Engaging Private Sector Health Care Providers to Reach SDGs in India

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.

Source: Census, India http://www.censusindia.gov.in/2011-Common/Sample_Registration_System.html

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.

Source: World Bank http://data.worldbank.org/indicator/SH.XPD.PUBL

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.

Key Achievements:

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.

Leaders and technocrats from the Ministry of Health and Family Welfare, USAID, professional associations, and JSI at the opening of the high-level national consultation on private sector engagement held on February 21, 2017.

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)

3 responses to “Engaging Private Sector Health Care Providers to Reach SDGs in India”

  1. Involving Private Sector in Health/Medical Care has two facets : one directly with individuals and two, through their professional bodies. In both cases, the government bears the subsidy costs on behalf of the beneficiaries. In recent years, few state governments adopted the first approach but results are mixed on its success or otherwise needing studying reasons for failures wherever it did not succeed. To me any scheme when formulated by a state government has to ingrain a solid element of trust and confidence on the private provider ( as a policy ) when it submits its claim of fee/financial returns( rightful dues) for the services rendered. The system of documenting, checklist , monitoring have to be logical & streamlined with efficiency inbuilt at every level in the government ( implementation weaknesses).

    A recently announced scheme by one state government involving private sector ( approved hospitals & diagnostics under CGHS/DHS) for undertaking/ sharing surgical load of public sector hospitals, though may be very well intentioned, yet all out efforts will need to be made by the policy makers in not putting unreasonable strain on the government machinery ( doctors, surgeons etc) for screening & referring such cases/patients to private hospitals in the process harming its own interest thru decelerating functioning within the government hospitals and even creating vested interests within its own domain.. The post operative follow up & complications has the potential threat of exposing the referring government surgeon to legal complications if an indemnity clause is missing from any such arrangements. The bottom line is that a thorough micro-level ground work should be integral to any such collaboration.

    The second approach thru professional associations seems to be promising as a joint secretariat at its level will be responsible for sorting out the above challenges when it comes to professional service charges reimbursements. More importantly, the periodic dissemination of government policies thru the professional platform will ensure uniformity and quality assurance in services.
    Another important requirement of such partnerships is defining standards in quality of care, admission & discharge criterion, uniformity in fixing rates of services, simplified un-bureaucratized documentation requirements etc etc. Use of IT in such partnership arrangements will be advantageous .

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