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PUBLIC PUBLIC PRIVATE PRIVATE PARTNERSHIPS PARTNERSHIPS IN IN HEALTH HEALTH CARE CARE POLICY AND PLANNING
PUBLIC PUBLIC PRIVATE PRIVATE PARTNERSHIPS PARTNERSHIPS IN IN HEALTH HEALTH CARE CARE POLICY AND PLANNING
PUBLIC PUBLIC PRIVATE PRIVATE PARTNERSHIPS PARTNERSHIPS IN IN HEALTH HEALTH CARE CARE POLICY AND PLANNING
PUBLIC PUBLIC PRIVATE PRIVATE PARTNERSHIPS PARTNERSHIPS IN IN HEALTH HEALTH CARE CARE POLICY AND PLANNING
PUBLIC PUBLIC PRIVATE PRIVATE PARTNERSHIPS PARTNERSHIPS IN IN HEALTH HEALTH CARE CARE POLICY AND PLANNING
PUBLIC PUBLIC PRIVATE PRIVATE PARTNERSHIPS PARTNERSHIPS IN IN HEALTH HEALTH CARE CARE POLICY AND PLANNING

PUBLIC PUBLIC PRIVATE PRIVATE PARTNERSHIPS PARTNERSHIPS IN IN

HEALTH HEALTH CARE CARE

POLICY AND PLANNING FRAMEWORK

The framework has been designed and developed by: Deepak Bhandari and Rajesh Jha © EPOS

The framework has been designed and developed by:

Deepak Bhandari and Rajesh Jha

© EPOS School of Health. 2008 All Rights reserved

Publisher:

Publisher:
Publisher:

EPOS School of Health

by: Deepak Bhandari and Rajesh Jha © EPOS School of Health. 2008 All Rights reserved Publisher:
by: Deepak Bhandari and Rajesh Jha © EPOS School of Health. 2008 All Rights reserved Publisher:
by: Deepak Bhandari and Rajesh Jha © EPOS School of Health. 2008 All Rights reserved Publisher:
by: Deepak Bhandari and Rajesh Jha © EPOS School of Health. 2008 All Rights reserved Publisher:
by: Deepak Bhandari and Rajesh Jha © EPOS School of Health. 2008 All Rights reserved Publisher:
by: Deepak Bhandari and Rajesh Jha © EPOS School of Health. 2008 All Rights reserved Publisher:
by: Deepak Bhandari and Rajesh Jha © EPOS School of Health. 2008 All Rights reserved Publisher:
by: Deepak Bhandari and Rajesh Jha © EPOS School of Health. 2008 All Rights reserved Publisher:
by: Deepak Bhandari and Rajesh Jha © EPOS School of Health. 2008 All Rights reserved Publisher:
by: Deepak Bhandari and Rajesh Jha © EPOS School of Health. 2008 All Rights reserved Publisher:
by: Deepak Bhandari and Rajesh Jha © EPOS School of Health. 2008 All Rights reserved Publisher:
by: Deepak Bhandari and Rajesh Jha © EPOS School of Health. 2008 All Rights reserved Publisher:
by: Deepak Bhandari and Rajesh Jha © EPOS School of Health. 2008 All Rights reserved Publisher:
by: Deepak Bhandari and Rajesh Jha © EPOS School of Health. 2008 All Rights reserved Publisher:
by: Deepak Bhandari and Rajesh Jha © EPOS School of Health. 2008 All Rights reserved Publisher:
by: Deepak Bhandari and Rajesh Jha © EPOS School of Health. 2008 All Rights reserved Publisher:
by: Deepak Bhandari and Rajesh Jha © EPOS School of Health. 2008 All Rights reserved Publisher:
by: Deepak Bhandari and Rajesh Jha © EPOS School of Health. 2008 All Rights reserved Publisher:
by: Deepak Bhandari and Rajesh Jha © EPOS School of Health. 2008 All Rights reserved Publisher:
by: Deepak Bhandari and Rajesh Jha © EPOS School of Health. 2008 All Rights reserved Publisher:
by: Deepak Bhandari and Rajesh Jha © EPOS School of Health. 2008 All Rights reserved Publisher:
by: Deepak Bhandari and Rajesh Jha © EPOS School of Health. 2008 All Rights reserved Publisher:
by: Deepak Bhandari and Rajesh Jha © EPOS School of Health. 2008 All Rights reserved Publisher:
by: Deepak Bhandari and Rajesh Jha © EPOS School of Health. 2008 All Rights reserved Publisher:
by: Deepak Bhandari and Rajesh Jha © EPOS School of Health. 2008 All Rights reserved Publisher:

POLICY AND PLANNING FRAMEWORK - PUBLIC PRIVATE PARTNERSHIPS IN HEALTH CARE

Public Private Partnerships (PPP) have begun in the heath sector. And they are here to stay. Many talk about it. Few understand its implications. Some get lost in semantics and related discussions, while others see this to be a simplistic solution for many challenges in the health sector. Result is a myriad configuration of opinions and approaches to public private partnerships in the Indian health sector today.

What has this complex configuration manifested in:

Isolated experiments with mixed results. Mismatch between the intent to venture into partnerships and the capacity to design and manage them. Design of PPP Models without much perspective thinking, planning and evidence. Implementation of initiatives without adequate preparation (environment, structures and systems). Absence of evidence and data to support the costing frameworks or to understand the financial implications.

and systems). Absence of evidence and data to support the costing frameworks or to understand the
and systems). Absence of evidence and data to support the costing frameworks or to understand the
and systems). Absence of evidence and data to support the costing frameworks or to understand the
and systems). Absence of evidence and data to support the costing frameworks or to understand the
frameworks or to understand the financial implications. Although it is widely known that public private partnerships

Although it is widely known that public private partnerships are:

not

means to an end. strategic approach to derive synergy between the comparative

strengths and weaknesses of the public and the private sectors.

a

a

an end in themselves.

public and the private sectors. a a an end in themselves. Despite this knowledge and understanding

Despite this knowledge and understanding how many times have questions like the ones below challenged us and led us to finding answers based on worldwide experience:

Can this service gap be addressed through PPP? Which services could be covered through PPP and which not? Would private partners be interested in such a partnership? If yes, to what extent and with what scope? If no, why? How to ensure that the sanctity of socially-driven service-orientation of the public sector remains undiluted and at the same time the private sector gets adequate returns (financial and non-financial) on its investments? How can the PPP Scheme be designed to ensure that private partners can get interested in joining hands? How to select the right private partners?

be designed to ensure that private partners can get interested in joining hands? How to select
be designed to ensure that private partners can get interested in joining hands? How to select
be designed to ensure that private partners can get interested in joining hands? How to select
be designed to ensure that private partners can get interested in joining hands? How to select
be designed to ensure that private partners can get interested in joining hands? How to select

If wishes were horses, chapels could have been churches. This framework could have

given us answers to all

But

the answers lie in the context within which the proposed partnership in expected to operate. One framework cannot

capture every context, because context by nature is myriad and specific.

the questions.

This framework therefore is an attempt to equip policy makers and planners with a structured tool and a sequential approach to design and implement PPPs.

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POLICY AND PLANNING FRAMEWORK - PUBLIC PRIVATE PARTNERSHIPS IN HEALTH CARE

FRAMEWORK - PUBLIC PRIVATE PARTNERSHIPS IN HEALTH CARE The Approach We recommend a nine-pronged approach to

The Approach

- PUBLIC PRIVATE PARTNERSHIPS IN HEALTH CARE The Approach We recommend a nine-pronged approach to structured

We recommend a nine-pronged approach to structured PPP design and implementation:

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approach to structured PPP design and implementation: 2 A. Policy Environment ^ B. Feasibility Assessment C.

A. Policy Environment

^

B. Feasibility Assessment

C. Designing the Partnership

D. Securing the Partnership

^

E. Enabling the Partnership

F. Managing the Partnership

^ E. Enabling the Partnership F. Managing the Partnership G. Promoting the Partnership ^ H. Regulating

G. Promoting the Partnership

^

H. Regulating the Partnership

I. Assessing the Partnership

F. Managing the Partnership G. Promoting the Partnership ^ H. Regulating the Partnership I. Assessing the
F. Managing the Partnership G. Promoting the Partnership ^ H. Regulating the Partnership I. Assessing the
F. Managing the Partnership G. Promoting the Partnership ^ H. Regulating the Partnership I. Assessing the
F. Managing the Partnership G. Promoting the Partnership ^ H. Regulating the Partnership I. Assessing the
F. Managing the Partnership G. Promoting the Partnership ^ H. Regulating the Partnership I. Assessing the
F. Managing the Partnership G. Promoting the Partnership ^ H. Regulating the Partnership I. Assessing the
F. Managing the Partnership G. Promoting the Partnership ^ H. Regulating the Partnership I. Assessing the
F. Managing the Partnership G. Promoting the Partnership ^ H. Regulating the Partnership I. Assessing the
F. Managing the Partnership G. Promoting the Partnership ^ H. Regulating the Partnership I. Assessing the
F. Managing the Partnership G. Promoting the Partnership ^ H. Regulating the Partnership I. Assessing the
F. Managing the Partnership G. Promoting the Partnership ^ H. Regulating the Partnership I. Assessing the
F. Managing the Partnership G. Promoting the Partnership ^ H. Regulating the Partnership I. Assessing the
F. Managing the Partnership G. Promoting the Partnership ^ H. Regulating the Partnership I. Assessing the
F. Managing the Partnership G. Promoting the Partnership ^ H. Regulating the Partnership I. Assessing the
F. Managing the Partnership G. Promoting the Partnership ^ H. Regulating the Partnership I. Assessing the
F. Managing the Partnership G. Promoting the Partnership ^ H. Regulating the Partnership I. Assessing the
F. Managing the Partnership G. Promoting the Partnership ^ H. Regulating the Partnership I. Assessing the
F. Managing the Partnership G. Promoting the Partnership ^ H. Regulating the Partnership I. Assessing the
F. Managing the Partnership G. Promoting the Partnership ^ H. Regulating the Partnership I. Assessing the
F. Managing the Partnership G. Promoting the Partnership ^ H. Regulating the Partnership I. Assessing the
F. Managing the Partnership G. Promoting the Partnership ^ H. Regulating the Partnership I. Assessing the
F. Managing the Partnership G. Promoting the Partnership ^ H. Regulating the Partnership I. Assessing the
F. Managing the Partnership G. Promoting the Partnership ^ H. Regulating the Partnership I. Assessing the
F. Managing the Partnership G. Promoting the Partnership ^ H. Regulating the Partnership I. Assessing the
F. Managing the Partnership G. Promoting the Partnership ^ H. Regulating the Partnership I. Assessing the

POLICY AND PLANNING FRAMEWORK - PUBLIC PRIVATE PARTNERSHIPS IN HEALTH CARE

A. Policy Environment

PRIVATE PARTNERSHIPS IN HEALTH CARE A. Policy Environment Need: Evidence-based PPP policy framework based on

Need:

Evidence-based PPP policy framework based on pre-existing policy prescriptions of the health and inter-related sectors at the central and state levels.

Tool:

Policy Document on Public Private Partnerships in the Health Sector

Implications if not addressed adequately:

the Health Sector Implications if not addressed adequately: Governments' decisions related to PPPs may be ad-hoc

Governments' decisions related to PPPs may be ad-hoc and may lack consistency. Private partners may perceive lack of commitment and lack of long term perspective and thus shy away. Serious and large private players may not be attracted in the absence of a clear statement from the government as to what lies in store for them in the longer-term. Element of mistrust on continuity may sustain among the private partners. May inhibit private partners for bringing in large investments which need longer time frame for adequate returns on investment .

private partners for bringing in large investments which need longer time frame for adequate returns on
private partners for bringing in large investments which need longer time frame for adequate returns on
private partners for bringing in large investments which need longer time frame for adequate returns on
private partners for bringing in large investments which need longer time frame for adequate returns on
private partners for bringing in large investments which need longer time frame for adequate returns on
private partners for bringing in large investments which need longer time frame for adequate returns on
private partners for bringing in large investments which need longer time frame for adequate returns on
private partners for bringing in large investments which need longer time frame for adequate returns on
private partners for bringing in large investments which need longer time frame for adequate returns on
private partners for bringing in large investments which need longer time frame for adequate returns on
private partners for bringing in large investments which need longer time frame for adequate returns on
private partners for bringing in large investments which need longer time frame for adequate returns on
private partners for bringing in large investments which need longer time frame for adequate returns on
private partners for bringing in large investments which need longer time frame for adequate returns on
private partners for bringing in large investments which need longer time frame for adequate returns on
private partners for bringing in large investments which need longer time frame for adequate returns on
private partners for bringing in large investments which need longer time frame for adequate returns on
private partners for bringing in large investments which need longer time frame for adequate returns on
private partners for bringing in large investments which need longer time frame for adequate returns on
private partners for bringing in large investments which need longer time frame for adequate returns on
private partners for bringing in large investments which need longer time frame for adequate returns on
private partners for bringing in large investments which need longer time frame for adequate returns on
private partners for bringing in large investments which need longer time frame for adequate returns on
private partners for bringing in large investments which need longer time frame for adequate returns on
private partners for bringing in large investments which need longer time frame for adequate returns on
private partners for bringing in large investments which need longer time frame for adequate returns on
private partners for bringing in large investments which need longer time frame for adequate returns on
private partners for bringing in large investments which need longer time frame for adequate returns on
private partners for bringing in large investments which need longer time frame for adequate returns on
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POLICY AND PLANNING FRAMEWORK - PUBLIC PRIVATE PARTNERSHIPS IN HEALTH CARE

FRAMEWORK - PUBLIC PRIVATE PARTNERSHIPS IN HEALTH CARE B. Feasibility Assessment Need: What are the service
FRAMEWORK - PUBLIC PRIVATE PARTNERSHIPS IN HEALTH CARE B. Feasibility Assessment Need: What are the service

B. Feasibility Assessment

Need:

PARTNERSHIPS IN HEALTH CARE B. Feasibility Assessment Need: What are the service gaps? Is PPP the

What are the service gaps? Is PPP the best way to strengthen that particular service? Is there adequate demand and captive market for that particular service? Are there adequate numbers of private providers available for that particular service? Would the private partners be interested in such partnerships? What will be the impact of PPP in a particular service on other services provided by the Government health facilities. What does it cost government to provide a particular service? Would it be cost effective as well as beneficial in terms of access, quality and utilisation to enter into PPP for a particular service?

effective as well as beneficial in terms of access, quality and utilisation to enter into PPP
effective as well as beneficial in terms of access, quality and utilisation to enter into PPP

Tool:

Methodology for feasibility study Checklists for feasibility study Costing of selected service Assessment of market practices in the private sector concerning that service

practices in the private sector concerning that service Implications if not addressed adequately: Decisions may be

Implications if not addressed adequately:

Decisions may be inappropriate and lacking evidence May be difficult to sell the proposition to
Decisions may be inappropriate and lacking evidence
May be difficult to sell the proposition to the potential private partners
Governments may not be able to scientifically determine the scope and structure of the partnership
Lack of cost related evidence will lead to irrational decisions which may cost the government dear
or lead to private partners walking out after a while
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POLICY AND PLANNING FRAMEWORK - PUBLIC PRIVATE PARTNERSHIPS IN HEALTH CARE

C. Designing the Partnership

PARTNERSHIPS IN HEALTH CARE C. Designing the Partnership Need: Partnerships need to be designed on principles

Need:

Partnerships need to be designed on principles of equity, access and demand. Essential service package needs to be designed on sound evidence. Investment and ownership patterns need to be determined. Roles, responsibilities and mutual obligations need to be clearly delineated. Standardization of inputs, processes and outputs need to be ensured through systems-based approach.

Tool:

Debriefing checklists Options Papers Group Consultations Partnership Scheme Standard Operating Procedures

Implications if not addressed adequately:

Procedures Implications if not addressed adequately: Government's intention remains inadequately known to the
Government's intention remains inadequately known to the private partners. Private partner
Government's intention remains inadequately known to the private partners.
Private partner views/reservations/concerns remain unknown until it is too late .
The PPP scheme is rejected by private partners or the response is inadequate to allow for
competition.
Standardization in service delivery and quality becomes difficult to ensure.
When the implications sink in partnerships are a casualty.
Governments find it difficult to monitor.
Accountability reduces.
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POLICY AND PLANNING FRAMEWORK - PUBLIC PRIVATE PARTNERSHIPS IN HEALTH CARE

FRAMEWORK - PUBLIC PRIVATE PARTNERSHIPS IN HEALTH CARE D. Securing the Partnership Need: For partnerships to
FRAMEWORK - PUBLIC PRIVATE PARTNERSHIPS IN HEALTH CARE D. Securing the Partnership Need: For partnerships to

D. Securing the Partnership

PARTNERSHIPS IN HEALTH CARE D. Securing the Partnership Need: For partnerships to sustain, right kinds of

Need:

For partnerships to sustain, right kinds of partners are required. Requirement of expertise and experience needs to be assessed keeping in mind the essential service package.

Tools:

Eligibility criteria for selection of partners (one-stage or two-stage depending on the nature of proposed partnership). RfQ and RfP documents. Process/checklists of assessment, selection including grading / scaling method. Memorandum of Understanding. Contract document(s)

Memorandum of Understanding. Contract document(s) Implications if not addressed adequately: Private

Implications if not addressed adequately:

Private partners' motive to enter into PPPs remains unknown Level of commitment to sustain the
Private partners' motive to enter into PPPs remains unknown
Level of commitment to sustain the partnership in a new environment remains unknown.
Lack of assessment of managerial and technical capacity may lead to irrational allocation of work
to private partners.
Will lead to higher mortality of PPPs.
Last minute dropouts of private partners when terms of agreement get known/unfold
Unscrupulous players attempt to corner partnerships.
Government's intention remains inadequately known to the private partners.
Standardization in service delivery and quality becomes difficult to ensure.
Governments find it difficult to monitor.
Accountability reduces.
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POLICY AND PLANNING FRAMEWORK - PUBLIC PRIVATE PARTNERSHIPS IN HEALTH CARE

E. Enabling the Partnership

PARTNERSHIPS IN HEALTH CARE E. Enabling the Partnership Need: Partnerships need to be enabled. Systems need

Need:

Partnerships need to be enabled. Systems need to be put in place. Capacities need to be built – capacity to manage contracts, capacity to manage partnerships, capacity to monitor and give feedback, capacity to re-plan strategically, capacity to manage finances – are some among them.

Tool:

capacity to manage finances – are some among them. Tool: Capacity needs assessment protocol / guidelines

Capacity needs assessment protocol / guidelines . Systems development / augmentation protocol based on the needs identified. Training manuals based on needs identified: audience-segment specific. Training plan with a timeframe which synchronizes with the launch of the partnerships and start of services.

Implications if not addressed adequately: Inadequate skills among the public sector representatives at different levels
Implications if not addressed adequately:
Inadequate skills among the public sector representatives at different levels who are the ground
level interface.
Overall objective may not be achieved.
Contracting authorities (State Health Departments, Rogi Kalyan Samities, District Health Societies,
Block Health Societies) may not have the capacity or the skills required to manage and monitor
contracts.
Conflict at operational levels and pre-occupation with conflict resolution at higher levels – blame
games.
Suboptimal accountability of private partners to social objectives of the PPP.
Misuse by public and private partners.
Lack of sustainability of the partnerships.
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POLICY AND PLANNING FRAMEWORK - PUBLIC PRIVATE PARTNERSHIPS IN HEALTH CARE

FRAMEWORK - PUBLIC PRIVATE PARTNERSHIPS IN HEALTH CARE F. Managing the Partnership Need: Partnerships are delicate
FRAMEWORK - PUBLIC PRIVATE PARTNERSHIPS IN HEALTH CARE F. Managing the Partnership Need: Partnerships are delicate

F. Managing the Partnership

PARTNERSHIPS IN HEALTH CARE F. Managing the Partnership Need: Partnerships are delicate especially in early years.

Need:

Partnerships are delicate especially in early years. They need to be nurtured. This requires investment of time and effort. This requires handholding, management support and on-site real time trouble shooting. It requires facilitation. PPPs require effective and timely management support along with review of rates of payment for service as soon as input cost change substantially.

for service as soon as input cost change substantially. Tool: List of process indicators, performance indicators

Tool:

List of process indicators, performance indicators and output and impact indicators. Management Information System. Guidelines and protocols for handholding, management support and on-site real time trouble shooting Market watch on trends in cost of inputs and cost of services. Terms of Reference for hiring technical and management support agency for this task.

cost of inputs and cost of services. Terms of Reference for hiring technical and management support
cost of inputs and cost of services. Terms of Reference for hiring technical and management support
cost of inputs and cost of services. Terms of Reference for hiring technical and management support
cost of inputs and cost of services. Terms of Reference for hiring technical and management support

Implications if not addressed adequately:

Private partners will flounder with initial teething operational troubles – may get disinterested. Lack of
Private partners will flounder with initial teething operational troubles – may get
disinterested.
Lack of clarity in expectations and delivery – can only get addressed over a period of time.
Unexpected delays in starting of services after the award of work / signing of
agreements.
pa
r
tnership
Governments will not be able to extend the support on their own in the initial period.
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POLICY AND PLANNING FRAMEWORK - PUBLIC PRIVATE PARTNERSHIPS IN HEALTH CARE

G. Promoting the Partnership

PARTNERSHIPS IN HEALTH CARE G. Promoting the Partnership Need: Value propositions of each PPP need to

Need:

Value propositions of each PPP need to be positioned in the population of the catchments especially amongst the disadvantaged groups to promote utilisation. Partnerships need to be promoted. Resistance pockets need to be allayed. Interest groups need to be involved. Service utilization needs to be optimized.

Tool:

Advocacy Strategy

Promotion and Marketing Plan.

Implications if not addressed adequately:

Marketing Plan. Implications if not addressed adequately: Vested interest groups may disrupt services. End users

Vested interest groups may disrupt services.

Vested interest groups may disrupt services.

End users may not know about professionalized services.

Service off-take may not be optimal.

Private operators may not have the economy of scale affecting financial viability of the scheme.

Disadvantaged population groups may be deprived of the value added service although may be entitled

as part of the deliverables from the private partner .

deprived of the value added service although may be entitled as part of the deliverables from
deprived of the value added service although may be entitled as part of the deliverables from
deprived of the value added service although may be entitled as part of the deliverables from
deprived of the value added service although may be entitled as part of the deliverables from
deprived of the value added service although may be entitled as part of the deliverables from
deprived of the value added service although may be entitled as part of the deliverables from
deprived of the value added service although may be entitled as part of the deliverables from
deprived of the value added service although may be entitled as part of the deliverables from
deprived of the value added service although may be entitled as part of the deliverables from
deprived of the value added service although may be entitled as part of the deliverables from
deprived of the value added service although may be entitled as part of the deliverables from
deprived of the value added service although may be entitled as part of the deliverables from
deprived of the value added service although may be entitled as part of the deliverables from
deprived of the value added service although may be entitled as part of the deliverables from
deprived of the value added service although may be entitled as part of the deliverables from
deprived of the value added service although may be entitled as part of the deliverables from
deprived of the value added service although may be entitled as part of the deliverables from
deprived of the value added service although may be entitled as part of the deliverables from
deprived of the value added service although may be entitled as part of the deliverables from
deprived of the value added service although may be entitled as part of the deliverables from
deprived of the value added service although may be entitled as part of the deliverables from
deprived of the value added service although may be entitled as part of the deliverables from
deprived of the value added service although may be entitled as part of the deliverables from
deprived of the value added service although may be entitled as part of the deliverables from
deprived of the value added service although may be entitled as part of the deliverables from
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POLICY AND PLANNING FRAMEWORK - PUBLIC PRIVATE PARTNERSHIPS IN HEALTH CARE

FRAMEWORK - PUBLIC PRIVATE PARTNERSHIPS IN HEALTH CARE H. Regulating the Partnership Need: Partnerships need as

H. Regulating the Partnership

PARTNERSHIPS IN HEALTH CARE H. Regulating the Partnership Need: Partnerships need as much regulation as they

Need:

Partnerships need as much regulation as they need nurturing. This provides an institutional framework for issues around licensing at the base level and accreditation at the optimal level.

Tool:

Institutional framework for a Regulatory Agency (on lines of IRDA, TRAI). Grievance Redressal System – framework, protocol, processes. Physical and service quality standards. Accreditation framework, guidelines and procedures for health care providers. Service quality audit mechanisms. Concurrent costing and cost regulation protocols .

procedures for health care providers. Service quality audit mechanisms. Concurrent costing and cost regulation protocols .
procedures for health care providers. Service quality audit mechanisms. Concurrent costing and cost regulation protocols .
procedures for health care providers. Service quality audit mechanisms. Concurrent costing and cost regulation protocols .
procedures for health care providers. Service quality audit mechanisms. Concurrent costing and cost regulation protocols .
procedures for health care providers. Service quality audit mechanisms. Concurrent costing and cost regulation protocols .

Implications if not addressed adequately:

Sub-standard quality in service delivery.

Variations in quality and service delivery across different service sites.

Prices may go beyond the paying capacity of people.

Private partners bringing in huge investments may not have confidence in the absence of an

independent regulator . Small disputes remain unaddressed; snowball into persistent conflict and walk outs by private players; unnecessary litigation.

disputes remain unaddressed; snowball into persistent conflict and walk outs by private players; unnecessary litigation.
disputes remain unaddressed; snowball into persistent conflict and walk outs by private players; unnecessary litigation.
disputes remain unaddressed; snowball into persistent conflict and walk outs by private players; unnecessary litigation.
disputes remain unaddressed; snowball into persistent conflict and walk outs by private players; unnecessary litigation.
disputes remain unaddressed; snowball into persistent conflict and walk outs by private players; unnecessary litigation.
disputes remain unaddressed; snowball into persistent conflict and walk outs by private players; unnecessary litigation.
disputes remain unaddressed; snowball into persistent conflict and walk outs by private players; unnecessary litigation.
disputes remain unaddressed; snowball into persistent conflict and walk outs by private players; unnecessary litigation.
disputes remain unaddressed; snowball into persistent conflict and walk outs by private players; unnecessary litigation.
disputes remain unaddressed; snowball into persistent conflict and walk outs by private players; unnecessary litigation.
disputes remain unaddressed; snowball into persistent conflict and walk outs by private players; unnecessary litigation.
disputes remain unaddressed; snowball into persistent conflict and walk outs by private players; unnecessary litigation.
disputes remain unaddressed; snowball into persistent conflict and walk outs by private players; unnecessary litigation.
disputes remain unaddressed; snowball into persistent conflict and walk outs by private players; unnecessary litigation.
disputes remain unaddressed; snowball into persistent conflict and walk outs by private players; unnecessary litigation.
disputes remain unaddressed; snowball into persistent conflict and walk outs by private players; unnecessary litigation.
disputes remain unaddressed; snowball into persistent conflict and walk outs by private players; unnecessary litigation.
disputes remain unaddressed; snowball into persistent conflict and walk outs by private players; unnecessary litigation.
disputes remain unaddressed; snowball into persistent conflict and walk outs by private players; unnecessary litigation.
disputes remain unaddressed; snowball into persistent conflict and walk outs by private players; unnecessary litigation.
disputes remain unaddressed; snowball into persistent conflict and walk outs by private players; unnecessary litigation.
disputes remain unaddressed; snowball into persistent conflict and walk outs by private players; unnecessary litigation.
disputes remain unaddressed; snowball into persistent conflict and walk outs by private players; unnecessary litigation.
disputes remain unaddressed; snowball into persistent conflict and walk outs by private players; unnecessary litigation.
disputes remain unaddressed; snowball into persistent conflict and walk outs by private players; unnecessary litigation.
disputes remain unaddressed; snowball into persistent conflict and walk outs by private players; unnecessary litigation.

POLICY AND PLANNING FRAMEWORK - PUBLIC PRIVATE PARTNERSHIPS IN HEALTH CARE

I. Assessing the Partnership

PARTNERSHIPS IN HEALTH CARE I. Assessing the Partnership Need: Ongoing assessment and monitoring is important. It

Need:

Ongoing assessment and monitoring is important. It helps in ensuring whether the desired objectives are being met or not. It helps to take strategic and operational mid-course corrections, if required. This may give insights into amendments in Partnership Scheme and Standard Operating Procedures based on what is working and what not.

Tool:

Procedures based on what is working and what not. Tool: List of indicators for assessment. Assessment

List of indicators for assessment. Assessment design and methodology. Study instruments . Framework for baseline, concurrent and annual assessments.

Implications if not addressed adequately:

Unable to assess whether things are moving on track or not.

Mid-course corrections and justifiable amendments to the Scheme and SOP may not be possible rendering the Scheme and SOP irrelevant.

and justifiable amendments to the Scheme and SOP may not be possible rendering the Scheme and
and justifiable amendments to the Scheme and SOP may not be possible rendering the Scheme and
and justifiable amendments to the Scheme and SOP may not be possible rendering the Scheme and
and justifiable amendments to the Scheme and SOP may not be possible rendering the Scheme and
and justifiable amendments to the Scheme and SOP may not be possible rendering the Scheme and
and justifiable amendments to the Scheme and SOP may not be possible rendering the Scheme and
and justifiable amendments to the Scheme and SOP may not be possible rendering the Scheme and
and justifiable amendments to the Scheme and SOP may not be possible rendering the Scheme and
and justifiable amendments to the Scheme and SOP may not be possible rendering the Scheme and
and justifiable amendments to the Scheme and SOP may not be possible rendering the Scheme and
and justifiable amendments to the Scheme and SOP may not be possible rendering the Scheme and
and justifiable amendments to the Scheme and SOP may not be possible rendering the Scheme and
and justifiable amendments to the Scheme and SOP may not be possible rendering the Scheme and
and justifiable amendments to the Scheme and SOP may not be possible rendering the Scheme and
and justifiable amendments to the Scheme and SOP may not be possible rendering the Scheme and
and justifiable amendments to the Scheme and SOP may not be possible rendering the Scheme and
and justifiable amendments to the Scheme and SOP may not be possible rendering the Scheme and
and justifiable amendments to the Scheme and SOP may not be possible rendering the Scheme and
and justifiable amendments to the Scheme and SOP may not be possible rendering the Scheme and
and justifiable amendments to the Scheme and SOP may not be possible rendering the Scheme and
and justifiable amendments to the Scheme and SOP may not be possible rendering the Scheme and
and justifiable amendments to the Scheme and SOP may not be possible rendering the Scheme and
and justifiable amendments to the Scheme and SOP may not be possible rendering the Scheme and
and justifiable amendments to the Scheme and SOP may not be possible rendering the Scheme and
and justifiable amendments to the Scheme and SOP may not be possible rendering the Scheme and
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POLICY AND PLANNING FRAMEWORK - PUBLIC PRIVATE PARTNERSHIPS IN HEALTH CARE

POLICY AND PLANNING FRAMEWORK - PUBLIC PRIVATE PARTNERSHIPS IN HEALTH CARE

POLICY AND PLANNING FRAMEWORK - PUBLIC PRIVATE PARTNERSHIPS IN HEALTH CARE
FRAMEWORK - PUBLIC PRIVATE PARTNERSHIPS IN HEALTH CARE Conclusion The framework suggested in this handbook is

Conclusion

The framework suggested in this handbook is a crystallization of hands-on experience of designing and managing PPPs in health care. The framework has evolved by learning while doing.

care. The framework has evolved by learning while doing. For further information regarding: Technical Assistance in

For further information regarding:

Technical Assistance in Design and Management Support:

Head, Public Health Division EPOS Health India

For Capacity Building and Training Support:

12
12

CEO, EPOS School of Health; and Senior Vice President, EPOS Health India

For Capacity Building and Training Support: 12 CEO, EPOS School of Health; and Senior Vice President,
For Capacity Building and Training Support: 12 CEO, EPOS School of Health; and Senior Vice President,
For Capacity Building and Training Support: 12 CEO, EPOS School of Health; and Senior Vice President,
For Capacity Building and Training Support: 12 CEO, EPOS School of Health; and Senior Vice President,
For Capacity Building and Training Support: 12 CEO, EPOS School of Health; and Senior Vice President,
For Capacity Building and Training Support: 12 CEO, EPOS School of Health; and Senior Vice President,
For Capacity Building and Training Support: 12 CEO, EPOS School of Health; and Senior Vice President,
For Capacity Building and Training Support: 12 CEO, EPOS School of Health; and Senior Vice President,
For Capacity Building and Training Support: 12 CEO, EPOS School of Health; and Senior Vice President,
For Capacity Building and Training Support: 12 CEO, EPOS School of Health; and Senior Vice President,
For Capacity Building and Training Support: 12 CEO, EPOS School of Health; and Senior Vice President,
For Capacity Building and Training Support: 12 CEO, EPOS School of Health; and Senior Vice President,
For Capacity Building and Training Support: 12 CEO, EPOS School of Health; and Senior Vice President,
For Capacity Building and Training Support: 12 CEO, EPOS School of Health; and Senior Vice President,
For Capacity Building and Training Support: 12 CEO, EPOS School of Health; and Senior Vice President,
For Capacity Building and Training Support: 12 CEO, EPOS School of Health; and Senior Vice President,
For Capacity Building and Training Support: 12 CEO, EPOS School of Health; and Senior Vice President,
For Capacity Building and Training Support: 12 CEO, EPOS School of Health; and Senior Vice President,
For Capacity Building and Training Support: 12 CEO, EPOS School of Health; and Senior Vice President,
For Capacity Building and Training Support: 12 CEO, EPOS School of Health; and Senior Vice President,
For Capacity Building and Training Support: 12 CEO, EPOS School of Health; and Senior Vice President,
For Capacity Building and Training Support: 12 CEO, EPOS School of Health; and Senior Vice President,
For Capacity Building and Training Support: 12 CEO, EPOS School of Health; and Senior Vice President,
For Capacity Building and Training Support: 12 CEO, EPOS School of Health; and Senior Vice President,
For Capacity Building and Training Support: 12 CEO, EPOS School of Health; and Senior Vice President,
For Capacity Building and Training Support: 12 CEO, EPOS School of Health; and Senior Vice President,
To be a Leading Multidimensional Resource Organisation Providing Turnkey Solutions for Health Care Service Providers

To be a Leading Multidimensional Resource Organisation Providing Turnkey Solutions for Health Care Service Providers in the Public, Private & Voluntary Sectors.

Providers in the Public, Private & Voluntary Sectors. EPOS School of Health is a leading institution
Providers in the Public, Private & Voluntary Sectors. EPOS School of Health is a leading institution

EPOS School of Health is a leading institution for learning and excellence in training, teaching and research to build up, augment and sustain skilled human capital to meet effectively the ever emerging challenges, needs and priorities of the health sector.

sustain skilled human capital to meet effectively the ever emerging challenges, needs and priorities of the
sustain skilled human capital to meet effectively the ever emerging challenges, needs and priorities of the
sustain skilled human capital to meet effectively the ever emerging challenges, needs and priorities of the
sustain skilled human capital to meet effectively the ever emerging challenges, needs and priorities of the
sustain skilled human capital to meet effectively the ever emerging challenges, needs and priorities of the
sustain skilled human capital to meet effectively the ever emerging challenges, needs and priorities of the
sustain skilled human capital to meet effectively the ever emerging challenges, needs and priorities of the
sustain skilled human capital to meet effectively the ever emerging challenges, needs and priorities of the
sustain skilled human capital to meet effectively the ever emerging challenges, needs and priorities of the
sustain skilled human capital to meet effectively the ever emerging challenges, needs and priorities of the
sustain skilled human capital to meet effectively the ever emerging challenges, needs and priorities of the
sustain skilled human capital to meet effectively the ever emerging challenges, needs and priorities of the
sustain skilled human capital to meet effectively the ever emerging challenges, needs and priorities of the
sustain skilled human capital to meet effectively the ever emerging challenges, needs and priorities of the
EPOS Health India Pvt. Ltd E-mail- eposHQ@epos.in EPOS School Of Health E-mail- schoolofhealth@epos.in 445 Udyog
EPOS Health India Pvt. Ltd E-mail- eposHQ@epos.in EPOS School Of Health E-mail- schoolofhealth@epos.in 445 Udyog
EPOS Health India Pvt. Ltd E-mail- eposHQ@epos.in EPOS School Of Health E-mail- schoolofhealth@epos.in 445 Udyog
EPOS Health India Pvt. Ltd E-mail- eposHQ@epos.in EPOS School Of Health E-mail- schoolofhealth@epos.in 445 Udyog
EPOS Health India Pvt. Ltd E-mail- eposHQ@epos.in EPOS School Of Health E-mail- schoolofhealth@epos.in 445 Udyog
EPOS Health India Pvt. Ltd E-mail- eposHQ@epos.in EPOS School Of Health E-mail- schoolofhealth@epos.in 445 Udyog
EPOS Health India Pvt. Ltd E-mail- eposHQ@epos.in EPOS School Of Health E-mail- schoolofhealth@epos.in 445 Udyog
EPOS Health India Pvt. Ltd E-mail- eposHQ@epos.in EPOS School Of Health E-mail- schoolofhealth@epos.in 445 Udyog
EPOS Health India Pvt. Ltd E-mail- eposHQ@epos.in EPOS School Of Health E-mail- schoolofhealth@epos.in 445 Udyog
EPOS Health India Pvt. Ltd E-mail- eposHQ@epos.in EPOS School Of Health E-mail- schoolofhealth@epos.in 445 Udyog
EPOS Health India Pvt. Ltd E-mail- eposHQ@epos.in EPOS School Of Health E-mail- schoolofhealth@epos.in 445 Udyog
EPOS Health India Pvt. Ltd E-mail- eposHQ@epos.in EPOS School Of Health E-mail- schoolofhealth@epos.in 445 Udyog
EPOS Health India Pvt. Ltd E-mail- eposHQ@epos.in EPOS School Of Health E-mail- schoolofhealth@epos.in 445 Udyog
EPOS Health India Pvt. Ltd E-mail- eposHQ@epos.in EPOS School Of Health E-mail- schoolofhealth@epos.in 445 Udyog
EPOS Health India Pvt. Ltd E-mail- eposHQ@epos.in EPOS School Of Health E-mail- schoolofhealth@epos.in 445 Udyog
EPOS Health India Pvt. Ltd E-mail- eposHQ@epos.in EPOS School Of Health E-mail- schoolofhealth@epos.in 445 Udyog

EPOS

EPOS Health India Pvt. Ltd E-mail- eposHQ@epos.in EPOS School Of Health E-mail- schoolofhealth@epos.in 445 Udyog Vihar,

Health India Pvt. Ltd

E-mail- eposHQ@epos.in

EPOS Health India Pvt. Ltd E-mail- eposHQ@epos.in EPOS School Of Health E-mail- schoolofhealth@epos.in 445 Udyog Vihar,
EPOS Health India Pvt. Ltd E-mail- eposHQ@epos.in EPOS School Of Health E-mail- schoolofhealth@epos.in 445 Udyog Vihar,
EPOS Health India Pvt. Ltd E-mail- eposHQ@epos.in EPOS School Of Health E-mail- schoolofhealth@epos.in 445 Udyog Vihar,
EPOS Health India Pvt. Ltd E-mail- eposHQ@epos.in EPOS School Of Health E-mail- schoolofhealth@epos.in 445 Udyog Vihar,
EPOS Health India Pvt. Ltd E-mail- eposHQ@epos.in EPOS School Of Health E-mail- schoolofhealth@epos.in 445 Udyog Vihar,
EPOS Health India Pvt. Ltd E-mail- eposHQ@epos.in EPOS School Of Health E-mail- schoolofhealth@epos.in 445 Udyog Vihar,
EPOS Health India Pvt. Ltd E-mail- eposHQ@epos.in EPOS School Of Health E-mail- schoolofhealth@epos.in 445 Udyog Vihar,
EPOS Health India Pvt. Ltd E-mail- eposHQ@epos.in EPOS School Of Health E-mail- schoolofhealth@epos.in 445 Udyog Vihar,
EPOS Health India Pvt. Ltd E-mail- eposHQ@epos.in EPOS School Of Health E-mail- schoolofhealth@epos.in 445 Udyog Vihar,

EPOS School Of Health E-mail- schoolofhealth@epos.in

445 Udyog Vihar, Phase III, Gurgaon 122016 Tel: 91-124-4264900, Fax: 91-124-4264906, visit us at : www.epos.in

Fax: 91-124-4264906, visit us at : www.epos.in EPOS Health Consultants GmbH Hindenburgring 18 D-61348 Bad

EPOS Health Consultants GmbH Hindenburgring 18 D-61348 Bad Homburg, Germany Homepage : www.epos.de

us at : www.epos.in EPOS Health Consultants GmbH Hindenburgring 18 D-61348 Bad Homburg, Germany Homepage :