How to Enhance Private Sector Participation in Achieving Public Health Goals: What We Can Learn from India Suneeta Sharma, PhD, MHA August 26, 2010

Outline Context: challenges and opportunities Building public private partnerships: a policy approach Three examples Voucher system Mobile health clinic ASHA Plus scheme Equitable policy reform Photo by Suneeta Sharma

Challenges High maternal mortality, infant mortality, and total fertility rates Use of FP methods and institutional facilities for deliveries is the lowest among poor Out-of-pocket expenditure on reproductive and child health (RCH) services in both government and private facilities is high Enormous access barriers to the poor Health expenditure – major cause of poverty Staff vacancies, lack of trained staff Difficult geographic terrain, remote populations Photo by Michael Foley

Opportunities Enabling environment under National Rural Health Mission Emphasis on reducing inequities and improving access to MH and FP services Capitalize on private sector market presence Private sector is preferred provider of choice in both urban and rural areas Increased demand for high-quality healthcare services Photos by Suneeta Sharma (top) and Meena Kadri (bottom)

Both Public and Private Sectors Have Important Roles to Play Public-private partnerships provide opportunities for: Creating Competition Achieving Economies of Scale Using Existing Capacity Expanding Service Delivery Network Targeting The Poor Capitalizing on Strengths Mobilizing Resources

Building Public-Private Partnerships: A Policy Framework Balance public- private sector roles Balance public- private sector roles Create an enabling environment Create an enabling environment Share information, foster dialogue, and develop a common understanding of health system goals Share information, foster dialogue, and develop a common understanding of health system goals Understand the market and policy environment Build public- private partnerships Build public- private partnerships

Using a Systematic Process of Building PPP Models Develop strategic options Develop strategic options Ensure sustainable financing Ensure sustainable financing Establish links with policy framework Establish links with policy framework Develop costed scale up strategy Develop costed scale up strategy Evaluate impact Government Leadership and Ownership Government Leadership and Ownership Design and test appropriate models Design and test appropriate models Prioritize needs Determine shared goals Determine shared goals Engage right partners Engage right partners

Effective Public- Private Models to Achieve Health Equity Goals Voucher system Social marketing Social franchising Mobile health vans ASHA Plus program Contracting out Photo by Suneeta Sharma