This document summarizes an organization that provides business consulting services and has a presence in India, Dubai and 20 other countries. It has a team of over 35 employees and 15 freelancers with experience across industries like healthcare, energy and retail. The document then discusses the Indian healthcare sector and issues like low spending, shortage of facilities and professionals. It provides examples of public-private partnership models in healthcare and case studies of successful PPP projects in Indian states like Andhra Pradesh, Karnataka and Uttarakhand that improved access to services. Challenges in PPPs and recommendations for the road ahead are also highlighted.

1. Organized by
Knowledge Partner

2. About Us
Started in 2002
With the aim of providing multiple services to companies wishing to engage in any business expansion.
Team Strength
Dedicated team of over 35 employees and 15 freelancers, with rich industry experience and domain expertise.
Global Presence
Well equipped offices in India and Dubai, also present in 20 countries and 5 cities in India through channel partners.
Sectors Served
Provide actionable insights to companies across a range of industries such as Healthcare, Energy, Retail among others.
One-Stop-Shop

3. Services
Business Consulting Services
• Strategic and Product Marketing
• Market Entry Strategies
• Pre-testing and post launch evaluation
• Concept and Product Testing
• Identifying potential clients
• Competitive Intelligence Services
Offices

4. Indian Healthcare : A Snapshot
2.9
2.6
0.7
US
China
India
Hospital Beds/1000 Population Ratio (2013)
There is only one doctor per 1,700 citizens in India
India would additionally need about 4 Lakh doctors by 2020
There is a severe shortage of hospital beds and medical facilities
Approximately one Million Indians die every year due to inadequate healthcare facilities
Nearly 700 Million people have no access to specialist care
3.31
1.53
0.59
US
China
India
Doctors/1000 Population Ratio (2013)
Source: World Bank
Source: World Bank

5. In comparison US and China, spend nearly 46% and 56%, respectively
Healthcare Spending Per Capita (US$)
9559
373
78.2
US
China
India
2009
2010
2011
2012
2013
2014
US
China
India
CAGR of Healthcare Spending Per Capita (2009-2014)
3.78%
17.07%
7.57%
Indian Healthcare : A Snapshot
Source: EIU
India spends a trivial 4% of GDP on healthcare
Government spending share out of the total 4% is a meager 33%
There’s a stark lack of awareness, accessibility & affordability in Tier 2-3 cities/rural areas
Disease burden in India is soaring due to inadequate hygiene & sanitation conditions
Source: EIU

6. Healthcare PPPs: Overcoming the Hurdles

7. PPP in Healthcare
A Public Private Partnership in healthcare is defined as a legal arrangement between a governmental and a private sector entity with health promotion as the aim of all health providers
 Benchmarked Performance
 Capitalization of Expertise and Strengths
 Synergy and Innovation
 Private Sector Expansion
 Target Achievement with Limited investments
PPP: Key Deliverables
 Delivery of Quality Results

8. Types of PPP Models
PPP Models in Healthcare Segment
Build Operate Transfer (BOT)
Operation and Management
Concessions
Lease
Joint Venture

9. Others (94%)
Healthcare (6%)
Source: Department of Economic Affairs, Ministry of Finance, GOI
1821 PPP Projects in India, as of March 31st, 2014
114 Healthcare PPP Projects by Status, as of March 31st, 2014
Pipeline, 40%
Operational, 39%
Bidding , 12%
Construction, 9%
Source: Department of Economic Affairs, Ministry of Finance, GOI
Healthcare PPP Scenario
*Others include PPP projects of construction, logistics etc.

10. The present share of PPPs in the healthcare sector is very low, with only 114 projects
Healthcare PPP Scenario
Karnataka, 35%
Uttarakhand, 22%
Maharashtra, 14%
Andhra Pradesh, 10%
Assam, 6%
Punjab, 5%
Rajasthan, 3%
Madhya Pradesh, 3%
Tamil Nadu, 1%
Orissa, 1%
Healthcare PPP Projects by State, as of March 31st, 2014
Source: Department of Economic Affairs, Ministry of Finance, GOI
Uttarakhand (25), Maharashtra (16) and Andhra Pradesh (11) projects
The maximum number of projects are in Karnataka, amounting to 40
Most of the PPP projects are based on O&M Model

11. In Karnataka, most of the healthcare PPP projects are in Operational phase (20 projects)
Healthcare PPP Scenario
Source: Department of Economic Affairs, Ministry of Finance, GOI
Operational, 50.0%
Pipeline, 42.5%
Construction, 7.5%
41 Healthcare PPP Projects in Karnataka by Status, as of March 31st, 2014
Majority of these projects are for Mobile Health Clinics (MHC)
MHCs benefit the poor, remote, hilly, forest and inaccessible areas

12. Healthcare PPP Scenario
Diagnostics, 53%
Elderly Care, 18%
Dialysis Centers, 18%
Hospital Management, 12%
Pipeline Healthcare PPP Projects in Karnataka as of March 31st, 2014
Source: Department of Economic Affairs, Ministry of Finance, GOI

13. Case Studies

14. Rajiv Aarogyasari Community Health Insurance Scheme (RAS)
Launch Year: 2007
PPP Type: O&M
Private Player: Network of private and government hospitals
Public Player: Government of Andhra Pradesh
Objective: Improvement of access to medical care of diseases involving hospitalization through a network of health care providers for poor families
Outcome: The insurance claims paid through scheme crossed INR 750 crore mark. The project covered more than 46 lakh BPL families in the 5th phase.

15. Operation and Management of Mobile Health Vans
Launch Year: 2009 PPP Type: O&M Private Player: Rajbhara Medicare, Jain video Public Player : Government of Uttarakhand Objective: Aimed at increasing accessibility of preventive, diagnostic and curative services in rural areas Outcome: Rajbhara Medicare served over 49,000 patients and set up nearly 900 camps in 2 districts, while Jain Video, in 11 districts served over 3,50,000 patients and set up more than 4500 camps.

16. Yeshasvini Co-operative Farmers Health Care Scheme (YCFHS)
Launch Year: 2002 PPP Type: O&M Private Player: Narayana Hrudayalaya Super Specialty Hospital and Network hospitals Public Player: Department of Cooperatives, Government of Karnataka Objective: Aimed at providing medical services to a clustered and organized group of middle to low income people with poor access to healthcare. Outcome: Free outpatient treatments at hospitals totaled nearly 36,000

17. Management of Primary Health Centers (PHCs)
Launch Year: 1996 PPP Type: O&M Private Player : Karuna Trust Public Player : Government of Karnataka Objective: To provide comprehensive Primary Health Care with innovative initiatives of integrating vision centres, mainstreaming traditional medicine, telemedicine, emergency medical services, and mobile dental care among others Outcome: The number of PHCs in Karnataka rose to 30 in 2012-13 with the number of patient registrations in these PHCs breaching 12,000 mark

19. Challenges
Lack of State Governments’ directives
Exclusion of private sector in the PPP governing body
Negligible involvement of people at the grass root level
No qualitative/quantitative benchmarks
Non utilization of Unspent Budget

21. The Road Ahead
Draft State-specific PPP Laws/Bylaws
Incentivize Private Sector
Innovation in Health Insurance
Build Capacity for Medical Education

22. SHUSHMUL MAHESHWARI
CEO
RNCOS E mail: shushmul@rncos.com
Website: www.rncos.com Phone: +91 120 4224700 /01 / 02/ 03
Address: B 129, Sector 6,
Noida, Uttar Pradesh
India - 201301
Contact
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