Public Private Partnership’- Public Private Partnership: The New Panacea in Oral Health
Vikram Pal Aggarwal*
Department of Public Health Dentistry, Surendera Dental College and Research Institute, India
Submission: July 14, 2017; Published: April 04, 2018
*Corresponding author: Vikram Pal Aggarwal, Department of Public Health Dentistry, Surendera Dental College and Research Institute, India, Tel:07734879313; Email: email@example.com
How to cite this article: Vikram Pal Aggarwal. Public Private Partnership’- Public Private Partnership: The New Panacea in Oral Health. Adv Dent & Oral Health.
2018; 8(2): 555734. DOI: 10.19080/ADOH.2018.08.555734
Deficiencies in the public sector health system in providing health services to the population are well documented. The inability of the public health sector has forced poor and deprived sections of the population to seek health services from the private sector. Evidence indicates that, in many parts of India, the private sector provides a large volume of health services but with little or no regulation. The private sector is not only India’s most unregulated sector but also it is the most potent and unexploited sector. To address the inefficiency and inequity in the health system, many state governments have undertaken health sector reforms. One of these reforms has been to collaborate with the private sector through Public/Private Partnership (PPP). State governments in India are experimenting partnerships with the private sector to reach the poor and underserved sections of the population. Thus this review focuses on the importance of public private partnership in oral health.
Keywords: Health care; Oral health; Public-private partnership
In spite of great achievements in oral health globally, problems still remain in many countries all over the world, particularly among developing countries. In India, though health care is provided individually through public and private sectors, till now the oral health has not reached its summit. One of the strategies to improve oral health is through encouraging Public–Private Partnership (PPP) . Although widely used, the term partnership is difficult to define. Some definitions  in the literature are so ambiguous that they cover practically any type of interaction between public and private actors. Yet partnership is often used to describe a range of inter-organizational relationships and collaborations. The useful definitions of public-private partnership are:
a) Means to bring together a set of actors for the common goal of improving the health of a population based on the mutually agreed roles and principles .
b) A partnership means that both parties have agreed to work together in implementing a program, and that each party has a clear role and say in how that implementation happens .
c) A form of agreement that entails reciprocal obligations and mutual accountability, voluntary or contractual relationships, the sharing of investment and reputational risks, and joint responsibility for design and execution .
The need to foster such arrangements is supported by a clear understanding of the public sectors inability to provide public goods entirely on their own, in an efficient, effective and equitable
manner because of lack of resources and management issues . The aggregate expenditure on health sector is 5.2% of the GDP; out of this, 17% is for public sector and 83% for private sector. But in case of oral health it is 0%, hence it is vital to promote public–private partnership (PPP) for preventive, curative, and promoted services in stirring the oral health. These partnerships blend political, economic, and social forces to raise awareness of the oral health needs of undeserved population and to provide inspiration for a public consciousness. Their combined effort produces an impact that is greater than the sum of the individual parts .
PPP emerged as a result of five contextual shifts:
a) An ideological shift in the 1990s from “freeing” the market (i.e., liberating business from restrictive bureaucracy) to “modifying” the market (i.e., creating a facilitating environment).
b) A growing disillusionment with the UN and its agencies and their overlapping mandates, parallel programs, and interagency competition.
c) An increasing recognition that the health agenda is so large that no single sector or organization can tackle it alone .
d) A realization that the market alone cannot solve the problems. Public involvement is needed if health services, drugs, and vaccines are to reach the poor .
e) A growing interest among private players to enhance
their involvement in social issues and to be seen as ethically
and socially responsible. For example, Unilever’s mission
statement declares that “corporate social responsibility is an
integral part of our operating tradition” .
There are a number of strategies that can enhance the success
of partnerships. These include employing the principles of good
governance, the selection of appropriate partners, transparency,
accountability and good communications, fair competition, equity,
and the evaluation of externalities.
These are largely generic across the range of public-private
partnerships relate to the dimensions such as global norms and
principals, impartiality in health, social safety nets, conflict of
interest, redirecting national health polices, contribution to
common goals and objectives, lack of outcome orientation6.
PPP brings convergence of private sector interests and public
sector goals. It intends to optimally utilize and enable increased
access to vast rural, poor and marginalized segments like slum
dwellers, etc. Government contributions to a PPP should not be
under looked because without its support, planning oral health
excellence will be like building a castle in the air. It plays a major
role in providing infrastructure (creating a post for dentist in every
PHC) and provide capital subsidy in the form of a one-time grant.
Government can develop fiscal policies and increase taxation on
harmful products like tobacco, alcohol, and cariogenic products,
and exempt taxation on healthy products like sugar substitutes,
fruits and vegetables, herbal products, dentifrice, and mouthwash.
In the current scenario, the impact of joint venture of public and
private sector is schematically presented in Figure 1 .
TII: The Tobacco Intervention Initiative (TII) is a professionallyled
“call to action” programme to eradicate tobacco addiction
while striving for a `tobacco free India’ and thus improving the
oral health of Indians by the year 2020. Tobacco use and smoking
in particular, causes many of the chronic and debilitating diseases
that affect the population and stress the national health-care
system. TII strives for a “Tobacco Free India” by helping patients
quit smoking and consumption of smokeless or chewing tobacco,
through certified dental clinics engaged in tobacco intervention.
These clinics form the supportive infrastructure of the initiative
for tobacco cessation .
Yeshasvini health scheme in Karnataka: The Yeshasvini
Co-operative Farmer’s Healthcare Scheme is a health insurance
scheme targeted to benefit the poor. It was initiated by Narayana
Hrudayalaya, super-specialty heart hospital in Bangalore, and by
the Department of Co-operatives of the Government of Karnataka.
The Government provides a quarter (Rs. 2.50) of the monthly
premium paid by the members of the Cooperative Societies, which
is Rs.10 per month. The incentive of getting treatment in a private
hospital with the Government paying half of the premium attracts
more members to the scheme. The cardholders could access free
treatment in 160 hospitals located in all districts of the state for
any medical procedure costing up to Rs. 2 lakhs. A Third Party
Administrator – Family Health Plan Limited that is licensed by
Karnataka’s Insurance Regulatory and Development Authority.
The FHPL has the responsibility for administering and managing
the scheme on a day-to-day basis .
Arogya Raksha scheme in Andhra Pradesh: The
Government of Andhra Pradesh has initiated the Arogya Raksha
Scheme in collaboration with the New India Assurance Company
and with private clinics. It is an insurance scheme fully funded
by the government. It provides hospitalization benefits and
personal accident benefits to citizens below the poverty line who
undergo sterilization for family planning from government health
institutions. The government paid an insurance premium of Rs. 75
per family to the insurance company, with the expected enrolment
of 200,000 acceptors in the first year. The medical officer in the
clinics issues an Arogya Raksha Certificate to the person who
undergoes sterilization. The person and two of her/his children
below the age of five years are covered under the hospitalization
benefit and personal accident benefit schemes .
Contracting in Sawai Man Singh hospital, Jaipur: The SMS
hospital has established a Life Line Fluid Drug Store to contract
out low cost high quality medicine and surgical items on a 24-hour
basis inside the hospital. The agency to operate the drug store is
selected through bidding. The successful bidder is a proprietary
agency, and the medical superintendent is the overall supervisor in
charge of monitoring the store and it’s functioning. The contractor
appoints and manages the remuneration of the staff from the
sales receipts. The SMS hospital shares resources with the drug
store such as electricity; water; computers for daily operations;
physical space; stationery and medicines. The contractor provides
all staff salaries; daily operations and distribution of medicine;
maintenance of records and monthly reports to SMS Hospital. The
SMS Hospital has also contracted out the installation, operation
and maintenance of CT-scan and MRI services to a private agency.
The agency is paid a monthly rent by the hospital and the agency
has to render free services to 20% of the patients belonging to the
poor socio-economic categories .
National rural health mission: has made an impressive
beginning to enhance Public Private Partnership. During the
eleventh five year plan based on past experiences, efforts have to
be made to develop a generic framework for different categories
of PPP at primary, secondary, and tertiary levels of oral health care
to reduce cost, enhance quality and coverage through extensive
stake holder consultations .
Mumbai smiles: Mumbai Smiles spreads awareness about
oral health, hygiene and improve access to oral health care for
the common-man. Driving the importance of oral health, ‘Mumbai
Smiles’ is an initiative in partnership with Wrigley’s Orbit, which
offers free dental check-ups and educate families on the need to
go for regular dental check-ups to ensure a good overall health.
Mumbai Smiles not only generates awareness but further reiterates
IDA’s commitment towards oral health. IDA also made Mumbai
proud by breaking the Guinness World Record by conducting the
largest number of dental check-ups in 24 hours .
Brush up challenge: Brush Up Challenge campaign was
started to adopt good oral care habits as many Indians are not
aware of the right technique to brush. Some people use finger
instead of a brush, black tooth powder, tobacco preparations,
herbal twigs, etc. IDA and Colgate-Palmolive (India) Ltd undertook
various innovative activities to promote oral healthcare. In
October 2007, a record number of 177,003 people brushed their
teeth simultaneously at 380 locations across India, in one day, at
one time. Thereby successfully creating a Guinness World Record
in India for ‘most people brushing their teeth (multiple venues)’.
Live Learn. Laugh. Programme: Live. Learn. Laugh.
Programme was unveiled in 2006, as a drive for behavioural
change and inculcates good oral habits and night brushing in children. Low-income families received oral health education
on importance of `tooth-brushing day and night’. Free dental
screenings was carried out as many do not have access to dentist
on a regular basis. The project is supported by the Federation
Dentaire Internationale (FDI), Unilever’s Pepsodent brand and
Bright smile and bright future: IDA under the “BRIGHT
SMILE AND BRIGHT FUTURE” initiative launched a training
programme for Anganwadi workers. Anganwadi – institutions
provide basic education to children from lowest rung of the
society, in rural areas. Educating these kids on oral health reaps
dual results. Kids get the relevant oral health information and in
turn educate their parents. Anganwadi workers are trained by
a dentist deputed by IDA, to inculcate essential oral care habits
in children. This education programme is supported by Colgate-
Palmolive (India) Limited .
Oral health problems are a perennial global problem, which
means a mouthful of silver for the patients and a pocketful of
gold for the dentists. This wrongly conceived notion may be
one of the reasons why people tend to put dental health on the
backburner. To change this notion, PPP, if introduced, can play a
magnanimous catalytic role in achieving excellence in oral health.
In India IDA has been involved in various school dental health
and tobacco cessation programmes but it happens to be symbolic
and transitory in nature with minimum impact. Mechanism of
accreditation of dental clinics, franchising, and regulation of cost
and adoption of standard treatment protocols besides continuum
dental education can be way forward to achieve meaningful PPP
and attainment of oral health goals.