Public Private Partenership

for health care in India

A panel discussion
moderated by
narendra malhotra
panelists
nc prajapati,usha sharma,vd agarwal

Although there have been some spectacular

achievements in the health sector, the overall
picture is rather grim. While we have sophisticated
world-class tertiary care facilites, our primary
healthcare is riddled with problems due to a
resource crunch and poor management of
manpower and equipment. Communicable diseases,
life style diseases, accidents and injuries and newer
emerging infections seem to have overwhelmed the
healthcare industry.

The Healthcare Conundrum

There is growing evidence that the current health
systems of nations around the world will be
unsustainable if unchanged over the next 15 years.
Globally, healthcare is threatened by a confluence of
powerful trends increasing demand, rising costs,
uneven quality, misaligned incentives.
If ignored, they will overwhelm health systems,
creating massive financial burdens for individual
countries and devastating health problems for the
individuals who live in them.
PwC HealthCast 2020: Creating a Sustainable Future

Heavy burden of patients, lack of medicines

and equipment, high absenteeism and
shrinking Government fundsthese are
some of the roadblocks to implementing
successful health programmes at primary
healthcare centres (PHCs). Are Public Private
Partnership (PPP) initiatives a solution to
help the Government achieve its
development goals of access to healthcare
by all? How can such ventures work?

We ask the experts

 Lets look at the financials. Indias healthcare

spend is nearly 5.2 per cent of the GDP. The
annual spend for healthcare delivery is
approximately $ 25 billion, of which the
Government spends a hefty $ 5 billion or
approximately Rs 22,000 crore. What is
critical is that this fund must reach the
bottom of the pyramid. Basic healthcare itself
is at a premium today, considering the poor
coverage across the country.

Health of our country who is

responsible ?

What is PPP ?

 The need for public-private

partnerships arose against the
backdrop of inadequacies on the
part of the public sector to
provide public good on their own,
in an efficient and effective
manner, owing to lack of
resources and management
issues.

WHAT IS THE ROLE OF PPP IN

HEALTH CARE SECTOR?

WE ALL AGREE ?
ROLE OF PRIVATE SECTOR
NEED FOR A PARTNERSHIP
PROPER UTILISATION OF SUCH A
PARTNERSHIP
BENIFFICIARIES
CONTROL OVER SUCH
PARTNERSHIPS AND MONITORING

WHO ARE THE ULTIMATE

BENIFICIARIES OF PPP ?

CAN PPP HELP IN IMPLIMENTATION OF

NATIONAL PROGRAMMS AND
MILLINEUM DEVELOPMENT GOALS ?

How do we involve the

alternative medicine
practisioners ?
OR SHOULD THIS SECTOR BE
INVOLVED

 WHEN EVER THERE IS

A PARTNERSHIP THERE
ARE CONCERNS
SIDES MAY FEEL
CHEATED
SIDES MAY WANT TO
DOMINATE
SIDES MAY BE SCARED
SIDES MAY NOT WANT
THE OTHER TO STEAL
THE LIMELIGHT
ETC ETC ETC

CONCERNS ?

WHAT DO YOU FEEL WILL BE THE

COMMON CONCERNS OF THE
PRIVATE SECTOR ?

WHAT ABOUT CONCERNS OF

PUBLIC SECTOR ?

LAST WORD FROM THE

PANELISTS

WHAT SERVICES IN THE

PRESENT SCENARIO TO
BE TAKEN UP IN PPP ?

MEDICAL UNIVERSITY AND

COLLEGES ??

PRIVATISATION OF
MEDICAL EDUCATION
IS IT THE NEED OF
TODAY ?

INVESTIGATIONS AND DRUGS ?

SHOULD THE PUBLIC SECTOR
OUTSOURCE INVESTIGATIONS AND
DRUG STORES ???
HOW WILL YOU KEEP QUALITY
CONTROL
HOW WILL YOU MONITOR
MANY CONCERNS HERE FROM BOTH
SIDES

EMERGENCY SERVICES AND

AMBULANCE ?
SHOULD THE CITY HAVE A PPP IN
HANDELING EMERGENCIES AND
TRANSPORTING PTS
AMBULANCE SERVICES TO BE RUN
BY PRIVATE SECTOR
WHO PAYS ??

DISTT HOSPITALS
PHC
SUBCENTRES
HEALTH WORKERS
ETC

 Even though there has been an

increase in the resource allocation,
because of the rising population and as
a percentage of the GDP, allocation has
actually dwindled. The State has not
been able to provide healthcare for the
masses. Even now, 80 per cent of
healthcare is under the domain of
private sector.

 The Governments primary role should

be in good governance, security and
law and order, infrastructure, education
and healthcare, but the model of
delivery needs to be radically changed
to being carried out by professionallymanaged expert organisations who
would be fully accountable for every
rupee spent.

 Private partners can widen the coverage of

foreign assistance programmes, help in
achieving the Governments development
goals and in the formulation of sound
projects. They can also assist to improve
identification of adequate investments, these
being sometimes overestimated by the local
authorities, which tend to over dimension
physical infrastructure, both qualitatively and
quantitatively, and therefore create
constraints to the timely deployment of
appropriate investments.

 State Governments can hand over

management of sub-health centres, PHCs,
community health centres to private partners
under lease agreements. The Govern-ment
could also pay annual capitation fee for PHC
services provided by the privately-run centre
to a declared list of poor residents in the
catchments areas. State Governments can
also partner with private players to set up
and operate a network of diagnostic centres
in the states (hub and spoke model) covering
their hospitals with appropriate range of
diagnostic services on a fee-for-service basis
and profit-sharing agreements.

 In order to maintain their commitment to

protect the underprivileged, the Government
can agree to pay on their behalf. Space can
be given to the diagnostic services within the
Government hospitals or these centres can
be set up in the hospital campus or adjoining
areas.
These agreements would be for 10-30 years
with suitable exit clauses. Collection centres
for pathology specimens/samples will be
encouraged to be set up in PHCs.

 The corporate sector can join hands with the

Government at the centre and with various
states for a JV to run resource-starved state
medical colleges and district hospitals in a
more efficient manner. Some of the large
industrial houses have their own excellent
hospitals, which can extend their services in
their districts and surrounding PHCs. These
hospitals can also provide health education
in these districts and PHCs

 Private sector can also provide facilities for

training of para-medical personnel laboratory
technicians, nurses, physiotherapists,
radiography and radiotherapy technicians.
Private sector can also play a pivotal role in
improving the environment, sanitation,
providing clean water supply preventing air
pollution and increasing the green cover. We
must empower the community to participate in
healthcare as informed and involved partners.
Patient education should be an integral part of
healthcare. In planning of all hospital
operations, community representatives should
be a part of all decision-making bodies

It is Time 100% Healthcare

reaches The Common Man

It is time 100 per cent of healthcare

reaches the common man. Resources
are available but need to be spent right.
Empirical data does not favour with
Government's ability to deliver. Time is
ripe to initiate PPP in India as the
answer to get to the bottom of the
problem and the pyramid.

THANK YOU
PANELISTS:
PROF USHASHARMA,
PROF NC PRAJAPATI
&
MR VD AGARWAL
THANK YOU AUDIENCE
THANK YOU MCI FOR ORGANISING
SUCH A MEETING