Public-Private Partnership (PPP) is a legal relationship and an arrangement between the government and statutory entity, government in one side and private sector entity on the other for making provision of public assets and /or public services to render. It is a mode of providing public infrastructure and services by government in partnership with private sector.
In precise, it is a long term arrangement between the government and private sector entity for provision of public utilities and services leading to GDP growth of the country as ultimate vision. The PPP model is practised round the world, especially in developing countries, to attract local and foreign investment in infrastructure in different sectors and improve the access to social-economic welfare services. The main objectives of the PPP model are to improve access and equity with better efficiency that can regulate accountability.
In Bangladesh, public-private partnership got its peak in 2009 when the new government took over the responsibility to run the country with the pledges of charter of change to transform the country into a middle income one while celebrating the golden jubilee of independence in 2021. Since then, every year, there was sufficient budget provision on the PPP head to encourage investments and make the PPP Cell fully functional.
In 2015, The Bangladesh Public-Private Partnership Act, 2015 was enacted to assume the obligation /responsibility for carrying out any public work or providing any services on behalf of contracting authority. The Act contains 8 Chapters with 49 clauses describing the composition of the Board of Governors indicating power and functions of the Authority, selection of private partners, corruption and conflict of interest and fund management etc. The Board of Governors of the PPP authority will be headed by Prime Minister as the Chairperson that reflects the commitment of the government. This indicates the importance the government attached to this partnership concept as a means of strategic investment for building up infrastructure and providing services for socio-economic uplift of the nation.
The health sector is one of the very important areas where the PPP model could play prominent role to ensure preventive, promotive and curative health care services. In many countries, the health sector is managed by a public-private partnership approach in order to ensure community ownership and belongingness of the public at large.
In India, Apollo Hospitals, a private sector health operator, developed a partnership with the government owned Rajib Gandhi super specialty hospital for management and providing services. The outcome was appreciated at home and aboard attracting patients from the Middle East and some African countries. Similarly in the state of Karnataka, Yeshvini cooperative Health Care Scheme launched a community based health insurance scheme in partnership with the government owned Swami Manshingh hospital of Jaipur. In Malaysia, Indonesia and Thailand such initiatives of PPP proved successful in the health sector services delivery system.
In Bangladesh, Local Government Division has undertaken two health sector projects namely Urban Primary Health Care Services Delivery Project (UPHCSDP) and Urban Public and Environment Health Sector Development Project (UPEHSDP) with the support of Asian Development Bank, Swedish Embassy, United Nation Fund for Population Activities (UNFPA) and the Government. The model is based on public-private partnership.
UPHCSDP has started its operation in 1998 where LGD through a Project Management Unit and in partnership with Non-Government Organisations has started its functioning in providing health care services in City Corporations and municipalities. As at present, NGOs like Nari Maitree, Khulna Mukti Seba Sangha (KMSS), Population Services and Training Centre, (PSTC) Dhaka Ahsania Mission, Shimatik, Bangladesh Association for Prevention of Septic Abortion (BAPSA), Unity Through Population Services (UTPS), Eco Social Development Organisation (ESDO), Resource Integration Centre (RIC), PSKP&PPS, etc are partners and providing services in 25 partnership areas. This project is functional in 10 City Corporations and 4 Municipalities and is planning to expand its coverage in 11 City Corporations and 12 more municipalities from 2018 to provide maternal health care, child health care, reproductive health care, adolescent health care, nutrition, family planning services and behaviour change communication programme to generate health awareness among urban slum dwellers in particular etc. The project has been evaluated as one of the best models of urban health project with pro-poor targeting and gender responsiveness.
Some independent evaluations observed on UPHCSDP as, “Public private partnerships for primary health service delivery among the urban poor and particularly women and children, proved to be a replicable, effective, and innovative approach.” Similarly, UPEHSDP has involved private sector operators in respect of solid waste management and medical waste disposal and operation of Short Transfer Station and Landfill.
In fact, there are enough potential to explore opportunities of application and operation of the PPP model in health services delivery system especially in the infrastructure building, services providing, management and creating innovation in the health care delivery system. As at present, some partnership exists in dialysis, ambulance services but there is enough scope to expand the opportunities of involving private sector in total health care delivery system in cooperation with the government initiatives.
There are enough opportunities to provide health care services through public-private partnership in the areas of Telemedicine, CT Scan, MRI etc as done in India in the Hospital of Professor Dr Devi Shetty at Bangalore under a PPP contract with state government. Similarly, mobile health clinics are operated on PPP model at UP of India. The demand side financing, /voucher scheme in Gujrat state of India proved successful to improve maternal health, increase institutional delivery and pre-natal post natal care.
The PPP model can be a successful one when there are clear terms and conditions of contract between contracting parties with obligations of partners defined clearly. There must be visible and achievable indicators without any scope of blaming each other for which guidelines to be framed judiciously and maximum precaution should be taken in case of unsolicited proposal. There must be a timeframe of completion of the project phase-wise with responsibility and duties identified.
We have to look beyond the so-called predominantly reductionist bio-medical model of health care to a holistic model of health care that puts human beings in the centre. The health of any nation is the sum total of the health of its citizens, communities and settlements in which they live.
A healthy nation is, therefore; only feasible if there is total participation of its citizens towards this goal. Unfortunately, development efforts have been rooted in our neither traditional institutions nor community initiatives that exist in some form or other throughout the country. Progress is easiest if we are tuned with the national genius that has developed over the centuries, with certain special traits. If this domestic capacity is ignored or discarded, development efforts will lose their bearing and roots, and gradually, vitality. The PPP model in health care can create such a situation consistent with national demand and expectation to emerge as a healthy nation.
It should be kept in mind that critical factors for success of PPP include regulation, transparency, clear policy guidance and clarity on operational procedures and responsibilities, proper evaluation mechanisms, sustained financial support, especially for NGO partners, and unwavering commitment from policy-makers.
The writer is a Former Secretary to the