PPP IN HEALTH CARE OF INDIA


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1 : Public –Private Partenershipfor health care in India A panel discussion moderated by narendra malhotra panelists nc prajapati,usha sharma,vd agarwal
2 : Although there have been some spectacular achievements in the health sector, the overall picture is rather grim. While we have sophisticated world-class tertiary care facilites, our primary healthcare is riddled with problems due to a resource crunch and poor management of manpower and equipment. Communicable diseases, life style diseases, accidents and injuries and newer emerging infections seem to have overwhelmed the healthcare industry.
3 : THE PROBLEM IMR/MMR is high and not declining fast enough, especially in rural areas and among the poor. High and prohibitive out of pocket expenditure makes access of poor people to health services difficult. Population stabilization is ineffective especially in a number of EAG States/ CMP districts. Public health system is on the decline- poor governance, manpower shortages, ineffective service delivery.
4 : THE PROBLEM - II Involvement of community/PRIs/ local government/ user groups in health programmes is weak. ?? Mapping of people’s health needs is not undertaken leading to people’s needs being different from what the system has to offer. ?? Convergence at Zila Parishad level is weak – implications for wider determinants of health.
5 : THE PROBLEM - III Large non governmental sector meets health needs of poor - at a price, often unethically, over prescription, syringe –saline syndrome. Government programmes have very little to do with the non – governmental sector even though it is 4-5 times larger and can improve indicators/outcomes.
6 : The Healthcare Conundrum “There is growing evidence that the current health systems of nations around the world will be unsustainable if unchanged over the next 15 years. Globally, healthcare is threatened by a confluence of powerful trends – increasing demand, rising costs, uneven quality, misaligned incentives. If ignored, they will overwhelm health systems, creating massive financial burdens for individual countries and devastating health problems for the individuals who live in them.” PwC HealthCast 2020: Creating a Sustainable Future
7 : Heavy burden of patients, lack of medicines and equipment, high absenteeism and shrinking Government funds—these are some of the roadblocks to implementing successful health programmes at primary healthcare centres (PHCs). Are Public Private Partnership (PPP) initiatives a solution to help the Government achieve its development goals of access to healthcare by all? How can such ventures work? We ask the experts…
8 : Question one ? What is the current status of health care system in India ?
9 : ‘Healthcare cannot be the sole responsibility of one sector alone’
10 : Who & what provides health care in public sector ?
11 : Who & what provides health care in private sector ?
12 : Let’s look at the financials. India’s healthcare spend is nearly 5.2 per cent of the GDP. The annual spend for healthcare delivery is approximately $ 25 billion, of which the Government spends a hefty $ 5 billion or approximately Rs 22,000 crore. What is critical is that this fund must reach the bottom of the pyramid. Basic healthcare itself is at a premium today, considering the poor coverage across the country.
13 : Health of our country who is responsible ?
14 : What is PPP ?
15 : The need for public-private partnerships arose against the backdrop of inadequacies on the part of the public sector to provide public good on their own, in an efficient and effective manner, owing to lack of resources and management issues.
16 : WHAT IS THE ROLE OF PPP IN HEALTH CARE SECTOR?
17 : WE ALL AGREE ? ROLE OF PRIVATE SECTOR NEED FOR A PARTNERSHIP PROPER UTILISATION OF SUCH A PARTNERSHIP BENIFFICIARIES CONTROL OVER SUCH PARTNERSHIPS AND MONITORING
18 : WHO ARE THE ULTIMATE BENIFICIARIES OF PPP ?
19 : CAN PPP HELP IN IMPLIMENTATION OF NATIONAL PROGRAMMS AND MILLINEUM DEVELOPMENT GOALS ?
20 : How do we involve the alternative medicine practisioners ? OR SHOULD THIS SECTOR BE INVOLVED
21 : CONCERNS ? WHEN EVER THERE IS A PARTNERSHIP THERE ARE CONCERNS SIDES MAY FEEL CHEATED SIDES MAY WANT TO DOMINATE SIDES MAY BE SCARED SIDES MAY NOT WANT THE OTHER TO STEAL THE LIMELIGHT ETC ETC ETC
22 : WHAT DO YOU FEEL WILL BE THE COMMON CONCERNS OF THE PRIVATE SECTOR ?
23 : WHAT ABOUT CONCERNS OF PUBLIC SECTOR ?
24 : "Private partnership can function as a tool to improve quality and quantity of services to consumers. The increase in public benefits may be either an increase in capacity to deliver or an increase in the quality of the delivery" - Dr Alok Roy, Vice PresidentFortis' Centre for Community Initiative,New Delhi
25 : "Healthcare cannot be the sole responsibility of one sector alone. In a country as diverse as ours, resource from all the agencies responsible for healthcare have to chip in. There has to be an alliance for the new vision of health sector" - Dr Prof PK Dave,Chairman, Advisory BoardRockland Hospital, New Delhi
26 : "We apply natural design principles to create living environments that align earth, mind and spirit, creating a sense of 'place', where visitors can experience a profound personal resonance" - Anil Kamath,PresidentHospital Business DevelopmentWockhardt Hospitals
27 : LAST WORD FROM THE PANELISTS WHAT SERVICES IN THE PRESENT SCENARIO TO BE TAKEN UP IN PPP ?
28 : MEDICAL UNIVERSITY AND COLLEGES ?? PRIVATISATION OF MEDICAL EDUCATION IS IT THE NEED OF TODAY ?
29 : INVESTIGATIONS AND DRUGS ? SHOULD THE PUBLIC SECTOR OUTSOURCE INVESTIGATIONS AND DRUG STORES ??? HOW WILL YOU KEEP QUALITY CONTROL HOW WILL YOU MONITOR MANY CONCERNS HERE FROM BOTH SIDES
30 : EMERGENCY SERVICES AND AMBULANCE ? SHOULD THE CITY HAVE A PPP IN HANDELING EMERGENCIES AND TRANSPORTING PTS AMBULANCE SERVICES TO BE RUN BY PRIVATE SECTOR WHO PAYS ??
31 : DISTT HOSPITALSPHCSUBCENTRESHEALTH WORKERS ETC
32 : Even though there has been an increase in the resource allocation, because of the rising population and as a percentage of the GDP, allocation has actually dwindled. The State has not been able to provide healthcare for the masses. Even now, 80 per cent of healthcare is under the domain of private sector.
33 : The Government’s primary role should be in good governance, security and law and order, infrastructure, education and healthcare, but the model of delivery needs to be radically changed to being carried out by professionally-managed expert organisations who would be fully accountable for every rupee spent.
34 : THE STRUCTURE Health is a State subject with a large number of vertical CSS /Centre funded disease control programmes, to be delivered through PHC system Family Welfare is a concurrent subject with large GOI financing Primary health care is a PRI devolved area – Mandated role of local governments.
35 : CMP PRIORITIES Raise public spending on health to 2-3% of GDP over the next five years. A national scheme for health insurance for poor families. Higher public investment for communicable diseases/ AIDS. Village women to be given responsibility for all development schemes relating to drinking water, sanitation, primary education, primary health and nutrition.
36 : THE CHALLENGE Investing more in reformed public health system that allows autonomy to delivery units Hospital, PHC, CHC, HSC. Making public health accountable to local communities with clear service delivery guarantees from autonomous health delivery units, even in remote rural regions.
37 : THE CHALLENGE - II Using non-governmental sector ( NGOs, Trusts, private providers) to improve health outcomes through innovative public-private partnerships that address equity and quality service delivery – demand side financing, ethical practice, community partnership.
38 : Private partners can widen the coverage of foreign assistance programmes, help in achieving the Government’s development goals and in the formulation of sound projects. They can also assist to improve identification of adequate investments, these being sometimes overestimated by the local authorities, which tend to over dimension physical infrastructure, both qualitatively and quantitatively, and therefore create constraints to the timely deployment of appropriate investments.
39 : State Governments can hand over management of sub-health centres, PHCs, community health centres to private partners under lease agreements. The Govern-ment could also pay annual capitation fee for PHC services provided by the privately-run centre to a declared list of poor residents in the catchments areas. State Governments can also partner with private players to set up and operate a network of diagnostic centres in the states (hub and spoke model) covering their hospitals with appropriate range of diagnostic services on a fee-for-service basis and profit-sharing agreements.
40 : In order to maintain their commitment to protect the underprivileged, the Government can agree to pay on their behalf. Space can be given to the diagnostic services within the Government hospitals or these centres can be set up in the hospital campus or adjoining areas. These agreements would be for 10-30 years with suitable exit clauses. Collection centres for pathology specimens/samples will be encouraged to be set up in PHCs.
41 : The corporate sector can join hands with the Government at the centre and with various states for a JV to run resource-starved state medical colleges and district hospitals in a more efficient manner. Some of the large industrial houses have their own excellent hospitals, which can extend their services in their districts and surrounding PHCs. These hospitals can also provide health education in these districts and PHCs
42 : Private sector can also provide facilities for training of para-medical personnel – laboratory technicians, nurses, physiotherapists, radiography and radiotherapy technicians. Private sector can also play a pivotal role in improving the environment, sanitation, providing clean water supply preventing air pollution and increasing the green cover. We must empower the community to participate in healthcare as informed and involved partners. Patient education should be an integral part of healthcare. In planning of all hospital operations, community representatives should be a part of all decision-making bodies
43 : ‘It is Time 100% Healthcare reaches The Common Man’ It is time 100 per cent of healthcare reaches the common man. Resources are available but need to be spent right. Empirical data does not favour with Government's ability to deliver. Time is ripe to initiate PPP in India as the answer to get to the bottom of the problem and the pyramid.
44 : THANK YOU PANELISTS: PROF USHASHARMA, PROF NC PRAJAPATI & MR VD AGARWAL THANK YOU AUDIENCE THANK YOU MCI FOR ORGANISING SUCH A MEETING
45 :

 

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