1 ` PUBLIC -PRIVATE PARTNERSHIP FOR HEALTH CARE DEVELOPMENT fi!LH fiajdfjss ixjO—kh i|yd rdcH yd fm!oa.,sl wxYhka fldgialrejka ùu by Dr A.K.S.B.DE Alwis

11

`

PUBLIC -PRIVATE PUBLIC -PRIVATE PARTNERSHIP FOR PARTNERSHIP FOR

HEALTH CARE HEALTH CARE DEVELOPMENTDEVELOPMENT

fi!LH fiajdfjss ixjO—kh i|yd rdcH fi!LH fiajdfjss ixjO—kh i|yd rdcH yd fm!oa.,sl wxYhka fldgialrejka yd fm!oa.,sl wxYhka fldgialrejka

ùuùubyby

Dr A.K.S.B.DE AlwisDr A.K.S.B.DE Alwis

Dr Luxman EdirisingheDr Luxman Edirisinghe

22

Private & public mix Private & public mix (partnership)(partnership)

Government Government hospitalhospital rcfha rcfha frday,frday,

Contracting Contracting out by out by governmentgovernment .sj.sjsiqus.; siqus.; fiajd ,nd .ekSugfiajd ,nd .ekSug

Paying wards Paying wards of governmentof government f.jk jdgsgqf.jk jdgsgq

Private Private hospitalshospitals mqoa.,sl frday,amqoa.,sl frday,a

Public rdcH Private mqoa.,sl

Funding uq,H iemhqu

Public rdcH

Private mqoa.,sl

ProductionProduction ksIamdokhksIamdokh

33

Aims of the partnershipAims of the partnership iyfhda.S;djfha wruqKiyfhda.S;djfha wruqK

1.1. Promote inter and intra-sectoral coordination and Promote inter and intra-sectoral coordination and cooperation for health developmentcooperation for health development.. fi!LH ixjrAOkh i|fi!LH ixjrAOkh i|yd jsjsO fCIa;% w;r iusnkaOSlrKh jrAOkh lsrSuyd jsjsO fCIa;% w;r iusnkaOSlrKh jrAOkh lsrSu

2. 2. Mobilize more resourcesMobilize more resources. . jevsmqr iusm;a jevsmqr iusm;a fhdod .ekSugfhdod .ekSug

3. 3. Reduce the service gapsReduce the service gaps. . fiajd ysoeia wju lsrSugfiajd ysoeia wju lsrSug

4. 4. Promote participation of community and other Promote participation of community and other stakeholdersstakeholders m%cd iyNd.S;ajh jevs lsrSugm%cd iyNd.S;ajh jevs lsrSug

5. 5. Ensure the equity and qualityEnsure the equity and quality. . .=Kd;aul;djh yd .=Kd;aul;djh yd idOdrk;ajh jevslsrSugidOdrk;ajh jevslsrSug

6. 6. Reduce wastage of resourcesReduce wastage of resources. . iusm;a kdia;sh iusm;a kdia;sh jevslsrSugjevslsrSug

44

There are many references to partnershipsThere are many references to partnershipsTo ensure the delivery of comprehensive health service, which reduce the

disease burden and promote health it is proposed -Rationalized health network,(that include allopathic & indigenous as well as public & private services mrsmQrAK fi!LH fiajdjla u.ska frda. ;;ajhlg uqyqK §ug mj;akd l%ufjsoh Yla;su;a lsrSu

Strengthened public-private partnerships to enhance efficient health service delivery. fi!LH fiajd iemhSu ldrAAhlaIu lsrSu i|yd rdcH-fm!oa.,sl fiajd w;r iyfhda.S;dj kxjd,Su

To empower communities towards more active participation in maintaining their health it is proposed to achieve fi!LH kxjd,Su i|yd m%cd iyNd.S;ajh iy;sl lsrSu

Improved participation of civil society and non governmental organizations

in promoting behavioral and life style changes cSjk rgdjka yd mqoa.,sl yeiSrSus rgdjka hym;a lrjSu i|yd isjs,a iudch iy rdcH fkdjk ixjsOdk iyNd.S lrjSu

To strengthen stewardship and management function of the health

system. fi!LH fiajd l<uKdlrk l%shdldrlus jevs oshqKq lsrSu

Strengthened coordination and partnerships with other sectors

(Strategic framework for health development in Sri Lanka,2004-2005\April 2003)

55

Health care Priority areas of the GovernmentHealth care Priority areas of the Government rdcH fi!LH ixrÌKfha m%uqL;djhka rdcH fi!LH ixrÌKfha m%uqL;djhka

EExpand access to curative health care services through hospitals and other xpand access to curative health care services through hospitals and other providers at the district level to move their services more accessible in poor and providers at the district level to move their services more accessible in poor and rural areas.rural areas.wvq jrm%ido,dNS ÿIalr m%foaYj, ck;dj i|yd fi!LH fiajdjka flfrys m%fõYhka wvq jrm%ido,dNS ÿIalr m%foaYj, ck;dj i|yd fi!LH fiajdjka flfrys m%fõYhka osia;s%la uÜgñka mq,q,a lsrSuosia;s%la uÜgñka mq,q,a lsrSu

EExpand the services to meet the needs of specific groups such as elderly, victims xpand the services to meet the needs of specific groups such as elderly, victims of war, displaced people, and specific health problems such as occupational health, of war, displaced people, and specific health problems such as occupational health, mental health, estate health etc…mental health, estate health etc… jhia.;jQjka, hqO mSä;hska iy wj;eka jQjka jhia.;jQjka, hqO mSä;hska iy wj;eka jQjka jeks úfYaIs; lKavdhï j, fi!LH wjYH;djka iy jD;a;Sh fi!LH, udkisl fi!LH iy j;= jeks úfYaIs; lKavdhï j, fi!LH wjYH;djka iy jD;a;Sh fi!LH, udkisl fi!LH iy j;= ck;djf.a fi!LH jeks úfYaIs; .eg,q ksrdlrKh lsrSu i|yd fi!LH fiajdjka mq,q,a ck;djf.a fi!LH jeks úfYaIs; .eg,q ksrdlrKh lsrSu i|yd fi!LH fiajdjka mq,q,a lsrSu lsrSu

DDevelopment of health promotion programs with specific emphasis on outreach evelopment of health promotion programs with specific emphasis on outreach through the schedule.through the schedule. fi!LH m%jrAOkh i|yd ÿria: jevigyka ilia lsrSu fi!LH m%jrAOkh i|yd ÿria: jevigyka ilia lsrSu

HHealth care financial options and partnershipsealth care financial options and partnerships

fi!LH ixrÌKfha uQ,Huh úl,amhka iy odhl;ajhkafi!LH ixrÌKfha uQ,Huh úl,amhka iy odhl;ajhka

HHuman Resource Developmentuman Resource Development. . udkj iïm;a ixjO—Khudkj iïm;a ixjO—Kh

66

Policy Issue: m%;sm;a;suh .eg,qj

Strengthening of public - private partnership in development of health care delivery system in NWP of Sri Lanka. jhT m<df;a fi!LH ;;ajh kxjd,Su i|yd rdcH yd mqoa.,sl wxY j,

iyfhda.S;djh Yla;su;a lsrSu

Policy Vision : Harmonious Public Private- partnership contributing to highest possible level of health for the people of NWP jhT m<df;a ck;djg b;du;au by, ugsgfus fi!LH fiajdjla ,nd §u i|yd rdcH iy mqoa.,sl wxY j, ukd odhlFjh iy;sl lsrSu

Policy Mission : To strengthen public -private- partnership in health care delivery fi!LH fiajdj i|yd rdcH iy mqoa.,sl wxY j, iyfhda.S;dj ,n§u

Policy Goal : To ensure the private sector participation in health care provision in NWP. jhT m<df;a fi!LH fiajdj iemhSfus§ mqoa.,sl wxYfha odhlFjh ,nd .ekSu

77

88

– Internal factorsInternal factors

• • Health care provision in essentially needs multi-sectoral collaboration. Health care provision in essentially needs multi-sectoral collaboration. fi!LH fiajd iemhSu i|yd w;HjYH f,ig jsjsO fCI;% j, odhlFjh u; mokus jSufi!LH fiajd iemhSu i|yd w;HjYH f,ig jsjsO fCI;% j, odhlFjh u; mokus jSu

• • To reduce rising cost in health care provision. To reduce rising cost in health care provision. jevsjk fi!LH fiajd jshou md<kh lsrSujevsjk fi!LH fiajd jshou md<kh lsrSu

• • To ensure the quality assurance in health care provision. To ensure the quality assurance in health care provision. fiajd iemhSfus .=Kd;aul ;;ajh wdrlaId lsrSug wjYH jSufiajd iemhSfus .=Kd;aul ;;ajh wdrlaId lsrSug wjYH jSu

• • To ensure accessibility in health care provision. To ensure accessibility in health care provision. fi!LH fiajdj ,nd.ekSug we;s yelshdj iy;sl lsrSufi!LH fiajdj ,nd.ekSug we;s yelshdj iy;sl lsrSu

• • To ensure the cost effectiveness of health strategies. To ensure the cost effectiveness of health strategies. fi!LH Wmdh udrA. j, M,odhs;djh iqrlaIs; lsrSu i|yd fi!LH Wmdh udrA. j, M,odhs;djh iqrlaIs; lsrSu i|yd

• • To ensure stakeholder participation in health policy implementation. To ensure stakeholder participation in health policy implementation. fi!LH m%;sm;a;s l%shd;aul lsrSfuS§ jsjsO mdrAYjlrejkaf.a iyNd.SFjh iy;sl fi!LH m%;sm;a;s l%shd;aul lsrSfuS§ jsjsO mdrAYjlrejkaf.a iyNd.SFjh iy;sl

lsrSug wjYH jSu lsrSug wjYH jSu

• • To resource sharing for better service delivery. To resource sharing for better service delivery. hym;a fiajdjka iemhSu i|yd iusm;a ksis whqrska fhdod .ekSug wjYH jSuhym;a fiajdjka iemhSu i|yd iusm;a ksis whqrska fhdod .ekSug wjYH jSu

• • To achieve national health objectives. To achieve national health objectives. cd;sl fi!LH wruqK lrd ,.d jSugcd;sl fi!LH wruqK lrd ,.d jSug

99

Evidence from international health agenciesEvidence from international health agenciescd;Hka;r fi!LH ixjsOdk j,ska ,efnk idÌscd;Hka;r fi!LH ixjsOdk j,ska ,efnk idÌs

WHO policy direction focuses on six priority WHO policy direction focuses on six priority areas, areas,

f,dal fi!LH ixúOdkfha ih jeoEreï m%uqL;djhkaf,dal fi!LH ixúOdkfha ih jeoEreï m%uqL;djhkaHealth sector reform & health system development.Health sector reform & health system development.

fi!LH m%;sixialrKh iy ixjO_khfi!LH m%;sixialrKh iy ixjO_kh

Communicable diseases control.Communicable diseases control.

fndajk frda. md,khfndajk frda. md,kh

Promoting healthy life styles & reducing environmental risk factors, Promoting healthy life styles & reducing environmental risk factors,

fi!LH iïmkak cSjk rgd m%jO_kh iy mdrsirsl wjOdku wju lsrSufi!LH iïmkak cSjk rgd m%jO_kh iy mdrsirsl wjOdku wju lsrSu

Integrating health services to enhance efficiency & effectiveness. Integrating health services to enhance efficiency & effectiveness.

ldrAhÌu;djh iy M,odhs;djh jeä lsrSu i|yd fi!LH fiajdjka wka;rA.%yKh ldrAhÌu;djh iy M,odhs;djh jeä lsrSu i|yd fi!LH fiajdjka wka;rA.%yKh lsrsulsrsu

Emergency preparedness & response.Emergency preparedness & response.

yosis wjia:djka i|yd iQodkïùu iy m%;spdr oelaùuyosis wjia:djka i|yd iQodkïùu iy m%;spdr oelaùu

Partnership & coordination.Partnership & coordination. iyfhda.S;djh iy iïnkaO;djhiyfhda.S;djh iy iïnkaO;djh

1010

Financial Evidence uQ,Huh idOl

Cost of Health: fi!LH fiajdfõ nerlï

In 1994 World Bank assured that basic package for health should be US$ 13 per person (WB,1994). The Sri Lankan government has been spending around US$ 10 (Annual Health Bulletine,2000).

If Sri Lanka wants to subsidize the health system, the

following new challenges should be addressed Y%S ,xld rch fi!LH iqNidOkh iemhSfïoS uqyqKoshhq;= kj wNsfhda.

1. Increasing elderly populations jeäjk jeäysá ck.yKh

2. NCD fnda fkdjk frda.

3. HIV/AIDS tps whs jS tavsia

4. Unfinished work in communicable diseases & malnutrition ksu fkdjQ fndajk frda. iy ukaofmdaIKh ms<sn| lghq;=

5. Dengue fvx.= frda.h

1991 § uQ,sl fi!LH fiajdjla iemhSu i|yd rgla jsiska wju jYfhka we fvd,rA 15la tla mqoa.,hl= i|yd jirlg jeh l, hq;= nj m%ldY lrk ,§ tfy;a tu ld,fha§ Y%S ,xldj ta i|yd jeh lrkq ,enqfjs we fvd,rA 10ls ^cd;sl fi!LH m%ldYh 2005&

1111

Estimatied Growth of Health Expenditure by govenrnment of Sri Lanka -1996-2015

0

50

100

150

2001996

1998

2000

2002

2004

2006

2008

2010

2012

2014

Year

Bil

lio

ns o

f R

s.

Low GDP Growth

Madium GDP Growth

High GDP Growth

This shows that public expenditure for health could rise from about 20 Billion Rupees in 2003 to between 70 & 173 billion Rupees in 2015.

ta wkqj 2003È ns,shk 20la jq rdcH jshou 2015§ ns,shk 70-173 olajd jkq we;

Source: Sri Lanka Health Financing Scenarios, 2000 to 2015

Y%S ,xldfjs rdcH wxYfha fi!LH i|yd jshou 1996-2015

1212

Total Government Expenditures by Function, 1997

42%

21%

11%

4%

20%

0%0%2%

In-patient care

Ambulatory care

Services of rehabilitative care

Ancillary services to medicalcare

Medical goods dispensed toout-patients

Preventive and Public healthservices

Health programmeadministration and insurance

Capital formation

Source: National health Accounts-2002

1313

Total Government Expenditures by Function, 1997

42%

21%

11%

4%

20%

0%0%2%

In-patient care

Ambulatory care

Services of rehabilitative care

Ancillary services to medicalcare

Medical goods dispensed toout-patients

Preventive and Public healthservices

Health programmeadministration and insurance

Capital formation

fkajdisl frda.S fiajd

idhksl

mqkre;a:dmk fiajd

wdOdrl fiajd

T!IO yd iemhSus ^ndysr frda.S&

frda. ksjdrK yd m%cd fi!LH fiajd

fi!LH mrsmd,khl<uKdlrKh

iuia: rdcH fi!LH jshous 1997

cd;sl fi!LH uq,H m%ldYh 2002

1414

Total Non-Government Expenditures by Function, 1997

31%

9%47%

10%

0%

1%2%

In-patient care

Ambulatory care

Services of rehabilitativecare

Ancillary services tomedical care

Medical goods dispensedto out-patients

Preventive and Publichealth services

Health programmeadministration andinsurance


1515

Total Non-Government Expenditures by Function, 1997

31%

9%47%

10%

0%

1%2%

In-patient care

Ambulatory care

Services of rehabilitativecare

Ancillary services tomedical care

Medical goods dispensedto out-patients

Preventive and Publichealth services

Health programmeadministration andinsurance

fkajdisl frda.S fiajd

idhksl

mqkre;a:dmk fiajd

wdOdrl fiajd

T!IO yd iemhSus ^ndysr frda.S&

frda. ksjdrK yd m%cd fi!LH fiajd

fi!LH mrsmd,khl<uKdlrKh

iuia: rdcH fkdjk fi!LH jshous 1997

cd;sl fi!LH uq,H m%ldYh 2002

1616

24

Variation in Government Expenditures on health by Province

Western

Central Southern

North-Western

North Central

Uva

Sabaragamuwa

North Eastern

-30

-20

-10

0

10

20

30

40

50

60

Dev

iati

on

in G

ove

rnm

ent

Sp

end

ing

as

% o

f N

atio

nal

Ave

rag

e


rdcH jshous j, m<d;a wkqj fjkialus

1717

Trends in Total Expenditure on Health, 1990-1999

0

5000

10000

15000

20000

25000

30000

35000

40000

45000

1990 1991 1992 1993 1994 1995 1996 1997 1998 1999

Rs. M

illio

n

Normal Constant 1997 prices

1999 – 1999 jir j, fi!LH wdfhdack

1818

rdPHrdPH fm!oa.,slfm!oa.,sl Pd;sl iuia:hPd;sl iuia:h

Pd;sl fi!LH jshouPd;sl fi!LH jshouFunding of national health Funding of national health expenditureexpenditure

50%50% 50%50% 3.4% of DGP-o< Pd;sl 3.4% of DGP-o< Pd;sl ksIamdokfha mqoa.,fhl= f,iksIamdokfha mqoa.,fhl= f,i

Pd;sl fi!LH jshoï Pd;sl fi!LH jshoï Wmfhda.s;djhWmfhda.s;djhUse of national health expenditureUse of national health expenditure

51%51% 49%49% 3.4% of DGP -3.4% of DGP -o< Pd;sl o< Pd;sl ksIamdokfha mqoa.,fhl= ksIamdokfha mqoa.,fhl= ioydioyd

frday,a fiajdjfrday,a fiajdj Hospital ServicesHospital Services

uq,H iemhquuq,H iemhqu

FundingFunding

87%87% 13%13% 1.4% of DGP-1.4% of DGP-o< Pd;sl o< Pd;sl ksIamdokfha mqoa.,fhl= ksIamdokfha mqoa.,fhl= ioydioyd

weoka ixLHdjweoka ixLHdj Bed availableBed available 96%96% 4%4% 3.0 per 1000 capita - 3.0 per 1000 capita - mqoa.,fhl= ioydmqoa.,fhl= ioyd

fkajdisl frda.skafkajdisl frda.ska Inpatient Inpatient admissionsadmissions

96%96% 4%4% 19.4 pre 100 capita -19.4 pre 100 capita -mqoa.,fhl= ioydmqoa.,fhl= ioyd

ndysr frda.s fiajdjndysr frda.s fiajdj

frdy,a fkdjk fiajdjfrdy,a fkdjk fiajdj 26%26% 74%74% 2.8% of DGP-2.8% of DGP-o< Pd;sl o< Pd;sl ksIamdokfha mqoa.,fhl= ksIamdokfha mqoa.,fhl= ioydioyd

frdy,a fkdjk fjk;a fiajdfrdy,a fkdjk fjk;a fiajd 27%27% 73%73%

Ndysr frda.s meusKsuNdysr frda.s meusKsu 48%48% 52%52% 3.9 per capita -3.9 per capita -mqoa.,fhl= ioydmqoa.,fhl= ioyd

Pd;sl fi!LH uq,H m%ldYh-2000National Health Accounts

1919

Total Expenditure on Health at Current Market Prices, 1990-99Total Expenditure on Health at Current Market Prices, 1990-99 19901990 19911991 19921992 19931993 19941994 19951995 19961996 19971997 19981998 19991999

Total public sources (Rs. Billion)Total public sources (Rs. Billion) 5.65.6 5.55.5 7.17.1 6.96.9 8.48.4 10.810.8 12.512.5 1414 17.717.7 19.219.2

Total private sources (Rs. Billion)Total private sources (Rs. Billion) 5.65.6 6.36.3 7.57.5 8.38.3 9.89.8 11.511.5 12.612.6 14.314.3 16.916.9 2020

Total national expenditures (Rs. Billion)Total national expenditures (Rs. Billion) 11.211.2 11.711.7 14.614.6 15.315.3 18.218.2 22.322.3 25.125.1 28.428.4 34.634.6 39.239.2


Total Expenditure on Health at Current Market Prices, 1990-99

0

5

10

15

20

25

1990 1991 1992 1993 1994 1995 1996 1997 1998 1999

Rs.

Bill

ion

Total public sources (Rs. Billion) Total private sources (Rs. Billion)

iuia: rdcH iy fm!oa.,sl fi!LH fiajdjka i|yd jshou 1990-99

2020

National Health Expenditures by Source as Share of GDP

1.7%1.7%1.6%1.6%1.6%1.4%1.4%1.7%

1.5%1.7%

1.7%

1.7%1.7%

1.8%

1.7%1.7% 1.6% 1.6%

1.6%1.9%

0.0

0.5

1.0

1.5

2.0

2.5

3.0

3.5

4.0

1990 1991 1992 1993 1994 1995 1996 1997 1998(Provisional)

1999(Provisional)

Total government Total private

%


National Health Expenditures by Source as Share of GDP fi!LH jshou o< foaYSh ksYamdokfha m%;sY;hla f,i

2121

Component of private Health Sector Component of private Health Sector fm!oa.,sl fi!LH fiajdfjs wx.hkafm!oa.,sl fi!LH fiajdfjs wx.hka

Private hospitals and nursing homes Private hospitals and nursing homes fm!oa.,sl frday,a iy ud;D ksjdifm!oa.,sl frday,a iy ud;D ksjdi

GPs full time (western & Indigenous medicine) GPs full time (western & Indigenous medicine) fm!oa.,sl ffjµ jD;a;sljka ^ngysr foaYSh&fm!oa.,sl ffjµ jD;a;sljka ^ngysr foaYSh&

Private practice of government health workers(MS, Dental Sur. Paramedics) Private practice of government health workers(MS, Dental Sur. Paramedics) rcfha fi!LH ldrH rcfha fi!LH ldrH uKav, j, mqoa.,sl fiajduKav, j, mqoa.,sl fiajd

Private pharmacies -5000 Private pharmacies -5000 fm!oa.,sl T!IO Yd,dfm!oa.,sl T!IO Yd,d

Private laboratories -450 Private laboratories -450 ridhkd.drridhkd.dr

Private ambulance services Private ambulance services .s,ka r: fiajd.s,ka r: fiajd

Contracting out of government services Contracting out of government services rdcH wxYh fj; ,nd fok .sjsiqus .; fiajdrdcH wxYh fj; ,nd fok .sjsiqus .; fiajd

Insurance companies. Insurance companies. rCIK wdh;krCIK wdh;k

Medical Manufactures /agents Medical Manufactures /agents ffjµ ksYamdok ksfhdacs;hka f,Iffjµ ksYamdok ksfhdacs;hka f,I

Traditional healers Traditional healers iusm%odhsl iqj lrkakkaiusm%odhsl iqj lrkakka

Quacks etc… Quacks etc… iqÿiqlus fkdue;s ffjµ ‘ffjµjreka’iqÿiqlus fkdue;s ffjµ ‘ffjµjreka’

^wOHCI-fm!oa.,sl ffjµ fiajd 2005&^wOHCI-fm!oa.,sl ffjµ fiajd 2005&

2222

Province Blood Banks CT/VS Scan MRI Units LithotriptorsWestern 6 6 2 0Southern 0 0 0 0Central 0 1 0 0NEP 0 1 0 0North Western 0 0 0 0Uva 0 0 0 0Sabaragamuwa 0 1 0 0Total 6 9 2 0

Facilities in Private sector Hospitals by Province in 2001

Source: CPCEH 2004

Contribution of Private Health Sector in Sri Lanka

fm!oa.,sl wxYfha odhl;ajh

2323

fm!oa.,sl frday,a - jhT m<d;

2424

Estimated Total Revenue of private hospitals1990-2001

0

500

1000

1500

2000

2500

3000

3500

1990 1991 1992 1993 1994 1995 1996 1997 1998 1999 2000 2001

Year

Rs

. M

illi

on

Source: CPCEH 2004

fm!oa.,sl wxYfha frday,a j, wdodhu

2525

This shows that estimated private health expenditure to grow from 30 to 34 Billion Rupees in 2002 to between 98 & 291 billion Rupees in 2015.Source: CPCEH 2004

Estimated private health expenditure in Sri Lanka 1999-2015

0

100

200

300

400

Year

Bil

lio

ns o

f R

s.

Elasticity1.1

Elasticity 1.5

fm!oa.,sl wxYfha jshou

2002 § ns,shk 30-34 jk w;r 2015§ ns,shk 98-291 jkq we;

2626

1990 1992 1994 1996 1998 2000 2001Mean beds per reporting hospital 35 37 37 38 36 35 35Total reporting hospitals 44 48 54 57 60 63 64Total beds in reporting hospitals 1,537 1,774 1,969 2,189 2,147 2,187 2,236Total estimated beds 1,607 1,848 2,042 2,266 2,219 2,222 2,271Total estimated hospitals 46 50 56 59 62 64 65Source:Ministry of Health IPS-Private hospital survey 1998, CPCEH 2004

Number of beds in private hospitals, Estimates for 1990-2001

Number of Beds in Private Hospitals,

Estimates for 1990-2001

0

500

1,000

1,500

2,000

2,500

1990 1992 1994 1996 1998 2000 2001

Year

valu

e

Mean beds per reporting hospital

Total reporting hospitals

Total beds in reporting hospitals

Total estimated beds

Total estimated hospitals

7

Source: Ministry of Health IPS-Private hospital survey 1998, CPCEH 2004

fm!oa.,sl frday,a j, we|ka ixLHdj 1990 - 2001

2727

69%

9%

8%

7%

4% 2% 0%1%

Western

Central

NEP

NWP

Southern

NCP

Uva

Sabaragamuwa


Percentage distribution of private hospital beds by province, 2001

m,d;a wkqj mqoa.,sl frday,a we|ka m%;sY;h -2001

2828

0

0.5

1

1.5

2

2.5

3

3.5

4

4.5

1990 1991 1992 1993 1994 1995 1996 1997 1998 1999 2000 2001

Year


Private sector admissions as a share of total admissions in the country

mqoa.,sl frday,a fkajdisl frda.Ska uq,q osjhsfka fkajdisl frda.Skaf.a m%;sY;hla f,i

2929

Estimated statistics for Private HospitalsYear 1990-2001 ('000')

0

500

1000

1500

2000

2500

3000

1990 1991 1992 1993 1994 1995 1996 1997 1998 1999 2000 2001

Year.

Total admissions ('000)

Total OP visits ('000)

Bed turnover rate

7


1990 1991 1992 1993 1994 1995 1996 1997 1998 1999 2000 2001Total admissions ('000) 74 79 87 91 95 104 110 109 110 114 118 122Total OP visits ('000) 419 394 554 616 767 901 1274 1341 1605 1924 2406 2609Bed turnover rate 46 46 47 47 47 47 49 47 50 51 54 54

Estimated statistics for private hospitals, 1990-2001

Source:Ministry of Health IPS-Private hospital survey 1998, CPCEH 2004

fm!oa.,sl wxYfha fiajd iemhSu 1992 - 2001

fkajdisl

ndysr

3030

Total inpatient admissions by all hospitals, Estimates for 1990-2001

0

1,000

2,000

3,000

4,000

5,000

1990

1991

1992

1993

1994

1995

1996

1997

1998

1999

2000

2001

Year

MOH admissions ('000)

Total private hospitaladmissions('000)

Co-operative and estateadmissions ('000) *


1990 1991 1992 1993 1994 1995 1996 1997 1998 1999 2000 2001MOH admissions ('000) 2,533 2,629 3,024 3,174 3,204 2,949 3,339 3,454 3,791 3,825 4,015 4,091Total private hospital admissions('000) 74 79 87 91 95 104 110 109 110 114 118 122Co-operative and estate admissions ('000) * 20 20 20 20 20 20 20 20 20 20 20 20Total private sector share 3.60% 3.60% 3.40% 3.40% 3.50% 4.00% 3.70% 3.60% 3.30% 3.40% 3.30% 3.40%Source:Ministry of Health IPS-Private hospital survey 1998, CPCEH 2004* Note: Data insufficient to estimate actual trend reliably.

Total inpatient admissions by all hospitals, Estimates for 1990-2001

iuia: fkajdisl frda.S ixLHdj – fm!oa.,sl wxYh 1990 - 2001

fkajdisl frda.Ska we;=,;a lsrSu

3131

Trends in outpatient visits at private hospitals, Estimates for 1990-2001

0

500

1000

1500

2000

2500

3000

1990 1991 1992 1993 1994 1995 1996 1997 1998 1999 2000 2001

year

Total OP Visits-Colombo ('000)

Total OP Visits-out of colombo ('000)

Total OP visits('000)


1990 1991 1992 1993 1994 1995 1996 1997 1998 1999 2000 2001Total OP Visits-Colombo ('000) 84 81 195 253 322 476 629 682 1,059 1,429 1,876 2,006Total OP Visits-out of colombo ('000) 336 313 359 363 446 426 645 660 546 495 530 603Total OP visits('000) 419 394 554 616 767 901 1,274 1,341 1,605 1,924 2,406 2,609Colombo share as a % total 20% 20% 35% 41% 42% 53% 49% 51% 66% 74% 78% 77%

Trends in outpatient visits at private hospitals, Estimates for 1990-2001


iuia: ndysr frda.S fiajdjka – fm!oa.,sl wxYh 1990 - 2001

mqoa.,sl wxYfha we;s ndysr frda.Ska

3232

Current situation in partnership

iyfhda.S;djfha jrA;udk ;;ajh1. No proper legal frame work ukd kS;suh mokula ke;

2. No coordination between two sectors wxY foflys iyiïnkaO;djhla fkdue;

1. Private sector institutions are not registered in health department mqoa.,sl fi!LH wdh;k rcfha ,shdmosxÑ lr fkdue;

2. No feedback mechanisms jsOsu;a ixksfjSok l%ufõohla fkdue;

3. No monitoring mechanisms wëÌK ms<sfj;la fkdue;

3. No participation in health planning & implementation

fi!LH ie,iqï lsrSfï iy l%shd;aul lsrSfï iyNd.S;ajhla fkdue;

4. No quality assurance mechanism for private sector

mqoa.,sl wxYfha ;;ajmd,k l%uhla fkdue;

5. No sharing of resources for the benefit to community

fmd\q iïm;a mrsyrK l%ufõohla fkdue;

6. Wastage and Duplication of works lghq;= oaú.=Kùfuka iïm;a wmf;a hdu

3333

3434

Possible causes for weak partnership\qrAj, iyfhda.S;djhg fya;=01. Lack of tradition in collaboration between two sectors.01. Lack of tradition in collaboration between two sectors.

tjeks iïm%odhla fkdmej;Sutjeks iïm%odhla fkdmej;Su 02. Objectives are differ 02. Objectives are differ tlu wruqKla fkd;sîutlu wruqKla fkd;sîu 03. The weak information 03. The weak information system. system. ÿrAj, ikaksfõokhÿrAj, ikaksfõokh04. Lack of capacity in public sector to manage and 04. Lack of capacity in public sector to manage and

regulate relationship with private sector. regulate relationship with private sector. mqoa.,sl wxYh iu. iïnkaO;d meje;aùfï oÌ;d mqoa.,sl wxYh iu. iïnkaO;d meje;aùfï oÌ;d rdcH wxYh fj; fkd;sîu rdcH wxYh fj; fkd;sîu 05. Political pressure. 05. Political pressure. foaYmd,k n,mEïfoaYmd,k n,mEï 06. Pressure from trade unions 06. Pressure from trade unions other stakeholders in other stakeholders in health. health. jD;a;Sh iñ;s we;=,q wfkl=;a mdY_jlrejkaf.a jD;a;Sh iñ;s we;=,q wfkl=;a mdY_jlrejkaf.a n,mEïn,mEï 07. Mistrust. 07. Mistrust. wúYajdih wúYajdih08. Weakly organized private sector in the country.08. Weakly organized private sector in the country. mqoa.,sl wxYh ;=, ukd ixúOdkh ùula fkd;sîumqoa.,sl wxYh ;=, ukd ixúOdkh ùula fkd;sîu

3535

cont….Possible causes for weak partnershipcont….Possible causes for weak partnership

09. Strong public confidence on government health system 09. Strong public confidence on government health system (socio-cultural influences). (socio-cultural influences).

rdcH wxYh flfrys we;s oeäúYajdihrdcH wxYh flfrys we;s oeäúYajdih

10. Weaknesses of private sector in maintaining quality assurance10. Weaknesses of private sector in maintaining quality assurance mechanism and fulfilling social responsibilities as expected by mechanism and fulfilling social responsibilities as expected by the people the people ck;d wfmaÌdjkag wkqj fiajh ie,iSug mqoa.,sl wxYh wiu;a ck;d wfmaÌdjkag wkqj fiajh ie,iSug mqoa.,sl wxYh wiu;a

ùuùu 11. Dependency of private sector on public sector for human 11. Dependency of private sector on public sector for human resources resources mqoa.,sl wxYh rdcH wxYfha udkj iïm;a u;mqoa.,sl wxYh rdcH wxYfha udkj iïm;a u; hemSuhemSu 12. No legal framework for partnership 12. No legal framework for partnership kS;s iïmdok fkd;sîukS;s iïmdok fkd;sîu 13. Less public interest.13. Less public interest. ck;d Wkkaÿj wvq njck;d Wkkaÿj wvq nj 14. Unsuccessful out comes from partnerships in other sector 14. Unsuccessful out comes from partnerships in other sector fjk;a wxYj, rdcH-mqoa.,sl iúnkaO;djhka widrA:l ùufjk;a wxYj, rdcH-mqoa.,sl iúnkaO;djhka widrA:l ùu

3636

Outcome of weak partnership.Outcome of weak partnership. ÿrAj, iyfhda.S;djfha m%;sM,ÿrAj, iyfhda.S;djfha m%;sM,

01. 01. Uncoordinated activities.Uncoordinated activities.

wixúOdkd;aul l%shdldrlïwixúOdkd;aul l%shdldrlï

The health authorities have no information on private sector The health authorities have no information on private sector investments or activities and private sector, therefore not involved in investments or activities and private sector, therefore not involved in national health policy formulation and their contribution towards national health policy formulation and their contribution towards implementation of national health strategies are not significant.implementation of national health strategies are not significant.

02. Waste of resources from both sectors due to duplication or 02. Waste of resources from both sectors due to duplication or overlapping of investments. overlapping of investments.

iïm;a wmf;a hduiïm;a wmf;a hdu

03. Lack of sound quality- assurance mechanism in private sector.03. Lack of sound quality- assurance mechanism in private sector.

mqoa.,sl wxYfha ukd ;;aj md,khla fkd;sîumqoa.,sl wxYfha ukd ;;aj md,khla fkd;sîu

04.Increasing cost to the government in health care provision.04.Increasing cost to the government in health care provision.

rdcH wxYh wkjYH rdcH wxYh wkjYH úhoula oerSuúhoula oerSu

05. Reluctance from donor agencies 05. Reluctance from donor agencies

m%;smdok imhk wdh;k ukafoda;aidyS m%;smdok imhk wdh;k ukafoda;aidyS ùuùu

3737

Policy options in public-private partnershipPolicy options in public-private partnershipm%;sm;a;suh úl,amm%;sm;a;suh úl,am

1. A national policy should be developed to allow private and other non- 1. A national policy should be developed to allow private and other non- government sectors to actively participate and contribute in optimum government sectors to actively participate and contribute in optimum manner to achieve national health objectives in maximum cost manner to achieve national health objectives in maximum cost effective manner. effective manner. rcfha ueosy;aùfuka m%;sm;a;s ilia lsrSu’ rcfha ueosy;aùfuka m%;sm;a;s ilia lsrSu’

2. Policymakers should achieve this task with the participation and 2. Policymakers should achieve this task with the participation and consultation with all internal and external stakeholders of health. consultation with all internal and external stakeholders of health. ish,q ish,q odhl;ajhka iu. tl.;djhlg meñKSuodhl;ajhka iu. tl.;djhlg meñKSu

3. Formulation of guidelines and protocols for partnership, including 3. Formulation of guidelines and protocols for partnership, including modalities for monitoring. modalities for monitoring. fldgialrejka ùu ms<sn|j ish,q kS;s iy fldgialrejka ùu ms<sn|j ish,q kS;s iy Wmfoia iïmdokh lsrSuWmfoia iïmdokh lsrSu

4. Orientation of private and other non-government sectors on national 4. Orientation of private and other non-government sectors on national health policies and strategies. health policies and strategies. wfkl=;a rdcH fkdjk iy mqoa.,sl wxY wfkl=;a rdcH fkdjk iy mqoa.,sl wxY rcfha fi!LH m%;sm;a;s iy Wmdh udrA. ms<sn| oekqj;a lsrSurcfha fi!LH m%;sm;a;s iy Wmdh udrA. ms<sn| oekqj;a lsrSu

Development of consensus among all stakeholders on partnerships. Development of consensus among all stakeholders on partnerships. mdY_jlrejka w;r wfkHdkH wjfndaOhla we;s lsrSumdY_jlrejka w;r wfkHdkH wjfndaOhla we;s lsrSu

Cont..Cont..

3838

6. The areas of possible partnerships should be identified, both in central and 6. The areas of possible partnerships should be identified, both in central and peripheral level. peripheral level. fldgialrejka ùu wjYH wxY yÿkd .ekSufldgialrejka ùu wjYH wxY yÿkd .ekSu

7. Address to the barriers for partnership. 7. Address to the barriers for partnership. ndOl yÿkd .ekSundOl yÿkd .ekSu

8. Capacity building and sharing of information in both sectors initially and 8. Capacity building and sharing of information in both sectors initially and provision of necessary assistance to the private sector for its development provision of necessary assistance to the private sector for its development and participation. and participation. mqoa.,sl wxYfha iïm;a ixjO_kh i|yd iydh oSumqoa.,sl wxYfha iïm;a ixjO_kh i|yd iydh oSu

9. Formulation of coordinating committees in national and peripheral level. 9. Formulation of coordinating committees in national and peripheral level. cd;sl cd;sl iy m%dfoaYSh kshdul lñgq msysgqùuiy m%dfoaYSh kshdul lñgq msysgqùu

10.Formulation of legal frame works for partnerships.10.Formulation of legal frame works for partnerships. kS;s iïmdokh lsrSukS;s iïmdokh lsrSu11. Operational research to evaluate the existing and identified areas of 11. Operational research to evaluate the existing and identified areas of

partnership. partnership. ióÌK u.ska l%shdldrlï we.ehSuióÌK u.ska l%shdldrlï we.ehSu

3939

Areas where public- private sector partnerships Areas where public- private sector partnerships could be establishedcould be established

rdcH-mqoa.,sl iyfhda.S;djh we;s l<yels fldgiardcH-mqoa.,sl iyfhda.S;djh we;s l<yels fldgia

* Joint policy formulation bodies and coordinated implementation * Joint policy formulation bodies and coordinated implementation of national health strategies. of national health strategies. cd;sl fi!LH m%;sm;a;Ska l%shd;aul lsrSucd;sl fi!LH m%;sm;a;Ska l%shd;aul lsrSu* Supportive services, Cleaning\Transport\ Training\ Security * Supportive services, Cleaning\Transport\ Training\ Security Wmldrl fiajdjka ^msrsisÿ lsrSu/ m%jdykh/ mqyqKqj/ wdrÌl Wmldrl fiajdjka ^msrsisÿ lsrSu/ m%jdykh/ mqyqKqj/ wdrÌl

fiajd&fiajd&* Sharing of information * Sharing of information f;dr;=re fnodyod .ekSuf;dr;=re fnodyod .ekSu* Coordinated curative activities. * Coordinated curative activities. taldnoaO m%;sldr fiajdtaldnoaO m%;sldr fiajd* High tech laboratory & curative services * High tech laboratory & curative services wë;dlaIksl ridhkd.dr iy mwë;dlaIksl ridhkd.dr iy m

%;sldr fiajd%;sldr fiajd* Long-term care * Long-term care oS._ ld,Sk m%;sldroS._ ld,Sk m%;sldr* Community based care * Community based care m%cd fi!LH fiajdm%cd fi!LH fiajd* Rehabilitation * Rehabilitation mqkre;a:dmkhmqkre;a:dmkh* Coordinated investments. * Coordinated investments. taldnoaO wdfhdackhtaldnoaO wdfhdackh* Training of human resource for private sector.* Training of human resource for private sector.

mqoa.,sl wxYh i|yd udkj iïm;a ixjO_khmqoa.,sl wxYh i|yd udkj iïm;a ixjO_kh* Quality assurance mechanism * Quality assurance mechanism ;;ajmd,k l%ufõo;;ajmd,k l%ufõo

4040

4141

PossiblePossible stakeholder reactionstakeholder reactionwfmaÌs; m%;spdrwfmaÌs; m%;spdr

1. Possible antagonism by trade unions 1. Possible antagonism by trade unions

jD;Sh iñ;s úfrdaO;djD;Sh iñ;s úfrdaO;d

2. Political sensitivity2. Political sensitivityfoaYmd,k m%;spdr foaYmd,k m%;spdr

3. Cooperation or resistance by health care managers3. Cooperation or resistance by health care managersfi!LH l<ukdlrKfha m%;sfrdaOhkafi!LH l<ukdlrKfha m%;sfrdaOhka

4. Low Interest from private sector4. Low Interest from private sectormqoa.,sl wxYfha WodiSk njmqoa.,sl wxYfha WodiSk nj

5. Possible resistance of private sector5. Possible resistance of private sectormqoa.,sl wxYfha m%;sfrdaOhmqoa.,sl wxYfha m%;sfrdaOh

6.6. Support from donor agenciesSupport from donor agenciesm%;smdok imhkakkaf.a iyfhda.hm%;smdok imhkakkaf.a iyfhda.h

7.7. Resistance from the publicResistance from the public

uyck úfrdaO;duyck úfrdaO;d

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THANK YOU

Documents

1 ` PUBLIC -PRIVATE PARTNERSHIP FOR HEALTH CARE DEVELOPMENT fi!LH fiajdfjss ixjO—kh i|yd rdcH yd fm!oa.,sl wxYhka fldgialrejka ùu by Dr A.K.S.B.DE Alwis