Scaling Up Public-Private Partnerships to Achieve Family Planning Equity Goals in India Suneeta Sharma, PhD MHA, Managing Director, Futures Group India Tanya Liberham, MA, Knowledge Management Officer, Futures Group India
Outline Taking PPP models to scale under Innovations in FP Technical Assistance Project (ITAP): success factors Four examples The Sambhav ( Possible ) Voucher system The Accredited Social Health Activist (ASHA) Plus program The Mobile Health Van Initiative The MerryGold Social Franchise Model Way forward
Scale Up: Success Factors Government (national and state) leadership and ownership Think scale up from the beginning Strengthen and build on existing structures and systems Consultative and transparent process of setting goals and building partnerships Clearly defined and agreed upon monitoring indicators and performance levels Follow an active problem solving approach Sustainable financing Linkage between proven models and policies
Framework for Strengthening Private Sector Role to Achieve Health Equity Goals Demand Create an enabling environment Policy Public Private Balance Public Private Sector roles Supply Build Public Private Partnerships Analysis Advocacy and Dialogue Action 4
Public-Private Partnerships (PPPs) PPPs are collaborative efforts between private and public sectors, with clearly identified partnership structures, shared objectives, and specified performance indicators for delivery of a set of health services. 5D Approach DESIGN DOCUMENT Develop the concepts for the innovation DEVELOP Design the details of the innovative approach Demonstrate feasibility of the innovation through piloting DEMONSTRATE Document achievements, challenges, and lessons learned Disseminate findings to inform scale-up DISSEMINATE
Sambhav Voucher System To reduce inequities in reproductive health care by enabling access to services, while empowering the below poverty line population to choose their own provider Voucher Redemption Voucher Management Agency Voucher Distribution Private Nursing Homes Payment for Services ANM/ASHA Voucher Redemption BPL Families Voucher Distribution 6
Voucher System Implementation IMPLEMENTATION SYSTEMS DEMAND CREATION QUALITY ASSURANCE SYSTEMS Design and conduct baseline survey Design, print and distribute vouchers Orient ASHAs and community members Develop guidelines for identification of BPL families Establish and build capacity of VMU Develop and implement MIS Create PNH network Develop contractual agreements between Society and VMU, and VMU and PNH Develop system for reimbursement for PNH Establish referral systems Design and conduct endline survey Conduct formative research Identify communication needs Design communication strategy Develop BCC/ IEC materials for PNH and clients Prepare quality standard guidelines for PNH Develop accreditation guidelines Assess and accredit PNH Design client verification system Conduct Medical Audit of PNHs Conduct Client Satisfaction Survey Provide Continuous Medical Education for PNH
Voucher System Achievements Sambhav voucher system pilots 12,500 institutional deliveries 44,000 ANC Visits/10,300 PNC visits 9,500 FP methods Uttarakhand: BPL population coverage increased Percentage 60 50 40 30 20 Improving FP/RH Uptake: Urban and Rural Poor 53.3 43 38.5 30.8 34.8 36 26.7 54 from 0.15million in two blocks (Pilot) 10 to 2.58 million poor across the state UP scaled up the urban slum voucher system from one city to eleven cities Jharkhand: injectables accounted for 43% of modern method use 0 Use of modern contraceptive use Institutional delivery Agra (rural) Baseline, 2006 Agra (rural) Endline, 2009 Kanpur Nagar (slum) Baseline, 2006 Kanpur Nagar (slum) Endline, 2011 Source: : IFPS Technical Assistance Project (ITAP). 2012. Sambhav: Vouchers Make High-Quality Reproductive Health Services Possible for India s Poor. Gurgaon, Haryana: Futures Group, ITAP. 8
ASHA Plus Program ASHAs introduced under NRHM to promote healthy behaviors In Uttarakhand, ASHAs faced challenges in providing uniform services due to Hilly terrain, Small scattered settlements covering large geographical area Poor connectivity Limited public transport ASHAs unable to sustain themselves covering a smaller number of people than intended ASHA Plus program a viable and evidence based Operations Research model Piloted in six blocks of three bordering districts Flexible population coverage Performance based remuneration Enhanced training package 9
Partnerships in ASHA Plus Ensuring financial flows Training and capacity building Coordinating with other departments Cooperating with ASHA Plus worker Conceptualize and design program Selection of project intervention areas Selection of NGOs Monitoring and review of the program State Government ITAP Recruiting and training of ASHAs Supportive supervision Taking feedback from the community Piloting all training materials and tools NGOs ASHA plus Workers Creating awareness & disseminating information on health programs Community mobilization Organizing community level meetings Strengthening linkages
Achievements of ASHA Plus Scale up: 6 blocks to 6 districts Population coverage increased from.26million to 3.13million 47 Block Coordinators and 550 ASHA Facilitators support 11,086 ASHA at block and sub block levels Learning's of ASHA Plus were incorporated in ASHA Support System Rural Development Institute and 10 NGOs are implementing ARCs across the state
Reaching the Underserved: Mobile Health Vans A fixed day, fixed time, and fixed place approach to provide primary healthcare services in remote rural areas
Facilitating Implementation Pilot phase Evaluation of early MHV models Van specifications Route design and operations Service provision Personnel Capacity building Community engagement and demand generation Management and oversight Links to public health system Private sector engagement Cost recovery Financial allocation and expenditures Scale Up Expansion of MHV operations in the state Evaluation of MHVs and design of a synchronization plan MHV synchronization strategy Refinement of monitoring activities Financial scale up 13
Scale up Mobile Health Vans Scale up From 1 van to 30 vans throughout UK Population coverage from 0.5 million to 10 million Performance (2010 2011) Organized 5000 camps Reached 300,000 people IFPS Technical Assistance Project (ITAP). 2012. Reaching Underserved Communities through Mobile Health Vans in Uttarakhand, India. Gurgaon, Haryana: Futures Group, ITAP.
MerryGold Social Franchising An innovative, sustainable, for-profit PPP model to deliver maternal health and family planning services at below market prices Business format approach for SUSTAINABILITY THROUGH INNOVATIONS Market research fundamental to future growth of the network Three-tiered approach with a mix of full and fractional franchising Building brand value: beyond just the logos Linkages with existing government schemes Franchisor s role in: Building capacities and training Development of vendors and procurement at competitive prices Regulating quality assurance systems Marketing of the network 15
Partnerships in Social Franchising Support formation and operation of network Overall management Monitor the project Benchmark formulation and report to USAID Design and develop the network Process documentation and dissemination Conduct periodic studies and assessments Adherence to network guidelines Provide quality services to clients at pre-determined prices Conduct outreach activities Quality management at facility As the franchisor, recruit qualified franchisees Build and market the brand; Define guidelines and protocols Manage the network Build capacities of franchisees Quality assurance Reporting to SIFPSA
Social Franchising Achievements Performance during Oct 2007 February 2012 Hub and Spoke model of MGHN 756,100 antenatal checkups L3 L3 133,900 deliveries L2 10,600 sterilizations 38,200 IUCD insertions L3 L3 >1 million CYPs generated so far L2 L0 L2 Under consolidation phase, included in the Program Implementation Plan (PIP) 2013 L3 L1 L2 L3 Replicating the same model in Rajasthan L3 L3 Source: IFPS Technical Assistance Project (ITAP). 2012. Social Franchising as a Public Private Partnership Model - Lessons Learned from the MerryGold Health Network of Uttar Pradesh, India. Gurgaon, Haryana: Futures Group, ITAP. 17
Extending Best Practices DFID RH Framework Family Planning (Bihar and Orissa) Social franchising, social marketing and innovative PPP models USAID PIPPSE Project HIV/AIDS (UP, Uttarakhand, Rajasthan) Employer led models PPP structures and roadmap PPP course Global Fund Malaria (7 north eastern states) Private sector mapping, capacity building, and engagement 18
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