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CLICK TO ADD TITLE [DATE][SPEAKERS NAMES] The 6th Global Health Supply Chain Summit November 18 -20, 2013 Addis Ababa, Ethiopia 1 PUBLIC-PRIVATE PARTNERSHIP.

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Presentation on theme: "CLICK TO ADD TITLE [DATE][SPEAKERS NAMES] The 6th Global Health Supply Chain Summit November 18 -20, 2013 Addis Ababa, Ethiopia 1 PUBLIC-PRIVATE PARTNERSHIP."— Presentation transcript:

1 CLICK TO ADD TITLE [DATE][SPEAKERS NAMES] The 6th Global Health Supply Chain Summit November 18 -20, 2013 Addis Ababa, Ethiopia 1 PUBLIC-PRIVATE PARTNERSHIP IN HEALTH SERVICES IN INDIA: MODELS & CHALLENGES A.Venkat Raman Faculty of Management Studies University of Delhi, India avr@fms.edu

2 HEALTH SYSTEM IN INDIA: PUBLIC & PRIVATE SECTORS Click to add text Health service delivery is provincial responsibility Vast, but poorly funded, staffed, and ill-equipped public sector health system Rapid, Rampant, Unregulated growth of private sector A.VENKATRAMAN-FMS,DU-INDIA 2

3 Private Sector in Service Provision Pvt. Sector- Hospitalization ( NSSO-2005) Pvt. Sector-Outpatients (NSSO:2005) Pvt. Diagnostics-Rural areas (NCMH,2005) A.VENKATRAMAN-FMS,DU-INDIA 3

4 4 Who Pays for the Services? (NHA-2004-05) Unregulated private sector and its behavior - effect on the poor But Private sector is indispensable A.VENKATRAMAN-FMS,DU-INDIA

5 WHY PPP IN HEALTH SECTOR? Given respective strengths and weaknesses, neither the public sector nor private sector alone is in the best interest of the health system PPP COULD POTENTIALLY –Improve Access –Reduce OOPE –Better Efficiency –Opportunity to Regulate –Improve Quality (rational practices) –Imbibe Best practices –Augment Resources A.VENKATRAMAN-FMS,DU-INDIA5

6 BUT WHAT IS PPP? o Rhetorical and Ideological Polarized views Financing vs Delivery: Public vs Private modes (Bloom, 2001) A.VENKATRAMAN-FMS,DU-INDIA 6

7 PPP MODELS IN HEALTH SECTOR (Venkat Raman, 2012) INFRASTRUCTURE PPP Variants of Design, Build, Finance, Own, Operate, Lease, Transfer Models (BOO, BOOT, BOLT) Joint Ventures PFI-VGF Land/ Tax Concessions SERVICE DELIVERY PPP Contracting ('in' & 'out') Management Contract Co-location Franchising FINANCIAL PROTECTION PPP Vouchers/ Health Cards/ Coupons Conditional Cash / Incentive Community Based Insurance / Microfinance Social Insurance State Illness Assistance fund OTHER MODELS Public Private Mix Technology Enablers (Telemedicine) Social Marketing / Health Promotion Training, Research, Capacity Buidling Regulation & Governance Networks/ Alliances PPP MODELS A.VENKATRAMAN-FMS,DU-INDIA7

8 HEALTH SERVICE PPP MODELS IN INDIA A.VENKATRAMAN-FMS,DU-INDIA 8

9 HEALTH SERVICE PPP MODELS IN INDIA A.VENKATRAMAN-FMS,DU-INDIA 9

10 CHALLENGES: 1. MINISTRY OF HEALTH Most PPPs are “Initiatives in Good Faith”: Lack of Policy Driven Strategy thus lack of continuity No Institutional structures to manage or lack of Institutional Capacity for PPPs Primarily Input-Based contracting A.VENKATRAMAN-FMS,DU-INDIA10

11 CHALLENGES: 2. PRIVATE SECTOR Diversity of Private Sector: Predominantly Individual run units- not easy to contract. Variable Quality - Lack of Accreditation or Regulation Risk of working with Govt.: Payment Delays, Auditing, Incompatible work culture…… A.VENKATRAMAN-FMS,DU-INDIA 11

12 CHALLENGES: 3. BUREAUCRACY & HEALTH STAFF Senior Bureaucracy: Often Enthusiastic- Pro reform image; but success takes them away View PPP from Infrastructure framework Health Staff/ Lower Bureaucracy: Do not comprehend or suspect PPP as privatisation- Fear job loss; Distrust private sector A.VENKATRAMAN-FMS,DU-INDIA12

13 CHALLENGES: 4. PERSPECTIVES OF POLITICAL & CIVIL SOCIETY GROUPS Cultural stereotype/ antipathy/ squeamishness towards private sector or term “profit” Govt.’s inability to regulate compounds scepticism on ability to manage PPP Long Term Sustainability – what happens to Public sector capacity? A.VENKATRAMAN-FMS,DU-INDIA13

14 IN CONCLUSION Working with Private Sector is inevitable PPP does improve access and reduce OOP (Venkat Raman & La Forgia, 2013) PPP portend huge potential….. But Policy, Institutional capacity, Regulatory systems and Accreditation systems are must for sustainable PPP A.VENKATRAMAN-FMS,DU-INDIA14

15 THANK YOU References: Book: A.Venkat Raman & J.W.Bjorkman. 2009. Public Private Partnership in Health Care in India: Lessons for Developing Countries. Routledge. London. Web-link: http://south.du.ac.in/fms/idpad/idpad.html A.VENKATRAMAN-FMS,DU-INDIA15

16 A.VENKATRAMAN-FMS,DU-INDIA16

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