Governance Framework and Public Private Partnership for Universal Health Coverage: Findings from Indias Federal Health Structure

BackgroundThe role of private health sector in advancing universal health coverage is being recognized globally. A number of public private partnership (PPP) strategies have been implemented across the states in India. States (provinces) are primarily responsible for health service delivery in India. ObjectivesTo document various PPPs models in health sector across Indian states and to map the policy, legal and institutional eco-system governing such partnerships. MethodsDesk review followed up with field visits and in-depth interviews. A total of 52 in-depth interviews were conducted from various levels of stakeholders. ResultsNearly 250 PPP initiatives in health sector across all Indian states were identified and studied. Partnership with the private sector was predominantly in the areas of emergency transport, laboratory diagnosis, and in the delivery of selected primary care services. PPPs in health infrastructure (hospitals and medical colleges) and purchasing arrangements are rapidly emerging across most states. However, only few Indian states have health sector specific PPP policy or legal and/ or institutional framework governing PPPs and organizational units implementing partnership schemes. The capacity to conceive, design, implement, and manage PPPs in health sector was found either absent or insufficient in most states. ConclusionEffective partnerships with the private health sector for achieving countrys health goals requires a well enunciated policy and governance framework; detailed assessment of the private health sector market behavior; legal, regulatory, and oversight mechanisms; building organizational structures with capacities, and developing platforms for stakeholder dialogue. Findings from the Indian context could offer useful insights for other low- and middle-income countries aiming to advance towards achieving UHC.