Sector
Private sector is diverse; Predominantly individuals (owner operated units) and from both recognized and unrecognized systems of medicine;
Diversity of tariffs, thus complicating information on cost vs tariff and tariff negotiations
A.VENKAT RAMAN FMS-DU
38
![Page 39: Public Private Partnership in Health Service Delivery: Experiences & Lessons A.Venkat Raman Faculty of Management Studies University of Delhi.](https://reader030.fdocuments.in/reader030/viewer/2022032523/56649d825503460f94a678cc/html5/thumbnails/39.jpg)
Process of Contracting : Partner selection
Primarily ‘input’ based contracting rather than outcome based.
(Only) competitively selected partners are less effective.
Priorities of : ◦Govt. Officials: Compulsion of L1 &
Completing procedural formalities. ◦Private Sector: Winning the bid by all means
A.VENKAT RAMAN FMS-DU39
![Page 40: Public Private Partnership in Health Service Delivery: Experiences & Lessons A.Venkat Raman Faculty of Management Studies University of Delhi.](https://reader030.fdocuments.in/reader030/viewer/2022032523/56649d825503460f94a678cc/html5/thumbnails/40.jpg)
Risk
Financial risk to the private partner- Non-timely release of funds; Fear of enquiry.
Risk of unsuccessful/ failed contract leading to lack of services – patinets suffer, resources wasted.
A.VENKAT RAMAN FMS-DU 40
![Page 41: Public Private Partnership in Health Service Delivery: Experiences & Lessons A.Venkat Raman Faculty of Management Studies University of Delhi.](https://reader030.fdocuments.in/reader030/viewer/2022032523/56649d825503460f94a678cc/html5/thumbnails/41.jpg)
Enabling conditions for successSuccessful partnerships are contextual.
Enabling conditions include ◦ leadership from both partners; ◦prior consultation; ◦relational / trust based contracting; ◦pilot testing, ◦timely payment; ◦periodic review and amendments / revision of
contract; ◦specific performance indicators…..
A.VENKAT RAMAN FMS-DU 41
![Page 42: Public Private Partnership in Health Service Delivery: Experiences & Lessons A.Venkat Raman Faculty of Management Studies University of Delhi.](https://reader030.fdocuments.in/reader030/viewer/2022032523/56649d825503460f94a678cc/html5/thumbnails/42.jpg)
Key Constraints Payment delaysPersonality styles and trust level Local political interference / political flip-flapsNon-revision of contract clauses (Tariffs) Lack of capacity or willingness to supervise /
monitor / guide the projectPerceptual and attitudinal orientation to
private sectorLack of clarity of the objective of PPP
A.VENKAT RAMAN FMS-DU 42
![Page 43: Public Private Partnership in Health Service Delivery: Experiences & Lessons A.Venkat Raman Faculty of Management Studies University of Delhi.](https://reader030.fdocuments.in/reader030/viewer/2022032523/56649d825503460f94a678cc/html5/thumbnails/43.jpg)
Limitations in Contract Features
Defining and verifying beneficiaries (BPL patients)- especially high cost services
Defining Quality or Performance or Outcome indicators;
Supervision and Monitoring mechanism;Timely revisions / updating of contract;Ombudsman for dispute settlement;Clarity on user fee
A.VENKAT RAMAN FMS-DU 43
![Page 44: Public Private Partnership in Health Service Delivery: Experiences & Lessons A.Venkat Raman Faculty of Management Studies University of Delhi.](https://reader030.fdocuments.in/reader030/viewer/2022032523/56649d825503460f94a678cc/html5/thumbnails/44.jpg)
Summary
Public-private partnership (PPP) is not privatization
Government continues to play a key role
Requires high degree of institutional capacity
A.VENKAT RAMAN FMS-DU 44
![Page 45: Public Private Partnership in Health Service Delivery: Experiences & Lessons A.Venkat Raman Faculty of Management Studies University of Delhi.](https://reader030.fdocuments.in/reader030/viewer/2022032523/56649d825503460f94a678cc/html5/thumbnails/45.jpg)
In conclusion….Public Private Partnership
……does help benefiting the poor. …………one of the pragmatic options for
health service delivery, but not an alternative to public delivery or better governance.
A.VENKAT RAMAN FMS-DU 45
![Page 46: Public Private Partnership in Health Service Delivery: Experiences & Lessons A.Venkat Raman Faculty of Management Studies University of Delhi.](https://reader030.fdocuments.in/reader030/viewer/2022032523/56649d825503460f94a678cc/html5/thumbnails/46.jpg)
THANK YOU
Ref. Book:A.Venkat Raman & J.W.BjorkmanPublic Private Partnership in Health Care in
India: Lessons for Developing Countries. Routledge, London, 2009
http://south.du.ac.in/fms/idpad/idpad.html A.VENKAT RAMAN FMS-DU
46