Partnering for Progress in Rajasthan: Inputs from private sector on improving enhancing public private collaborations in health

As many governments explore means to improve coverage of healthcare services, the role of the private sector in the healthcare system is gaining more attention. While the private sector is an important part of the healthcare system, there are still limited efforts to understand the contributions that the private sector makes and has the potential to make in achieving public healthcare goals. There is a need for engaging the private sector for various reasons - investments, efficiency in service provision, innovation to name a few. Yet, there is a resistance to change. Barriers to engaging the private sector include lack of information on the private sector, perceived loss of power by the policy makers, lack of skills and capacity to engage the private sector, and a general mistrust toward the private sector.

The Partnering for Progress initiative is a joint initiative by ACCESS Health International and Max Institute of Healthcare Management, Indian School of Business. In the initiative, we work toward the goal of making a transformative change in healthcare through the medium of healthier partnerships between public and private sectors. We are working closely with the Government of Rajasthan to provide them with technical assistance on public private partnerships. The government of Rajasthan is committed to engaging the private sector in a meaningful way to address healthcare challenges and to strengthen the health system.

ACCESS Health is a regional partner for Center for Health Market Innovations (CHMI) in India. The team from the initiative along with CHMI convened a discussion in Jaipur with the major private organizations involved in healthcare public private partnerships in Rajasthan.  It was one of the ‘Chai and Chat’ sessions, which are typically discussions that provide an informal setting to all participants to have constructive and transparent dialogue. Our objective was to talk through common challenges that the private organizations would like to bring up with the government on regulation, policies and identify opportunities for private sector engagement. We were also laying the ground for a larger engagement forum between the public officials and private players in the State. The discussion had representatives from Piramal Swasthya (running the HMRI 104 call center for health), GVK- Emergency Management and Research Institute (Managing the 108 Ambulance for Emergency) and Soni-Manipal Hospital group (Running the CT/ MRI and Linear Accelerator for specialized cancer care through a public private partnership at SMS Hospital, Jaipur).

The session brought many important lessons. The private organizations unanimously agreed that the government of Rajasthan is co-operative and that there is significant commitment to take public private partnerships forward. The discussion also highlighted the lack of an institutional system to resolve concerns of both the parties that arise in execution of partnerships; the lack of an empowered PPP cell within the health department, which has led to administrative hassles and significant time delays in taking decisions on operational partnerships. They pointed out that centralized online payment systems and designing of contracts around these payment systems would be beneficial to avoid severe delays and improve the transparency of payments. They brought to notice that many decisions about public private partnerships are unilateral without representation from private sector, which limits the opportunities for constructive discussions about the potentials of partnerships. Another important point was that partnerships with private sector must not only be on a short term contracting basis. It is important to allow some partnerships to be longer term to allow innovations to be tested and revised for improved outcomes. The need for partnerships to be monitored on an input, output and outcome basis to ensure progress was also discussed.

One of the representatives mentioned “Partnerships are formed at a State level while the monitoring and payments happen at district level. There is a need for the payment systems to be supported by a good and efficient information technology system that would [allow] for monitoring and give due information to the districts to ensure timely payments”.

There was concurrence among the private organizations that there is a need for a formal policy that translates the states intention and commitment into guidelines for implementation of partnerships. There is also a need for an institutional resident expert within the state that has been mandated by the highest authority to provide direction on partnerships. This regulatory framework is important to safeguard the interest of the partnerships in time of political uncertainty. Many experiences reiterate that change in governments after elections brings much uncertainty to existing partnerships. This risk must be reduced.

Over the course of the next few months we will assist the government of Rajasthan in improving their ecosystem for private sector engagement and also in identifying opportunities for future engagements. The inputs from this discussion helped us to set the stage for the larger dialogue with the government and also to build trust with the private players so that they are ready to engage in a meaningful dialogue with the Government.

The Center for Health Market Innovations has allowed us to create a network of private organizations with expertise and interest in partnering with governments to increase the impact of services. We are looking forward to building yet stronger ties between these organizations and governments in partnership with CHMI.