• Public-Private partnerships

Public-Private partnerships

This paper describes the design, development and implementation of a Public Private Partnership (PPP) for managing urban health services in Ahmedabad city in the Indian state of Gujarath.

It also presents an analysis of a wide range of  PPP arrangements in social services through case studies located in rural and urban areas across India.These include diagnostic services, curative care, maternal health services, child development services, health promotion activities and food catering services.

The case studies are analysed under two main frameworks:

• operational issues in PPP and policy related issues in PPP
• contracting as the predominant model of PPP

Based on the analysis, the authors note that:

• while the forms of partnerships vary, there is little evidence to indicate the relative merits of any one form of PPP over the others
• little is known about the scope and coverage of the services under partnership with the private sector in India
• there is a dearth of research indicating the institutional capacity of government agencies to design, negotiate, implement and monitor such partnerships
• the current knowledge base is silent on subsidies, performance and quality of services under PPP, operational constraints, overall effect on the health system and the stakeholders’ perception on PPP
• there is no clear consensus on the appropriate private sector involvement in healthcare or an appropriate policy towards the private sector

Some of the lessons emerging from the analysis include:

• selection of Private Partners is a critical component for a successful PPP, but often neglected
• clear vision and leadership of key people, relationships based on trust or compelling circumstances trigger partnership initiative as against enabling circumstances created through policy pronouncements
• in the absence of any formal Monitoring & Evaluation system, it is not possible to verify the extent of benefits to the poor and vulnerable sections of the society under PPP even if the partnership gives special privileges to the poor under various clauses of agreement
• it is important to providing autonomy to the private sector for additional services which they might be willing to provide if they are not conflicting with the core activities
• notice period for withdrawal from PPP is an important component. It is necessary to provide enough time for the public sector to select a new partner, and not to disrupt the service delivery

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