Objective="Access to facility-based RCH services."
Details for Reform Option "Public Private Partnership for delivery of Reproductive Child Health services to the slum population of Guwahati city, Assam"
The urban health intervention in Guwahati, Assam, involves contracting a trust hospital - Marwari Maternity Hospital (MMH) to provide services in eight low-income municipal wards of the city, having a total population of 2 – 2.5 lakh. The state government pays the MMH for providing outreach and referral services, in the identified areas.
In addition, vaccines and contraceptives are provided free to MMH. MMH is covering 14 outreach sites in these areas. It is mainly providing RCH services but the outreach team includes a doctor and they can also treat simple ailments or refer patients to the hospital.
In the hospital, sterilisation, spacing and abortion services are provided free of cost to patients, while deliveries, operations and diagnostic tests are charged at concessionary rates.
The initial contract was for one year (2002-2003). Government of Assam reviewed the performance after one year and renewed the contract.
To build up the referral system, the Government of Assam also proposes to upgrade three or 4 health posts/urban family welfare centres to secondary hospitals in the urban limits of Guwahati, within or near the slum areas.
The first hospital will be partly funded from the Sector Investment Programme (SIP) of the European Commission (INR 252 lakh) and the others will be funded from the Department of Family Welfare’s (DoFW) urban health allocation /other sources. The construction of the first hospital has already begun, under the management of the Kamrup district health & family welfare society.
The PPP initiative has had significant successes. Apart from direct provision of services, it has induced replication in the public sector. The secondary/ referral system is being strengthened with marginal investment since the staff are already available.
The MMH management has started a programme of RCH camps in peri-urban areas at their own cost. Other private and trust hospitals in the city are expressing interest in joining this initiative.
Cost of contract: INR 17.91 lakh for the first year, INR 29.07 lakh for the next two years.
Guwahati city, Assam.
Discussions began mid-2000, the MMH - State Government agreement was signed 16 February 2002 and the outreach work formally started 31 March 2002.
Once concerned parties have agreed to proceed, things can move very quickly because infrastructure requirement is minimal.
Improved access to services: Particularly for the urban poor, floating population and women and children who were previously unserved.
Increases use: Of institutional deliveries, immunisation coverage levels, improved management of obstetric emergencies and provision of basic curative care.
Popular: Wide community and political support.
Economic: Needs little infrastructure, not very costly and can start functioning very quickly.
Support: Can be excessively dependant on the commitment and dedication of one person or of a small group.
Relies on private sector cooperation: Reluctance of private facility managers to get involved with government programmes (this caused serious delay in this case).
Needs government cooperation: Delays and non-cooperation from government officials can kill such initiatives very quickly - particularly delays in funds transfers.
Possible opposition: In a similar initiative in Karnataka, the NGO managing Primary Health Centres (PHCs) faced difficulties with a private nursing home which feared a loss of business (See ECTA Working Paper 61 for details).
Agreement between the government and service providers specifying their respective roles and responsibilities, especially with regard to the areas to be covered, payments, supplies, reporting etc.
Prior to implementation, extensive consultations with community and religious leaders, to secure their support.
Who needs to be consulted
State / District health sector managers, the private management, community leaders.
Sustainable as long as there is interest on both sides, the Government and the private participant.
Chances of Replication
The service delivery model has now been replicated at another 90 sites in Guwahati city, using available state government staff. The staff (both medical and paramedical) were based in various city dispensaries and were under-used.
Another 10 sites will also be added.
A similar arrangement is reported in rural areas in Andhra Pradesh, Orissa and Karnataka.(See ECTA Working Paper 61 for details)
The complement of government staff meant for the urban area identified for PPP, if any, would have to be re-assigned elsewhere. This would probably involve moving one or more existing health posts/sub-centres or re-defining the outreach areas for the post-partum centres located at district/sub-district hospitals.
Mr. Indrajit Pal, Former Programme Advisor, ECTA, New Delhi. March 2004.
Last Updated: July 2006