Scaling Up Public-Private Partnerships to

Achieve Family Planning Equity Goals in India

Suneeta Sharma, PhD MHA, Managing Director, Futures Group India
Tanya Liberham, MA, Knowledge Management Officer, Futures Group India

Outline
Taking PPP models to scale
under Innovations in FP
Technical Assistance Project
(ITAP): success factors
Four examples
The Sambhav (Possible)
Voucher system
The Accredited Social Health
Activist (ASHA) Plus program
The Mobile Health Van
Initiative
The MerryGold Social
Franchise Model

Way forward

Scale Up: Success Factors

Government (national and state) leadership and ownership
Think scale up from the beginning
Strengthen and build on existing structures and systems
Consultative and transparent process of setting goals and building
partnerships
Clearly defined and agreed upon monitoring indicators and
performance levels
Follow an active problem solving approach
Sustainable financing
Linkage between proven models and policies

Framework for Strengthening Private

Sector Role to Achieve Health Equity Goals

Demand
Policy

Public

Private

Supply

Analysis

Advocacy and Dialogue

Create an enabling
environment
Balance Public
Private Sector roles
Build Public Private
Partnerships

Action

Public-Private Partnerships (PPPs)

PPPs are collaborative efforts between private and public sectors, with
clearly identified partnership structures, shared objectives, and specified
performance indicators for delivery of a set of health services.

5D Approach
DESIGN

Develop
the
concepts
for the
innovation
DEVELOP

Design the
details of
the
innovative
approach

DOCUMENT

Demonstrate
feasibility of
the innovation
through
piloting

DEMONSTRATE

Document
achievements,
challenges,
and lessons
learned

Disseminate
findings to
inform
scale-up
DISSEMINATE

Sambhav Voucher System

To reduce inequities in reproductive health care by enabling access to
services, while empowering the below poverty line population to
choose their own provider
Voucher
Management
Agency

Voucher Distribution

Payment for
Services

ANM/ASHA

Voucher
Redemption

Private Nursing Homes

Voucher Redemption

BPL Families

Voucher Distribution6

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

Improving FP/RH Uptake: Urban
and Rural Poor
60
54
53.3

Sambhav voucher system pilots

12,500 institutional deliveries

50

9,500 FP methods

Uttarakhand: BPL population

coverage increased

Percentage

44,000 ANC Visits/10,300 PNC visits

30.8

34.8

36

30 26.7
20
10

to 2.58 million poor across the state

Jharkhand: injectables accounted for

43% of modern method use

38.5

40

from 0.15million in two blocks (Pilot)

UP scaled up the urban slum voucher

system from one city to eleven cities

43

Use of modern
contraceptive
use

Institutional
delivery

Agra (rural) Baseline, 2006

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

Source: : IFPS Technical Assistance Project (ITAP). 2012. Sambhav: Vouchers Make High-Quality Reproductive Health Services
Possible for Indias Poor. Gurgaon, Haryana: Futures Group, ITAP.

ASHA Plus Program

ASHAs introduced under NRHM

ASHA Plus program

to promote healthy behaviors

a viable and evidence based

Operations Research model

In Uttarakhand, ASHAs faced challenges

in providing uniform services due to
Hilly terrain,
Small scattered settlements covering
large geographical area
Poor connectivity
Limited public transport
ASHAs unable to sustain themselves
covering a smaller number of people than intended

Piloted in six blocks of

three bordering districts
Flexible population
coverage
Performance based
remuneration
Enhanced training
package

Partnerships in ASHA Plus

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

Recruiting and training

of ASHAs
Supportive supervision
Taking feedback from the
community
Piloting all training
materials and tools

State
Government

ITAP

NGOs

ASHA plus
Workers

Creating awareness &

disseminating information
on health programs
Community mobilization
Organizing community level
meetings
Strengthening linkages

Achievements of ASHA Plus

Scale up:
6 blocks to 6 districts
Population coverage increased from .26million to 3.13million

47 Block Coordinators and 550 ASHA Facilitators support 11,086 ASHA at block and
sub block levels

Learning's of ASHA Plus were incorporated in ASHA Support System

Rural Development Institute and 10 NGOs are implementing ARCs across the state

Reaching the Underserved: Mobile Health Vans

A fixed day, fixed time, and fixed place approach to
provide primary healthcare services in remote rural areas

Facilitating Implementation
Pilot phase
Evaluation of early MHV models
Van specifications
Route design and operations
Service provision
Personnel
Capacity building
Community engagement and demand
generation
Management and oversight
Links to public health system
Private sector engagement
Cost recovery
Financial allocation and expenditures

Scale Up
Expansion of MHV operations
in the state
Evaluation of MHVs and design
of a synchronization plan
MHV synchronization strategy
Refinement of monitoring
activities
Financial scale up

13

Scale up
Mobile Health Vans
Scale up
From 1 van to 30 vans
throughout UK
Population coverage from
0.5 million to 10 million

Performance (2010 2011)

Organized 5000 camps
Reached 300,000 people

IFPS Technical Assistance Project (ITAP). 2012. Reaching Underserved

Communities through Mobile Health Vans in Uttarakhand, India. Gurgaon,
Haryana: Futures Group, ITAP.

MerryGold Social Franchising

An innovative, sustainable, for-profit PPP model to deliver maternal
health and family planning services at below market prices
Business format approach for SUSTAINABILITY THROUGH
INNOVATIONS
Market research fundamental to future growth of the network
Three-tiered approach with a mix of full and fractional franchising
Building brand value: beyond just the logos
Linkages with existing government schemes
Franchisors role in:

Building capacities and training

Development of vendors and procurement at competitive prices
Regulating quality assurance systems
Marketing of the network
15

Partnerships in Social Franchising

Support formation and operation of
network
Overall management
Monitor the project
Benchmark formulation and report
to USAID

Adherence to network guidelines

Provide quality services to
clients at pre-determined prices
Conduct outreach activities
Quality management at facility

Design and develop the network

Process documentation and
dissemination
Conduct periodic studies and
assessments

As the franchisor, recruit qualified

franchisees
Build and market the brand; Define
guidelines and protocols
Manage the network
Build capacities of franchisees
Quality assurance
Reporting to SIFPSA

Social Franchising Achievements

Performance during Oct 2007
February 2012

Hub and Spoke model of MGHN

756,100 antenatal checkups

L3

L3

133,900 deliveries

L2

10,600 sterilizations

38,200 IUCD insertions

L2

>1 million CYPs generated so far

Under consolidation phase, included

in the Program Implementation Plan
(PIP) 2013
Replicating the same model in
Rajasthan

L3

L3
L2

L0

L3

L3

L1

L2
L3

L3

Source: IFPS Technical Assistance Project (ITAP). 2012. Social Franchising as a Public Private Partnership Model - Lessons
Learned from the MerryGold Health Network of Uttar Pradesh, India. Gurgaon, Haryana: Futures Group, ITAP.

17

Extending Best Practices

DFID RH Framework Family Planning
(Bihar and Orissa)
Social franchising, social marketing
and innovative PPP models
USAID PIPPSE Project HIV/AIDS
(UP, Uttarakhand, Rajasthan)
Employer led models
PPP structures and roadmap
PPP course
Global Fund Malaria
(7 north eastern states)
Private sector mapping, capacity
building, and engagement
18

Thank You!