Managing Primary Health Care Centres Through Public Private Partnership in Andhra Pradesh in South India

Presenter: Subodh Kandamuthan, Administrative Staff College of India

Abstract

Introduction: Public Private Partnership (PPP) in the health sector is seen as an instrument by governments to improve efficiency, reliability and availability of services in health system. PPP is undertaken to improve access of services to the poor and socially vulnerable sections of the population especially in the remote and underserved areas. For the study, “Public” was defined as Government or organizations functioning under State budgets, “Private” was the Profit/Non-profit/Voluntary sector and “Partnership” meant a collaborative effort and reciprocal relationship between two parties with clear terms and conditions to achieve mutually understood and agreed upon objectives following certain mechanisms. One such initiative in India which has been prominent since the eighties is the management of Primary Health Centres (PHCs) through PPP. Numerous states in India like Orissa, Arunachal Pradesh, Gujarat, Karnataka, Himachal Pradesh etc have such initiatives in their states. In 2008, the Government of Andhra Pradesh had considered giving two tribal PHCs to be managed by an NGO through PPP.

Objective: The objective of the study was to look into the feasibility of giving two tribal PHCs to be managed by NGO through PPP in Adilabad district, in the state of Andhra Pradesh in India.

Methods: A review of the existing models of managing PHCs through PPP was done initially to derive the most suitable model for Andhra Pradesh. Once the model was arrived, it was discussed at the district level with various stakeholders like District Collector, District Medical and Health officer, People’s representatives, Medical officers etc in a workshop to get their views on the model. Based on the suggestions from the workshop an NGO was selected which had experience in other states in managing PHCs.

Results: The study provided numerous insights into the various models of PPP in managing PHCs in India. There were various issues like retaining/transferring of staff, percentage of government contribution for the PPP, performance indicators for the monitoring of the PHCs. Based on the suggestions from the workshop conducted, the government of Andrhra Pradesh decided to select an NGO which had experience in other states in managing PHCs through PPP.

Conclusion: The study gives a clear justification on the importance of PPP in delivering health care services to the poor. Along with the Government sector, the private and Non-profit sectors are also very much accountable to overall health systems and services of the country. The synergies where all the stakeholders feel they are part of the system and do everything possible to strengthen the policies and programmes needs to be emphasized. It should be noted that PPP would not mean privatization of the health sector and such partnerships are not meant to be a substitution for lesser provisioning of government resources nor an abdication of government responsibility but as a tool for augmenting the public health system.