Public Private Partnership: Specific Characteristics in Different Sectors SilvaSuvahRaisa
This slide provides information about public private partnership (PPP) and specific characteristics of PPP in different sectors. Public Private Partnership is the relationship between government and private sector entities in the context of infrastructure and other development services. At present, it is a popular method to provide quality service to citizens. As government have not enough money to provide better service and develop infrastructure, partnership with private entities help government in these regards. As private sections are financially strong, they can help government to develop infrastructure and provide service according to citizen demands.
PPP possessed several features in different sectors such as transport, power supply, education, health and so on. Each sectors has unique features. This slides contains all required information.
Transport Sectors:
Public-private partnerships (“PPPs”) can be an effective way to build and implement new infrastructure or to renovate, operate, maintain or manage existing transport infrastructure facilities. In both areas PPPs can be a mutually beneficial way to solve critical transportation problems.
Transportation infrastructure (airports, ports, rail, roads, urban transport) is indispensable to sustainable socio-economic development and trade. They link peoples and regions and connect firms to markets. Efficient transportation infrastructure is a major contributor to enhanced productivity.
PPPs provide a useful avenue for governments to access additional capital as well as technical expertise in the private sector to meet the very substantial demand from their populations for new and expanded transportation infrastructure in the coming decades.
Fiber optic:
The project company lays the fiber optic cables to link key demand centre and sells access to various telecommunication operators and internet service provider. Where new build residential development contemplated, PPP project can provide the full range video, audio, and telecommunication service from fixed line telephone service to broadband video streaming.
Issues—
Property
Access
Power Generation sectors:
The public sector alone cannot respond to the enormous investment needed to meet the growing demand for electricity. Bringing in the private sector through the use of public-private partnerships (PPPs) allows governments to share the burden of financing and management. The government must set clear limits in market power of distribution utilities while allowing competition in the generation segment with the establishment of a market for energy.
Issues:
Regulations
Planning and strategy
Health Sectors:
Public-Private Partnerships (PPP) in health sector services can be described as a long-term contract (typically 15-30 years) between a public-sector authority and one or more private sector companies.
In Bangladesh, private sector health financing includes household expenditures, private nursing home investments and drug fund.
Public Private Partnership: Specific Characteristics in Different Sectors SilvaSuvahRaisa
This slide provides information about public private partnership (PPP) and specific characteristics of PPP in different sectors. Public Private Partnership is the relationship between government and private sector entities in the context of infrastructure and other development services. At present, it is a popular method to provide quality service to citizens. As government have not enough money to provide better service and develop infrastructure, partnership with private entities help government in these regards. As private sections are financially strong, they can help government to develop infrastructure and provide service according to citizen demands.
PPP possessed several features in different sectors such as transport, power supply, education, health and so on. Each sectors has unique features. This slides contains all required information.
Transport Sectors:
Public-private partnerships (“PPPs”) can be an effective way to build and implement new infrastructure or to renovate, operate, maintain or manage existing transport infrastructure facilities. In both areas PPPs can be a mutually beneficial way to solve critical transportation problems.
Transportation infrastructure (airports, ports, rail, roads, urban transport) is indispensable to sustainable socio-economic development and trade. They link peoples and regions and connect firms to markets. Efficient transportation infrastructure is a major contributor to enhanced productivity.
PPPs provide a useful avenue for governments to access additional capital as well as technical expertise in the private sector to meet the very substantial demand from their populations for new and expanded transportation infrastructure in the coming decades.
Fiber optic:
The project company lays the fiber optic cables to link key demand centre and sells access to various telecommunication operators and internet service provider. Where new build residential development contemplated, PPP project can provide the full range video, audio, and telecommunication service from fixed line telephone service to broadband video streaming.
Issues—
Property
Access
Power Generation sectors:
The public sector alone cannot respond to the enormous investment needed to meet the growing demand for electricity. Bringing in the private sector through the use of public-private partnerships (PPPs) allows governments to share the burden of financing and management. The government must set clear limits in market power of distribution utilities while allowing competition in the generation segment with the establishment of a market for energy.
Issues:
Regulations
Planning and strategy
Health Sectors:
Public-Private Partnerships (PPP) in health sector services can be described as a long-term contract (typically 15-30 years) between a public-sector authority and one or more private sector companies.
In Bangladesh, private sector health financing includes household expenditures, private nursing home investments and drug fund.
International Journal of Business and Management Invention (IJBMI) is an international journal intended for professionals and researchers in all fields of Business and Management. IJBMI publishes research articles and reviews within the whole field Business and Management, new teaching methods, assessment, validation and the impact of new technologies and it will continue to provide information on the latest trends and developments in this ever-expanding subject. The publications of papers are selected through double peer reviewed to ensure originality, relevance, and readability. The articles published in our journal can be accessed online
Across the world, governments are searching for new policy measures to mobilise investment for long-term sustainable development. The UNEP Inquiry is working across 15 countries to identify practical policy options and in India is partnering with FICCI, which has formed a national advisory committee, chaired by Ms Naina Lal Kidwai, Chairman HSBC India and Executive Director HSBC Asia Pacific.
This is the Interim Report of the UNEP India Inquiry work, a recommendatory report for developing a long-term sustainable financial system.
This presentation was delivered during the 6th Meeting of the OECD Southeast Asia Regional Programme’s Regional Policy Network on Sustainable Infrastructure, which took place on 25-26 April 2022 in Manila, the Philippines. The OECD’s Public Governance Directorate and Environment Directorate teamed up with the OECD Korea Policy Centre to organise the event. The National Economic and Development Authority (NEDA) of the Philippines co-chaired the event alongside the United States, and the Public Private Partnership Centre of the Philippines graciously provided the venue. For more details about the meeting, including the agenda and a short summary record, please visit: https://www.oecd.org/site/sipa/events/sipa-searp-philippines-2022.htm.
The high rates of non-communicable diseases combined with large expatriate populations leads GCC countries to use different strategies to control healthcare expenditure among which is the PPP solution. This presentation highlights the formula for PPP success based on international cases.
An outline of India's Medical Devices market, along with practical tips on Market Entry for Startups and SME's on navigating the complexities. For more details connect at https://ontogenix.com
International Journal of Business and Management Invention (IJBMI) is an international journal intended for professionals and researchers in all fields of Business and Management. IJBMI publishes research articles and reviews within the whole field Business and Management, new teaching methods, assessment, validation and the impact of new technologies and it will continue to provide information on the latest trends and developments in this ever-expanding subject. The publications of papers are selected through double peer reviewed to ensure originality, relevance, and readability. The articles published in our journal can be accessed online
Across the world, governments are searching for new policy measures to mobilise investment for long-term sustainable development. The UNEP Inquiry is working across 15 countries to identify practical policy options and in India is partnering with FICCI, which has formed a national advisory committee, chaired by Ms Naina Lal Kidwai, Chairman HSBC India and Executive Director HSBC Asia Pacific.
This is the Interim Report of the UNEP India Inquiry work, a recommendatory report for developing a long-term sustainable financial system.
This presentation was delivered during the 6th Meeting of the OECD Southeast Asia Regional Programme’s Regional Policy Network on Sustainable Infrastructure, which took place on 25-26 April 2022 in Manila, the Philippines. The OECD’s Public Governance Directorate and Environment Directorate teamed up with the OECD Korea Policy Centre to organise the event. The National Economic and Development Authority (NEDA) of the Philippines co-chaired the event alongside the United States, and the Public Private Partnership Centre of the Philippines graciously provided the venue. For more details about the meeting, including the agenda and a short summary record, please visit: https://www.oecd.org/site/sipa/events/sipa-searp-philippines-2022.htm.
The high rates of non-communicable diseases combined with large expatriate populations leads GCC countries to use different strategies to control healthcare expenditure among which is the PPP solution. This presentation highlights the formula for PPP success based on international cases.
An outline of India's Medical Devices market, along with practical tips on Market Entry for Startups and SME's on navigating the complexities. For more details connect at https://ontogenix.com
PT MANAGEMENT OF URINARY INCONTINENCE.pptxdrtabassum4
A home-based pelvic floor muscle training and bladder training in women with urinary incontinence showed that combined pelvic floor muscle training and bladder training decreased the symptoms and improved the quality of life
To strengthen your pelvic floor muscles, squeeze the muscles up to 10 times while standing, sitting or lying down.
Do not hold your breath or tighten stomach, bottom or thigh muscles at the same time.
When you get used to doing pelvic floor exercises, you can try holding each squeeze for one second
Unlocking the Benefits of Cognitive Behavioural Therapy (CBT) with Renewed Edgerenewed edge
Discover the transformative potential of Cognitive Behavioural Therapy (CBT) with Renewed Edge. This presentation covers the core principles of CBT, its development, practical applications, benefits, and how to get started with this evidence-based approach to improving mental well-being.
How many patients does case series should have In comparison to case reports.pdfpubrica101
Pubrica’s team of researchers and writers create scientific and medical research articles, which may be important resources for authors and practitioners. Pubrica medical writers assist you in creating and revising the introduction by alerting the reader to gaps in the chosen study subject. Our professionals understand the order in which the hypothesis topic is followed by the broad subject, the issue, and the backdrop.
https://pubrica.com/academy/case-study-or-series/how-many-patients-does-case-series-should-have-in-comparison-to-case-reports/
Defecation
Normal defecation begins with movement in the left colon, moving stool toward the anus. When stool reaches the rectum, the distention causes relaxation of the internal sphincter and an awareness of the need to defecate. At the time of defecation, the external sphincter relaxes, and abdominal muscles contract, increasing intrarectal pressure and forcing the stool out
The Valsalva maneuver exerts pressure to expel faeces through a voluntary contraction of the abdominal muscles while maintaining forced expiration against a closed airway. Patients with cardiovascular disease, glaucoma, increased intracranial pressure, or a new surgical wound are at greater risk for cardiac dysrhythmias and elevated blood pressure with the Valsalva maneuver and need to avoid straining to pass the stool.
Normal defecation is painless, resulting in passage of soft, formed stool
CONSTIPATION
Constipation is a symptom, not a disease. Improper diet, reduced fluid intake, lack of exercise, and certain medications can cause constipation. For example, patients receiving opiates for pain after surgery often require a stool softener or laxative to prevent constipation. The signs of constipation include infrequent bowel movements (less than every 3 days), difficulty passing stools, excessive straining, inability to defecate at will, and hard feaces
IMPACTION
Fecal impaction results from unrelieved constipation. It is a collection of hardened feces wedged in the rectum that a person cannot expel. In cases of severe impaction the mass extends up into the sigmoid colon.
DIARRHEA
Diarrhea is an increase in the number of stools and the passage of liquid, unformed feces. It is associated with disorders affecting digestion, absorption, and secretion in the GI tract. Intestinal contents pass through the small and large intestine too quickly to allow for the usual absorption of fluid and nutrients. Irritation within the colon results in increased mucus secretion. As a result, feces become watery, and the patient is unable to control the urge to defecate. Normally an anal bag is safe and effective in long-term treatment of patients with fecal incontinence at home, in hospice, or in the hospital. Fecal incontinence is expensive and a potentially dangerous condition in terms of contamination and risk of skin ulceration
HEMORRHOIDS
Hemorrhoids are dilated, engorged veins in the lining of the rectum. They are either external or internal.
FLATULENCE
As gas accumulates in the lumen of the intestines, the bowel wall stretches and distends (flatulence). It is a common cause of abdominal fullness, pain, and cramping. Normally intestinal gas escapes through the mouth (belching) or the anus (passing of flatus)
FECAL INCONTINENCE
Fecal incontinence is the inability to control passage of feces and gas from the anus. Incontinence harms a patient’s body image
PREPARATION AND GIVING OF LAXATIVESACCORDING TO POTTER AND PERRY,
An enema is the instillation of a solution into the rectum and sig
ASSISTING WITH THE USE OF BED PAN BY ANUSHRI SRIVASTAVA.pptxAnushriSrivastav
When a patient uses a bedpan, promote comfort and normalcy and respect the patient’s privacy as much as possible. Be sure to maintain a professional manner. In addition, provide skin care and perineal hygiene after bedpan use
Regular bedpans have a rounded, smooth upper end and a tapered, open lower end. The upper end fits under the patient’s buttocks toward the sacrum, with the open end toward the foot of the bed
. A special bedpan called a fracture bedpan is frequently used for patients with fractures of the femur or lower spine
Fracture bedpan - used for patients with fractures of the femur or lower spine. The fracture pan has a shallow, narrow upper end with a flat wide rim, and a deeper, open lower end. The upper end fits under the patient’s buttocks toward the sacrum, with the deeper, open lower end toward the foot of the bed.
Ordinary Bedpan
EQUIPMENTS
Bedpan (regular or fracture)
Toilet tissue
Disposable clean gloves
Additional PPE, as indicated
Cover for bedpan or urinal (disposable waterproof pad or cover)
ASSESSMENT
Assess the patient’s normal elimination habits.
Determine why the patient needs to use a bedpan (e.g., a medical order for strict bed rest or immobilization).
Assess the patient’s degree of limitation and ability to help with activity.
Assess for activity limitations, such as hip surgery or spinal injury, which would contraindicate certain actions by the patient.
Check for the presence of drains, dressings, intravenous fluid infusion sites/equipment, traction, or any other devices that could interfere with the patient’s ability to help with the procedure or that could become dislodged.
Assess the characteristics of the urine and the patient’s skin
Assisting With Use of a Bedpan When the Patient Has Limited Movement
Patients who are unable to lift themselves onto the bedpan or who have activity limitations that prohibit the required actions can be assisted onto the bedpan in an alternate manner using these actions
CRISPR-Cas9, a revolutionary gene-editing tool, holds immense potential to reshape medicine, agriculture, and our understanding of life. But like any powerful tool, it comes with ethical considerations.
Unveiling CRISPR: This naturally occurring bacterial defense system (crRNA & Cas9 protein) fights viruses. Scientists repurposed it for precise gene editing (correction, deletion, insertion) by targeting specific DNA sequences.
The Promise: CRISPR offers exciting possibilities:
Gene Therapy: Correcting genetic diseases like cystic fibrosis.
Agriculture: Engineering crops resistant to pests and harsh environments.
Research: Studying gene function to unlock new knowledge.
The Peril: Ethical concerns demand attention:
Off-target Effects: Unintended DNA edits can have unforeseen consequences.
Eugenics: Misusing CRISPR for designer babies raises social and ethical questions.
Equity: High costs could limit access to this potentially life-saving technology.
The Path Forward: Responsible development is crucial:
International Collaboration: Clear guidelines are needed for research and human trials.
Public Education: Open discussions ensure informed decisions about CRISPR.
Prioritize Safety and Ethics: Safety and ethical principles must be paramount.
CRISPR offers a powerful tool for a better future, but responsible development and addressing ethical concerns are essential. By prioritizing safety, fostering open dialogue, and ensuring equitable access, we can harness CRISPR's power for the benefit of all. (2998 characters)
Damage to the spinal cord above the sacral region causes reflex incontinence. This condition causes loss of voluntary control of urination; but the micturition reflex pathway often remains intact, allowing urination to occur without sensation of the need to void
Overflow incontinence occurs when a bladder is overly full and bladder pressure exceeds sphincter pressure, resulting in involuntary leakage of urine. Causes often include head injury; spinal injury; multiple sclerosis; diabetes; trauma to the urinary system; and postanesthesia sedatives/hypnotics, tricyclics, and analgesia
Hyperreflexia, a life-threatening problem affecting heart rate and blood pressure, is caused by an overly full bladder. It is usually neurogenic in nature; however, it can be caused functionally by blockage
Diseases that cause irreversible damage to kidney tissue result in end-stage renal disease (ESRD).
uremic syndrome- An increase in nitrogenous wastes in the blood, marked fluid and electrolyte abnormalities, nausea, vomiting, headache, coma, and convulsions characterize this syndrome. As the uremic symptoms worsen, aggressive treatment is indicated for survival
Nocturia - awakening to void one or more times at night
An excessive output of urine is polyuria.
. A urine output that is decreased despite normal intake is called oliguria.
increased urine formation (diuresis)
a stoma (artificial opening)
Urinary Retention. Urinary retention is an accumulation of urine resulting from an inability of the bladder to empty properly.
URINE OVERFLOW- The sphincter temporarily opens to allow a small volume of urine (25 to 60 mL) to escape. With retention a patient may void small amounts of urine 2 or 3 times an hour with no real relief of discomfort or may continually dribble urine.
pain or burning during urination (dysuria) as urine flows over inflamed tissues
blood-tinged urine (hematuria)
Urinary incontinence is the involuntary leakage of urine that is sufficient to be a problem. It can be either temporary or permanent, continuous or intermittentUrinary elimination depends on the function of the kidneys, ureters, bladder, and urethra. Kidneys remove wastes from the blood to form urine. Ureters transport urine from the kidneys to the bladder. The bladder holds urine until the urge to urinate develops. Urine leaves the body through the urethra. All organs of the urinary system must be intact and functional for successful removal of urinary wastes. Intact efferent and afferent nerves from the bladder to the spinal cord and brain must be present
INTAKE AND OUTPUT OF URINE
Assess the patient’s average daily fluid intake.
at home, ask him or her to estimate his or her intake by showing a measurement on a commonly used glass or cup
Special receptacles (urimeters) that attach between indwelling catheters and drainage bags are a convenient means of accurately measuring urine volume. A urimeter holds 100 to 200 mL of urine. After measuring urine from a urimeter, drain the cylinder
Achieve optimal dental health with 5 easy steps recommended by dentists. Visit Bayview Village Dental for expert care and advice to maintain a healthy smile.
Welcome to Secret Tantric, London’s finest VIP Massage agency. Since we first opened our doors, we have provided the ultimate erotic massage experience to innumerable clients, each one searching for the very best sensual massage in London. We come by this reputation honestly with a dynamic team of the city’s most beautiful masseuses.
CHAPTER 1 SEMESTER V PREVENTIVE-PEDIATRICS.pdfSachin Sharma
This content provides an overview of preventive pediatrics. It defines preventive pediatrics as preventing disease and promoting children's physical, mental, and social well-being to achieve positive health. It discusses antenatal, postnatal, and social preventive pediatrics. It also covers various child health programs like immunization, breastfeeding, ICDS, and the roles of organizations like WHO, UNICEF, and nurses in preventive pediatrics.
Antibiotic Stewardship by Anushri Srivastava.pptxAnushriSrivastav
Stewardship is the act of taking good care of something.
Antimicrobial stewardship is a coordinated program that promotes the appropriate use of antimicrobials (including antibiotics), improves patient outcomes, reduces microbial resistance, and decreases the spread of infections caused by multidrug-resistant organisms.
WHO launched the Global Antimicrobial Resistance and Use Surveillance System (GLASS) in 2015 to fill knowledge gaps and inform strategies at all levels.
ACCORDING TO apic.org,
Antimicrobial stewardship is a coordinated program that promotes the appropriate use of antimicrobials (including antibiotics), improves patient outcomes, reduces microbial resistance, and decreases the spread of infections caused by multidrug-resistant organisms.
ACCORDING TO pewtrusts.org,
Antibiotic stewardship refers to efforts in doctors’ offices, hospitals, long term care facilities, and other health care settings to ensure that antibiotics are used only when necessary and appropriate
According to WHO,
Antimicrobial stewardship is a systematic approach to educate and support health care professionals to follow evidence-based guidelines for prescribing and administering antimicrobials
In 1996, John McGowan and Dale Gerding first applied the term antimicrobial stewardship, where they suggested a causal association between antimicrobial agent use and resistance. They also focused on the urgency of large-scale controlled trials of antimicrobial-use regulation employing sophisticated epidemiologic methods, molecular typing, and precise resistance mechanism analysis.
Antimicrobial Stewardship(AMS) refers to the optimal selection, dosing, and duration of antimicrobial treatment resulting in the best clinical outcome with minimal side effects to the patients and minimal impact on subsequent resistance.
According to the 2019 report, in the US, more than 2.8 million antibiotic-resistant infections occur each year, and more than 35000 people die. In addition to this, it also mentioned that 223,900 cases of Clostridoides difficile occurred in 2017, of which 12800 people died. The report did not include viruses or parasites
VISION
Being proactive
Supporting optimal animal and human health
Exploring ways to reduce overall use of antimicrobials
Using the drugs that prevent and treat disease by killing microscopic organisms in a responsible way
GOAL
to prevent the generation and spread of antimicrobial resistance (AMR). Doing so will preserve the effectiveness of these drugs in animals and humans for years to come.
being to preserve human and animal health and the effectiveness of antimicrobial medications.
to implement a multidisciplinary approach in assembling a stewardship team to include an infectious disease physician, a clinical pharmacist with infectious diseases training, infection preventionist, and a close collaboration with the staff in the clinical microbiology laboratory
to prevent antimicrobial overuse, misuse and abuse.
to minimize the developme
1. Improving Access and Equity
through Digital Healthcare
aided by Private Partnerships
September 2021
2. Your Presenter
Kartik Agrawal
Deputy Director,
Private Investment Unit,
Department of Economic Affairs,
Ministry of Finance,
Government of India
E: fca.kartik@gov.in
▪ Kartik Agrawal is a 2016 batch Indian Cost Accounts Service Officer. He is a Chartered Accountant by
qualification and is currently pursuing Doctorate in Management.
▪ He holds MBA degree from ICFAI and has also completed Company Secretary Executive level course and
has a Diploma in Information System Audit. He is also a Green Belt for Lean Six Sigma Course.
▪ In his previous assignment in Department of Expenditure, Sh. Kartik Agrawal handled Cost Studies of
Government Procurements, Vetting of Price Support Scheme Claims, Re-valuation of Coal Mines
Infrastructure, etc.
▪ In his current assignment, he is handling Analysis and Appraisal of project proposals for consideration of
PPPAC, Analysis and Appraisal of project proposals under the VGF Scheme for consideration of EC,
Revamping of PPPAC, VGF and IIPDF and Analysis of proposals for development of Model Concession
Agreements.
3. 3
Table of contents
Healthcare Sector Overview
• Overview of Healthcare in India
• Key Challenges in Healthcare Sector
• The Road Ahead
5
7
8
India’s PPP Landscape
• PPP in India
• PPP in Healthcare
• Healthcare PPP Characteristics
• Challenges with PPPs
• Learnings from Global PPPs
• Leapfrogging with Digital
• Telemedicine
• Viability Gap Funding Scheme (VGF )
10
11
13
17
19
21
25
27
New developments in India
• NFP Hospital Model 29
Appendix
• References
• Major Health Programs
32
33
5. 5
Healthcare has become one of the largest sectors of the Indian economy,
growing at a CAGR of 22%
Also one of the largest employment generating
sectors in the country - Employs 4.7 Million
people directly.
Sector has the potential of adding 500,000 new
jobs per year
Growth Trend of India’s Healthcare Sector (USD Billion)
Source: Niti Aayog
Ayushman Bharat
Pradhan Mantri
Jan Arogya Yojana
(AB PM-JAY)
Rs 50,000 cr guarantee cover
both for expansion & new
projects related to
health/medical
Pradhan Mantri
Swasthya
Suraksha Yojana
(PMSSY)
Loan Guarantee
Scheme for Covid
Affected Sectors
22 new AIIMS & upgradation
of 75 Govt. Medical Colleges
(GMCs) sanctioned so far
Largest Govt. funded health
assurance/ insurance scheme in
the world
New Scheme for
strengthening
public health
infrastructure and
human resources
Outlay of Rs. 23,220 cr with
focus on short term
emergency preparedness
6. 6
Challenges remain, which are being addressed by traditional and
digital interventions, especially after COVID
Challenges posed by the pandemic led to digital interventions in health
• Opened doors for Indian start-ups - accelerating development of low-cost, scalable, and quick solutions.
• Pandemic has paved way for digital interventions such as telemedicine
Govt spends ~ 1.2 % of GDP on healthcare and aims to
increase it to 2.5% of GDP.
135% increase in healthcare
spending in 2021-22 over last year
(30.6 bn USD)
Low healthcare insurance penetration in the country. High
Out of Pocket expenses by citizens
Largest public
insurance/assurance scheme in
the world – Ayushman Bharat
~ 75 % of healthcare infrastructure can be found in the
urban areas where only 27 % of the Indian population
resides
Health and Wellness Centres are
being built on mission mode
India has a huge shortage of doctors, nurses and
paramedics. WHO recommends one doctor for every 1,000
people (1:1000), India stands at 1:1445.
Significant increase in capacity. 90
Medical Colleges added in last 3
years
Traditional Challenges in Sector in India Govt’s Steps in last 5 years
7. 7
These challenges and opportunities, together, make India’s
healthcare industry ripe for investment
Hospitals & Infrastructure
Health Insurance
Pharmaceuticals & Biotechnology
Medical Devices
Medical Tourism/ Medical Value Travel
Home Healthcare
Telemedicine & Other technology related
health services
✓ In hospital segment, opportunity for
expansion of private players to Tier 2 and
Tier 3 locations, beyond metropolitan cities
✓ Domestic manufacturing of
pharmaceuticals, supported by PLI
schemes
✓ Investment in segments: contract
manufacturing and research, over-the counter
drugs, and vaccines
✓ Opportunities for expansion of diagnostic
and pathology centres as well as miniaturized
diagnostics
There is need to further innovate to attract PPP investments into the healthcare space
9. 9
PPP can be the panacea to India’s healthcare supply challenges
▪ Long-term nature of the partnership creates an
opportunity for both public and private partners to
leverage mutual strengths
▪ PPP in India has seen success in traditional sectors:
transport, energy, education, urban development,
tourism, and more.
▪ Now, PPP is being encouraged in social sectors –
health, education, sanitation
Under the National Infrastructure Pipeline for FY
2020 – 2025, 2nd largest share of social sectors
67%
10%
9%
8%
4%
2% 0%
% No of PPP Projects by Sector (NIP)
Transport
Social Infrastructure
Commercial
Infrastructure
Energy
Water & Sanitation
Logistics
Communication
37%
23%
22%
18%
% No of Projects
Affordable
Housing
Sports
Infrastructure
Medical
Infrastructure
Education
Infrastructure
Under the National
Infrastructure Pipeline
22% of PPP projects
under social are those for
creating medical
infrastructure
10. 10
Viability Gap Funding revamped to drive PPP uptake in healthcare
▪ A fully functional hospital also needs support for operational expenses (maintenance, manpower, medical equipment)
other than the initial capex
▪ Shortfall of hospitals in Tier 2 and 3 cities
Revamped VGF Scheme (upto 1.2 bn USD support)
✓ Huge infrastructure deficit and requirement of efficient delivery of social infrastructure services (Health, Education,
Waste-water, Solid Waste Management, Water Supply, etc.)
✓ Provide much-needed boost to economically justified but commercially unviable economic and social infrastructure
projects
✓ Special focus has been given to unserved and undeserved areas including aspirational districts
CAPEX Up to 60% - 80% of TPC OPEX Up to 50% for first 5 years*
* Applicable only to Health and Education Sectors
11. 11
01 04
03
02
Long-Term
Contract
Government
Ownership of
Assets
Risk
Allocation
Performance
Indicators
Key
Characteristics of
PPPs in Healthcare
typically, 15+
years, usually at
least longer than
five)
transfer of risk from
the public to the
private sector (both
parties have “skin in
the game”)
contract based on
mutually agreed upon
performance
indicators
Govt. ownership of
the assets (facilities
& equipment) at the
end of the contract
Major Models
Private
Partner Role
Public Partner Role
Greenfield (Build +
Service) Project
FDBMOD
▪ Land/Site (at lease)
▪ Finance Support (VGF)
Brownfield
(Equipment/ Infra
Upgrade) Project
FDBMOD
▪ Land & Equipment
▪ Land & Existing Infra
▪ Land, Existing Infra &
Finance (VGF)
Brownfield
(Equipment/ Infra
Upgrade +
Services) Project
EMOD
▪ Equipment Capex &
Opex
▪ Land, Infra, Equipment
& Staff
▪ Land & Staff
End to End
Services Project
MOD
▪ Provide land, infra,
equipment
▪ Land lease, infra,
equipment
Of 50+ hospitals executed via PPP in India, 4 major
models have evolved
F: Finance, D: Design, B: Build, E: Equip, M: Maintain; O: Operate, D: Deliver
PPP provisioning of healthcare can take place across multiple verticals
which have 4 key characteristics
12. 12
These PPP models come under three categories based on impact on
healthcare services…
Infrastructure-based model
▪ Address supply needs
through construction and
operation of facilities
(hospitals) (including
nonclinical or clinical
services)
Clinical Services model
▪ Focus on the provision of
standalone clinical
services;
Integrated PPP model
▪ Offer a suite of clinical
services bundled with the
building of new, or
refurbishment of existing,
infrastructure
Three major categories of
PPPs
▪ Design Build Finance
Maintain (DBFM)
▪ Design Build Finance
Maintain Operate (DBFMO)
▪ Design Build Operate
Transfer (DBOT)
▪ Operation and
Management (O&M)
Contracts
▪ Design Build Operate
Deliver (DBOD)
▪ Public Private Integrated
Partnership (PPIP)
Common Model Names
Healthcare
Delivery Impact
Lower
Higher
Private Partner Responsibilities
▪ Private partner contracted to
design, build, finance & maintain
facilities
▪ Non-clinical service such as
(laundry, cafeteria etc.)
▪ Some may include clinical services
(lab, radiology)
▪ Private partner contracted to deliver
clinical services (e.g., clinical
support/specialty services)
▪ Private partner contracted to
design, build, finance, operate
facilities and deliver non-clinical and
clinical services
13. 13
…of which, Brownfield PPP Models are of 3 main types
Option
Private – Public Partner
(CHC/DH)
PPP – PSU
PPPP (Consortium of Large and
Small units)
Description
• Existing State Government
hospitals are upgraded and
run by private player;
transferred
• Existing PSU Hospitals are
upgraded and run by private
player; transferred back to
govt
• Catchment area bid out
exclusively to upgrade and
operate existing private hospitals,
with financial support – bed
reservation for regulated patients
Pros
• Strong interest from private
players
• Established patient flow
• Linkages with broader
public healthcare system
• Limited dependency on state
government
• Some PSU hospitals
already equipped
• Limited dependency on
government
• Drives supply aggregation and
quality
• Bundling across areas (Tier 2 bid
with Tier 4) to drive social impact
Cons
• Concerns around
community perception of
privatisation
• Coordination challenges with
PSUs
• Concerns around community
perception of privatisation
• Complexities of managing multiple
stakeholders
• Potentially higher VGF needed
CHC Manoharpur, Rajasthan
5+5 years (E-M-O-D)
NMDC Apollo, Chhattisgarh
M-O-D
14. 14
Model Concession Framework (DEA Greenbook): Current Guidelines &
Measures to Strengthen existing MCA
Topic DEA Framework for Brownfield PPPs**
Role of Authority
• Provide complete access to site
• Provide project hospital
Role of Concessionaire
• Procure finance for facility
• Undertake design, monitoring, procurement, construction, upgradation, equipping
and/or installation of facility
• Submit Annual Maintenance Plan prior to COD
• Obtain NABH accreditation withing 2 years of COD
• Undertake O&M of facility
• Maintain consumables inventory
Revenue Model
Core Revenue
• Paid Patients – charge at rates defined in agreement
• Other Patients (free/ BPL)
Ancillary Revenue
• Concession Stand
• Cafeteria
• Florist shop
• Others (approved by Authority)
Quality • Achieve & maintain NABH Accreditation within 2 years of operation
15. 15
Model Concession Framework: Current Guidelines & Measures to
Strengthen existing MCA
Topic DEA Framework for Brownfield PPPs**
Bidding Parameters • Option 1: Authority will provide a fixed cash grant to the concessionaire.
Concessionaire will in turn bid on the concession fee offered
• Option 2: VGF quoted (Capital + Opex for 5 years)
Authority Conditions
Precedent
• Provide Concessionaire unrestricted access to site
• Appoint an independent monitor
• Approve/ provide comments on DPR
• Establish payment reserve account or letter of credit
• Setup project steering committee to monitor project
• Timelines established
Concessionaire Conditions
Precedent
• Evidence of submitting performance guarantee
• Procure all permits
• Submit DPR
• Financial Close
• Executed Escrow account
• Submit Maintenance & Service Manual
• Timeline & Penalty established
**Greenbook for PPP in Brownfield Medical Hospital
16. 16
Case Study: Andhra Pradesh PPP Project (Clinical Services model)
▪ International Finance Corporation (IFC), WB Group
assisted Andhra Pradesh in structuring a novel
public-private partnership (PPP) model
▪ Involves upgrading radiology services at 4
hospitals attached to medical colleges in Kakinada,
Kurnool, Vishakhapatnam, and Warangal.
▪ Bidding parameter was average price per scan
▪ Winning bidder’s quote was nearly 50 percent less
than the prevailing market rate
▪ This low-cost model enabled provisioning of a larger
number of patients in underserved areas within a
small budget
• Diagnostic radiology services provided
to ~ 100,000 patients per year
• ~85% patients were underprivileged
Success factor(s)
Project awarded to (Wipro GE Healthcare Limited, an
international equipment manufacturer, + Medal Healthcare
Private Limited, a chain of diagnostic services) after a
competitive bid.
▪ Project completion took only eight months
Impact
17. 17
Case Study: Uttarakhand Health Systems Development Projects
(variant of Integrated model)
▪ Uttarakhand Health Systems Development Project
(UKHSDP) - to be implemented over a period of 6 years
expecting completion in 2023
▪ Goal of project to "support Uttarakhand in improving access
to & quality of health services and providing health
financial risk protection"
▪ Total project cost of USD $125 million
▪ USD$100 million awarded by the World Bank
▪ Remaining USD$25 million funded by local government.
“stewardship and system improvement”
focuses on logistical fix for capacity building
• Goal to hire contractors in multiple areas to
help with contract management etc
• System would improve the supply chain,
multi-sectoral communication, data
management, etc
The project has two component areas
“innovations in the private sector”
addresses issues of rural supply:
• mobile specialty units
• integration of Public-Private partnership
(PPP) centers
• expanding RSBY health coverage for poor
affected with Noncommunicable diseases
(NCDs).
1
2
18. 18
Learnings from successful Global PPPs which can be adopted..
6+ PPPs across Spain & 3+ PPPs across Peru
implemented successfully
Private player not penalized in case of delays due to
admin hurdles in La Flordia and Maipu hospitals, Chile
La Ribera PPP, Spain had payments adjusted by
medical rate - higher than std. inflation
Global Best Practices
• Bundling across levels of care within a district to create "feeder
system" of smaller facilities with large sized facilities
• Improves viability of smaller facilities
• Ensures comprehensive coverage of healthcare services
• Flexible processes; conducive regulatory landscape
• 'Appropriate' inflation adjusted payments for the
private player – market-linked cost for the private player
Key Takeaways
Hospital Alberto, Peru had KPIs fixed: Satisfaction,
quality of care and outcomes
(%complications during delivery, % resolved complaints)
• Shift towards outcome-based metrics to improve
quality; impact evaluations and monitoring
19. 19
Some of the roadblocks to success of PPP in Healthcare..
1 Challenging unit economics
• Problems due to sub-optimal hospital design, highly variable revenue projections
etc. (Occupancy and paying patient mix - two revenue drivers were lower than
expected)
Seven Hills, Mumbai had 40% occupancy than expected; filed for bankruptcy
Limited paying capacity impacting Max Bhatinda's profitability
2
Increasing Operational
Expenditures
• Input costs high (wage inflation, rising consumables, import costs), reduces
margins
• Commercial rates for utilities, subsidized rates for government hospitals
3
Difficult capital raising
environment
• Raising funds from private banks & equity investors difficult
esp for greenfield projects in Tier 2++ cities; short moratorium (1-2 years) and
repayment period (5-7 years) -vicious debt cycle esp for small providers
• Interest rates charged by equipment providers are very high (18-20%)
4
Inadequate
reimbursements to private
players
• Delayed and not adjusted for the full concession period
5
Limited provision for
additional revenue streams
Unlike global Healthcare PPPs, most domestic PPPs do not have provision for
additional revenue streams (example, restaurants, vacant land, pharmacy) - with few
exceptions like Apollo DRDO PPP
20. 20
6
Restrictive eligibility criteria
and technical specs in some
bidding documents
• Some RFPs have restrictive eligibility criteria/ specifications allowing only a
small pool to qualify
• Draft Concession Agreements for healthcare sector under process to prevent
such issues in future
7
Partial alignment/consultation
with various stakeholders
• Public protests by public/ unions/ opposition, stalling/ delaying where public
projects are being handed over to private sector to run
• Public protests against privatization of CHC Barmer (Rajasthan);
• Protests by union, opposition for non-Maharashtra management. Palanpur
Hospital-Wockhardt; Seven Hills
8
Poor health
outcomes in few
PPPs
• Due to gaps in quality of care provided
For example, GK General Hospital: High neo-natal mortality
Some of the roadblocks to success of PPP in Healthcare..
21. Leapfrogging with Digital Health
▪ Telemedicine Practice Guidelines released jointly by MoHFW & NITI Aayog in March 2020.
▪ Government’s tele-consultation services, e-Sanjeevani and e-Sanjeevani OPD. (Over 1 Million tele-consultations had
taken place through e-Sanjeevani across 550 districts in India as of Dec 2020)
22. 22
Post-pandemic, the necessity of digital healthcare
interventions became paramount
How India Accessed Healthcare During Covid-19 Pandemic
▪ Telemedicine and e-Health potential
solutions for addressing lack of access.
▪ Developed telemedicine market has
potential for export of healthcare services
▪ Affordable & quality healthcare can be
enabled by Artificial Intelligence,
wearables and other mobile technologies as
well as Internet of Things.
▪ Technology products can prove to be next
major booming industry in India
▪ Fundamental approach to medicine could change drastically with the entire human biology getting represented as data
and patterns.
▪ Machine intelligence can assist doctors and patients in diagnosis and save time to address complicated cases
23. 23
Case Study: Apollo TeleHealth
▪ Apollo Hospitals has one of the largest & multi-specialty telemedicine network in South Asia
▪ Apollo TeleHealth has multiple PPPs with various State Governments, 750+ Telemedicine centres,
350,000+ common service centres and has delivered over 15 million + teleconsultations
Key
Service
Offerings
under
Telemedi
cine
Tele Clinics
Tele Cardiology
Doc on Call
Chronic Disease M
Tele Radiology
Tele Emergency
Condition
Management
Healthy Motherhood
▪ Tele-Ophthalmology centres will be screening about 20% to 30% of the total
footfalls at Community Health Centres in Andhra Pradesh
▪ Stabilisation of 1200 emergency cases has been done through tele-emergency
services in Himachal Pradesh
▪ Setting up Digital Dispensaries across 100 select PHCs of Jharkhand with
state-of-the-art equipment for vital signs monitoring, screening program, and
ICT devices
▪ Partner for 250,000 CHCs at Gram Panchayats through Digital India initiative
▪ 183 electronic Urban Primary Health Centres (eUPHCs) established across
9 districts of AP to provide essential primary healthcare services for the urban
poor living in slums
24. 24
Case Study: Uttar Pradesh PPP Project (Tele-Radiology Services)
▪ Tele-Radiology services at 134 CHCs awarded to Apollo
Hospitals via competitive bidding
▪ Scope of services include identification of technological
pathways & setting up digitization, transmission and
reporting of X-Rays
▪ Price per scan
One the most populated states (~ 230 million); dearth of healthcare providers like Radiologists; most resources at CHCs
are not utilized in its entirety
Key Challenges identified
Govt. initiatives to address the challenges
▪ More than 70,000 radiology reports delivered
▪ Digital infrastructure / IT based solutions to be provided
by selected Service Provider which shall be used to transfer
images to radiologists
▪ Project intended to serve ~14 million people, envisions
service to 2400 X-Ray reads on daily basis.
Impact
25. 25
Case Study: Odisha Telemedicine solving access issue
▪ Digital dispensary or ‘a hospital in a box’ – innovative
centre aiming to provide primary and emergency
healthcare solutions from a single point.
▪ Dedicated physicians to leverage technology to provide
quality primary care using Telemedicine.
▪ Aims at providing complete primary healthcare solution
such as consultation, confirmatory tests, & medicines
from a single point.
Media Update
Glocal is a social venture bringing Healthcare to the rural population in India through an integrated model of block level
comprehensive primary & secondary care hospitals, digital dispensaries and technology.
▪ Govt or Civil Society gives funds or land to set up
▪ Oversight remains with Government
▪ Private provides Telemedicine and Basic Testing
services
▪ Technicians recruited from unemployed youth in and
around the village
▪ Subsidised rates paid by patients
27. 27
List of References
1. The Emerging Role of PPP in Indian Healthcare Sector Prepared By CII In collaboration with KPMG
2. Media Article: https://www.thehindubusinessline.com/opinion/why-india-needs-private-public-partnership-in-
healthcare/article34099324.ece
3. https://www.niti.gov.in/sites/default/files/2021-03/InvestmentOpportunities_HealthcareSector_0.pdf
4. PPPs in healthcare: Models, lessons and trends for the future, PwC report
5. https://www.apollotelehealth.com/public-private-partnerships/up-tele-radiology-centers/
6. https://www.apollotelehealth.com/
7. Uttarakhand Health Systems Development Project, The World Bank Funded Project Implemented by Uttarakhand Health and
Family Welfare Society
8. Public-Private Partnership Stories India: Andhra Pradesh Radiology, IFC, WB Group
9. Initiatives to Promote Indian Healthcare Industry, Ministry of Health and Family Welfare,
https://pib.gov.in/Pressreleaseshare.aspx?PRID=1737184
10. National Digital Health Mission (NDHM); https://www.nhp.gov.in/national-digital-health-mission-(ndhm)_pg;
https://pib.gov.in/PressReleasePage.aspx?PRID=1722132 ;
28. 28
Telemedicine market is well primed for PPP on account of
extensive smartphone penetration in India
Market size for telemedicine in India was around USD 830 Million in 2019. It is projected to increase to USD 5.5
Billion by 2025 growing at a CAGR of 31% during 2020-25.
▪ The Telemedicine Practice
Guidelines released jointly by
MoHFW & NITI Aayog in March
2020.
▪ The Government’s tele-
consultation services, e-
Sanjeevani and e-Sanjeevani
OPD. (Over 1 Million tele-
consultations had taken place
through e-Sanjeevani across 550
districts in India as of Dec 2020)
Some Government Initiatives to
push telemedicine
