By Lalitha Vadrevu
In India, there is a growing interest in partnership driven innovative service delivery models for providing health services to the poor. Consequently, the state and central governments in India have initiated 226 innovative programs of which 43 are through public private partnerships (PPPs). In spite of this interest in PPPs, very few programs have been scaled up to reach a wider population.On one hand, PPPs are lauded as an innovative model for service delivery and multiplicative scale-up that includes multiple actors. On the other hand, it is argued that factors such as inadequate funding, changing political context and PPP modalities like tendering and contracts limit the resources available for development and scale-up of innovations. But the fundamental question is – how can partnerships based on the premise of collaborative functioning that leverages each other’s strengths foster innovative solutions for local problems and drive them to scale?
To understand how PPPs can drive innovative programs to scale, FHS researchers interviewed many government and NGO personnel working in the Indian Sundarbans as a part of FHS India- Maternal and Child Healthcare Innovation Study. We studied two popular innovative programs - the Mobile Medical Boats and Community Delivery Centres (CDC). Mobile Medical Boats are out-patient and diagnostic services provided via boat to populations living in remote areas, while CDCs are delivery posts managed by local NGOs in order to provide institutional delivery services in inaccessible regions. Both of these programs were initiated by the government and are being implemented by NGOs working in the Indian Sundarbans. However, neither of these programs has witnessed a significant increase in coverage or network in the past few years.
Our interviews with program officials point to three critical bottlenecks to ensuring that PPPs stimulate innovations:
- lack of adaptation and learning
- lack of capacity for implementation and partnership, and
- weak relationships and dynamics between NGOs and the public sector.
The first and the most fundamental challenge is the technical capacity of both parties (NGOs – the implementers, and the government – the funders) to implement programs under PPP in health. As one of the NGO personnel rightly pointed out,"Health programs are not the same as contracts for building roads or bridges. They need to be viewed and managed differently."Often governments do not have enough suitable NGOs to partner with that are sufficiently competent to implement health programs. To add to this, the relationship between the public and the private sectors is riddled with mistrust, making mutual dialogue and exchange very difficult. Consequently, it is not a surprise that there is little room for mutual learning or adaptation through discussions between both the parties.
Innovation is an outcome of knowledge exchange and dialogue between different health system actors, and the lack of this questions our assumption that PPPs are,indeed, effective models of partnerships. It is important to view PPPs as dynamic systems of engagement between public and private health system actors that need to be strengthened to stimulate and scale up innovations in health.