Monitoring and Evaluating PPPs in India

In the last decade or so, India has seen the emergence of Public Private Partnerships (PPPs) as a strategy to improve access to healthcare services. The inclusion of PPPs under the National Rural Health Mission (NRHM) has further encouraged governments to apply this approach to improve public health services in rural regions. ACCESS Health International has been involved with the Center for Health Market Innovations for the past two years and has documented more than 240 programs in India. It was observed that for the majority of the programs documented, the source of funding was either through donor funding including bilateral agreements (41.18%) or through government funding (30%) and PPPs were a popular strategy to deliver care to the poor. ACCESS Health felt that there was a need to understand these programs better and build a better knowledge base.

A key way to ensure PPPs are being implemented effectively is to ensure that adequate monitoring and evaluation (M&E) mechanisms are in place. It has been observed that often, once the implementation of the PPP is underway, little attention is paid to this process. Even in cases where the agreement provides for it, the implementation of M&E is not assured or is done on ad-hoc basis. Some of the programs do have some protocols and performance indicators dictated by the government but the evaluation component is neglected. A possible reason for the neglect of M&E mechanisms is because the designated monitoring agency suffers from a lack of time and/or resources. In some cases, the agency/body responsible for undertaking the monitoring has not been given a clear mandate, and this may result in a scenario where no monitoring takes place, even if it is provided for in the partnership agreement. In the absence of such mechanisms, it is difficult to measure the effectiveness of the partnership and subsequently there is no incentive for the policy makers to improve on the policy per se or to improve the regulatory framework.

Given this context, ACCESS Health decided to study a few programs in India to understand the existing monitoring and evaluation mechanisms and provide recommendations for improvement. ACCESS Health has undertaken a comparative case study of mobile medical units (MMUs) in Bihar (through Arogya Rath) and in Madhya Pradesh (through Deen Dayal Chalit Aspatal), with the objective of understanding and analyzing the functioning of the programs. The case study focuses on the monitoring and evaluation mechanisms of the program, and provides recommendations to strengthen these mechanisms. The study was developed through interviews with public and private partners, field visits, and secondary research. The report will soon be shared on the platform.

The second study is a rapid assessment of the Thayi Bhagya Scheme in Karnataka similar to Chiranjeevi Yojana in Gujarat. This study is being done in collaboration with Karnataka State Health Resource System. This is scheduled to be completed by the end of August.