Public Private Partnership in Health

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  • 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 SIHFW: an ISO 9001: 2008 certified institution 2
  • 3. ……then what is Partnership? SIHFW: an ISO 9001: 2008 certified institution 3
  • 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) SIHFW: an ISO 9001: 2008 certified institution 4
  • 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 SIHFW: an ISO 9001: 2008 certified institution 5
  • 6. Selection of Service Provider Ø Competitive Bidding Ø Swiss Challenge Approach Ø Competitive Negotiation SIHFW: an ISO 9001: 2008 certified institution 6
  • 7. Payment mechanism Ø Contractual payments Ø Grants-in-aid and Ø Right to levy user charges for the asset created/leased-in. SIHFW: an ISO 9001: 2008 certified institution 7
  • 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. SIHFW: an ISO 9001: 2008 certified institution 8
  • 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. SIHFW: an ISO 9001: 2008 certified institution 9
  • 10. Ø Legal risk, arising from: Øchanges in law; Øchanges in title/lease rights; Øinsolvency of developer/service provider; Øchange in security structure. SIHFW: an ISO 9001: 2008 certified institution 10
  • 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 SIHFW: an ISO 9001: 2008 certified institution 11
  • 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 SIHFW: an ISO 9001: 2008 certified institution 12
  • 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 SIHFW: an ISO 9001: 2008 certified institution 13
  • 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 SIHFW: an ISO 9001: 2008 certified institution 14
  • 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 SIHFW: an ISO 9001: 2008 certified institution 15
  • 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 SIHFW: an ISO 9001: 2008 certified institution 16
  • 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 SIHFW: an ISO 9001: 2008 certified institution 17
  • 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 SIHFW: an ISO 9001: 2008 certified institution 18
  • 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 SIHFW: an ISO 9001: 2008 certified institution 19
  • 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 SIHFW: an ISO 9001: 2008 certified institution 20
  • 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 SIHFW: an ISO 9001: 2008 certified institution 21
  • 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 SIHFW: an ISO 9001: 2008 certified institution 22
  • 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 SIHFW: an ISO 9001: 2008 certified institution 23
  • 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 SIHFW: an ISO 9001: 2008 certified institution 24
  • 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 SIHFW: an ISO 9001: 2008 certified institution 25
  • 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 SIHFW: an ISO 9001: 2008 certified institution 26
  • 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 SIHFW: an ISO 9001: 2008 certified institution 27
  • 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 SIHFW: an ISO 9001: 2008 certified institution 28
  • 29. Partnerships with Professional Associations Expert Pool Ø IAPSM, IPHA ØFOGSI – Vande Matram scheme ØIMA – Aao Gaon Chalein Protocols/ Quality Assurance/ Accreditation SIHFW: an ISO 9001: 2008 certified institution 29
  • 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 SIHFW: an ISO 9001: 2008 certified institution 30
  • 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 SIHFW: an ISO 9001: 2008 certified institution 31
  • 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 SIHFW: an ISO 9001: 2008 certified institution 32
  • 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 SIHFW: an ISO 9001: 2008 certified institution 33
  • 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 SIHFW: an ISO 9001: 2008 certified institution 34
  • 35. Ø Policing Ø Regulatory Mechanism Ø Performance Ø Promotion Ø Accreditation Mechanism SIHFW: an ISO 9001: 2008 certified institution 35
  • 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 SIHFW: an ISO 9001: 2008 certified institution 36
  • 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 SIHFW: an ISO 9001: 2008 certified institution 37
  • 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 SIHFW: an ISO 9001: 2008 certified institution 38
  • 39. Thank You For more details log on to www. sihfwrajasthan.com or contact : Director-SIHFW on sihfwraj@yahoo.co.in