Agra, Uttar Pradesh, India, May 2008. “Now I understand what public private partnership in health really means. It does not mean a buy-out of the health sector and actually makes a lot of sense in our context. The contracting of NGOs for some key health services might actually help us a lot if we want to improve the health outcomes in our state. ” This is how a participant from Uttarankhand summed up a week-long course on public private partnership in health which was recently held in Agra, India.  | Government health officials, chief medical officers and professors from medical schools coming from nine Indian states attended the course. |
47 government health officials, chief medical officers and professors from medical schools coming from nine Indian states (Himachal Pradesh, Rajasthan, Uttar Pradesh, Uttarakhand, Orissa, Madhya Pradesh, Chattisgarh, Karnataka and Delhi) attended the course as state teams. “All of them are involved in the implementation of the National Rural Health Mission (NRHM), the Government's Health Flagship program which provides a lot of flexibility for state-level health officials in experimenting with new innovative models to improve health indicators and help India to reach the Millennium Development Goals”, highlights Peter Berman, Lead Economist in the Delhi office of the World Bank who has been supporting the program for the past three years. “A course on public-private partnership is, therefore, very relevant in the current health environment in India”, he adds. Participants studied different models of public-private partnership (PPP), learned about international experiences in PPP and how best to ‘contract out’ or ‘contract in’ services in the primarily public health sector in India. Real life case studies from India and other countries helped the participants to relate new innovative models to their own context. In group work with colleagues from their own states they developed plans on how to apply some of these new ideas in their home states. “It was great to hear from other states and learn about their approaches” says one participant from Orissa after hearing an example from Uttar Pradesh which has pioneered a PPP model to provide better access to health care services in remote rural and underserved areas – a major problem in India which lacks large numbers of doctors and nurses in rural health centers. “I really liked the practical learning, particularly the contracting tool kit which is a great tool to take back home and just start” adds another participant from Karnataka.  | Participants visited several private hospitals which participate in a successful voucher scheme supported by the Government of Uttar Pradesh |
Equipped with a checklist, participants visited several private hospitals which participate in a successful voucher scheme supported by the Government of Uttar Pradesh to increase institutional deliveries and pre-natal care. “Getting first hand exposure to a functioning PPP model and being able to ask questions and learn about the difficulties and challenges has been great. Models become much clearer when you see them in reality”, emphasized a participant from Chattisgarh.
Monitoring, impact evaluation and how to build reliable and lasting partnerships were other key elements of the course. “Listening to a NGO which is a ‘contractor’ for the state government in Arunachal Pradesh helped me to understand the other side much better. What we need are actually collaborative partnerships with NGOs on the basis of clear terms and conditions. ‘Contracting’ as it is called makes now much more sense to me”, says a participant who works for the health directorate in Rajasthan. Dr. Akhilesh Bharghava, Director of the State Institute for Health and Family Welfare in Rajasthan, the State government’s apex training arm in health, adds: “We now need to find a way to sensitize our colleagues at the district level so they can identify service oriented NGOs for rural areas. We would like to develop a two-day PPP course such as this one for district-level health officials in Rajasthan.” “We have come a long way starting three years ago with a series of consultations with the Ministry of Health and Family Welfare”, says Alexandra Humme, World Bank Institute (WBI) task manager for the program. “Last year, we undertook health training needs assessments together with our partner, the National Institute for Health and Family Welfare (NIHFW), to three Indian States and identified public-private partnership in health as one key area where the states wanted to learn more. The presentations from the group work show that participants have internalized some of the PPP concepts and are committed to implement some of the new learning in their home settings. This is very encouraging!” “It will now be important to provide a good follow-up mechanism to ensure that the learning is actually applied. We need to make sure that once they are back in their work environment, participants don't feel overwhelmed. We want to be there for them, check in on a regular basis and support them when they face challenges”, highlights Dr. Deoki Nandan, Director of the National Institute for Health and Family Welfare. More courses on public-private partnership, human resource management and quality of health care are planned in the next fiscal year anchored with NIHFW and supported by WBI and other development partners. “We want this to be a long-term sustainable program in India, because the needs are too great to achieve any results with one-off events” agree the co-organizers. An electronic resource center which will house all course materials including presentations, reading materials, agendas and case studies is currently under preparation and expected to be open to the public by August 2008. Contributed by Alexandra Humme, World Bank Institute Office: New Delhi
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