Despite their proven benefits, the development of PPPs has been uneven globally, in part due to a lack of understanding of how best to integrate private sector capacities into traditional public sector activities and political antipathy. However, the United Kingdom, parts of Europe and Japan have embraced the concept, and recent trends suggest that these partnerships have produced fruitful results. 2. Private funding initiatives and other agreements in which the public sector mandates the purchase of high-quality long-term services in order to harness the management skills of the private sector supported by a risk of private financing, and 38 FUTURE OPTIONS Continuation of the current system = Micro-PPPNational Heart Service – National project = Real PPP Outsourcing of the cardiac service entirely to a private institution for a Fixed fee per patient Return to care Full government Need for public-private partnership Source: Report on National Health Accounts 2004-05 by MOHFW/GOI. (With preliminary estimates from 2005-06 to 2008-09) Example of awarding contracts • SMS Hospital outsourced the installation, operation and maintenance of CT and MRI services to a private agency • Free services for 20% of patients belonging to poor socio-economic categories 20 PRIVATE RETURN OUR STORY – CARDIAC UNIT @ WCHOpportunity to define and develop a national cardiac service opportunity to introduce advanced methods and treatments. . That is, personal growth, prestige, experience The ability to generate additional income from limited private practice PPPs is more than just privatization. The main drivers of improving the efficiency of a privatization project are freedom of investment, management skills and the pursuit of profit. Using PPPs to harness these strengths can provide a sustainable and long-term approach to improving social infrastructure, improving public sector assets and making better use of taxpayers` money that is politically acceptable. Three main factors draw a line between our current partnership (privatization) practices and those of PPPs: Case studies: ChiranjeeviYojna Programme • Launched in Gujarat in 2005 • Objective: Improving access to institutional services for poor families (BPL) • Form of partnership: Voucher programme to involve private providers in the provision of maternity care • Reasons for the contraction: High maternal mortality, • Financing: NRHM and State Budget Optimal risk sharing between the public and private sectors PPPs are about changing the way the government does business and interacts with the private sector in order to bring the skills, experience and extensive financial resources of the private sector to the wide range of public sector activities for new and innovative solutions. Government-non-profit partnership • Public/private DOTS model established on a pilot basis in Hyderabad at Mahavir Trust Hospital • Mahavir Trust Hospital acts as coordinator and intermediary between public and private doctors • PMPs refer suspected TB patients to a hospital • Government delivery because DOTS medicines are not wasted • Mahavir Trust Hospital has also benefited as a healing service Patient Operationalization • True partnerships in the direction of equal partner equality, mutual commitment to goals, joint decision-making and risk-taking are rare.
• Lack of beneficiary representation in the process • Lack of effective governance mechanisms for accountability • Non-transparent mechanisms • Lack of institutional capacity to design, mandate and monitor PPPs • Late payment • Local political interference Joint ventures • Joint ventures are companies created with the participation of government and the private sector. • Joint ventures have not been successful in most cases due to a lack of understanding and trust between partners 1. The introduction of private ownership in state-owned enterprises, using all possible structures and selling a majority or minority stake; Need for a public-private partnership Source: Pearson M, Impact and Expenditure Review, Part II Policy issues. DFID, 2002 Adoption of Public Sector Comparators (PSRs) to determine whether PPPs offer value for money to the public sector; In these models, the private sector was responsible for the design, construction, operation and maintenance of the hospital, while the public was responsible for basic medical services such as patient care, hiring doctors and nurses, etc. In addition to taking into account the stability of the business plan of private partners and the security of funding when selecting the private sector partner, the success of the partnership is based on the following key factors: The success of PPPs depends on whether the added value generated benefits the users of the public service and the wider community. The government must protect the public interest by applying a structured tendering process to assess the benefits of services offered by the private sector in relation to the total costs to be incurred; ensure better value for money and better management of the capital spent; Create effective rules to ensure that all public services are accountable to customers and the communities that depend on them; and maintaining the government`s continued involvement in PPP elements, in which it remains a strong public interest. Case studies: Mother NGO Program • Mother NGO Program was launched as a centrally funded program within RCH I. • Under RCH II, the program was decentralized, with states being more involved in selection and monitoring. • Objective: To provide RCH coverage to underserved areas. .
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