Public private partnership: A case study on Urban Primary Health Care Center in Rajshahi City Corporation

Chapter : 1

Introductory discussion

1.1 Introduction (this point has contained too many sub points , some of them are irrelevant & broad)

                  Public–private partnership (PPP) describes a government service or private business venture which is funded and operated through a partnership of government and one or more private sector companies. These schemes are sometimes referred to as PPP, P3 or P3.

PPP involves a contract between a public sector authority and a private party, in which the private party provides a public service or project and assumes substantial financial, technical and operational risk in the project. In some types of PPP, the cost of using the service is borne exclusively by the users of the service and not by the taxpayer. In other types (notably the private finance initiative), capital investment is made by the private sector  on the strength of a contract with government to provide agreed services and the cost of providing the service is borne wholly or in part by the government.

The new global drive for minimal states role by improving private sector in service delivery has led to the development of various modes and forms of  public private partnership (ppp) both in developed and developing countries. PPP is considered as a solution to public sector’s inefficiency in service delivery without losing ‘Public good characteristics of basic services like health, education and so on. Therefore as an effort to enhance efficiency governments are now retrenching from direct service provisioning by putting the responsibility to local government  bodies, privatizing service delivery and contracting out to private sector or NGOs (Goldsworthy 2001/2002:21) sometimes under the banner of PPP. In this context the central aim of this paper is to explore the implications of the process with special focus on the health sector in Bangladesh.

Primary healthcare in Bangladesh is supposed to be a public responsibility, and until recently the government has tried to provide basic services directly through its own bureaucracy. However, the public sector faces acute problems in meeting the growing needs of urban population, especially the poor. In recent years, new institutions such as partnerships with not-for-profit private organizations are sought to improve the access and quality of primary care. This paper focuses on one urban partnership project, UPHCP in Bangladesh. It analyzes the service providing  process,  accountability relationships among different stakeholders involved in the project and cost effectiveness of contracting out.

Public –Private Partnership

The new global trust for promoting efficiency and effectiveness in public service delivery is pushing forward the increasing recognition of PPP , especially in the developing countries . In the new global context , state is becoming an enabler rather than direct provider of services. Using the metaphor developed by Gilbert and et al., the changing role of government could be illustrated as a shift from ‘rowing’ to ‘steering’ the government should set broad objectives and create such an environment that will ensure the accomplishment of certain essential activities. Here it is less important to consider who finally provides the services . It might be commercial for profit enterprise , NGO’s , co-operative societies, community based organizations, religious organizations, professional organizations, or trade unions. Therefore this new context is creating the space for PPP. There is a growing tendency to see it as a panacea for solving public sector in efficiency and ineffectiveness and it has received donors preference as well. This is also consider as a means to reduce governments financial burden by leveraging resources and funds for social services . In fact the lion’s share of governmental expenditure is occupied by social services . From annual report on National Accounts published by the Economic planning Agency (EPA) in Japan , it is found that the core functions of the state (pure public good) i.e., general public service and defense , account only for 14.4% of total public expenditure . Whereas social sector activities , housing and community amenities , economic services , other community and social services and other purposes , occupy the rest 85.6% . Thus the desire for promoting PPP comes from the belief that it can be used effectively to expand resources and improve services.

 

GO-NGO Partnership in Bangladesh

Bangladesh is considered as a fertile land for GO-NGO partnership. The government’s inability and incompetence in the field of development activities have paved the way of emergence of a large number of NGO’s in Bangladesh. Various national as well international NGO’s are active in various field of development for a long time and they have also successfully drawn attention from various donors as well as the government by achieving tremendous success in their efforts (Begum 2003:119). Nonetheless, large scale GO-NGO partnership started mainly since the mid 1990s. By this time , the Bangladeshi GO-NGO partnership models have received global attention and have also been replicated in other countries in Asia Africa and Latin AMERICA (Haque 2004:273-274)

 

GO-NGO Partnership in the Health and Population Sector in Bangladesh

In Bangladesh , GO-NGO partnership in the health and the population sector is very common and the country is the fore –runner in this respect (Neaz 2004:1) Incapability of the government alone to deliver extended health service up to grass root level has made the room for increasing Go-NGO partnership in this sector (Haque 2004:278) . According to the Bangladesh National  Health Accounts Survey, a considerable number of NGOs 3700 among 24000, are now active in health and population sector either in partnership with government or within their own policy agenda(Neaz 2004:1) . Some of them have contributing in this sector since the independence in 1971. Though GO-NGO partnership in the health sector increased significantly during the 1970s and 1980s , this relationship also through difficult phases due to some political reasons and completion for foreign donors’ funds between the government and NGOs . Afterward in the 1990s , international donors dissatisfaction over public sector inefficiency and incompetence paved the way of channeling more donors’ funds to NGOs for health and development.

Consequently in the fifth Five –Year plan (1997-2002) the Bangladesh government gave emphasis on GO-NGO partnership in the health sector with a view to expand basic health services up to the grass root levels (Haque 2004:278) The fifth Five –Year plan stated (Fifth-Five Year plan 1997-2002:463) , “The basic health needs of the population , especially the need of children , women and the poor will be met [by public services]….other health services will be expanded and improved through partnerships with or contracting out of services to NGOs ………” the move towards more pro-partnership strategies was eventually a result of donors preference. As Haque( 2004 ) states , “….to a large extent the GO-NGO partnership emerged in Bangladesh not only as a result of the influence of major foreign donors strongly prescribing such partnerships (Haque 2004:279)

Why Public Private Partnership ?

Over the past two decades more than 1400 PPP deals were signed in the European Union, which represent an estimated capital value of approximately €260 billion .Since the onset of the financial crisis in 2008, estimates suggest that the number of PPP deals closed has fallen more than 40 percent. These difficulties have placed significant strains on governments that have come to rely on PPPs as an important means for the delivery of long-term infrastructure assets and related services .Moreover, this has occurred precisely at a time when investments in public-sector infrastructure are seen as an important means of maintaining economic activity during the crisis, as was highlighted in a European Commission communication on PPPs .As a result of the importance of PPPs to economic activity, in addition to the complexity of such transactions, the European PPP Expertise Centre (EPEC) was established to support public-sector capacity to implement PPPs and share timely solutions to problems common across Europe in PPPs.

Health Public-Private Partnerships

A health services PPP can be described as a long-term contract (typically 15 to 30 years) between a public-sector authority and one or more private sector companies operating as a legal entity. The government provides the strength of its purchasing power, outlines goals for an optimal health system, and empowers private enterprise to innovate, build, maintain and/or manage delivery of agreed-upon services over the term of the contract. The private sector receives payment for its services and assumes substantial financial, technical and operational risk while benefitting from the upside potential of shared cost savings.

The private entity is made up of any combination of participants who have a vested interested in working together to provide core competencies in operations, technology, funding and technical expertise. The opportunity for multi-sector market participants includes hospital providers and physician groups, technology companies, pharmaceutical and medical device companies, private health insurers, facilities managers and construction firms. Funding sources could include banks, private equity firms, philanthropists and pension fund managers.

For more than two decades public-private partnerships have been used to finance health infrastructure. Now governments are increasingly looking to the PPP-model to solve larger problems in healthcare delivery. There is not a country in the world entirely by the government. While the where healthcare is financed provision of health is widely recognized as the responsibility of government, private capital and expertise are increasingly viewed as welcome sources to induce efficiency and innovation. As PPPs move from financing infrastructure to managing care delivery, there is an opportunity to reduce overall cost of healthcare.

Market Potential for Health PPPs

The larger scope of Health PPPs to manage and finance care delivery and infrastructure means a much larger potential market for private organizations. Spending on healthcare among the Organization for Economic Cooperation and Development (OECD) and BRIC nations of Brazil, Russia, India and China will grow by 51 percent between 2010 and 2020, amounting to a cumulative total of more than $71 trillion. Of this, $3.6 trillion is projected to be spent on health infrastructure and $68.1 trillion will be spent on non-infrastructure health spending cumulatively over the next decade. Annually, spending on health infrastructure among the OECD and BRIC nations will increase to $397 billion by 2020, up from $263 billion in 2010. The larger market for health PPPs will be in non-infrastructure spending, estimated to be more than $7.5 trillion annually, up from $5 trillion in 2010.

Health spending in the United States accounts for approximately half of all health spending among OECD nations, but the biggest growth will be outside of the U.S. According to PwC projections, the countries that are expected to have the highest health spending growth between 2010 and 2020 are China, where health spending is expected to increase by 166 percent, and India, which will see a 140 percent increase. As health spending increases it is putting pressure on governments and spurring them to look for private capital and expertise.

.International examples

International product development partnerships and public–private partnerships include:

  • The Drugs for Neglected Diseases Initiative (DNDi) was founded in 2003 as a not-for-profit drug development organization focused on developing novel treatments for patients suffering from neglected diseases.
  • Aeras Global TB Vaccine Foundation is a PDP dedicated to the development of effective tuberculosis (TB) vaccine regimens that will prevent TB in all age groups and will be affordable, available and adopted worldwide.
  • FIND is a Swiss-based non-profit organization established in 2003 to develop and roll out new and affordable diagnostic tests and other tools for poverty-related diseases.
  • The Global Alliance for Vaccines and Immunization is financed per 75% (750 Mio.US$) by the Bill and Melinda Gates Foundation, which has a permanent seat on its supervisory board.
  • The Global Fund to Fight AIDS, Tuberculosis & Malaria, a Geneva-based UN-connected organization, was established in 2002 to dramatically scale up global financing of interventions against the three pandemics.
  • The International AIDS Vaccine Initiative (IAVI), a biomedical public–private product development partnership (PDP), was established in 1996 to accelerate the development of a vaccine to prevent HIV infection and AIDS. IAVI is financially supported by governments, multilateral organizations, and major private-sector institutions and individuals.

 

Bangladesh Demographic and Health Survey 2004

(is it necessary?)

After an almost decade-long stagnation, fertility in Bangladesh declined to 3.0 children per woman in 2004. A trend towards increasing utilization of health services for mothers and children is also asserting itself, while awareness of HIV/AIDS among ever-married women almost doubled to 60 per cent in 2004 (from 31 per cent in 2000).
These are among the interesting findings of the recently released Bangladesh Demographic and Health Survey (BDHS) 2004, prepared by the National Institute of Population Research and Training (NIPORT), Dhaka; Mitra and Associates; and ORC Macro, Calverton, Maryland United States of America.
A nationally representative survey, the BDHS is designed to provide policy-makers and program managers in health and family planning with detailed information on fertility and family planning, childhood mortality, maternal and child health, nutritional status of children and mothers, and awareness of HIV/AIDS.
Previously, BDHS surveys were carried out in 1993-1994, 1996-1997, and 1999-2000.
“The findings of the 2004 BDHS presented in this report provide up-to-date and reliable information on a number of key health and demographic topics of interest to planners, policy makers, program managers and researchers, that will guide the planning, implementation, monitoring and evaluation of the Heath, Nutrition and Population Sector Program in Bangladesh”, Mr. A.F.M. Sarwar Kamal, Secretary to the Ministry of Health and Family Welfare, Government of Bangladesh explained in a foreword.

 

 

1.2 Statement of the problem

The new global thrust for promoting  efficiency and effectiveness in public service delivery in pushing forward the increasing recognition of ppp, especially in the developing countries .In the new global context state is becoming an enabler rather than direct provider of services. Using the metaphor developed by Gilbert and et al. ,the changing role of the government could be illustrated as a shift from ‘rowing’ to ‘steering’ the government should set broad  objectives and create such an environment that will ensure the accomplishment of certain essential activities.

Here it is less important to consider who finally provides the services (Awortwi 2003:81) . It might be commercial for-profit enterprise , NGOs, co-operative societies, community based organization , religious organization , professionals organizations  or trade unions (Ahmed 2000:223). Therefore this new context is creating for space for ppp. There is a growing tendency to see it as a panacea for solving public sector inefficiency and ineffectiveness ; and it has received donors preference as well(Haque 2004:272). This is also considered as a means to reduce governments financial burden by leveraging resources and funds for social services. Infact the lion’s share of governmental expenditure is occupied by social services.

In the context of developing countries especially in social service sector NGOs are increasingly being considered as partners of governments because of their perceived flexibility wide spread network , long experience in developmental activities (for those places where NGOs are working for a long time), and overall non-profit orientation.

 

 

Health status in Bangladesh:

Demographic trends

The total population of Bangladesh is about 140 million. The annual population growth rate has declined from 2.33 percent in 1981 to 2.15 percent in 1991 and further declined to 1.50 percent in 2002  (SVRS/2002).  Similar declining trends are seen over the period of 1981-2002 for the crude birth rate (34.4 to 20.9), crude death rate (11.5 to 5.9) and total fertility rate (5.24 to 3.0) (SVRS/2002).

 

 Source: Bangladesh Bureau of Statistics, SVRS 2002

 

 

Source: BDHS 2004

 

Source: BDHS 2004

In Bangladesh, 38 percent of population was under 15 years, 55 percent in the age group of 15-59 years and 7 percent in the age group of 60 years and above (BDHS 2004).

Life expectancy at birth

The average life expectancy in Bangladesh has improved from 55 years in 1981 to 65 years in 2002, with 55 years for male and 54 years for female in 1981 to 64 years and 65 years for male and female, respectively, in 2002 (SVRS 2002)

Infant Mortality Rate (IMR)

In Bangladesh, Infant Mortality has declined during the period of 1981-2002. In 1981, 111 infants died per 1,000 live births, which has declined to 87 in 1991 and 53 in 2003 (BBSSVRS 2003).

 

Source: BBSSVRS 2003

 

Maternal Mortality Rate

In Bangladesh, Maternal mortality has declined during the period of 19920-2002. In 1992 it was 4.7 and in 2002 it was 3.9 per thousand live birth. (SVRS/2002)

 Social trends

The adult literacy rate in the population over 15 years of age has shown a gradual increase from 1981 (males 39.7% and females 18.0%) to 2002 (males 55.5% and females 43.4%) (BBS, SVRS 2002). Whether this increase has resulted in better utilization of health services is difficult to ascertain.

In Bangladesh, Gross Enrollment Ratio (GNR) in primary education for both sexes is not much different. In the case of males, GNR was 94 percent in 2002-03, and for females it was 98 percent during the same period.

In case of secondary education, GNR for both the sexes has increased from 42 percent in 1998 to 47 percent in 2002-03. The GNR in secondary education for female has increased from 41 percent in 1998 to 50 percent in 2002-03, higher than males for whom the increase is from 43 percent in 1998 to 45 percent in 2002-03 (UNESCO)

 Food supply and nutritional status

The prevalence of low birth weight (weight <2500 grams) has decreased from about 50 percent in 1993-95 to 40 percent in 2005. The percentage of underweight (weight-for-age) in children below 5 years was: severe – 12.8 percent, moderate – 47.5 percent, and that of height-for-age was: severe – 16.9 percent, moderate – 43.0 percent (Bangladesh Demographic and Health Survey 2004).

About 69 percent of the population suffers from Iodine Deficiency Disorders (IDDs), as estimated by the urinary excretion of iodine. Among the population, the total goiter rate is 47.1 percent, of which 8.8 percent have visible Goiter. The presence of cretinism is 0.5 percent (1993). The IDD control programme now targets hyper endemic areas with lipiodol injections as a short term measure, and universal iodization of salt as the long term intervention.

Anaemia in pregnant women

The prevalence of anaemia among adult women was estimated at 74 percent and that of children less than five years at 73 percent (1982-83). Studies conducted in 1990 and 1995 found the situation unchanged.

Benefit of PPP by Primary Healthcare and Family Planning Project (PHC-FP)

Providing low-cost quality healthcare services on the chars can be considered one of the next steps in ensuring extreme poor households remain protected from the often devastating economic consequences of a health shock. In January 2008, the PHC-FP pilot project began operating 212 Satellite Health Clinics (SHC) each month through three IMO partners in Gaibandha and Sirajganj, and a further two NGOs across Kurigram, Gaibandha and Jamalpur. During the first year of the pilot more than 4700 SHCs were active, providing nearly 194,000 patients with healthcare services. These patients were mostly women, often seeking essential ante-/post-natal care and family planning services.  PHC-FP services are channelled through trained and qualified paramedics in each SHC. These paramedics offer basic healthcare consultancy services and refer complex cases to designated referral centres at the Upazila and District levels. In addition to the monthly SHCs, CLP also provides funding for 400 Community Health Volunteers (CHVs), who live within the community and can be seen by patients in their home at any time of the month. CHVs provide simple healthcare services and also stock family planning materials and medicines.  These services are not free: consulting either the CHV or the paramedic at the SHC costs 10 Tk. Payment can be made either in cash or via vouchers from the Health Cost Reimbursement Scheme (HCRS). While only core beneficiary households are part of the HCRS, it should be stressed that anyone is allowed to access and use the SHC services. The rationale behind voucher provision to extreme poor households is evident, with a recent CLP healthcare patient satisfaction study showing that 89% of HCRS recipients would not have sought healthcare support without voucher provision. Recently the PHC-FP project has been dramatically scaled up, with five more organizations contracted to provide these services across all CLP working areas. It is anticipated that each month, 800 satellite clinics will eventually operate providing vital healthcare services to an estimated 30,000

1.3 Rational of the study:

Bangladesh is one of the most populated countries in the world. From the mid -1970s the country is experiencing rapid urbanization mainly due to rural urban migration . The results of such unplanned rapid urbanization are increasing urban poverty, inequity , high unemployment , underemployment and mushrooming of urban slums and squatters. According to Bangladesh Bureau of Statistics (BBS), 43% (1990-2000) of the urban population are poor (based on head count ratio). A large portion of urban poor are lives in slums and squatters and their and health facilities is worse than that of rural poor. However unlike rural areas , there was no urban heath service center for urban poor before 1998(Banik 2005:11). In response to the need for better health care service of urban poor , the Urban Primary Health Care Project (UPHC) was formulated under the financial support of Asian Development BANK (ADB) in 1998.

The project is a typical example of PPP (Ahmed 2000:239) which is also considered as a Asia’s  first large scale contracting out based Primary Health Care Program (PHC) . The project aim is to provide Primary Health Care in and around urban slum area through 190 health centers in four largest city corporation , i.e., Dhaka , Chittagong, Rajshahi and Khulna .

During 2005-2006 a number of professionals and civil society organizations came together to discuss the possibility of creating a civil society network to regulatory and systematically measure and monitor our progress and performance in health. It was felt that health is a critical national concern and citizen groups ought to take an active interest in health policy formulations, implementation , monitoring and oversight.

In Bangladesh pressure in and other development indicators is gauged in many different ways. The census and other systematic surveys conducted by the government through the Bangladesh Bureau of Statistics provide longitudinal information.

The under five mortality rates in the urban areas have always been lower than that of the rural areas . Over the years the under five mortality rates reduced in both urban and rural areas . The rural urban gap in under five mortality was 38.9 in 1993-1994 and it reduced to 6 in 2004 (NIPORT , Mitra and associates , ORC macro 2005, Mitra et.al.94)

GO-NGO partnership in Bangladesh primarily represents the collaborative or complementary form of partnership instead of the dominance of one over the other or adversarial. However there are various more specific form of GO-NGO partnership which are currently in practice formal collaboration between GO and NGO on the basis of shared objectives , for example the FP-FP  program  of Bangladesh Rural Advancement Committee (BRAC); contracting out , for instance , Urban Primary Health Project (UPHC); making linkage between GO and NGO activities without strong mutual obligation or commitment , i.e., Rural Maintenance Program (RMP)  CARE Bangladesh and the Ministry of Local Government and Rural Development, sharing experiences in the form of consultation, for example the policy dialogue in Health and Population sector program.

There is  very little work has been done in PPP in health sector especially  in local level , so this study will try to focus PPP in health sector in local level it can also be said that Government and NGO collaboration in health sector is a new intervention to provide services to the people and it has a important academic value in New Public Management.

 

1.4 Research objective

The present study will be with a view to serve the following objective. Objective may be more than one. If objective is only this, so  some of the following Research Questions are irrelevant

1)      To find out the service providing process in urban primary health care center.

2)      To know the pattern of accountability while providing services?

 

1.5 Research Questions

1)      What are the services you are providing for ensuring primary health care?

2)      What is the financial source to conduct the services?

3)      Whom do you accountable for your services ?  this question has been like as a  questionnaire  it may be (what is the style or pattern of accountability?)

4)      What are the obstacles that you face to provide services to the people? (What are the obstacles while providing services to the people?)

5)      What is your recommendation for providing better services to the people? How better health services can be provided?

 

1.6 Research Methodology: A method is simply the way of doing something in a systematic way. Every researcher whether dealing with scientific, legal or social research has to adopt some specific method to conduct his or her research.

The selection of research method is crucial for what conclusions we can make about a phenomenon. It affects what we can say about the cause and factors influencing the phenomenon. It also important to choose a research method which is within the limits of what the researcher can do. Time, money , feasibility, ethics and availability to measure the phenomenon correctly are examples of issues constraining the research.

In this chapter we have discussed about research design of the study and which method and why it is taken is argued shortly.

There are three types of research design and these are

1)    Qualitative research design

2)    Quantitative research design

3)    Mixed research design

Qualitative research design:

In psychology qualitative research has come to be defined as research     whose findings are not arrived at by statistical or other quantitative procedures. It is often said to be naturalistic.

Quantitative research design:

In quantitative research one’s aim is to determine the relationship between one thing (an independent variable ) and another (a dependent or outcome variable) in a population.

Mixed research method

In general sense mixed research means where both qualitative and quantitative methods are used.

To conduct this study we want to use qualitative methods due to some reasons. These are

  • It fully depends on the opinions of the respondents.
  • Qualitative research usually involves few cases with many variables, while quantitative involves many phenomena with few variables.
  • Conducting a social research observation is very important . In these case we think qualitative research will be more important.

Techniques of data collection:

There are two main source of collecting data. These are

1)    Primary data

2)    Secondary data

The primary data will be collected by questionnaire and conducting a dirrec interview.

Here open ended questionnaire is used to conduct this interview. As this study is related with service providing process of urban primary health care center so the member of the primary health care center who are working there is the main respondent  of this study because  only by them we can know about what type of service they are providing to the people , in which way they provides their service, does they can ensure better service to the people.

Secondly, we conducted interview to the people who are receiving services from primary health to know that is they are satisfied that they receiving from there can ensure better health service.

The secondary data have been collected from the news papers, journals, articles, books internet etc.

 

 

 

Chapter -2

Theoretical and conceptual framework

The conceptual frame work is one of the very important parts of any research work. Through reading this part one can understand what has been done and what would be the result of the study. The major concepts related to the study has been operationalized below and design a research model/framework for doing rest of the study.

A variable is something that changes. It changes according to different factors. In this research variables are divided into two parts that are dependent variables and independent variables according to what we are measuring. In this chapter research variables are discussed in the context of urban primary health care center.

2.1 Independent variables:

The independent variable is the which the researcher would like to measure the cause while the dependent variable is the effect or assumed effect. Independent variables is dependents on the dependent variables. Here independent variable is Public private partnership. In our research area is Public private partnership is alarming because of some potential dependent factors such as the service providing process, financial sources, accountability etc. Independent variable is the result of dependent variable.

 

2.2 Dependent variables:

In this study the urban primary health care center is the dependent variable because how the urban primary health care center is providing their services to the people , from where they collect their finance , whom they give their accountability for their performance . Though the urban primary health care center is a public private partnership based organization how it is maintaining its work .

 

In this research the dependent variables are the urban primary Health care center, decision, service providing process, financial source, accountability and quality and this elements are discussing below in the context of public private partnership.

 

  1. Decision making process:

As public private partnership is a combination of many group like government and the private company in this case decision making process plays a very important role because in any organization decision is a crucial point that how and what decision will be taken for the organization which decision will be needed for the organization for the development of the organization and in the case of public private partnership it is very crucial point that  which level has the ultimate authority for taking decision for the implementation.

In public private partnership basically decisions are taken by the upper level that means who give the financial assistance for running the project have the major power for taking decision and their decisions always paved the prior position for any decision making problem.

In the case of urban primary health care center decisions are made by the government  according to the plan of the donor country and when the planning is finally made the donor country justify the plan and give decision what will be done that means they give approval for the project.

  1. Service providing process:

As public private partnership is a joint effort so it is a question that how the organization will run and what format or structure they will follow. The Urban Primary Heath Care Center is a joint venture by public private partnership so there are many groups are involved in the project and the groups are the government itself and the private company are divided by NGO and the donor country. Here the groups will be decided what services and how the services will be provided to the people and what procedure or structure they will follow for providing the services to the people. Who will take the duty to provide the services , where they will provide their services in local level or urban level and what percentage of people they will take under this service. These whole subjects will be included in the service providing process.

C. Financial source:

In the case of maintaining any public private partnership project the main question is money because money plays a very important role for any project implementation. In the case of PPP project basically the outsider country gives the money and the government has the duty to manage that money for a sound implementation of the project. In Primary Health Care Center here the ADB is the main donor country for running the project and has the supreme power in the project.

 

  1. Accountability:

Accountability is the driving force that generates the pressure for key actors involved to be responsible for and to secure good public service performance. In the case of UPHC project the accountability have to pave to the donors country. There is a monitoring system in monthly basis by the government side and they gives accountability to the donors country.

 

  1. Quality:

When there is a question of quality then it can be said that the UPHC project has started in2005 since then it has successfully continue its program . And it is also said that at present the UPHC is continuing its second phase.

 

Research Variables

Dependent variables

*Decision

*Donors country (it should be  Independent Variables)

*Service providing process

*Financial source

*Accountability

*Quality

 

Independent Variables

                                                                                      * PPP

*Government

*NGO

 

 

Here we will see that how public private partnership is going through successful projects by the following two cases. we will discuss about the Global fond to fight Aids , Tuberculosis and Malaria project  and the family planning project in Bangladesh.

Case : 1 The Global Fund to Fight AIDS, Tuberculosis and Malaria

The Global Fund to Fight AIDS, Tuberculosis and Malaria (often called The Global Fund or GFATM) is an international financing organization that aims to attract and disburse additional resources to prevent and treat HIV and AIDS, tuberculosis and malaria. A public–private partnership, the organization has its secretariat in Geneva, Switzerland. The organization began operations in January 2002. Microsoft founder Bill Gates was one of the first private foundations among many bilateral donors to provide seed money for the project.

The Global Fund is the world’s largest financier of anti-AIDS, TB and malaria programs and at the end of 2010 has approved funding of USD 21.7 billion that supports more than 600 programs in 150 countries. The organization states that it has financed the distribution of 160 million insecticide-treated nets to combat malaria, provided anti-tuberculosis treatment for 7.7 million people, and provided AIDS treatment for some three million people, saving 6.5 million lives. In 2009, the Fund accounted for 20 percent of around international public funding for HIV, 65 percent for tuberculosis, and 65 percent for malaria.

 Assumptions

The following assumptions have been made in formulating arguments and in modeling

possible fund characteristics:

Resources for vaccination are scarce and may be subject to rationing.

Country contributions to vaccination will remain stable or grow.

Financier and other partner contributions to vaccination will remain stable or decrease.

A Global Fund for New Vaccines would not address research and development costs for new vaccines.

A Global Fund for New Vaccines would not finance purchases of the basic six EPI vaccines: BCG, DTP, DT, TT, polio and measles.

A Global Fund for New Vaccines would finance infrastructure only in

exceptional circumstances.

Five parameters to measure the achievements

The five parameters of new vaccine finance to be considered here and these are equity, impact, feasibility, sustainability and scope. In some cases, several goals are relevant for a given parameter, as described below.

 Equity

Access: Everyone has a right to vaccines and those who are most at risk of infection and its complications, the poor, the malnourished, the sick, should have priority in accessing vaccine financing. This could mean that resources would go into providing vaccines in the poorest, most remote and the most war-torn areas, even where such work is difficult, risky and expensive and co-financing is required for vaccine-related infrastructure and personnel.

 Impact

a) Effectiveness: Global vaccine finance should be allocated in order to maximize the reduction in burden of disease per dollar spent on new vaccines. This could mean that people with easy and cheap access to health services would be much more likely to have access to vaccine than people in remote, underserviced areas, and countries that are “risky” investments due to poor infrastructure or political instability would be avoided.

b) Coverage and speed: Global vaccine finance should be allocated in order to vaccinate as many children as possible with the new vaccines, as quickly as possible. This could mean that countries with highly functioning delivery systems and concentrations of population in urban areas would be favouredfor financing, regardless of the risk of vaccine-preventable disease faced by these populations. Emphasis on speed of implementation may also bias programes against capacity building, which takes time.

 Feasibility

a) Feasibility: Global vaccine finance should be planned such that the capitalisation required is attainable, and the coalition of capitalisers, technical experts and participating governments is broadly supportive of the plan, and there are local champions with enough power to galvanise implementation .Local absorption capacity also needs to be assured. Further, financing should take into account population level demand for the vaccines based on perceived risk. The rationale behind this is that perceived risk is a key determinant of care-seeking behaviour and could have a significant impact on access and effectiveness. This could mean that the financing is severely limited in scope, perhaps due to artificial constraints, or is not cost-effective

 

b) Transparency: Global vaccine finance should be seen to be fairly distributed among target groups, according to an explicit, transparent process. This could mean that mechanisms such as a ceiling for financing to any one country, or a minimum number of recipient countries would be used to ensure that one or a few countries do not monopolise financing.

Sustainability

Independence: From a global perspective, vaccine finance should be used to encourage the development of sustainable local finance mechanisms as well as to influence the expansion and improvement of vaccination, not to serve as a substitute for government financed vaccination. This could mean that governments would not have access to finance unless they can show that they have a plan to become self-sufficient in the purchase or production of quality vaccines. Such a plan may not be feasible for some of the least developed countries in the foreseeable future. From the country perspective, vaccines are a strategic resource and every sovereign nation should have the capacity to supply itself with vaccine through local production or through purchase from friendly nations. This could be construed to mean that global vaccine finance should be used to build up local or sub-regional new vaccine production capacity even where this is not cost effective.

Achievements:

1. Equity: Access The focus on the neediest countries that can absorb vaccine is meant to improve

access: High

2.1 Impact: Effectiveness It is unclear whether new vaccines can be introduced as outlined and funds

dispersed in an effective manner: ??

2.2 Impact: Coverage and Coverage would be greatly improved by this plan. Speed of response is

speed unknown: High

3.1 Feasibility The plan involves raising over one billion dollars of capital: Low

3.2 Feasibility: Transparency There is a clear system proposed for choosing vaccines, target countries, and so

on: High

4. Sustainability: There is a proposal to include movement towards financial independence as an

Independence eligibility criterion, but there is some question about whether to invest in

absorption capacity with this fund: Medium

5.1 Scope: Focus/simplicity There appear to be a number of features to this fund, such as eligibility criteria,

advocacy for a vaccine budget line, possible investment in infrastructure, and a

global procurement strategy which make this a complex proposal: Low

5.2 Scope: Globalism This proposal is aimed at the neediest countries, wherever they are

 

Case :2

The Impact of Household Delivery of Family Planning Services on Women’s Status in Bangladesh

From 1978 to 1997, the Bangladesh government hired and trained married women to provide family planning counseling and services to couples in rural households. At the peak of the program, a total of 28,000 of these “family welfare assistants” were working in hamlets throughout the country. By the early 1990s, evidence showed that doorstep service delivery had helped to increase family planning awareness, as well as the rate of method uptake and the continuity of method use, among rural couples. Furthermore, by increasing access to reversible methods, the program helped to reduce the proportion of contraceptive users who adopted female sterilization a method that the government family planning program had heavily promoted. In areas where family welfare assistants had been trained to administer the injectable, the reduction in the reliance on sterilization was particularly pronounced and was also accompanied by a reduction in reliance on the pill. Even so, overall pill use increased steadily following the initiation of doorstep delivery, with family welfare assistants providing nearly 85% of all pills dispensed in Our analyses are based on the assumption that measuring the social impact of doorstep services requires statistical modeling of women’s status in a large, random sample of women. After adjustment for clients’ background characteristics, baseline status, previous visits received and visitation bias, results from our regression analyses support the hypothesis that the household service delivery program in rural Bangladesh leads to gender benefits. In addition, there is no evidence of detrimental gender effects from participation in the program.

Result:

This study shows that use of doorstep family planning services is positively associated with women’s status at the end of the study period, and an increasing number of visits is related to an improvement in status. However, gender benefits come from the program’s impact on fertility regulation rather than directly from the social interaction involved in a household visit. Although these findings do not demonstrate direct “beyond-supply” social benefits, they suggest that encounters with family welfare assistants indirectly enhance the status of women by fostering reproductive autonomy.

In 1997, the Bangladesh Ministry of Health and Family Welfare abandoned the doorstep approach in favor of a passive approach using community clinics. Recent evidence has established that the fertility transition in Bangladesh has stalled, primarily because of a deterioration in the effectiveness of family planning. The results of our analysis suggest that a deterioration in the effectiveness of fertility regulation may be accompanied by significant effects on women’s autonomy, thereby offsetting gains in women’s status that would arise if family planning needs were fully met.

In 2003, amid considerable controversy, the Ministry instituted a policy reinstating doorstep services. Given the results of this study, this policy shift can now be reviewed in light of the gender benefits that may arise from the resumption of doorstep service delivery.

So it can be said that public private partnership is successfully runs its activities in the following two cases.

 

 

Chapter -3

Historical Background

 

3. Defining Primary Health Care:

There are a number of definitions of primary health care currently in use. The following definition endorsed by the Australian Health Ministers’ Council in 1988 and widely used since then, takes as its starting point the WHO 1978 Alma-Ata declaration:

“Primary health care seeks to extend the first level of the health system from sick care to the development of health. It seeks to protect and promote the health of defined communities and to address individual problems and populates health at an early stage. Primary health care services involve continuity of care, health promotion and education, integration of prevention with sick care, a concern for population as well as individual health, community involvement and the use of appropriate technology.”

 

Primary care is often used interchangeably with primary medical care as its focus is on clinical services provided predominantly by GPs, (full meaning)as well as by practice nurses, primary/community health care nurses, early childhood nurses and community pharmacists.

Primary health care incorporates primary care, but has a broader focus through providing a comprehensive range of generalist services by multidisciplinary teams that include not only GPs and nurses but also allied health professionals and other health workers, such as multicultural health workers and Indigenous health workers, health education, promotion and community development workers, as well as providing services for individuals and families, PHC services also operated at the level of communities.

Community health services may share a number of characteristics of primary care and primary health care services, as well as provide more specialised community based health services for defined target groups, for example post acute care, aged care, mental health, drug and alcohol, sexual assault.
Go-NGO partnership in Bangladesh

Bangladesh is considered as a fertile land for GO-NGO partnership. The government’s inability and incompetence in the field of development activities have paved the way of emergence of a large number of NGO’s in Bangladesh. Various national as well international NGO’s are active in various field of development for a long time and they have also successfully drawn attention from various donors as well as the government by achieving tremendous success in their efforts (Begum 2003:119). Nonetheless, large scale GO-NGO partnership started mainly since the mid 1990s. By this time , the Bangladeshi GO-NGO partnership models have received global attention and have also been replicated in other countries in Asia Africa and Latin AMERICA (Haque 2004:273-274)

GO-NGO partnership in Bangladesh primarily represents the collaborative or complementary form of partnership instead of the dominance of one over the other or adversarial. However there are various more specific form of GO-NGO partnership which are currently in practice formal collaboration between GO and NGO on the basis of shared objectives , for example the FP-FP  program  of Bangladesh Rural Advancement Committee (BRAC); contracting out , for instance , Urban Primary Health Project (UPHC); making linkage between GO and NGO activities without strong mutual obligation or commitment , i.e., Rural Maintenance Program (RMP)  CARE Bangladesh and the Ministry of Local Government and Rural Development, sharing experiences in the form of consultation, for example the policy dialogue in Health and Population sector program. Nevertheless, the dominant form of partnerships are joint implementation agreement between the government and NGOs and contracting out service delivery to NGOs. Between the two the one is gradually becoming more common in the area of primary health , primary education , rural banking, adult  literacy, rural works, crop storage and training extension. Here it is important  to mention that nearly all of the GO-NGO partnership are supported and financed by international donors(Haque 2004:275)

Health Public-Private Partnerships

A health services PPP can be described as a long-term contract (typically 15 to 30 years) between a public-sector authority and one or more private sector companies operating as a legal entity. The government provides the strength of its purchasing power, outlines goals for an optimal health system, and empowers private enterprise to innovate, build, maintain and/or manage delivery of agreed-upon services over the term of the contract. The private sector receives payment for its services and assumes substantial financial, technical and operational risk while benefitting from the upside potential of shared cost savings.

The private entity is made up of any combination of participants who have a vested interested in working together to provide core competencies in operations, technology, funding and technical expertise. The opportunity for multi-sector market participants includes hospital providers and physician groups, technology companies, pharmaceutical and medical device companies, private health insurers, facilities managers and construction firms. Funding sources could include banks, private equity firms, philanthropists and pension fund managers.

For more than two decades public-private partnerships have been used to finance health infrastructure. Now governments are increasingly looking to the PPP-model to solve larger problems in healthcare delivery. There is not a country in the world where healthcare is financed entirely by the government. While the provision of health is widely recognized as the responsibility of government, private capital and expertise are increasingly viewed as welcome sources to induce efficiency and innovation. As PPPs move from financing infrastructure to managing care deliery, there is an opportunity to reduce overall cost of healthcare.

 

 

UPHCP-II is the urban health care project of the Government of the People’s Republic of Bangladesh (GOB) under Local Government Division, Ministry of Local Government Rural Development & Cooperatives. This project is funded by GOB, Asian Development Bank (ADB), Department for International Development (DFID) of the United Kingdom, Swedish International Development Cooperation Agency (SIDA), United Nations Population Fund (UNFPA) and ORBIS International. The project has commenced on July 1, 2005 and will continue till December 31, 2011.

 

 

Chapter – 4

Data Analysis

The purpose of this chapter to find out the service providing process in urban primary health care center or it can be said that what they are serving to the people , how they are providing  their service to the people and what is the ultimate result and is the people those who are receiving the are satisfied or not .

4.1 We have asked the medical officer of urban primary heath care of  dashmary union that in their organization how many people are working  and is the number of people are sufficient for providing their services?

The responded answered that in their organization 18 people are working for providing their services. They basically provides their service to the people in two parts number one is static that means one stop service and the another one is the satellite that means by doing camp one persons house to provide their service. In static parts there are a office assistant to co-ordinate the office function, a counsellor to motivate the people, a paramedic officer to give health service. And the satellite part have  the same function. There is a chief medical officer who obtains the highest position in static part to provide health service to the people. The respondent said that they have only one medical officer to provide health service but sometimes it very difficult to provide service to the people when the number of people is very high.

4.2 We have asked the respondent what type of services they are providing to the people?

The respondent said that they are basically serves the following services

  • Reproductive health care
  • Child health care
  • Communicable disease control
  • Limited curative care of LCC
  • Assistance to violence against women
  • Behavior change communication
  • Others
  • Adolescent program

The respondent said that they are trying to improve the health status of the urban population, especially of the poor, in all the six city corporations and five municipalities to be identified. The Project will help ensure the delivery of a package of preventive, promotive, and curative health services. At least 30% of all the services provided under the Project will be targeted at the poor.

The specific project objectives are to improve

*     access to and use of urban primary health care (PHC) services in the project area, with a particular focus on extending provision to the poorest;

*  the quality of urban PHC services in the project area; and

*     the cost-effectiveness, efficiency, and institutional and financial sustainability of PHC to meet    the needs of the urban poor.

The services will be designed to reduce child and maternal mortality and morbidity, and help the country achieve the Millennium Development Goals (MDGs).

 

4.3 Then we asked to the respondent have they receive any fees from the patient in exchange of services , if yes then why?

The respondent said that urban primary health care center is a combination of go-ngo partnership and it is fully run by the donors assistance the government has a little access in case of finance so they have to receive a service charge from the patient  but it is very little amount and it depends on what type of service they are receiving , there is a catalogue showing different rates of different service. The respondents also said that there is a chance for the poor to receive free service from them. In that case they identify those people who are really lives under the poverty line and have no capability to receive service n exchange money . Only for them the UPHC gives a red card to receive service without money.

 

4.4Then we asked the respondent that what is the difference between the first phase of urban primary health care center and the second phase of urban primary health care?

The respondent said that there is no basic difference between the first phase of urban primary health care center and the second phase of urban primary health care. The functions of first phase and the second phase are same and the donors are the same party. The respondent said that it is run through a project and by doing second phase it has extended it project life time.

 

4.5 What type of reproductive health care you are providing ? What percentage of women take this service from here?

The respondent said that reproductive health care service is one of the most important  health care service that they are providing . These includes safe delivery of children, pre – delivery service , service to the new born baby, titanas injection for the women who are 15-49 years old etc.

The respondent said that at first when this service was  started then the percentage of women taking this type of service was very little. Most of the women gone to the government hospital or other community clinic. But now a days the percentage of women who are taking this service has been increased. The respondent said that it will be 75% the women who are taking reproductive health care service.

4.6 What type of children health care service are you providing? What is the result of that services ? Does it ensure better health care service to the children?

The respondent said that basically they provide expanded immunization program, control of diarrhea , lack of iodine and vitamin D, lack of nutrition etc.

The respondent also said that the result of children health care service is positive from earlier because in the earlier the percentage of polio attacked children was 79% but now the rate of polio attacked children is very low.

They provides services that how to control diarrhea diseases . When a children comes to take this type of service they provides suggestion to use sanitary latrines , how to make hand made saline etc and also advice them to use clean water and take nutritious food.

 

4.7 What is the financial sources to run the urban primary health care project?

In Bangladesh , Go- NGO partnership in the health and population sector is very common and the country is the fore- runner in this respect . Incapability of the government alone to deliver extended health service up to grass-root level has made the room for increasing GO-NGO partnership in this sector.

The respondent said that the main source of finance has been collected from USAID and ADB . The donors give assistance to run this project Urban primary health care center is one type of project and the project run through a fixed time . The governance has few assistance in this project . It can be said that the management control is under the government and the accountability will be give to the donors country.

They collect the finance from the donors country through the local government . The local government has the power to distribute this finance to the chief executive of urban primary health care center. Rajshahi the main branch of UPHC is Nawdapara.

The respondent said that UPHC is run through a contract under the population service and training center (PSTC).

 

4.8 How Rajshahi City Corporation is involved with this project?

The respondent said that Rajshahi city corporation is in the charge of monitoring. An officer from Rajshahi City Corporation comes to monitor their services one or two times in a month to know about how they are delivering their services to the people. They also talk with the patient that are they getting services in the proper way and also try to know are they satisfy by receiving this type of services.

4.9 To conduct your total services and to maintain your procedures who take the ultimate decision?

The respondent said that basically they have to maintain the order that is decided by the upper level and their duty is to follow the procedure. There is nothing to do to change the decision but they can give suggestion for the betterment in delivering services.

4.10 Whom do you accountable for your services?

The respondent said that here is  a project manager from the donor’s country is the supreme power to run the project and the project manager comes their office several times in a month for monitoring them , so it can be said that they basically accountable to the donors country.

4.11 What do you think about GO-NGO partnership for providing health care service?

Bangladesh is considered as a fertile land for GO-HGO partnership. According to the Bangladesh National Health Accounts survey a considerable numbers of NGOs , 3700 among 2400 are now active in health and population sector either in partnership with the government or within their own policy agenda.

The respondent said that in the fifth Five –Year plan (1997-2002) the Bangladesh government gave emphasis on GO-NGO partnership in the health sector with a view to expand basic health services up to the grass root levels.

The respondent also said that it is a good initiative from the government for the people because government alone can unable to give health service to the people properly.

 

 

 

 

 

 

 

 

 

 

 

 

Chapter :5

Findings

Finding is a reformulate predominant aspect of a research. Findings of this research are presented below:- tomake kisuta korte hobe tobe a bisoy guloi ashbe & tomar personal observation

  • urban primary heath care of  dashmary union provides health services by two parts. These are static & satellite. static means one stop service. In static parts there are a office assistant to co-ordinate the office function, a counsellor to motivate the people, a paramedic officer to give health service. on the other hand, satellite means by doing camp one persons house to provide their service. the satellite part have  the same function. There is a chief medical officer who obtains the highest position in static part to provide health service to the people.

 

  • urban primary heath care of dashmary union provides different health services.These are as follows that I have known by virtue of the respondent: Reproductive health care, Child health care, Communicable disease control, Limited curative care of LCC, Assistance to violence against women, Behavior change communication, Adolescent program. The respondent replied that they are trying to improve the health status of the urban population, especially of the poor, in all the six city corporations and five

Municipalities to be identified.

  • It is known from the respondents that UPHC receives limited service charge from the clients because it is a combination of GO NGO partnership & mainly lead by donors. Govt has limited excess here. Inspite of that, vulnerable people can receive free services from UPHC.
  • Ø The respondent claimed that reproductive health care service is one of the most important health care service that UPHC is providing ………………………………………………………………………………………………………………………………………………………………………………………….
  • UPHC provides different types of child health services such as: Expanded immunization program (EPI), lack of iodine and vitamin D, lack of nutrition etc…………………
  • It is known from the respondent that main source of finance are collected from USAID and ADB. The donors give assistance to run this project & continue till a fixed time. UPHC  collects the finance from the donors country through the local government
  • Respondent of my research claimed that Rajshahi city corporation is in the charge of monitoring of UPHC. An officer from Rajshahi city corporation comes to monitor their services one or two times in a month to know about how they are delivering their services to the people.
  • The respondent said that basically they have to maintain the order that is decided by the upper level and their duty is to follow the procedure. There is nothing can be changed of the decision but they can give suggestion for the betterment in delivering services.There is a project manager from the donor’s country who belongs supreme power to run the project and the project manager comes their office several times in a month for monitoring them , so it can be said that they basically accountable to the donors country.

 

Chapter :6

Discussion and conclusion

Typically, a private sector consortium forms a special company called a “special purpose vehicle” (SPV) to develop, build, maintain and operate the asset for the contracted period. In cases where the government has invested in the project, it is typically (but not always) allotted an equity share in the SPV. The consortium is usually made up of a building contractor, a maintenance company and bank lender(s). It is the SPV that signs the contract with the government and with subcontractors to build the facility and then maintain it. In the infrastructure sector, complex arrangements and contracts that guarantee and secure the cash flows and make PPP projects prime candidates for project financing. A typical PPP example would be a hospital building financed and constructed by a private developer and then leased to the hospital authority. The private developer then acts as landlord, providing housekeeping and other non-medical services while the hospital itself provides medical service.

Bangladesh Second Urban Primary Health Care Project :

UPHCP-II is the urban health care project of the Government of the People’s Republic of Bangladesh (GOB) under Local Government Division, Ministry of Local Government Rural Development & Cooperatives. This project is funded by GOB, Asian Development Bank (ADB), Department for International Development (DFID) of the United Kingdom, Swedish International Development Cooperation Agency (SIDA), United Nations Population Fund (UNFPA) and ORBIS International. The project has commenced on July 1, 2005 and will continue till December 31, 2011.

Program goals/rationale:

Government of Bangladesh has made a substantial commitment to provide health care to its people in best possible way. Notable success has been made in the delivery of EPI, ORS, sanitation and family planning services for which Bangladesh is internationally recognized. The national development plans laid out the foundations for comprehensive delivery of a wide variety of Health and Family Planning services through a package in urban and rural areas. However, for a period of time, there was proportionately less than optimum investment in the primary health care services for the urban poor and slum dwellers to meet those priority needs.

Key program components:

The Project will improve the health status of the poor in six city corporations and five municipalities by providing an essential package of high-impact services. By reducing child and maternal mortality, the Project will help Bangladesh achieve the MDGs for child mortality and maternal health. Women and children will constitute more than 75% of all project beneficiaries. The Project will improve the efficiency of urban health services by (i) improving the spatial distribution of health center, e.g. PHC centers,, comprehensive reproductive health care (CRHC) centers, and mini-clinics, in accordance with population density and geographical factors; (ii) supporting cost-effective interventions to reduce mortality and morbidity; (iii) enabling least-cost private sector participation in the provision of preventive and promotive health care services by partner NGOs; (iv) allowing appropriate user fees; (v) improving the monitoring and supervision system; and (v) concentrating on provision of health services that will create the greatest public good, to use scarce government resources more efficiently.

More than 50% of the project population is from four main groups: (i) slum dwellers living legally in slums; (ii) squatters living illefally onland owned by others; (iii) floating populations with no fixed residence; and (iv) other urban poor living throughout urban areas, mixed with the nonpoor. The Project will target all the four groups through mini- or satellite clinics, outreach activities, and domiciliary services. both demand- and supply-side interventions will be used to target the poor. Large slums will have mini-clinics, which will be open in the evening to maximize their use by the poor.

The Project will continue to contract out primary health care (PHC) services to nongovernment organizations through partnership agreements that were pioneered under the first Urban Primary Health Care Project (UPHCP-I). The Project will ensure pro-poor targeting by requiring at least 30% of the preventive, promotive, and curative services provided are for the poor.

Program history:

Government endorsed the goals of health for all and proposed the following principles by which future activities are guided to: (i) focus on providing a package of essential primary health services with an emphasis on preventive intervention, giving priority to maternal and child health, (ii) expand the role of the private sector including NGOs in the provision of health, nutrition and population services, (iii) take gender, equity, poverty and developmental issues into account in designing and provision of services, (iv) expand cost recovery and improve efficiency of resource utilization in the public sector, and (v) involve beneficiaries in the management of health care, (vi) emphasize on the sustainability and environmental issues, and (vii) endeavor to provide one stop shopping for health and population services. The current Health, Nutrition and Population Sector Program (HNPSP) of the Ministry of Health & Family Welfare, Government of Bangladesh embodies all of these and adds a few new dimensions, e.g. risk sharing and risk spreading to address catastrophic illnesses and piloting of demand-side financing in different forms and decentralization of decision making by the lower level managers.

The Second Urban Primary Health Care Project explicitly promotes the above mentioned policies in all the six city corporations and five selected municipalities of Bangladesh. Since independence, the Government has regarded reducing population growth as one of its principal development priorities. The Government has also endorsed the Millennium Development Goals (MDGs) undertaken by the Millennium Summit of UN. The Project aims at contributing towards the achievement of these goals.

Country of Operation Bangladesh

City/Village of Operation

Dhaka

Chittagong

Rajshahi

Khulna

Barisal

Sylhet

(http://healthmarketinnovations.org/program/bangladesh-second-urban-primary-health-care-project)

Success factors of UPHC:      ??????

 

 

 

 

 

 

 

 

 

 

Conclusions

 

In recent years public private partnership shows the efficiency and effectiveness in service delivery like health sector. Such partnership could be with profit enterprise , NGOs co-operatives ,CBOs religious charity organizations, professional organization  or trade union based on kind of task and responsibilities to be carried out and the local institutional setting .Again such partnership could take various forms , from one party’s dominance over another to collaborative or complementary to each other by taking various modalities of service delivery such as formal collaboration, contracting out, building formal linkage between partners etc.

In countries like Bangladesh, where NGOs have long experience and expertise in the health and population sector, the dominant form of partnership are joint implementation agreement between Go and NGO , and contracting out to NGOs for service delivery .

By reviewing different forms of Go-NGO partnership programs in health sector this paper clearly illustrate that whether such partnership will result in social equity and efficient resource allocation mainly depends on various socio-economic and institutional factors such as

*mutual commitment and support among the parties involved in partnership

*sound institutional arrangement for example

-creating completion among partners

-introducing positive incentive system

-setting clearly defined job description and performance criteria

-enforcing properly designed effective monitoring and evaluation system

 

 

 

 

 

 

References:

 

  • UNICEF (1998) Workshop on Vaccine Independence Initiative. Abidjan,

15-16 October, 1998. Summary Report

 

  • The World Bank. (1993) Investing in Health. New York: Oxford University Press.

 

  • World Health Organization (1993) Macroeconomic Environment and Health.

WHO, Geneva.

 

http://www.ppp.gov.za/

 

(http://healthmarketinnovations.org/program/bangladesh-second-urban-primary-health-care-project)

Children’s Vaccine Initiative (1999) Sustainable Financing for Vaccine Programmes. Background paper for the meeting at Labouisse Hall, UNICEF House, New York, 4-5 February, 1999, meeting report and associated document “A Framework for Immunization Financing”

 

Ahmed M .2000 ,promoting public private partnership in health and education: The case of Bangladesh. In Yidan Wang (eds) public private partnership in social sector: Issues and country experience in the Asia and the pacific . Asian Development Bank.

 

Begum, A. 2003 Government –NGO interface in development management: Experience of selected collaboration models in Bangladesh: A.H development publishing house.

 

Haque ,M.S. 2004  “Governance based on partnership with NGOs : implication for development and environment in Bangladesh” ,international review of administrative science 70(2): 271-290

 

Russo ,G . 2001/2002 “The role of the private sector in health services”, Asian Economic Bulletin,11(2): 190-209

 

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