Public models in action are Contracting management of

PublicPrivate Partnership in Health CareExploringThe Possibilities      Needfor PPP            At present ,one side we are seeing virtualbreakdown of public health system due to known causes like overload ofpatients, inadequate health budget, increasing deficiencies ,poor image andother side, rapid expansion and dominance of private health sector. At present70 % of people are using private health sector which is expensive,commercialized and mostly unregulated. Most of expenditure in private healthsector is out of pocket by patients which lead to debilitating effects on thepoor. Given respective strengths andweaknesses, neither the public sector nor private sector alone is in the bestinterest of the health system, so need arises for collaboration of Publicand Private sector to achieve goal of Universal Health Care.

 Definition of PPPPPP means to bring togethera set of actors for the common goal of improving the health of a populationbased on the mutually agreed roles and principles” (WHO 1999)Benefitsof working with PPP   Benefits of working with private sector are improve access & reach, better Efficiency, opportunityto regulate & accountability ,improvequality/ rational practice ,imbibe bestpractices ,augment resources- funds, technology, HR . PPP encompassesacollaborative relationship between the partners with clear terms and conditions, Clear partner obligations,Clear performance indicators within stipulatedtime period with overall healthobjectives . Partnerships entail, relative equalitybetween partners, mutual commitment to health objectives, autonomy for each partner,shared decision-making and accountability, equitable returns / outcomes,benefits to the stakeholders.    Common PPP models   Common PPP models are Contracting (‘in’ and’out’) ,Build/ Rehabilitate,Operate, Transfer ,Demand/Supply Side Financing ,JointVentures ,Mobile Health Units ,Telemedicine ,Franchising ,SocialMarketing ,Public-Private Mix. Some of the selected PPP models in action are Contractingmanagement of Primary health Centres and Community Health Centres, Contracting management of Super Speciality Hospitalsin which 30-40 % beds are allotted for poor patients and free OPD services topoor are given, Contracting management of CT and MRI diagnostics which is free for all poor patients and subsidized rate for others, Demand side financing forinstitutional delivery and infant care in which Institutionaldeliveries through private obstetricians ,primarily for women from poorfamilies,Community based health insurance in which expenses for Hospitalization was given for  Members of farmers’ co-operatives and theirdependents,Mobile health clinics in which clinical diagnosis was done ,Telemedicine.

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 Issuesand challenges in PPP MostPPPs are “Initiatives in Good Faith,Not Policy driven ,No Institutionalstructures or Institutional Capacity for PPPs. Issues in privatesector:Diversityof private sector, PredominantlyIndividual / small units-not easy to contract.,Variable Quality -Lack ofRegulation / AccreditationRisk of working with Govt: Payment Delays,Non-Revision of contracts; Auditing, Incompatible work culture Lack of political commitmentBureaucracy suspect privatisation; Fear Job Loss;Distrust private sectorConstraints on PPP•Defining Beneficiaries in High value services•Local political interference•Non-revision Contract •Payment Delay •Attitude / PersonalityStyles  Way Forward  Health Sector Specific PPP Policy withFinancing Options•Institutional Framework (PPP Cell) andCapacity building• Accreditation & Physical Standards•EffectiveLicensing and Regulation   Summary  ·       Working with Private Sector is inevitable·       PPPs improves access & reduces OOP(Out of Pocket)·       PPP is not privatization·       Need capacity to optimise benefits·       Continue strengthen public sector abilityto deliver services  –        DrPravin Yerpude,Dept of Community Medicine,GAIMS,Bhuj         

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