Engaging with the Private Sector

Expanding the Provider Base for Meeting the Family Planning Needs of the Urban Poor

Evidence of the Impact of Increasing Private Sector Engagement for Family Planning Services

The table below shows evidence of the increased uptake of FP services associated with an increase in the number of empanelled providers and accredited facilities under the Hausala Sajhedari initiative of the Government of Uttar Pradesh.

*Data Source: Hausala Saiheedari Web Portal (From Sep. 2015 to Dec. 2016)

The UHI program provides an example of the impact of the private sector engagement, wherein it was found that in Bareilly city, following accreditation in 2013, one of the private accredited facilities conducted more than one-third of all the female sterilization cases in the city.

Guidance on Facilitating the Process of Accreditation and Empanelment 

In Uttar Pradesh, the process of accreditation and empanelment is facilitated by the government through the web-based ‘HausalaSajhedari’  scheme. This scheme makes the process of accreditation and empanelment, especially the reimbursement process, simple and transparent.

In other states, where this scheme is yet to be introduced, the following actions are recommended to be undertaken by the CMHO to generate demand for accreditation and to facilitate a smooth accreditation process:

• Convene meetings with private providers and/or FOGSI members to build their interest in applying for accreditation.
• Inform private providers that they can receive an advance for providing sterilization services to upto 25 clients (i.e. up to Rupees 7500 against bank guarantee of the same amount) as well as be assured of the timely release of subsequent payments to them. Enquire from private providers during their visit to the government facilities in connection with Janani Suraksha Yojana (JSY) and Jansankhya SthirataKosh (JSK), regarding their interest in being empanelled for providing family planning services.
• Provide support to the providers in the application process of accreditation, including support in filling the application form along with a cover letter. Schedule visits to the private hospitals and clinics periodically by officials from the CMO office, to clarify the process and encourage applicants for accreditation.
• Ensure timely release of fund for services rendered by the private providers to keep them motivated.
• Facilitate dialogue between the satisfied accredited providers and the potential providers who have shown interest. Ensure that the application process is smooth. Once an application is received, it is essential that the District Quality Assurance Committee (DQAC) visits the applicant facility within 1-2 days and submits its report within 2-3 days (Refer to the private nursing home/NGO/private medical practitioner assessment form; and the letter from the NRHM SPMU on accreditation).
• Make the process transparent and efficient through an online system.

The above points are described in detail in the guidelines document. (Refer to the guidelines for accreditation of private health facilities to provide RCH services).

Also, GO-143 provides concrete guidance on the steps required to be followed for empanelment by the Government of India.

Roles and Responsibilities

Monitoring: Periodic Tracking of the Process of Accreditation and Empanelment

In the DHS or the quarterly DQAC review meetings, the CMHO/CDMO/CMO regularly requests information from the DPM and the DQAC on the following indicators:

• Number of applications received in the preceding month for accreditation
• Number of final applications submitted to the DHS for accreditation and empanelment
• Number of facilities visited/assessed by the DQAC
• Number of approvals for accreditation granted by the DHS
• Number of applications received and granted for renewal of accreditation
• Number of accreditation and empanelment applications processed within a defined time period
• Number of private providers and facilities accredited in a year (agreement done, letter issued for providing services, reporting formats shared, advance provided to private hospitals, facilities oriented by the District Program Manager to maintain appropriate records)
• Number of facilities and providers not qualified for accreditation and empanelment and the reasons for not being qualified, in order to provide feedback to help them improve their quality standards and become accredited or empanelled
• Number of family planning clients who received services from the private providers
• Percentage of clients verified (with their feedback on quality of services received) through telephone or other means by a team designated by the CMO/DQAC in the district.
• Number of reimbursement requests received and funds released to private providers within 45 days of receiving the report
• Number of facilities in Uttar Pradesh receiving the renewal of accreditation online

Cost Elements

The following cost elements required for accreditation may exist in the Program Implementation Plan (PIP) of the current year. If not, they can be requested in the next year’s PIP.

Advertisement costs for call for applications may additionally be required and may be suitably incorporated into the PIP.

This table is indicative and illustrates the manner in which cost elements are provisioned in a govt. PIP, thus giving guidance to the audience on where to look for elements related to a particular task, such as ‘Private Sector Engagement’ in this tool.

Sustainability 

The following actions would help maintain the commitment and the interest of the private providers and the facilities to continue providing FP services over time and would ensure institutionalization and sustainability:

• The discussion of the planning and the monitoring of these activities in the monthly CMHO meetings
• Encouragement by the DPM of all accredited facilities to apply for renewal in a timely manner
• Ensuring that the funds required to compensate the accredited facilities and their clients are included in the PIP every year, by the CMHO/CDMO/CMO/DPM
• Recognition of the high performing private facilities, release of funds in a timely manner and transparency in the terms and conditions of the renewal of accreditation.

Disclaimer: This document is based on the learnings collated from Urban Health Initiative, Health of the Urban Poor (supported by USAID) and Expanded Access and Quality (EAQ) to broaden method choice in Uttar Pradesh. This document is not prescriptive in nature but provides overall guidance of how this particular aspect was dealt with in these projects for possible adoption and adaptation.

The downloadable versions of this document are slightly modified to make it state representative for Uttar Pradesh, Madhya Pradesh and Odisha, respectively.