ROLE OF THE

PRIVATE SECTOR IN
DELIVERY OF HEALTH
CARE
Dr. Aruna Rabel
Medical Administration Manager
Durdans Hospital

Annual Health Forum – 2007, BMICH

 This is a joint presentation of
• Appollo Hospital
• Ceylon College of General Practitioners
• Durdans Hospital
• Glaxo Smith Kline
• Mackwoods
• Nawaloka Hospital
• Oasis Hospital
 What is the Private Sector ?

Any thing other than

Government (State or Public) Sector

- Mr.C.P.de Silva – Former Chairman Chamber of Commerce

At OPA Annual Sessions 2004
 Private Sector in Health Care

The whole gamut from

small scale pharmacies
and
General Practitioners
to
large scale hospitals and
pharmaceutical companies
 Contribution to GDP
• State Sector - 20%

• Informal Private Sector – 45%

• Formal Private Sector – 35%

 Private Sector in Health Care
• Hospitals
• General Practitioners
• Diagnostics Services
• Physiotherapy and Rehabilitation Units
• Ambulance Services
• Home Nursing Services
• Centres for Disabled
• Pharmacies
• Pharmaceutical Companies
• And many more
Health Expenditure – Sri Lanka
as a percentage share of GDP
[Source – National Health Accounts 2000 – 2002 ]
2.5 Public

Private
2

1.5

0.5

0
1990
1991
1992
1993
1994
1995
1996
1997
1998
1999
2000
2001
2002
 Number of Private Hospitals
Courtesy – Institute of Health Policies

60

50

40
<10
30 .10 - 29
.30 - 99
20
100 +
10

0
1990 1995 2000 2005
 Beds in Private Hospitals
Courtesy – Institute of Health Policies

1800
1600
1400
1200 100 +
1000 .30 - 99
800 .10 - 29
< 10
600
400
200
0
1990 1995 2000 2005
 Bed Capacity
• State : Private –
Sri Lanka -- 16 : 1
Western Province – 8 : 1

• 65 % of the Private Sector beds are in Western

Province
Performance
 Performance ( 1990 – 2005 )
• Number of Private Hospital beds - + 100 %

• Number of Inpatients - + 100 %

• Number of Out patients - + 140 %

 Performance - CABG

1400
1200
1000
800
State
600 Private
400
200
0
2001 2002 2003 2004 2005
 Performance - PTCA

900
800
700
600
500
State
400
Private
300
200
100
0
2001 2002 2003 2004 2005
 General Practice
• Full Time GPs – 600 ( CCGP )
800 ( Independent Survey)

• 2.8 / 100,000 population ( 1:35,000 people )

• 35 % of Ambulatory Care handled by GPs

Exact details of the private sector performance
is not readily available as there is no mechanism
to collect data.
 Challenges
• Investment barriers
• Infrastructure
• Human Resources
• Maintenance of High Quality Care
• Introduction of Cutting - edge Technology
• Expectations of Consumers
 History of
Public – Private Partnership
• Involvement of Traditional Health Care
Providers
• Referrals to State Hospitals by General
Practitioners
• ‘Channel Practice’ by Government Sector
Consultants
• Supply of equipment and pharmaceuticals by
private sector
 Partnership - unofficial
• State sector doctors working in private sector after working
hours

• Referrals to govt. hospitals from General Practice

• Investigations and admissions through channel consultations

• Certain investigations sent to private sector and patient bears the

cost.
 Partnership - official
• Laboratory and other diagnostic services are obtained during
trade union actions and break downs.

• Purchases – drugs
state sector monopoly was done away with open economy in
1978.

• Purchases – equipment
mainly supplied by the private sector
 Partnership - official
• President’s Fund –
assistance in major surgical procedures, treatment
abroad

• Employees’ Trust Fund

• Social Services Ministry

• Govt. employees’ insurance

 Advantages of Partnership
• Multi - sectoral collaboration

• Cost reduction

• Participatory planning

• Increased efficiency in delivery of health care

• Fill the service gap

 Advantages ……..
• Sharing of resources

• Quality assurance

• Improved community participation

• Reduced cost for health

• Confidence of donor agencies

 Outcome of Poor Partnership
• Poor utilization of available resources

• Unnecessary investments by both parties

• Increasing cost of health care

• Drawbacks in quality assurance

• Unplanned health care delivery

 Areas for partnership
• Primary Health care
• Secondary Health care
• Tertiary Care
• Training of Health Care Personnel
• Health Care Planning
• Management
 State Policy
The government will facilitate the development
and regulation of the private health care sector
and promote better coordination with this
sector.

-National Health Policy 1996

Private Sector must be enhanced and
strengthened to provide a buffer for free health
care

Hon. Nimal Siripala de Silva

Minister of Health & Nutrition
Annual Health Forum - 2007
 Need of the Hour
Public – Private Dialogue

initiated by the state

With equity and fairness

Can’t we do it now?
 Acknowledgements
• AHF – Secretariat

• Dr. Amal Harsha de Silva – Director PHSD

• Dr. Ravi Rannaneliya

Thank you