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In a country like Pakistan, it is a general understanding that basic healthcare provision is the responsibility of the public sector. In the province of Punjab, however, 70 percent of the share of health care services is offered by the private sector, and the remaining 30 percent gap is filled by the public sector.
The performance of the public sector is greatly below par and thats why the government of Punjab, under the healthcare reform agenda, brought this new initiative of public-private partnership in healthcare. This is certainly a positive step, especially in the rural sector where the health care system has completely collapsed. Initially, the project will begin with Basic Health Units (BHUs) and Rural Health Centers (RHCs) in six low-performing districts in the province.
According to the plan, there will be a bidding process that will determine the private partner who will take over. These health care centers are not going to be completely taken over by the private sector. The Punjab government will be retaining substantial control over the health center. Once the private sector partner is chosen, the government will transfer annual funding to the private entity. The private sector will be bound to keep the government staff members but can transfer underperforming staff to other places. These private entities will also be allowed to hire new staff to make the public health facilities fully functional.
Public-private partnerships (PPPs) are based on sharing investment, risk, responsibility and reward amongst each another. The understanding behind this partnership lies in the fact that each of them has unique characteristics which provide them with advantages in specific aspects of the healthcare sector.
It is worth mentioning here that public-private partnerships in the health sector have been running successfully in both developed and developing countries. There are several models; these partnerships are doing an excellent job in India, Sri Lanka, and Bangladesh. Similarly, these partnerships are not new to Pakistan: in Khyber Pakhtunkhwa provincial government has implemented public-private partnerships in secondary care hospitals.
There are several issues that Punjabs healthcare is facing at the moment. The healthcare system lacks organized and correct data and research, and has a skewed human resource profile, chronic staff absenteeism, critical shortage of female healthcare professionals, and location disadvantages (like poor access, physical condition of buildings, accommodation and other services). These are manifest of a governance deficit in the public health sector in the Punjab. The public-private partnership together can overcome these issues a lot easier than the public sector alone.
It is worth noting that there are some major issues associated with public-private partnership in developing countries and Pakistan will not be immune to this. The government has to make sure that there is lucidity in the selection process of the private entity.
The evaluation process should be prompt and on a regular basis and should be done by independent auditors. Even though the Punjab government has sufficient control over the whole process, they must also work to make sure that the cost of treatment does not go up with the quality of the treatment.

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