1. ENGAGING PRIVATE SECTOR IN PRIMARY CARE FOR UHC
A.VENKATRAMAN
Faculty of Management Studies (FMS)
University of Delhi
UHC DAY, 12TH DEC., 2017

2. WHY P.S.E. IS CRITICAL IN INDIAN CONTEXT?
DEMAND FOR HEALTH INFRA.
MORE HUMAN RESOURCES
MORE HOSPITAL / BEDS
OPTIMAL USE OF PUBLIC FACILITIES
LARGE VACANCIES
LACK SPECIALTY SERVICES
PROTECTING THE POOR FROM OOP
PAY FOR SERVICE
STRATEGIC PURCHASE
1.8 million additional beds by 2025 (Bains Report) to reach 2 beds per 1000 (In China it is 3.8 beds per 1000)
250,000 doctors for 1:1000; 1.2 Million if 2.5 doctors per 1000
Investment of US$ 60 Bill or 1.62 lakh crores
>30% of PHCs unstaffed
>80% specialist positions vacant
>85% of population not insured
A.Venkat Raman, FMS-Delhi Univ

3. Share of Private Sector in Inpatient Care in India (3 decades)
But dependence on public health facilities has risen by 6% for OPD and 7% for IPD between 2004 to mostly among rural women mostly for institutional deliveries (Janani Surakhsha Yojana)
A.Venkat Raman, FMS-DU

4. A.Venkat Raman, FMS-Delhi Univ
Kapoor, Raman , et al (2012) How Did the TB Patients Reach DOTS Services in Delhi? A Study of Patient Treatment Seeking Behavior. PLoS ONE 7(8) August
A.Venkat Raman, FMS-Delhi Univ

5. PPP/PSE MODELS IN HEALTH SECTOR
(Venkatraman, 2012)
INFRASTRUCTURE PPPs
Variants of Design, Build, Finance, Own, Operate, Lease, Transfer Models (DBF, BOO, BOOT, BOLT)
Joint Ventures
Financing (PFI, VGF)
Land/ Tax Concessions
SERVICE DELIVERY PPPs
(Clinical/ Non Clinical Services)
Contracting ('in' & 'out')
Management Contract
Co-location
Franchising
FINANCING / PURCHASING PPPs
DSF (Vouchers/ Health Cards/ Coupons
Conditional Cash)
SSF (Incentive)
Community Based Health Insurance
Social Insurance/ Illness Assistance fund
STRATEGIC PURCHASING
OTHER P.S.E. OPTIONS
Public Private Mix
Technology Demo. (e,g. Telemedicine)
Social Marketing
Drug Research
Capacity Building/ Human Resource
Self Regulation (Networks/ Alliances)
MODELS
A.Venkat Raman, FMS-DU

6. MODELS OF ENAGAGING PRIVATE SECTOR IN PRIMARY CARE
SCOPE OF SERVICES
Management Contract
Contracting Out/ In
Franchising
Social Marketing
Demand Side Financing
Supply Side Financing
Community Based Health Insurance / Social Insurance
Grant-in-Aid
Tele-health/Informatics
PHC / CHC Facility Management
MNCH/ RCH Services (Delivery, IMNCI, Birth Control)
Disease Control (TB, HIV)
Mobile Medical Units-Boats
Diagnosis/ Screening
Community Mobilization
IEC/ Advocacy/ Capacity Building
Emergency Response
Dental/ Eye Care

7. Private Sector in TB Control under UATBC, BMGF
© Bill & Melinda Gates Foundation |
© Bill & Melinda Gates Foundation

8. PHC Management Contract- Karuna Trust
© Bill & Melinda Gates Foundation |

9. AP Free Diagnostics Scheme
Source: WHO (2017) Evaluation of the Free Diagnostics Scheme in the State of Andhra Pradesh: Draft Report

10. Source: World Bank: Integrated Primary Care Model in Uttarakhand (Proposed)

11. Engage the Private Sector?….. Bah!… Yuck!! How dare!!! SELL-OFF!!!!
WHAT DOES WORKING WITH THE PRIVATE SECTOR MEAN????

12. ISSUES AND CHALLANGES Mapping Private sector and its Capacity
Diversity of capacity, quality, and regulatory oversight
Purchasing from Primary Care Providers? Interface Agency?
Political and Administrative Commitment
PSEs cannot be ‘Relational / Good faith Contracts’
Hostility towards PSE / PPP- Cognitive level distrust
Lack of Continued Dialogue with Key Stakeholders
Clarity of Objective for PSE / PPP
Define what is expected of the Private Sector under PSE? (Define level- Performance, Outcomes, Impact)
Have realistic expectations

13. Policy, Regulatory and Institutional Ecosystem
Policy based approach to Private Sector /PSE/PPP – Build Regulatory and Legal Framework
Technical and Managerial Capacity
Dedicated Organizational Units and Systems
Capacity (Expertise) to design, implement and evaluate Contracts
Dedicated Financing and Purchasing Modality
PPPs fail due to Payment Delays
Same tariffs for public and private sector under purchasing?
Costing, Tariffs and Purchasing Modality

14. States State PPP Policy Andhra Pradesh Assam Bihar Chhattisgarh Goa
PPP Legislation
PPP Guidelines
PPP Cell
Health Sector PPP Policy
Health Sector PPP Cell
Andhra Pradesh
× D √
√ F
Assam
√ P
Bihar
√ A
Chhattisgarh
Goa
Gujarat
× S
Haryana
Himachal Pradesh
Jammu and Kashmir
Jharkhand
Karnataka
Kerala
Madhya Pradesh
Maharashtra
Meghalaya
Odisha
Punjab
Rajasthan
Tamil Nadu
√ F/A
Telangana
Uttar Pradesh
Uttarakhand
West Bengal

15. No Single ‘fit all’ model for PSE Contract: Contextual Design
Private Sector
Is Private Sector is keen to partner?
Contract Design and Management:
Move away from Traditional Tendering / Procurement (Input criteria) to Performance based contracting
Clearly define the Scope of Services; KPIs; Governance Structure and Oversight; Monitoring; Dispute settlement; Renewal; Create Awareness- More detailed more Complex

16. PRIVATE SECTOR ENGAGEMENT: IDEAL STRATEGY
(Venkatraman, 2012) E
PPP/ PSE
(Infra, Delivery, Financing)
Institutional
System (Policy, Unit, Capacity-M&S, Payment)
Licensing
Regulation
STAKEHOLDERS & ECO SYSTEM
Quality & Accreditation

17. PPPs ACROSS THE WORLD (KPMG, 2017)

18. Thank you !!!