Spotlight on ACCESS Health- Facilitating Public Private Partnerships for Health

In this blog, CHMI spotlights ACCESS Health, based in Hyderabad, India. ACCESS Health and Swasti are CHMI’s Regional Partners in India, playing the dual role of connecting programs to opportunities and pressing for systems-level change. By Rachel Neill and Rohini Rao. 

How do you deliver healthcare to over 1.2 billion people? Ensuring access and quality health services for India’s booming population is no easy task, with over 350 million living below the poverty line. According to 2012 WHO data, 86% of health care expenditure is out-of –pocket[1], and most patients access services in the private sector. Resources are also concentrated in the private sector—up to 85% of licensed physicians, 93% of hospitals, and 80% of India’s outpatient clinics operate, in whole or part, within the for-profit, private sector[2].  Consequently, India has become a vibrant testing ground for health market innovations, with over 270 programs profiled on CHMI alone[3].

The Indian government is looking to public-private partnerships (PPPs) as one of the key vehicles to meet India’s vast health challenges and capitalize on existing private sector capacity. PPPs can combine government- level patient volumes with private efficiency, providing lower-cost and higher quality care. But the road to establishing a successful PPP is filled with challenges—from identifying the right stakeholders and models, managing partnerships and expectations, to contracting, payment systems and legal protections.

One of the Center for Health Market Innovation’s (CHMI) two India partners, ACCESS Health, is seizing the opportunity to build PPPs in two states—Rajasthan and Andhra Pradesh. In both, state-level governments have identified PPPs as a valuable way to meet the priority health challenges, and have partnered with ACCESS Health to help them find innovative models and provide technical capacity in developing new PPPs. This is a great opportunity for CHMI programs to become engaged with state-level governments and learn the ins-and-outs of participating in a PPP.

CHMI in Rajasthan—Solving priority challenges in MNCH, NCDs, and Primary Care

In Rajasthan, ACCESS has become the official technical partner for the state, tasked with (1) providing support to develop the state’s new health PPP policy, including the development of sustainable institutional structures such as the PPP cell and to create a platform for continuous dialogue with the private sectors, (2) providing technical assistance to the state when forming new PPPs (in partnership with the Indian School of Business), and (3) implementation of pilot models to generate learnings (in partnership with the WISH Foundation’s SCALE Rajasthan project). ACCESS and CHMI have a unique role to play in this broader project—by leveraging CHMI’s extensive database of India-based programs and relationships to private sector entrepreneurs, ACCESS and CHMI are able to identify and showcase potential innovations and models that can meet the state’s priority health challenges. They have also given a platform for private and public sector to come together to brainstorm about newer, contextualized models to suit specific state uniqueness.

Work is already underway to promote sustainable PPPs. On 7 November, 2014, ACCESS, through CHMI, brought together representatives from successful PPPs including 108 Emergency Response Services, Health Management and Research Institute (HMRI), which runs the 104 mobile service, Sawai Man Singh Hospital Radiology Services, and the Linear Accelerator Centre for Radiation Oncology Treatment . Representatives discussed the main challenges in running successful PPPs and what the government could do to overcome them, providing ACCESS with priority discussion points to raise with the Rajasthan government. Major challenges identified include very slow time frames, a lack of legal protections, payment systems that force too much risk on the private partner, unilateral decision making, and short timelines for successful MOUs. Building on this work, ACCESS and its partners will hold an engagement forum with the government, current PPPs, and innovators that are potential candidates for new partnerships with government, likely in January 2015.

CHMI in Andhra Pradesh—Contracting with the private sector to create new National Urban Health Missions

In May 2013, Indian parliament approved the establishment of National Urban Health Missions (NUHM)[4], which will specifically cater to the health needs of the urban poor, particularly those in informal settlements. In response, the state government of Andhra Pradesh began looking for appropriate models to reach slum dwellers with primary care. Concerned about providing direct public services, policy makers turned to the private sector to promote better health outcomes. ACCESS Health has become a principal advisor to the state in how to set up their NUHM.

Moving forward, ACCESS will convene successful programs that are key players in India’s primary healthcare space. These organizations will discuss key issues such as model design, services to be included, implementation mechanisms and monitoring with the government of Andhra Pradesh to establish a new PPP model for the NUHM. CHMI primary care programs will also be given the opportunity to be showcased to the government, potentially forming new PPPs in the state.

 

CHMI India’s Impact

In India, state governments are keen to utilize PPPs as a new way to meet priority health challenges. By identifying programs through the CHMI database, understanding “what works” with a particular model or sector, and connecting programs, policy makers and other stakeholder to one another, CHMI is well positioned to bridge the gap, translating knowledge and opportunity into impact for the lives of the poor. Through ACCESS Health and Swasti, CHMI India is working to promote promising models and transform public sector delivery to increase access and affordability of care. Stay tuned to the CHMI blog to hear more about how CHMI is building PPPs in India, learn about Swasti’s hands on model of mentoring CHMI programs, and read outcomes from this and other CHMI in-country activities.

 

Are you a CHMI program? Get involved!

If you are a CHMI profiled program in India working in primary care, NCDs, or MNCH, there may be opportunities to get involved in the states of Andhra Pradesh and Rajasthan. By keeping your profile updated and reporting your results, your program can stand out to policy makers and others looking for innovation health market solutions.

For more information on getting involved in future PPPs, please contact Rohini Rao (rohini.rao@accessh.org). For support on navigating CHMI and finding technical or operational support, please contact Shama Karkal (shama@swasti.org).

                                                                                     

Photo: A mother and child visited at home by Merrygold Health Network. Photo by Rachel Neill for CHMI.

[1] http://data.worldbank.org/indicator/SH.XPD.OOPC.ZS?order=wbapi_data_value_2012+wbapi_data_value+wbapi_data_value-last&sort=asc

[2] http://www.who.int/bulletin/volumes/91/3/12-110791/en/

[3] For analysis on emerging trends  in CHMI’s profiled India programs, visit CHMI’s Database at a Glance-- India

[4] http://nrhm.gov.in/nhm/nuhm.html