Can be viewed at www.sihfwrajasthan.com

1. Public Private Partnership in
Health
State Institute of Health & Family Welfare
Jaipur

2. Public Private Partnership
Not all interactions between the
private and the public sector is PPP
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3. ……then what is Partnership?
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4. PPP ?
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
(MOHFW,GOI)
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5. Attribute Privatization PPP
Responsibility Entrepreneur Govt.
Ownership Private sector Govt.
Nature of Decided by Mutual
services private operator agreement
Risk & reward Private sector Shared between
Govt. & Private
party
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6. Selection of Service Provider
Ø Competitive Bidding
Ø Swiss Challenge Approach
Ø Competitive Negotiation
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7. Payment mechanism
Ø Contractual payments
Ø Grants-in-aid and
Ø Right to levy user charges for the asset
created/leased-in.
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8. Risk & Revenue Sharing
Ø Construction/implementation risk,
arising from:
Ødelay in project clearance;
Øcontractor default;
Øenvironmental damage
Ø Market risk, arising from:
Øinsufficient demand;
Øimpractical user levies.
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9. Ø Finance risk, arising from:
Øinflation;
Øchange in interest rates;
Øincrease in taxes
Øchange in exchange rates.
Ø Operation and maintenance risk, arising
from:
Øtermination of contract;
Øtechnology risk;
Ølabor risk.
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10. Ø Legal risk, arising from:
Øchanges in law;
Øchanges in title/lease rights;
Øinsolvency of developer/service
provider;
Øchange in security structure.
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11. Potential benefits of PPP
Ø Cost-effectiveness-
Ø Higher Productivity-by linking payments
to performance,
Ø Accelerated Delivery – since the
contracts generally have incentive and
penalty clauses vis-a-vis.
Ø Clear Customer Focus - the shift in
focus from service inputs to outputs
Ø Enhanced Social Service-
Ø Recovery of User Charges-Innovative
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12. PPP Messages
Ø PPPs is about health impact not just
resource generation
Ø Start early in developing partnerships
Ø Take the time to look for opportunities for
PPPs
Ø Not all projects lend itself to
partnerships/alliances
Ø Some successful country examples exists
Ø There are tools & resources to help you to
develop PPPs
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13. Public-Private Equilibrium
Public Private
Sector Sector
Advantages: Advantages:
ØImprovement in Health ØMarket/Choice
is the primary objective and Access
ØEconomies of Scale ØEfficiency
ØMore Equitable ØFlexibility
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14. Public Private
Sector Sector
Things to watch: Things to watch:
Ø Efficiency • Primary objective is
Ø Inflexibility/Responsiv profit
eness • Quality of services
Ø Customer satisfaction • Cost
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15. Objectives
Ø Improving access to essential
services
Ø Improving the quality of services
Ø Exchange of expertise
Ø Mobilize additional resources for
activities
Ø Improve efficiency
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16. Ø Better Management of Health
services
Ø Increasing scope and scale of
services
Ø Increasing community ownership of
programs.
Ø Ensuring optimal utilization of govt.
investment and infrastructure
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17. Basics of PPP
Ø Problem
Ø Profile of Partners
Ø Process of Building a partnership
Ø Profit – Mutual Benefit
Ø Phase – start small & build
Ø Proliferate –Grow, Expand, & Sustain
Ø Priorities & Preferred group
Ø Policing – Mechanism of Monitoring
& Transparency
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18. Ø Politics – Governance, Administration,
People’s audit
Ø Protection/proof: A security system
Ø Price: A cost share in terms of
money/kind
Ø Professional Network
Ø Platform
Ø Prize: Acknowledgement/recognition
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19. Factors Influencing PPP
Ø Clarity of Purpose
Ø Creation of value
Ø Congruency of Mission, Strategy and
Values
Ø Connection with purpose and people
Ø Communication between partners
Ø Continual learning
Ø Commitment to the partnership
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20. Action Principles for PPP
Ø Combined action at all stages
Ø planning,
Ø follow up and
Ø termination20
Ø Complimentary roles
Ø expectation of each other are clarified
and stabilized
Ø Creation of a temporary system
Ø task force with representatives from
both sides
Ø Continuous Communication
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21. How PPP helps:
Economies of scale
Utilizing existing capacity
Create synergy
Targeting poor Better Better
Services Health
Flexibility in action
Resource mobilization
Technical Up-gradation
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22. Models of PPP
Ø Social Franchising
Ø Branded Clinics
Ø Contracting
Ø Social Marketing
Ø Build, Operate and Transfer
Ø Joint Venture Companies
Ø Voucher System
Ø Donations from individuals
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23. Ø Involvement of Corporate sector
Ø Partnership with Professional
Associations
Ø Capacity Building of Private
Providers
Ø Autonomous Institutions
Ø Mobile Health Vans
Ø Health Insurance
Ø Partnerships with Social Clubs
and Groups
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24. STRAIGHT approach to PPP-
Ø Identifying the Scope of partnership
Ø Identifying the appropriate Target
Population
Ø Selecting the Right Partners and Model
Ø Ensuring Accountability
Ø Ensure active Involvement of the Govt.
Ø Generate Support of stakeholders through
IEC, advocacy and rapport building
Ø Highlight achievements
Ø Build Trust of all the partners and clients
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25. Some PPP models in India
Conventional SMS Hospital, Radiology & Private Company/
Contracting in Jaipur Drug store Individual
Bhagajatin Hospital Diet, Cleaning, Entrepreneurs
Kolkata Laundry, security
Contracting out Karuna Trust, PHC Mgt. Charitable NGO
Karnataka CHC Mgt. Charitable NGO
Shamlaji Hospital Tertiary care Private company
Gujarat hospital
Rajiv Gandhi
Hospital, Raichur
Performance APUHS Project, RCH Services Charitable NGO
Management Adilabad, AP RCH/MH services Private clinics
Contracts Chiranjeevi Yojana, Charitable NGO
Gujarat
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26. Community/ Yeshashvini Surgical Care Private
Health Scheme,Karnataka Hospitals
Insurance consortium
Voucher Arogya Raksha Hospitalization Private
Scheme Scheme, AP Maternity Care/ Hospitals/PSU
SIFPSA, Agra UP Institutional insurance
SCOVA, Haridwar, Delivery Private
UK Hospitals
Hospital RKS, Bhopal / & Patient welfare Public Hospital
Autonomy Other Places committee
Franchising Merri Tarang; Merri M CH / Other Franchised
Silver; Merri Gold; curative private
Life Spring- services entrepreneurs
HLFPPT/ SIFPSA’
Janani, Bihar
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27. Contracting –in and out
Legally enforceable
Contract
ØDefined Set of
healthcare services
Public ØQuantity of services Private
ØQuality of services
ØDuration of Service
Provisioning
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28. Voucher System/ Demand Side
Financing
Government or
Donor Agency
A voucher is a
document that can Voucher
be exchanged for Agency
defined goods or
services as a token
of payment (tied- Service Voucher
cash). Providers Distributor
Agra Model Voucher
Recipients
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29. Partnerships with Professional
Associations
Expert Pool
Ø IAPSM, IPHA
ØFOGSI – Vande Matram
scheme
ØIMA – Aao Gaon Chalein
Protocols/ Quality
Assurance/ Accreditation
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30. Rajasthan :Success stories in PPP-
Ø Linear Accelerator
Ø MRI and Radio-imaging in Tertiary
care Teaching Hospitals
Ø Geriatric Clinic/ Diabetic centre at
Bikaner
Ø RMRS
Ø Contracting out of support services
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31. Mobile Health Vans
Ø Already implemented in
inaccessible areas
Ø Comprehensive Health Services
Ø Fixed Journey Plans
Ø Public Sector contribution
Medical Officers and Medicines
Ø Private Sector for Purchase and
Management of Vans
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32. Ø These vans are useful in:
Ø Provide access to services
people living in inaccessible
terrain
Ø Make services available at
central location to reduce
travel time and costs of clients
Under NRHM many states have introduced this scheme
Rajasthan has entered into an MoU with EMRI, to this
effect
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33. What should investor look into?
Ø Policy prescriptions
Ø Procedural details
Ø Possibilities
Ø Provisions at its command
Ø Presence of Public sector
Ø Purchasing power
Ø Phasing
Ø Proliferation
Ø Profits
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34. What Public sector should look into:
Key Steering variable
Ø Preparedness
Ø Land Bank
Ø Priorities
Ø Provisions
Ø Policy
Ø Procedures
Ø Paper work
Ø Time fame
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35. Ø Policing
Ø Regulatory Mechanism
Ø Performance
Ø Promotion
Ø Accreditation
Mechanism
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36. Health Care spending in India
2004-05
• AP : 1118 • Maharashtra :1576
• Bihar : 1497 • Punjab : 1813
• Gujarat : 1187 • Rajasthan : 808
• Karnataka : 997 • Tamil Nadu : 933
• Kerala : 2952 • UP : 1152
• MP : 1200 • WB : 1188
National Commission on Macro-economics & Health, GOI, 2005
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37. Source of Health Spending in India
Source of Health Spending in India, 2001-02
2.20%
14.40%
Household
External funding
7.20% Firms
0.30% Others incl. NGOs
5.10% Central government
2.00% State government
68.80% Local government
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38. Healthcare Financing –
Rs. billion
1993- 1994- 1995- 1996- 1997- 2000- 2002-
94 95 96 97 98 01 03BE
Public Centre 7 11 12 13 14 23 35
State 68 72 89 99 113 156 186
Total 75 83 101 112 127 179 221
%Govt. 2.91 2.13 2.98 2.94 2.70 2.91 3.17
%GDP 0.87 0.81 0.86 0.83 0.83 0.81 0.85
Private 195 279 329 373 459 982 1200
%GDP 2.27 2.75 2.77 2.73 3.00 4.46 4.62
Source: Public Expenditures - Finance Accounts up to 2001 and Budget for
2003; Private – CSO estimates on Consumption Expenditure 1985 series;
BE = Budget Estimate
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39. Thank You
For more details log on to
www. sihfwrajasthan.com
or
contact : Director-SIHFW on
sihfwraj@yahoo.co.in