PUBLIC PRIVATE

PARTNERSHIP
IN
HEALTH SECTOR
DR. SANGITA RAI
JUNIOR RESIDENT 2017
SPH & CM
18TH NOV 2019
Context
• Introduction
• Objectives
• Models of Public – Private Partnership
• Public-Private partnership Policy
• Challenges
• Conclusion
What is a public-private partnership?
• First, these partnerships involve at least one
private for-profit organization and at least one
not-for-profit or public organization.

• Second, the partners have some shared objectives

for the creation of social value.

• Finally, the core partners agree to share both

efforts and benefits.
Public Private Partnership in Health
Sector

A collaborative efforts, between private and public

sectors, with clearly identified partnership
structures, shared objectives and specified
performance indicators for delivery of a set of
health services in a stipulated time period.
“A long-term contract between a private party and a
government entity, for providing a public asset or
service, in which the private party bears significant
risk and management responsibility, and
remuneration is linked to performance.”

(World Bank 2016)

Public Private Partnership has goals of improving
the accessibility, availability and penetration of
quality services.

• Improving healthcare delivery

• Increasing mobilization of resources for

healthcare from different sources.
 What is Public Organization for PPP?

Its comprise of the government spending the tax revenues

on health and the individual spending out of pocket for
their healthcare.
MoHP and its agencies
Other ministries
Social insurance institutions
Local government units

National Research Institues/NHRC

Public health education facilities are examples of

public for PPP
The strength of the Public sector
• Works on a very large scale; can utilize economics of
scale
• A lot of technical and professional expertise exists in
the system
• Presence in the rural and inaccessible
• More equitable
 What is Private Organization for PPP ?

• It consists of for profit and not-for-profit sectors. The

private partners involved in the PPP initiatives also
include corporate institutions, non-governmental
organizations , community based organization etc and
even individuals interested in contributing to the
creation in an area.
• Individual practitioners
• Associations of practitioners
• I/NGOs
• Cooperatives
• Community organizations
• Civil society networks
• Private companies/association
• Private hospitals
• Private research institutions are examples of private
organizations for PPP
 The strength of private Sector
• Presence at all levels of the community
• Viable enterprises, many of them with good business
models
• Many of them have good market presence, with plenty
of clients
• Good management systems
• Efficiency is higher
• Flexibility to act independently at a short notice
 Public –Private Equailibrium

Public sector Private sector

Advantages Advantages
Improvement in health (primary objective) Market/choice and Access
Economies of scale and more equitable Efficiency and flexibility
Thing to watch Thing to watch

Efficiency Primary objectives is profit

Inflexibility/responsiveness Quality of services
Customer satisfaction Cost

•
There are four key factors driving governments
worldwide to use the PPP model for health sector
improvements:

• Desire to improve operation of public health services and

facilities and to expand access to higher quality services

• Opportunity to leverage private investment for the

benefit of public services
• Desire to formalize arrangements with non-profit
partners who deliver an important share of public
services

• More potential partners for governments as

private healthcare sector matures
Figure :- Health system building blocks
KEY GUIDING PRINCIPLES

• Sustained collaboration among public, civil society,

cooperatives, community or private organizations in
order to maximize access, quality, equity and
effectiveness.

• Contribution to the design, financing and

project implementation according to each partner’s
abilities, capacities and needs.
• Each partner taking on managing risks related
to the benefits to be achieved from the mutual
objectives.

• To develop and coordinate government/ non-

governmental partnerships in such a way as to
strengthen the capacity of the public sector in
the long run.
• Joint action at all stages from planning, follow
up and termination.

• Complimentary roles expectation of each other

are clarified from the very onset.

• Continuous Communication lines of

communication between partners should be always
kept open.
Table 1 : Elements of public-private partnership
 Essentials for PPP
• To strengthen public sector and implementation of
national health policies.

• To enhance equity, efficiency and effectiveness (a major

focus of reform).

• To reduce both duplication and gaps in health services.

• To promote innovation and equitable access to the fruits

of innovation.
 The main objective is
• To achieve the maximum benefit from public-private
partnerships without compromising public interest.

• Universal coverage and equity.

• Improving quality, accessibility, acceptance and

efficiency of health services.

• Exchange of skills and expertise between the public

and private sectors.
• Improve the efficiency in allocation of resources and
additional resource generation.

• Strengthening the existing health infrastructure and

Mobilizations of additional services.

• Widening the range of services.

• Community ownership.
Factors influencing PPP
HYPOTHESISED BENEFITS (of working
with Private Sector)

• Improve Access & Reach

• Improve Equity (Reduce out of pocket expenses)
• Better Efficiency
• Opportunity to Regulate & Accountability
• Improve Quality/ Rational Practice
• Imbibe Best practices
• Augment Resources- Funds, Technology, HR
PPP MODELS
• Contracting (‘in’ and ‘out’)
• Build/ Rehabilitate, Operate, Transfer
• Demand/ Supply Side Financing
• Joint Ventures
• Mobile Health Units
• Franchising
• Social Marketing
• Public-Private Mix
Types of PPP models supported
Types of PPP models supported
Defining Categories of (PPP) Public Private
Partnerships
Straight approach to PPP
• Identifying the scope of partnership
• Identifying the appropriate target Population
• Selecting the right partners and model
• Ensuring Accountability
• Ensure active involvement of the government
• Generate support of stakeholders through advocacy
and rapport building
• Highlight achievements
• Build Trust of all the partners and clients
Model of PPP in Nepal
1. Service contracts:
Blood transfusion services with Nepal Red Cross
society.
Family Planning services with Family Planning
Association of Nepal.
Safe abortion services with Mary Stopes clinics.
Eye service with Natra Jyoti Sangh
2. Management Contract:

• Lamjung District Hospital and Dadeldhura hospital

with NGO (Human development and community
services)
• Jiri Hospital with local community, Tansen mission
hospital, Rukum chaurajahari hospital, okhaldhunga
community hospital.
3. Build, own, operate and transfer (BOOT):

• Maternity hospital, Thapathali- by Paropkar, a national

NGO.
• Phaplu Hospital, Phapalu – Himalayan Trust
• Am Pipal Hospital, Goraka- UMN/ local community
• Manipal Medical College, Pokhara – 50 years contract.
• Bharatpur Medical College – 50 years contract
• Build and transfer: Lahan hospital, several eye
hospitals.
• Build, operate and transfer: Trisuli Hospital,
Nuwakot
• Build, transfer and operate: Western regional
hospital, Pokhara with INF
4. Joint venture:
Nepal Eye Hospital
5. Leasing:
Pharmacy services in several hospitals.
6.Contracting via social franchising:
Potential model for drug supply management.
7. Contracting+Pay for performance (P4P)
Prevention and surgery of uterine prolapsed cases
 Social Marketing
“The adaptation and adoption of commercial marketing
activities, institutions and processes as a means to
introduce behavioral change on a temporary or permanent
basis”. (World Social Marketing Conference, 2007)

Social marketing seeks to impact personal behavior by

persuading target audiences to:
• Avoid risky practices (e.g., smoking)
• Take preventive measures (e.g., safety belts)
• increase fruit and vegetable consumption and decrease fat
consumption
• promote breastfeeding
• Promote oral rehydration
• Reduce HIV risk behavior
• Combat various NCDS, promote physical activity
• Family planning
A GLOBAL PERSPECTIVE ABOUT
PPP
• On the database of the Public-Private Partnerships for
Health of the Global Forum for Health Research lists 91
international partnership arrangements in the health
sector, which can qualify to be called public-private
partnerships.
• Out of these, 76 are dedicated to infectious disease
prevention and control, notably AIDS, tuberculosis and
malaria; four focus on reproductive health issues, three on
nutritional deficiencies whereas a minority focus on other
issues.
• The public-private arrangements are raised both when
governments and inter-governmental agencies
interface with the for-profit private sector to tap into
resources, or the non-profit private sector for
technical expertise or outreach.

• Several varieties of arrangements of various sizes,

forms and scope at a global, regional or country level
qualify to fall within this categorization.
• Depending upon their structure, they may bring
together several governments, local and international
NGOs, research institutions and UN agencies in
transnational programs, often also involving the non-
profit sector.

• Such partnerships can be contained and coordinated

by different sources .
They can be owned by the pubic sector and
have private sector participants such as

Global Alliance for Vaccines and Immunization

(GAVI), Roll Back Malaria (RBM) , Stop TB
partnership (Stop TB) , Safe Injections Global Network
(SIGN) , Global Polio Eradication Programme (PEI) ,
the Special Programme for Research and Training in
Tropical Diseases (TDR), and
the Special Programme for Research Development and
Research Training in Human Reproduction (HRP).
 There are eight principal aspects to the
protocol for effectiveness
1.The relationship between the public and private sectors.
2. The nature of the partnership between public and private
sector participants.
3. The financial arrangements of the PPP project.
4. The government policy enacted to promote partnership
efforts.
5. Identification and quantification of PPP outcomes.
6. Assessing issues of equity.
7. Identifying the potential weakness of the analysis.
SDG
• PPP is the one of the targets for the third
Sustainable Development Goal ensuring healthy
lives and promoting well-being for all is to
achieve universal health coverage, including
financial risk protection, access to quality
essential health care services, and access to safe,
effective, and affordable essential medicines and
vaccines for all
Reference
• https://thehimalayantimes.com/opinion/public-private-partnership-new-
model-healthcare/

• http://globalhealthgovernance.org/blog/2017/5/26/p11nd55ehaabf5n16pnqtm
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