Public-private partnerships (PPPs) in healthcare aim to improve universal access, equity, and affordability of primary care through collaboration between government and private sectors. PPPs can help address India's shortage of healthcare professionals and facilities, which are disproportionately located in urban areas despite most of the population living rurally. Common forms of PPPs in India include contracting private providers for service delivery, outsourcing management of public facilities, health insurance schemes, and joint ventures. Successful PPPs require transparency, impartiality, value for money, integrated services, and financial viability to equitably meet public health goals through shared responsibilities between sectors.

1. IN HEALTHCARE SERVICES
Dr. VINOTHINI. J
Junior Resident
Dept. of Community Medicine
Banaras Hindu University

2. Characterized by sharing of;
• Resources
• Risks
• Rewards
• Responsibilities for the mutual benefit of both parties
What is PPP?
Partnership between the government and the private sector
( Profit, Non-Profit, Private Service Provider)
Principal objective:
Providing Public infrastructure, community needs
and other related services that were traditionally
provided by the public sector

3. Policy formulation Planning Implementation Monitoring Evaluation Training & Research
DEFINING PUBLIC PRIVATE PARTNERSHIP IN HEALTH
Main objective of any PPP mechanism related to health services:
Universal coverage and equity for primary health care
Partnership in
PPP in health sector is an instrument for improving the health of the population
PPP is viewing the whole medical sector as a national asset with health promotion as
goal of all health providers, private or public.
Private and Non-profit sectors are also accountable to health systems and services of the country

4. Objectives of PPP
To ensure government services are delivered in an economical, effective and efficient manner
To create opportunities for private sector growth and to contribute to the
overall economic development of the district/state/country through the
stimulation of competitiveness and initiative
To ensure the best interests of the public, the private sector and the community are
served through an appropriate allocation of risks and returns between partners.

5. Why do we need PPP in Health Sector?
The key to establishing an effective and efficient healthcare delivery system in
any country is to ensure the three ‘A’s:
 The WHO recommendation on Doctor- Population ratio - 1:1000
 India’s Doctor-Population ratio – 1:1,404 ( National Health Profile 2019)
 Rural India Doctor-Population ratio – 1:10,926 ( National Health Profile 2019)
Availability Accessibility Affordability
Availability (Recommendation vs Reality)

6.  A shortfall of 86.5% of Surgeons, 74.1% of Obstetricians & Gynecologists, 84.6% of
Physicians and 81% of Pediatricians.
 Overall, there was a shortfall of 81.6% specialists at the CHCs as compared to the
requirement for existing CHCs.
 Public health facilities continue to face staff shortage as over 85% specialist doctors, 75%
doctors, 80% lab technicians, 53% nursing and 52% ANM posts are vacant across States.
 The density of health professionals is also more in urban areas compared rural areas.
 According to WHO, India‟s ranking is 52nd out of 57 countries facing crisis in human
resources in health.

7. 74% of doctors in India and 75% of healthcare structure are in urban areas
Accessibility
Urban area: only 27% of Indian population resides
Affordability
NHP-2017 recommends govt. expenditure on health to be increased by 2.5% to 3% of GDP by 2025
But between 2015-16 to 2020-21 there’s only a mere increase of 0.02% in the health budget
INDIA SPENDS JUST 1.26% OF GDP ON PUBLIC HEALTHCARE
The national policy also recommended that expenditure on health by states should be
increased to 8% or more of their budget by 2020, but none of the states have allocated 8%
of their budget towards health in 2020-21. On an average, the state governments have just
allocated 5.4% of their total budget towards public health care systems.

8. The Economic Survey 2020-21 has strongly
recommended an increase in public spending on
healthcare services from 1% to 2.5-3% of GDP, as
envisaged in the National Health Policy 2017.
The Union Minister for Finance & Corporate Affairs, Smt
Nirmala Sitharaman tabled the Economic Survey 2020-21
in Parliament ( JAN 29TH 2021)
Out-of-Pocket-Expenditure from 65%
to 35% of the overall healthcare spend

9. Over the years the private health sector in India has grown remarkably
At independence the private sector in India had only 8% of health care facilities but
recent estimates indicate that 93% of all hospitals, 64% of beds, 85% of doctors,
80% of outpatients and 57% of inpatients are in the private sector.
Given the overwhelming presence of the private sector in health, various state governments in
India have been exploring the option of involving the private sector and creating partnerships
with it in order to meet the growing health care needs of the population
There is huge growth in private sector with its large number of private
companies (for profit ) becoming multinational from being national

10. Advocates argue that the public and private sectors can potentially gain from one
another in the form of resources, technology, knowledge and skills, management
practices, cost efficiency and even a make-over of their respective images.
It is assumed that collaboration with the private sector in the form of Public-Private
Partnership would improve Equity, Efficiency, Accountability, Quality and
Accessibility of the entire health system.

11.  Infrastructure Development
 Management and Operations
 Capacity Building and Training
 Financing Mechanism
 IT Infrastructure
 Materials Management
PRIVATE SECTOR
 Cost-effectiveness
 Higher Productivity
 Accelerated Delivery
 Clear Customer Focus
 Enhanced Social Service
 Recovery of User Charges
PPP
BENEFICIAL ASPECTS

12. Under the Tenth Five Year Plan (2002-2007), initiatives have been taken to define the role
of the government, private and voluntary organizations in meeting the growing needs for
health care services including RCH and other national health programme;
• Family welfare services
• TB control program
• Leprosy control program
• Trachoma & Blindness control program
• National AIDS control program
INTRODUCTION TO PPP IN HEALTH SECTOR
PPP has emerged as one of the options to influence the growth of private sector with public goals in mind

13. National Rural Health Mission (NRHM 2005-2012) also proposes to support the development
and effective implementation of regulating mechanism for the private health sector to
ensure Equity, Transparency and Accountability in achieving the public health goals.
In order to tap the resources available in the private sector and to conceptualize the
strategies, Government of India has constituted a Technical Advisory Group for this purpose,
consisting of officials of GOI, development partners and other stakeholders.

14. The responsibility for delivery and
funding a particular service rests
with the private sector.
Full retention of responsibility by
the government for providing the
service
Ownership rights are sold to the
private sector along with associated
benefits and costs
May continue to retain the legal
ownership of assets by the public
sector
Determined by the private provider
Contractually determined between
the two parties
All the risks inherent in the business
rest with the private sector
Shared between the government
(public) and the private sector
PPP
PRIVATIZATION
Responsibility:
Ownership:
Nature of service:
Risk & Reward:
(vs)

15. • Partnerships in health financing through health insurance
• Contracting-in and contracting-out of service delivery
• Outsourcing of operations & management of public health facilities
• Build-operate-transfer model
• Concession model
FORMS OF PUBLIC – PRIVATE PARTNERSHIP IN HEALTH IN INDIA
Build
Operate
Transfer

16. • Joint venture model
• Social franchisee model
• Voucher schemes
• Corporate social responsibility

17. Partnerships in health financing through health insurance
 The National Health Insurance Programme
known as RSBY was launched by the GOI in
October 2007 to provide BPL families
 State Health Insurance programme for tertiary
health care – the Rajiv Aarogyasri programme
 Yeshasvini Health Scheme in Karnataka
 Arogyaraksha scheme in ANDRA PRADESH

18. Contracting-in and contracting-out of service delivery
It is becoming a well-established form of PPP that many state governments are trying out with
varying degrees of success, especially under NRHM. In one of the good-performing models in the
state of Odisha, an NGO contracted out some PHCs along with the sub-centres reporting to them
It is a contracted-out model and one of the most successful PPP models in India
Chiranjeevi Yojana Scheme
The public-sector hospital invites private doctors to undertake normal and
caesarean deliveries to increase patient volumes at an institution
The contracting-out of PHCs
EMRI 108

19. Outsourcing of operations and management of public health facilities
 Non-clinical hospital services such as laundry, catering, security (Bhagajatin hospital)
 the contracting-out of kitchen, cleaning and laundry services
 Clinical services such as radiology and laboratory services, the directly-observed therapy
programme for antitubercular therapy
 Private management of primary healthcare centres in Tamil Nadu and the Rajiv Gandhi
Gram in Mobile Medical Centre in Rajasthan

20.  The Rajiv Gandhi super-speciality hospital in Raichur Karnataka is a joint venture of
the Govt. of Karnataka and Apollo Hospital Group, with financial support from OPEC.
Joint venture model
Social franchisee model
 The MGHN project was implemented in 35 districts of Uttar Pradesh (a network of
franchised hospitals offering quality RCH services at pre-fixed prices)
The private partner takes complete responsibility for marketing and distribution of
low-cost health products (contraceptives, insecticidal bed nets, etc.).

21. Partnership between the Government and the for Profit sector
1. Contracting in Sawai Man Singh Hospital, Jaipur
2. The Uttaranchal Mobile Hospital and Research Center (UMHRC) is three-way partnership.
The motive behind the partnership was to provide health care and diagnostic facilities to
poor and rural people at their doorstep in the difficult hilly terrains
3. Contracting out of IEC services to the private sector by the State Malaria Control Society in
Gujarat is underway in order to control malaria in the state

22. 4. Contracting in of services like cleaning and maintenance of buildings, security, waste
management, scavenging, laundry, diet, etc. to the private sector has been tried in states like
Himachal Pradesh; Karnataka; Orissa (cleaning work of Capital Hospital by Sulabh
International); Punjab; Tripura (contracting Sulabh International for upkeep, cleaning and
maintenance of the G.B. Hospital and the surrounding area); Uttaranchal, etc.
5. The Government of Andhra Pradesh has initiated the Arogya Raksha Scheme in
collaboration with the New India Assurance Company and with private clinics

23. Family Welfare Programme
Partnership between the Government and the non-profit sector
Involvement of NGOs
SEWA-Rural
Govt. of Gujarat has provided grants to SEWA-
Rural for managing one PHC and three CHCs.
The NGO provides rural health, medical services
and manages the public health institutions in
the same pattern as the Government
Emergency Ambulance Services
Government of Tamil Nadu has initiated the
scheme in Theni district in order to reduce
the maternal mortality rate in its rural area
Urban Slum Health Care Project
Andhra Pradesh Ministry of Health and
Family Welfare contracts NGOs to manage
health centers in the slums of Adilabad

24. Collaboration
Management of Primary Health Centers in Gumballi and Sugganahalli was contracted out by
the Government of Karnataka to Karuna Trust in 1996 to serve the tribal community in the
hilly areas. 90% of the cost is borne by the Govt. and 10% by the trust
Between Govt. of Arunachal Pradesh, VHAI & Karuna Trust in managing number of PHCs

25. Partnership between the Government and a private sector and/or the non-profit
sector and/or a private service provider and/or multilateral agencies
National Malaria Control Programme National Blindness Control Programme
National AIDS Control Programme
RNTCP
Involved private practitioners and NGOs
for rapid expansion of the DOTS strategy
Involved both the voluntary and
private sector for outreaching the
target population through Targeted
Interventions
District Blindness Control Societies have
been formulated, which are represented
by the Government, non-government and
private sectors. The NGOs have been
involved for providing a package of services
Involved the NGOs, private practitioners
at the district level for the distribution
of medicated mosquito nets

26. Govt. of Karnataka, the Narayana Hrudalaya
hospital in Bangalore and ISRO initiated an
experimental tele-medicine
Rajiv Gandhi Super-specialty Hospital Community health insurance scheme
Karnataka Integrated Tele-medicine
and Tele-health Project
Yeshasvini Health Insurance Scheme
Rogi Kalyan Samiti
Public Private Mix DOTS
Chiranjeevi experiment
Joint venture of the Government of
Karnataka and the Apollo hospitals Group,
with financial support from OPEC
Karuna Trust in collaboration with the National Health
Insurance Company and Government of Karnataka
Formed in Jai Prakash Governement Hospital to
manage & maintain it with public cooperation
A public/private DOTS model was established in
Hyderabad at Mahavir Trust Hospital, which is a private
non-profit hospital. This partnership also involves
private service providers (doctors and nursing homes)

27. CASE STUDIES
 Chiranjeevi Yojana Scheme
 Rashtriya Swasthya Bima Yojana
 The Rajiv Aarogyasri Programme
 National AIDS Control Program
 Contracting –Out PHC – Orissa
 PPP Initiatives In Bihar
• Outsourcing Of Hospital Maintenance
• Operationalization And Management State
and District Data Centre
• Radiology Services
• Pathology Services
• Mobile Medical Units

28. Best PPP Should be built up on the following tenets
 PPP as a part of social responsibility of the public sector
 Transparency
 Impartiality between public & private sectors
 Value for money
 Integration of healthcare services
 Financially workable

29. REFERENCES

30. REFERENCES

31. REFERENCES

32. THANK YOU