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

  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

Outline

  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

Scale Up: Success Factors

Framework for Strengthening Private Sector Role to Achieve Health Equity Goals

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Advocacy and Dialogue Action

Public Private

Demand

Policy

Supply

Create an enabling environment

Balance Public Private Sector roles Build Public Private

Partnerships

Analysis

5D Approach

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.

•  Develop the concepts for the innovation

DEVELOP

•  Design the details of the innovative approach

DESIGN

•  Demonstrate feasibility of the innovation through piloting DEMONSTRATE

•  Document achievements, challenges, and lessons learned

DOCUMENT

•  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

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Voucher Management

Agency

Voucher Redemption

Private Nursing Homes

Voucher Redemption

BPL Families Voucher Distribution

ANM/ASHA

Voucher Distribution

Payment for Services

Voucher System Implementation IMPLEMENTATION

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

DEMAND CREATION

• Conduct formative research •  Identify communication

needs • Design communication

strategy • Develop BCC/ IEC

materials for PNH and clients

QUALITY ASSURANCE SYSTEMS

• 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

•  from 0.15million in two blocks (Pilot)

•  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

8 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.

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34.8 30.8

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Use of modern contraceptive

use

Institutional delivery

Perc

enta

ge

Improving FP/RH Uptake: Urban and Rural Poor

Agra (rural) Baseline, 2006 Agra (rural) Endline, 2009 Kanpur Nagar (slum) Baseline, 2006 Kanpur Nagar (slum) Endline, 2011

ASHA Plus Program

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ASHAs unable to sustain themselves covering a smaller number of people than intended

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

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

Partnerships in ASHA Plus

• Creating awareness & disseminating information

on health programs • Community mobilization

• Organizing community level meetings

• Strengthening linkages

• Recruiting and training of ASHAs

• Supportive supervision • Taking feedback from the

community • Piloting all training materials and tools

• Conceptualize and design program

• Selection of project intervention areas

• Selection of NGOs • Monitoring and review of

the program

• Ensuring financial flows • Training and capacity

building • Coordinating with other

departments • Cooperating with ASHA

Plus worker State

Government ITAP

ASHA plus Workers NGOs

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

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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

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.

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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

Partnerships in Social Franchising •  Support formation and operation of

network •  Overall management •  Monitor the project •  Benchmark formulation and report

to USAID

•  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

•  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

Social Franchising Achievements

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  Performance during Oct 2007 – February 2012

•  756,100 antenatal checkups

•  133,900 deliveries

•  10,600 sterilizations

•  38,200 IUCD insertions

•  >1 million CYPs generated so far

  Under consolidation phase, included in the Program Implementation Plan (PIP) 2013

  Replicating the same model in Rajasthan

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.

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Hub and Spoke model of MGHN

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

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Thank You!