Although many countries already make use of private sector services to achieve policy objectives in public health care provision, it remains a controversial topic. Drawing on a wide range of country experiences, this book considers the use of the private sector in the provision of public health services in developing countries, in terms of: assessing the potential for private sector involvement, contracting with the private sector for health services, regulating the sector, and what to do when key information is not available.

This book considers the use of Public-Private Partnerships (PPPs) in the delivery of physical assets, infrastructure and technologies and related clinical services, in the health sector. The PPP model represents the most complex form of contracting transaction yet to have emerged in the health sector, owing to its long-term character, financial complexity, and risk-allocation mechanisms. This book draws on the lessons of policy-makers, managers and private companies to address the specific challenges in the health sector. It is the reference guide to PPPs in health, presenting the theory, evidence and practice, and making them operationally relevant to all PPP stakeholders.

Over the past several decades, the public and private sectors made significant investments in global health, leading to meaningful changes for many of the world's poor. These investments and the resulting progress are often concentrated in vertical health programs, such as child and maternal health, malaria, and HIV, where donors may have a strategic interest. Frequently, partnerships between donors and other stakeholders can coalesce on a specific topical area of expertise and interest. However, to sustain these successes and continue progress, there is a growing recognition of the need to strengthen health systems more broadly and build functional administrative and technical infrastructure that can support health services for all, improve the health of populations, increase the purchasing and earning power of consumers and workers, and advance global security. In June 2015, the National Academies of Sciences, Engineering, and Medicine held a workshop on the role of public-private partnerships (PPPs) in health systems strengthening. Participants examined a range of incentives, innovations, and opportunities for relevant sectors and stakeholders in strengthening health systems through partnerships; to explore lessons learned from pervious and ongoing efforts with the goal of illuminating how to improve performance and outcomes going forward; and to discuss measuring the value and outcomes of investments and documenting success in partnerships focused on health systems strengthening. This report summarizes the presentations and discussions from the workshop.

Many developing countries face a critical gap between the demand for health care services and their supply. Public resources often fall short of what is needed to provide universal health care, and the typical incentive structure in the public sector may not always be conducive to expanding access, improving the quality of care, and ensuring efficient use of limited funding and expertise. This Note defines options for mobilizing private resources to achieve public health objectives. A government seeking to encourage private participation in health care provision can choose among six basic policy and regulatory options that vary widely in the risks and responsibilities borne by the private (for-profit or nonprofit) entity. At one end of the spectrum the private sector takes on limited responsibilities while the public sector remains the primary provider of health care services. At the other, the government establishes a policy environment in which qualified private entities may freely enter and exit the health care market. In this option private providers assume the full risks and responsibilities associated with service provision, and the public sector limits its role to regulation.

Public-private partnerships are increasingly advocated to alleviate deficiencies in the public health system as well as to reduce economic stress on those who seek services from an expensive, burgeoning and unregulated private health sector. Focusing on India, this book examines how the private sector in developing countries is tapped to deliver health care services to poor and under-served sections of society through collaborative arrangements with the government. Having emerged as a key reform initiative, aspects of public-private partnership are examined such as the genesis of private sector partnerships, the ways in which the private sector is encouraged to deliver public health services, and the models and formats that make such partnerships possible. Based on in-depth case studies from different states of India and drawing on experiences in other countries, the authors analyse challenges, opportunities and benefits of implementing public-private partnerships and explore whether partnership with the private sector can be designed to deliver health care services to the poor as well as the consequences for beneficiaries. This book will be of interest to scholars of public policy and development administration, health policy and development economics as well as South Asian Studies.

This paper discusses the nature of private sector involvement in health service delivery in developing countries, the potential for expanding it, and areas where health sector policy goals might benefit from greater private participation. It takes the wide and rarely occupied middle ground between the extreme pro-public and pro-private approaches to health care delivery. A simple distinction between the private and public sectors is applied -- anything not done by the government itself is treated as part of the private sector. The area of greatest potential for private sector involvement in developing countries is in hospital care. It would require, however, the development of third party payment systems and a re-evaluation in areas where governments are most heavily involved. This would allow governments to retreat to the simpler and more appropriate tasks of financing and regulating health service delivery. Governments probably cannot extract themselves completely form direct provision of curative care, especially in rural areas. Greater reliance on the private sector to supply remaining government facilities, however can stimulate the development of more diversified private markets and supply lines in rural areas.

Public–private partnerships (PPPs) have shown their ability to meet some of the challenges in the health and education sectors both in India and overseas. The Asian Development Bank (ADB) has been assisting the Government of India since 2006 to develop PPPs across sectors in India, through a programmatic joint PPP Initiative, Mainstreaming PPPs in India. Under the initiative, a special task team of the ADB, together with the Government of India's Ministry of Finance and KPMG consultants undertook a rapid assessment study to develop possible PPP solutions for meeting the challenges of India's health and education sectors. Assessments of local PPP projects in the sector, consultations with state government officials in India, and best practice examples from the United Kingdom and other countries, have led to the development of this report. This report will therefore provide a quick guide to international and national PPP cases in the sectors as well as practical ideas and suggested models to interested project sponsors, especially within government bodies responsible for sector development. Development of possible PPP projects based on some of the models and ideas suggested herewith will hopefully spur investment and efficiency gains in health and education infrastructure and service delivery mechanisms of the country.