Is Public Private Partnership an Effective Alternative to Government in the Provision of Primary Health Care? A Case Study in Odisha

Existing public health services are inadequate to cater to the growing demands of quality health care. Public Private Partnership (PPP) has evolved over the last decade as a newer arrangement. This study aimed to understand the breadth and depth of services in primary health centres (PHC) under government (PHC-GOV), NGO (PHC-NGO) and corporate (PHC-COR) management in Kendrapara district of Odisha. One PHC from each model was selected at random. Compliance with Indian Public Health Standards (IPHS), programme performance of last one year and perception of end-users about quality of services were studied. The Government of India (GOI) prescribed IPHS checklist, a performance indicator matrix and a semi-structured interview schedule, respectively, were used for data collection. There were no significant differences in the breadth and depth of services across all three models of PHC management. Comprehensive primary health care including immunization services, health promotion, treatment of common ailments, malaria management and delivery services were almost non-existent in these facilities. PHC-GOV had better accessibility, infrastructure, behaviour of doctors and availability of medicines, whereas laboratory service was better in PHC-NGO and PHC-COR. Human resources and programme performance of last one year was grossly inadequate across all three models. There is no remarkable improvement in the quality of services provided by PPP models. It may not serve as a substitute to inadequate recruitment and retention of staff, erratic programme review and poor capacity building, for attainment of optimal outcomes.