India’s maternal mortality ratio and under-five mortality rate have declined steeply since 1990. In order to achieve the Sustainable Development Goals (SDGs), both these estimates need to be halved from 2015 levels of 140 per 100,000 live births and 49 per 1000 live births respectively.
In countries like India, low public investment in health care makes private sector health care providers critical partners. Over the past several years, there has been a sharp increase in private sector penetration in facility-based health care in the country. Between 2002 and 2010, for example, over 70 percent of the total increase in hospital beds was attributed to this sector.
Nearly 90 percent of the private sector health care spending in India is out-of-pocket. This negates any financial gains made by lower income households with no access to health insurance and traps them in the vicious cycle of poverty.[i],[ii] Therefore, engaging the private sector for affordable health care is imperative. It has been debated, piloted, and even integrated into public programs in India for over a decade.
India’s experience in public-private partnerships for Reproductive, Maternal, Newborn, and Child Health (RMNCH) services has mostly been in contracting out or outsourcing services through models such as voucher scheme and social franchising. Most of these private sector engagement models lack rigorous evaluations but offer experiential lessons, some of which have been documented.[iii],[iv] Private sector providers have successfully implemented cross subsidy to improve the reach of RMNCH services to vulnerable populations.[v],[vi],[vii]
Based on available lessons, JSI has adopted a consultative, evidence-based, sequenced approach to developing a private sector engagement strategy that is shown below.
This approach is being implemented under the USAID-supported Vriddhi, a technical assistance project in collaboration with the Government of India’s Ministry of Health and Family Welfare, to scale up the government’s RMNCH program. Vriddhi, led by IPE Global in partnership with JSI, supports six state governments—Delhi, Haryana, Himachal Pradesh, Jharkhand, Punjab, and Uttarakhand—to scale up RMNCH interventions. One of the project’s key strategies is to increase private sector engagement in RMNCH.
1. The highest administrative leadership of the Ministry of Health and Family Welfare has endorsed JSI’s approach and state specific strategy for increasing private sector engagement in RMNCH services.
2. A rollout of the private sector engagement strategy has been initiated in three of the six states in partnership with the state governments and the professional associations of paediatricians and neonatologists (Indian Academy of Pediatrics National Neonatology Forum – IAP/NNF) and obstetricians and gynaecologists (The Federation of Obstetric and Gynaecological Societies of India – FOGSI).
3. JSI secured the support of the leadership of IAP/NNF and FOGSI thereby increasing its reach to a network of over 8,000 public health specialists in the six states. Champions from the two professional associations are using advocacy forums and social media platforms to move the agenda forward.
i World Development indicators: Health System, Table 2.15 available at http://wdi.worldbank.org/table/2.15
ii Raban MZ, Dandona R, Dandona L. Variations in catastrophic health expenditure estimates from household surveys in India. Bull World Health Organ 2013;91:726–735
iii Planning Commission. Draft report of the recommendation of the task force on a public private partnership for the 11th plan (2007-2012).
iv MsKinsey&Company. India Healthcare: Inspiring possibilities, challenging journey. Prepared for Confederation of Indian Industry (CII). December 2012.
v http://www.lifespring.in/services.html (accessed on 26.7.17)
vi Innovation Working Group Task Force. Fostering Healthy Businesses. Delivering Innovations in Maternal and Child Health. A Report by IWG task force on Sustainable Business Models. The Partnership for Maternal, Newborn and Child Health, Merck and Norad.
vii http://healthmarketinnovations.org/program/vaatsalya-hospitals (accessed on 26.7.17)