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Objectives
• Improve the efficiency in allocation of resources and additional
resource generation.
• Strengthening infrastructure the existing health infra structure.
• Widening the range of services.
• Clearly defined sharing of risks.
Public private partnership in health care (PPP)
• Public: It generally refers to government or organizations Two component
functioning under state budget. • 1. Shared interest or objectives
• 2. Mutual responsibility
• Private: It refers to the profit/ nongovernmental / voluntary
Shared goals
sector.
Shared resources(time,money,expertise, people)
Shared risks and benefits
• Partnership: Its a an agreement between two or more parties.
It reflects the mutual responsibilities of shared interests
Objectives Public private partnership in health care
• Universal coverage and equity
• Improving quality, accessibility, acceptance and efficiency of
health services. • It is an approaches to addressing public health problems
through the combined efforts of public private and
• Exchange of skills and expertise between the public and
development organizations complimenting each other by
private sector
contributing or sharing their core competency.
• Mobilizations of additional services
• Community ownership.
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Need of PPP
• Because existing services fails to reach all people 3. Social marketing
• Government on its own cannot always fully address the most needy
population. • A promotional business idea applied to increase awareness
about a social welfare campaign.
• To set minimum standard for quality of services and legal regulation.
• For mutual benefits(cost,manpower and financial resources.) 4. Joint venture
• To improve Consumer's involvement in planning and monitoring of • It is a business arrangement in which two or more parties
services agree to pool their resources for the purpose of accomplishing
• To commitment for public good a specific task. This task can be a new project or any other
business activity.
• To avoid duplication
Models
1.Contracting:
5. Voucher scheme
• Contracting out : government pays outside individual to mange • It is a ticket or piece of paper that can be used instead of
a specific function money to pay for something
• Contracting in: government hires individual on a temporary
6. Hospital autonomy
basis to provide services • It is the quality or state of being self-governing, existing or
capable of existing independently.
• Eg. Human resources.
2. Franchising 7. Partnership with corporate sector/ industrial houses,
Eg.CIl(Confederation of IndianIndustry) , FICCI(Federation of
Arrangement where one party (the franchiser) grants another Indian Chambers of Commerce and Industry)
party
8. Involving professional association
• Partial franchising
• Eg. IAPSM (Indian Association of Preventive and Social
• Full franchising Medicine)
• Branded clinic
Eg. Butterfly clinic, Titli clinic in bihar
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Advantages
• 9. Donation and philanthropic contribution • Early Completion Bonus
• 10. Involvement of social groups and clut li rotary club, lions • Cut down tax
club • Project completion effciency
• 11. Partnership with cooperative societies • Project feasibility
• 12. Partnership with nonprofit community based organizations • Superior quality standards
• 13.Running mobile health units • Excellent infrastructure solutions
• 14.Community based health insurance
Existing scenario of PPP Disadvantages
Tenth-five year plan, national health policy 2002 and other • Involves risk for private firms
national health program like RNTCP, NCB, NLEP, RCH and NRHM
initiated under five basic mechanisms • Raise government expenses
> Contacting-in • May not be cost-efficient
> Contacting -out • Dependency on private sector
> Subsidies:
> Leasing or rental
> Privatization
Anticipated outcomes PPP models in India
• Chiranjeevi Yojana Scheme Project Partner Mode Details
• 1. Cost effectiveness
Project
• 2. Higher productivity Tamil Nadu Emergency ambulance service Seva Nilyam NGO O &
M NGO operated Government Ambulances.
• 3. Accelerated delivery of goods • Karnataka Health Insurance National Health Insurance
Company NA Health Insurance Scheme cost shared between
• 4. Client focused
Government and Private Players.
• Andhra Pradesh Aarogyaraksha National Health Insurance
Company NA Health Insurance Scheme cost shared between
Government and Private Players Andhra Pradesh Rajiv Aarogyasri
Different vendors NA Vendor services to sponsored patients;
refunded the costs.
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PPP models in India
• Maharashtra Seven Hills Hospital Seven Hills DBFOT • Planning: The govérnment initiates the basic plan of the bridge and select a
suitable private company providing the best offer to undertake the project.
Government Land free of cost. • Financing: Now, comes the role of the private entity. It first analyzes the whole
life costing of the bridge and accordingly finances the project. This cost can be
• Gujarat Chiranjeevi Yojana Network of Practitioners NA recovered from the government later on.
Practitioners reimbursed by Government. • Designing: The experts and engineers then draft the final layout of the bridge,
and both the parties give their input for the purpose. Also, a time frame is
• Gujarat Multispecialty Hospital Narayana Hridalaya DBFOT ascertained for project accomplishment through the Critical Path Method.
Multi- Specialty Hospital. • Building: The company engages an experienced contractor and the labourers to
construct the bridge. The project completes efficiently within the estimated
• Punjab Multi Specialty Hospital, Bhatinda, Mohali Max Health duration.
Care DBFOT Revenue Share. • Operating: After the proper testing and quality check, the bridge is opened for
the public to use. Thus, facilitating the connectivity and conveyance for the
• Delhi Indraprastha Hospitals Apollo Hospital -DBFOT natives.
• Maintaining: As estimated in the whole life costing, after five years of use, the
Government land free of cost. bridge requires some repairing. Such maintenance cost is also borne by the
private company which has undertaken the project.
Journal: An Overview of PPPin Health* Conclusion
• If partnerships are to be effective in addressing the issues of • Public and private partnership have a critical role in improving
poverty reduction and equity, quality improvement, and cost
containment, considerable work will need to be done to the performance of health system worldwide, by bringing
develop the accountability and transparency, the legal and together the best characteristic of public and private sectors to
regulatory framework,and the mutual trust that Isnecessary
for partnerships to succeeded improve efficiency, quality, Innovation and health impact of
both private and public system.
Reference
• 1. Heggenhougen, K., & Quah, S. R. (2008). International
encyclopedia of public health (Vol. 5). Amsterdam: Elsevier.
• 2. Detels, R., Gulliford, M., Karim, Q. A., & Tan, C. C. (2015).
Oxford textbook of public health. Oxford: Oxford University
Press.
• 3. Ramani, K. V., Mavalankar, D., & Govil, D. (2008). Strategic
issues and challenges in health management. Ahmedabad:
Centre for Management of Health Services.
• 4. M. M. (2002). An overview of Public-private partnerships in
health. Cambridge, MA: Harvard Center for Population and
Development Studies.
• 5.Text book of National Program
