Public-private partnerships: potential for health equity in India

The private sector is a rapidly growing source of health care in India. Private medical providers are a popular choice for health care but they are poorly regulated and vary in the quality of care they provide. Their greater involvement in the public health system is essential to achieve equity in health care.

India’s public health system is not sufficient to meet the country’s need for tuberculosis (TB) and HIV and AIDS treatment. Private for-profit providers fill these gaps whilst employing 80 percent of India’s qualified doctors and accounting for 87 percent of its total health expenditure.

Private medical providers (PMPs) have been criticised for providing inequitable services that do not meet the needs of poor people. Involving PMPs in public-private partnerships (PPPs) can harness the strengths of public and private sector providers.

Researchers from the London School of Hygiene and Tropical Medicine, UK reviewed two studies conducted in Pune, India, which examine the role of PMPs in TB and HIV and AIDS care. They explored the themes of equity and access in private sector delivery of care for TB and HIV and AIDS, and identified future policy directions for involving PMPs in public health programmes.

The first study they examined was a year-long intervention to involve rural private practitioners in a TB programme. This intervention used a partnership model that encouraged PMPs to refer patients to public health clinics and to provide directly observed treatment (DOTS).  The second study examined the involvement of PMPs in HIV and AIDS diagnosis and treatment.

Findings from the review included:

• Through involving PMPs in the TB programme, patients' choice has been enhanced without adversely effecting access to services.
• Attempts at collaboration in the TB programme have been affected by disagreements between the public and private sectors.
• PMPs' treatment and care of HIV and AIDS do not conform to recommended guidelines.
• Private providers refer HIV and AIDS patients to specialists within the private sector suggesting that networks exist between PMPs.
• HIV and AIDS patients were most often referred to the public sector because of their inability to pay for private treatment, rather than for specialist treatment.
• PMPs do not have adequate mechanisms to provide continuity of care for HIV and AIDS patients, who frequently ‘shopped around’ for alternative diagnoses and treatments.

The studies revealed a need for greater involvement of PMPs in order to improve equity of access and continuity of care. The report draws attention to the following areas for policy action:

• Developing networks between PMPs and PPPs can improve the flow of information between providers and ensure continuity of care for patients with chronic infectious diseases.
• PPPs need a proactive, committed approach from the public health system at both policy and programme level.
• Training programmes to involve PMPs in the care of HIV and AIDS must be supported by research into the needs of the various parts of the private medical sector.
• There is an urgent need for unified leadership among PMPs in order to advance their role in public health, regulate the quality of services and guide the development of the sector.

Source(s):
‘Public-private partnerships for equity of access to care for tuberculosis and HIV/AIDS: lessons from Pune, India’, Transactions of the Royal Society of Tropical Medicine and Hygiene 100, pages 312-320, by Kabir Sheikh, John Porter, Karina Kielmann and Sheela Rangan, 2006
HINARI subscribers can access the full-text article here. Full document.

id21 Research Highlight: 16 June 2006

Further Information:
Kabir Sheikh
121 Sundar Nagar
New Delhi 110003
India

Tel: +91 11 5150 7185
Fax: +91 11 2435 8585
Contact the contributor: kabir.sheikh@lshtm.ac.uk

London School of Hygiene and Tropical Medicine, UK

Other related links:
'On the same side – public-private partnerships in TB control'

'Two wrongs can make a right – public-private partnerships in tuberculosis control'

'A public-private partnership: fighting tuberculosis in South Asia'

Initiative on Public-Private Partnerships for Health (IPPPH)

IPPPH Partnerships database

Eldis Health Systems Resource Guide: public-private partnerships

'Public-private partnerships in health', Harvard Series on Population and International Health, Edited by Michael R. Reich, April 2002