PPP in health care

The 2015 Constitution guarantees the right to healthcare for all Nepali citizens, however public sector healthcare systems have been insufficiently resourced to provide for this right. In this context, the public-private partnership (PPP) model offers great potential. 

Following the 2015 Gorkha Earthquake, the healthcare system of Dolakha district was devastated. More than 95 per cent of Dolakha’s health posts were damaged, and further damage was caused to Primary Health Centres and the district hospital.

Nyaya Health Nepal (NHN) entered into a PPP with the Ministry of Health and Population (MoHP) for rebuilding the damaged health facilities and strengthening the health system in Dolakha district at the request of the latter. This PPP was historic as it was the first time an NGO was managing service delivery at a functioning government facility.

This partnership has helped fill the gaps in the government health care system in general. There has been significant improvement in healthcare indicators over five years with the introduction of the PPP’s community healthcare program – increased institutional birthrate, improved surgical complication rate, improved neonatal death rate.

Similarly, reconstruction of 19 health posts of Dolakha, implementation of regular continuing medical education (CME) curriculum, regular services of general and orthopaedic surgeries, emergency care, collaborative care model of mental healthcare, introduction of digital X-ray and digital data recording system, implementation of performance-based system for the employees are the other major achievements of this partnership.

There have been significant positive changes since NHN started working in Dolakha. Bagmati Province has decided to upgrade Charikot Hospital to a provincial hospital. Public sector investment in healthcare has increased due to COVID-19. Accessibility has increased, and health status in the district has improved. Yet it has also experienced challenges. Initially, there were issues with effective stakeholder collaboration, lack of clarity surrounding PPP policy and effective mechanisms to integrate staff.

There are still places to improve public contribution to strengthen services, regularise monitoring and evaluation of PPP and start a health insurance programme in the district. Despite the challenges, the partnership has really been fruitful to improve the overall healthcare of the district.

A lesson from Charikot Hospital should guide the nation towards affordable and high-quality healthcare to set an example of success.