Can PPPs solve common public health challenges?
Private-Public Partnerships have seen a resurgence of interest in recent years as a means to improve pro-poor services in lower-middle income countries (LMICs). In a PPP, private sector companies and organizations bid for government resources to provide public services, surfacing private sector groups who can provide the best value for money to governments.
PPPs are usually long-term in nature, entail a shared asset or financial contribution, and transfer risk from the public to private sectors. The Center for Health Market Innovations currently profiles 249 programs that have a private-public partnership component.
How do PPPs Organize Care?
PPPs in the database are almost exclusively organized into health service networks (80%), a group of providers that are loosely joined to deliver services to a specific population, or chains (16%), a group of health outlets that operate under the same brand, and are owned and operated by a single parent organization. Networks and chains organize an often fragmented private market, making PPPs a feasible option for governments looking to leverage existing economies of scale.
In Bihar, for example, the government contracted Jagran, a for-profit firm, to run a network of 16 mobile medical units (MMUs). MMUs provide patients with early diagnostic services for common health problems, immunizations, treatment and free medication for common illnesses, anti-natal check-ups, family planning services, and hospital referrals for complex cases. The network of MMUs created by Jagran, called Arogya Rath, is reaching 200 villages and over 13,000 patients. For a fixed budget per MMU, Arogya Rath provides the equipment, software, technical backup, maintenance, and medical and technical service staff.
How do PPPs finance care?
Of the 98 programs reporting on financing care, 60% rely on contracting to provide services, 20% rely on insurance payments (either government or micro insurance), and 13% rely on voucher systems. Although currently utilized by a relatively small percentage of PPPs, the percentage using vouchers is higher than the overall percentage of the database (5%). Vouchers, or subsidized coupons distributed to a target population, can be used by governments to subsidize specific health goods and/or services from approved providers on the private market. Vouchers are an attractive strategy in environments with many small-scale, quality private providers, in low-income communities where patients do not have access to free government services, or when patients have no access to insurance.
In Pakistan, Contech International was hired by the government to create the Sehat Sahulat Card, a voucher card which pregnant mothers can present to private providers in exchange for free services. The Sehat Sahulat Card covers antenatal, natal and postnatal care, including transportation during the entire process, and beneficiaries are determined through a poverty index to ensure pro-poor targeting. Similarly, Blue Card Hospitalization in the Philippines covers free hospitalization for low-income residents at three private hospitals that have signed an MOU with the city government of Tagbilaran.
Enhancing the supply chain through the private sector
Developing efficient and transparent supply chains is an enormous challenge in low-resource settings that often lack basic infrastructure. 18 PPPs in the CHMI database are working to streamline supply chains by leveraging private sector capacity.
CommTrack, created by the for-profit company Dimagi, Inc., is a mobile platform designed to support health workers in low resource settings. Staff can track current stock levels, manage orders, analyze consumption rates, and capture receipt and disbursement data through mobile platforms. CommTrack is approaching national level scale through partnerships with the Ministries of Health in Ghana, Uganda and Tanzania, and is being employed by John Snow International in Malawi.
Similarly, the Wireless Reach Initiative, managed jointly by for-profit Qualcomm Incorporated and not-for-profit RTI, is equipping antiretroviral treatment (ART) centers with technology and software designed to automate the manual reporting system for managing supplies of ARVs. Electronic reports are delivered to the Kenya Medical Supplies Agency, allowing nearly real-time tracking of ART adherence, stocks, and patient care. The pilot, operating in 16 centers, aims to improve coordination between the health care centers, the districts and the Provincial Medical Office (PMO) of Nairobi, with the long term goal of scaling across health centers in Kenya.
PPPs—the way forward?
PPPs have become a popular way to harness the power of the private sector to meet national health challenges. Often providing highly efficient, quality care, PPPs have proven they can be an effective vehicle through which to improve health systems in low- and middle-income countries in certain contexts. But despite success, the scale-up and coordination of PPPs remains an enormous challenge. CHMI, through regional partners ACA, Access Health, and Solina, are actively showcasing innovations and working to develop new PPPs to solve priority health problems in Kenya, India, and Nigeria. Stay tuned as CHMI continues to document these innovative partnerships!
Photo: An Arogya Rath Mobile Clinic in Bihar, © Aftab Alam Siddiqui 2010.