Assignment on public private mix in health care in Bangladesh


Efforts to change the public-private mix in health care provision are becoming a common feature of health sector reform programmes world wide. There are a number of reasons for this trend. First, rising health costs and the growing demand for health services have led many governments to realise the goal of universal free care may not be attainable. Second, growing acceptance of the principles of New Public Management. Theory which seeks to inject a more business oriented approach to public sector management, including the separation of responsibilities for purchasing and providing health care. Third, the recognition that the private sector is already a significant player in health sector financing and provision and benefits of the sector should be harnessed.
The Health and Population Sector Programme (HPSP) emphasises the importance of forging partnerships with the private sector for the provision of services as well as making management changes that change the nature of the relationship between public purchaser and provider. The Project Implementation Plan (PIP) accompanying documents recognise the need for additional sources of funding and provision to complement what can be financed and provider by the state. References include
• the need to provide non-ESP services “through partnerships with or commissioning of services from NGOs and private not-for-profit hospitals”;
• the need to reform the existing system of providers cum purchaser of the public sector” such that “the local authority will be formed to act as local purchaser”;
• decentralisation of health and FP services to the peripheral level.
The identification of one HPSP component (Public-Private Partnerships financed by DFID) is another indication that the Government is looking very seriously at utilising the capacity of the private sector to enhance services provided to improve public health.

The growing interest in the concept of planned markets and managed competition has demonstrated that it is not necessary for the public sector to be privatised in order to incorporate some of the features of private behaviour into health sector provision. In fact there several dimensions of public-private mix that should be considered including ownership, management and distribution of profits/surplus.

1. Ownership of physical infrastructure
One dimension is the ownership of the building and land. This can take one of a number of forms including public ownership in central or municipal trust, or out-right private freehold or some form of leasehold of land and buildings.