Public private partnerships in health
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Public-Private Partnerships in Health. Keerti Bhusan Pradhan [email protected] Overview of the Paper. Definition of Public-Private Partnership (PPP) in Health Evolution of PPP in Health Current Focus of PPP in Health Successful Models Challenges to overcome Conclusion.

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Overview of the paper
Overview of the Paper

  • Definition of Public-Private Partnership (PPP) in Health

  • Evolution of PPP in Health

  • Current Focus of PPP in Health

  • Successful Models

  • Challenges to overcome

  • Conclusion

Public private partnerships ppp in health
Public Private Partnerships (PPP) in Health

PPP in health is an approach to addressing public health problems through the combined efforts of public, private and development organisations complimenting each other by contributing or sharing their core competency

This synergy leads to better outcome of goals

Evolution of ppp in health
Evolution of PPP in Health

  • Government/Public Sector

    • Government sector finds it difficult to support health

      • Eg. 1.1% of GSDP was the health expenditure in 1993-94 in 14 States in India

      • 70% of budget allocation is spent on resource maintenance like Human Resources

      • Has to lead to decreased capital investment

Evolution of ppp in health1
Evolution of PPP in Health

  • Private Sector

    • 80% of well qualified medical professionals work in private sector

    • State-of-the-art facilities

    • Private health care expenditure is around 4.25% of the GDP; increase @ 12.5% per annum

    • Private Sector Share is significant: Hospitals - 57% & Beds - 32%

Current ppp in india
Current PPP in India

  • Contracting out to manage clinical and non-clinical services; health projects

  • Joint ventures; private capital to set up hospitals

  • Incentives system to influence desired geographic distribution of health facilities – qualified providers through contract mechanisms in rural areas

Current focus of ppp in health
Current Focus of PPP in Health

  • Develop strategies to utilise untapped resources and strengths of the private sector

  • Enhance the capacity to meet growing health needs

  • Reducing financial burden of government expenditure on tertiary care

  • Reducing geographical disparity in provision of services and its access

  • Reaching remote areas; target specific group of populations

  • Improving efficiency through evolving new management structures

Some options examples
Some options & examples

  • Partnership in disease surveillance (CMC-Kerala)

  • Partnership in pharmaceutical procurement & supply (TNSMC)

  • Partnership in managing high-risk pregnancies

  • Partnership in promotive care (IEC-HIV/AIDS)

  • Partnership with communities & industries

Models government s initiatives
Models…Government’s initiatives

  • Rajasthan

    • Acknowledged the inability to develop service delivery systems to tackle chronic diseases

    • Categorization of medical institutions and awarding benefits accordingly

    • Subsidised initial set up costs in rural areas (offering land at a lesser cost)

    • Fiscal incentives in acquiring medical equipment and machinery - sizable tax exemptions

Critical success factors from others
Critical Success Factors from Others

  • Presence of a catalyst-A catalyst can bring partners together and offer expertise

  • Public sector backing-reassurance to private sector

  • Existence of a vibrant private sector

  • Commitment of private sector decision-makers

  • Road Map

  • Ownership

  • Understanding roles, responsibilities, expectations

Ngo s contribution
NGO’s contribution

  • Aravind Eye Hospitals, a private trust contributes to the State by performing high volume, a staggering 42% of total surgeries in the State relieving its burden


  • Involvement of private sector will improve efficiency; however no concrete steps have been taken to initiate this

  • Clarity in policies to effect the partnerships is still evolving

  • Lack of appropriate regulatory and monitoring mechanisms have raised doubts about PPP in health – still poor are not taken care of…

Policy constraints
Policy constraints

  • Weak regulatory regimes to monitor private health sector

  • Weak capacity of Government

  • Lack of a research and information base on the dynamics of private sector

  • Lack of a policy framework for promoting private health sector





Break Even

Profit Maximization

Free Provision of Products

and Services

Unsustainable for Consumers

Unsustainable for Government &


Goal is to create financially

sustainable system

Challenges ahead
Challenges Ahead

  • Involving private providers in managing various components of health sector programmes

  • Developing joint ventures or inviting private capital to set up hospitals

  • Contracting out services (Catering, Cleaning, Security, Laboratory…..)

  • Consumer Protection Act (Safeguarding the interest of consumers)

  • Regulation and Accreditation of private providers by Government


  • Public-Private partnerships in health are at very early stages

  • Will need significant institutional development work in terms of financial analysis capabilities, monitoring and evaluations systems

  • Appropriate regulations to check the unintended outcomes of private sector growth in health