The Hindu Business Line : Public-private partnerships: Working to deliver better health

Good partnerships should ensure a balanced and participative approach. However, the balance runs the danger of being upset at times by a stronger financial or bureaucratic partner.

Ram Sharma

In today’s world, the private sector is playing an increasingly important role in shaping global health agendas. Public private partnerships (PPPs) are fast gaining acceptance as both the public and the private sector recognise their individual inabilities to address emerging public health issues.

There is a lot of enthusiasm about PPPs as they seem to offer a way to overcome governmental red tape on account of being both resource rich and flexible.

Reach and capital

Some of the important contributing factors behind the emergence of these partnerships include the limited reach of the public health machinery, re-emergence of “old” health problems such as diarrhoea, dengue as well as the emergence of drug resistant strains of diseases like malaria and tuberculosis and HIV/AIDS compounded by the scourge of TB.

The rapid pace of technology evolution and lack of public funds for R&D activities have also resulted in a need for the private sector to commit funding towards development of newer drugs and diagnostics to combat these global diseases.

Creation of PPPs is being seen as a win-win arrangement wherein the public sector gets the much-needed infusion of capital and skilled human resource to initiate newer health initiatives and run the existing ones more efficiently, whereas the corporates and the various private foundations get the needed governmental backing and hence credibility to be a part of the national health programmes.

Symbiotic arrangement

These considerations have led to the emergence of a range of symbiotic arrangements that brought together organisations with the mandate to offer public good on one hand, and technical expertise, and financial resources on the other.

Some Global Partnerships in the health sector as categorised by the Initiative on Public-Private Partnerships for Health have been summarised in the Table.

PPPs in India

In a recent development, the Planning Commission is actively looking at the prospects of mainstreaming PPPs between the government, private sector and the non-profit sector in healthcare under the Eleventh Plan.

Some examples of successful PPPs in India include the Malaria Control Society in Gujarat hiring private agencies for information dissemination, the Government of Orissa allowing an NGO to run some of its primary healthcare centres and the Government of India engaging the private practitioners to run the TB control programme at 14 sites across the country.

AIDS initiative

The National AIDS Control Organisation (NACO) has also successfully collaborated with corporates such as ACC, Godrej, and BILT on the National AIDS Control Program for enhancing availability of antiretroviral (ARV) drugs, diagnostic and other care and support facilities. Other activities under this PPP include implementation of “AIDS in workplace” programmes, training of physicians, nurses and doctors, setting up of counselling help lines, and advocacy against stigma and discrimination of HIV-infected people.

NACO has also partnered with an American NGO by outsourcing some of its HIV testing centres. In fact, the battle against the scourge of HIV/AIDS provides good examples of successful PPPs. For instance, the Clinton Foundation is partnering companies such as Ranbaxy, Cipla, Matrix, Roche and Becton Dickinson (BD) to negotiate better pricing for ARV drugs and diagnostics to assist NACO in its care and treatment programmes.

Corporates such as BD work closely with non-profit organisations such as the Hindustan Latex Family Planning Promotion Trust, the Indian Medical Association and the Indian Academy of Paediatrics to train health care workers in safe injection and immunisation practices.

The modality

For initiation of PPPs, the public sector can invite participation from the corporate entity to harness its capacity and resources, whereas the private sector can initiate this to achieve their CSR objectives, or to marry CSR with their business interests An example of a PPP along these lines is that of Apollo Tyres working with NACO to set up STI clinics for the truckers who are an integral part of their business. Non-profit foundations can partner with country governments to build capacity in strategic areas such as improving health infrastructure, HR development and procurement related functions such as forecasting and supply chain logistics. PPPs are creating a powerful mechanism for addressing daunting global health problems, but they are also beset with complex process-related challenges.

Transparency

PPPs should develop transparent policy and procedural frameworks, towards ensuring public interest. They should at also mainstream their activities and be a part of the national dialogue.

Conflict of interest should be avoided and the difference between corporate sponsorships and donations with long term public health goals should be clearly separated.

At times, large sums of money pledged by rich private foundations and corporate entities may tend to redirect national health priorities and eventually derail crucial local and national efforts.

Conflict

Good partnerships should ensure a balanced and participative approach, however the balance runs the danger of being upset at times by a stronger financial or bureaucratic partner.

To ensure the smooth running of PPPs, all partners should be accountable for the delivery of desired results in an efficient manner.

There should be established systems for communication with reference to decision-making, funding, and resource allocation with a provision for documenting desired outcomes.

The success of various initiatives clearly demonstrates that in order to fast track the efficient delivery of state objectives, it is critical to develop sustainable public private partnerships by harnessing the rich pool of managerial and other resources available in the private sector and enrolling them in national developmental framework.

(The author is Managing Director, Becton Dickinson India Pvt. Ltd.)