Public–Private Partnerships in Health Services Delivery

Abstract

In this article, we conceptualize public–private partnerships (PPPs) from a network organizations perspective, and apply interorganizational relations (IOR) to study fifteen PPPs in a district health system in the state of Rajasthan in India. We find that the Government occupies a dominant position in the network because of the centrality of its functions, authority and control over resources and information. There is greater reliance on formal mechanisms of co-ordination. For effective network governance, it is imperative to reduce the power asymmetry, develop horizontal co-ordination, trust and social capital, and enhance public managers’ capacity for effectively managing interorganizational relationships.

Key words:

• Health system
• interorganizational co-ordination
• interorganizational relations
• network governance
• network organizations
• public–private partnerships

Notes

1 Networks emerge from the pluralization of society, flexible partnerships and fluid boundaries (Chandhoke 2003). Because of the redefining of power and authority in the network (Wolfish and Smith 2000; Peters 2002), the Government comes to play a co-ordinating role (Peters and Pierre 1998; Kooiman 2003). Co-ordination in the network is established through shared goals (Rosenau 1992) or self-organization (Jessop 1998), and policy emerges through negotiation (Marsh and Rhodes 1992).

2 These include franchising, vouchers for service delivery, Built Operate Transfer (BOT) and Joint Ventures for construction and operation of large hospitals, social marketing, corporate philanthropy, social work by individuals and VOs, management of government training institutes, research work undertaken by independent bodies, activities such as advocacy, support to NGOs and awareness generation programmes undertaken by corporates and industry associations as part of corporate social responsibility. PPPs of whatever type, may be one-time such as donation of land, money, equipment and so on, one-time campaign, short-term contract or continuous or long-term partnerships, such as social franchising, long-term contracting, social marketing and capacity building.

3 Formal relationships are those where a contract or MoU is signed between the parties.

4 Informal relationships are those based on trust, norms, shared values, reciprocity and collaboration.

5 Joint ventures are excluded because they are a legal entity separate from either parent (Pfeffer and Nowak 1976).

6 Macro-culture is a system of widely shared assumptions and values, comprising industry-specific, occupational or professional knowledge that guides actions and creates typical behaviour patterns among independent entities. Macro-culture is diffused and sustained through socialization of professionals (apprenticeships, trainings), trade or industry journals and industry specific events.

7 Only two private hospitals in the district have more than ten beds each (GoR 2003).

8 Apex institution of democratic local self-government at district level.