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The 6th Global Health Supply Chain Summit November 18 -20, 2013 Addis Ababa, Ethiopia 1. CLICK TO ADD TITLE. PUBLIC-PRIVATE PARTNERSHIP IN HEALTH SERVICES IN INDIA: MODELS & CHALLENGES A.Venkat Raman Faculty of Management Studies University of Delhi, India avr@fms.edu. [SPEAKERS NAMES].

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  1. The 6th Global Health Supply Chain Summit November 18 -20, 2013Addis Ababa, Ethiopia1 CLICK TO ADD TITLE PUBLIC-PRIVATE PARTNERSHIP IN HEALTH SERVICES IN INDIA: MODELS & CHALLENGES A.Venkat Raman Faculty of Management Studies University of Delhi, India avr@fms.edu [SPEAKERS NAMES] [DATE]

  2. HEALTH SYSTEM IN INDIA: PUBLIC & PRIVATE SECTORS Health service delivery is provincial responsibility Vast, but poorly funded, staffed, and ill-equipped public sector health system Rapid, Rampant, Unregulated growth of private sector Click to add text A.VENKATRAMAN-FMS,DU-INDIA

  3. Private Sector in Service Provision Pvt. Sector-Outpatients (NSSO:2005) Pvt. Sector- Hospitalization (NSSO-2005) Pvt. Diagnostics-Rural areas (NCMH,2005) A.VENKATRAMAN-FMS,DU-INDIA

  4. Who Pays for the Services?(NHA-2004-05) • Unregulated private sector and its behavior - effect on the poor • But Private sector is indispensable A.VENKATRAMAN-FMS,DU-INDIA

  5. WHY PPP IN HEALTH SECTOR? • PPP COULD POTENTIALLY • Improve Access • Reduce OOPE • Better Efficiency • Opportunity to Regulate • Improve Quality (rational practices) • Imbibe Best practices • Augment Resources Given respective strengths and weaknesses, neither the public sector nor private sector alone is in the best interest of the health system A.VENKATRAMAN-FMS,DU-INDIA

  6. BUT WHAT IS PPP? Financing vs Delivery:Public vs Private modes(Bloom, 2001) • o • Rhetorical and Ideological Polarized views A.VENKATRAMAN-FMS,DU-INDIA

  7. PPP MODELS IN HEALTH SECTOR(Venkat Raman, 2012) A.VENKATRAMAN-FMS,DU-INDIA

  8. HEALTH SERVICE PPP MODELS IN INDIA A.VENKATRAMAN-FMS,DU-INDIA

  9. HEALTH SERVICE PPP MODELS IN INDIA A.VENKATRAMAN-FMS,DU-INDIA

  10. CHALLENGES: 1. MINISTRY OF HEALTH • Most PPPs are “Initiatives in Good Faith”: Lack of Policy Driven Strategy thus lack of continuity • No Institutional structures to manage or lack of Institutional Capacity for PPPs • Primarily Input-Based contracting A.VENKATRAMAN-FMS,DU-INDIA

  11. CHALLENGES: 2. PRIVATE SECTOR • Diversity of Private Sector: Predominantly Individual run units- not easy to contract. • Variable Quality - Lack of Accreditation or Regulation • Risk of working with Govt.: Payment Delays, Auditing, Incompatible work culture…… A.VENKATRAMAN-FMS,DU-INDIA

  12. CHALLENGES: 3. BUREAUCRACY & HEALTH STAFF • Senior Bureaucracy: Often Enthusiastic- Pro reform image; but success takes them away • View PPP from Infrastructure framework • Health Staff/ Lower Bureaucracy: Do not comprehend or suspect PPP as privatisation- Fear job loss; Distrust private sector A.VENKATRAMAN-FMS,DU-INDIA

  13. CHALLENGES: 4. PERSPECTIVES OFPOLITICAL & CIVIL SOCIETY GROUPS • Cultural stereotype/ antipathy/ squeamishness towards private sector or term “profit” • Govt.’s inability to regulate compounds scepticism on ability to manage PPP • Long Term Sustainability – what happens to Public sector capacity? A.VENKATRAMAN-FMS,DU-INDIA

  14. IN CONCLUSION • Working with Private Sector is inevitable • PPP does improve access and reduce OOP (Venkat Raman & La Forgia, 2013) • PPP portend huge potential….. But Policy, Institutional capacity, Regulatory systems and Accreditation systems are must for sustainable PPP A.VENKATRAMAN-FMS,DU-INDIA

  15. THANK YOU References: Book: A.Venkat Raman & J.W.Bjorkman. 2009. Public Private Partnership in Health Care in India: Lessons for Developing Countries. Routledge. London. Web-link: http://south.du.ac.in/fms/idpad/idpad.html A.VENKATRAMAN-FMS,DU-INDIA

  16. A.VENKATRAMAN-FMS,DU-INDIA

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