International Journal of Innovation and Scientific Research ISSN 2351-8014 Vol. 15 No. 1 May 2015, pp. 180-187 © 2015 Innovative Space of Scientific Research Journals http://www.ijisr.issr-journals.org/ Corresponding Author: Alka Barua 180 A Study of Three Public Private Partnership Models for Health in Gujarat, India Alka Barua 1-2 1 Senior Consulting Associate, Gynuity Health Projects, India 2 PhD Scholar, Tata Institute of Social Sciences, Mumbai, India Copyright © 2015 ISSR Journals. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. ABSTRACT: Public Private Partnerships have been implemented in India to help improve the performance of the public health sector. The experiences of implementation have been a mixed bag with some successes. There have been concerns during implementation about the designs not accounting for disparate motivations, ambiguous roles and risks to partners that affect the management, sustainability and ultimately the services. A study was conducted to understand the designs of three Public Private Partnerships addressing reproductive health needs of women at primary and secondary health care level in rural Gujarat. These partnerships were with a corporate body, a Non-Government Organisation and with private empanelled gynaecologists respectively. Review of data and relevant documents from the government and private partners and in-depth interviews with select key informants were conducted. The Government of Gujarat has drafted elaborate conceptual framework and guidelines for Public Private Partnership. Yet, the non-competitive selection of partners, conflict of interest, lack of commitment and attention to standards of care and insufficient monitoring and accountability mechanisms all point towards weaknesses in design of these models. Implementation without fidelity to the purpose and design of the PPP and un-addressed risks to partners make these partnerships vulnerable to exploitation and un-sustainable in the original format. The study highlights the need for thorough review of partners and evaluation of existing models to ensure that the potential benefits of PPPs are not frittered away at the altar of weak designs and lack of monitoring. KEYWORDS: Design, Selection, Roles, Responsibilities, Risks, Sustainability. 1 INTRODUCTION Essential reproductive health services are not available to the majority (70%) of women in India through the public health system. [1] Provision of health facilities is a constitutional obligation of the government and yet the poor performance on health indicators in India has been largely attributed to inadequacies in availability, accessibility, acceptability and quality of health services, particularly in the public sector health system. [2] To improve the performance of the public health sector, successive Five-Year Plans since 1992 [3] have stressed on the need for health sector reforms. Public Private Partnerships (PPPs), one such reform has a very strong symbolic appeal as it envisages bringing together the two sectors to improve the health of the poor and deprived sections of the population. The task force set up under the National Rural Health Mission (2005) of Government of India, re-iterated the need for PPPs to meet the public health challenges in the country. [4] At the core of this is the assertion that the easily accessible and better managed private sector will promote accessibility, efficiency, accountability and cost effective and good quality services. [5] The PPPs have been conceptualized as effective, efficient, equitable and sustainable models of service delivery. Till the advent of health sector reforms and PPPs, private collaboration was limited and largely informal or ad hoc. Increasing importance of efficiency in service delivery mandated a more formal, equitable relationship between partners to deliver comprehensive services. [6] A variety of PPP intervention models have been implemented in India. Many of these PPPs have succeeded in providing an efficient, flexible, equitable cost effective and viable alternative for “government only” service delivery models. Subsidies and local reach of these models succeeded to some extent in ensuring that services are affordable and reach the unreached. Those in partnership with Community Based Organisations (CBOs) were especially found to be more transparent, accountable