Zaidi Shehla, Raman A Venkat, Chowdhury Mahbub Elahi, Azam Farooq, Balasubramanium Priya
Global Business School for Health, University College London, London, UK.
Faculty of Management Studies, University of Delhi, Delhi, India.
Int J Health Plann Manage. 2025 Sep;40(5):1167-1181. doi: 10.1002/hpm.3947. Epub 2025 May 16.
Formalised public-private-partnerships (PPPs) for primary care have proliferated in the mixed health systems of India, Pakistan and Bangladesh, managed and funded by the state. This perspective provides a process-based understanding of pathways adopted by home-grown PPPs and underlying drivers to identify lessons for advancement under Universal Health Coverage (UHC). PPPs have been deployed to respond to local primary care needs ranging from diagnostic screening, maternity services, management of government health centres, mobile clinics to urban primary care systems. Partnerships have evolved to include a diverse range of private partners and more purposeful arrangements, with increase in service volumes, innovations albeit less standardised quality of care. The pathway of PPP instigation, rollout and sustaining in South Asia is based on local starting points by sub-national governments, diffusion of practice across states, common interests and shared bureaucratic coalitions. Success drivers include administrative support beyond the health sector, simplified contractual and payment systems providing operational ease and decision space, and the use of relational management and digital monitoring for resolving issues. However, PPPs are constrained by either too little accountability or excessive accountability in contract design, trust deficits between private and government, and fire-walled PPP implementation creates disconnects from national primary care planning and regulation. Donor supported projectized PPP funding and accompanying rules of business makes PPPs implementation more cumbersome. We conclude that future attention must centrally focus on pathways and drivers to impactfully introduce, scale-up and sustain PPPs in South Asia. Emphasis must be on pathways that build on local simplified ideation, progressive adaptation and allowing contextual diversity under a larger UHC planning architecture, as opposed to centralised one-fit and heavily technocratic initiatives. Success drivers must feature in design of PPP initiatives. Furthermore, we contend that international donor assistance should shift from projectized support for PPPs to building public sector competencies for stewardship, private sector engagement skills as well as the more traditional performance management capacity.
在印度、巴基斯坦和孟加拉国的混合卫生系统中，由国家管理和资助的初级保健正式公私伙伴关系（PPPs）大量涌现。本观点从基于过程的角度，阐述了本土公私伙伴关系所采用的路径及其潜在驱动因素，以确定在全民健康覆盖（UHC）下推进工作的经验教训。公私伙伴关系已被用于满足当地的初级保健需求，范围涵盖诊断筛查、孕产妇服务、政府卫生中心管理、移动诊所及城市初级保健系统。伙伴关系不断发展，纳入了更多样化的私人合作伙伴和更具针对性的安排，服务量有所增加，虽有创新，但护理质量标准化程度较低。南亚公私伙伴关系的启动、推广和维持路径基于地方政府的起点，在各邦之间实践传播、共同利益以及共享官僚联盟。成功的驱动因素包括卫生部门以外的行政支持、简化的合同和支付系统以提供运营便利和决策空间，以及利用关系管理和数字监测来解决问题。然而，公私伙伴关系在合同设计中存在问责不足或过度问责的问题，公私部门之间存在信任赤字，且公私伙伴关系的实施与国家初级保健规划和监管脱节。捐助方支持的项目化公私伙伴关系资金及相关业务规则使公私伙伴关系的实施更加繁琐。我们得出结论，未来必须集中关注在南亚有效引入、扩大和维持公私伙伴关系的路径和驱动因素。重点应放在基于地方简化构想、逐步适应并在更大的全民健康覆盖规划框架下允许因地制宜的路径上，而非集中式的一刀切和高度技术官僚化的举措。成功驱动因素必须体现在公私伙伴关系举措的设计中。此外，我们认为国际捐助援助应从对公私伙伴关系的项目化支持转向建设公共部门的管理能力、私营部门的参与技能以及更传统的绩效管理能力。
