Engaging with the Private Sector

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

Purpose: To provide guidance on engaging the private sector under government schemes, towards providing Family Planning (FP) services to the urban poor to address their unmet needs. The engagement aspects include accreditation, empanelment, facilitation of reimbursement for services provided and legal protection through the FP indemnity scheme.

Audience:

  • Chief Medical and Health Officers (CMHO/CDMO/CMO)
  • Nodal Officer – Urban Health
  • Nodal Officer – Family Planning
  • District Program Managers
  • Persons In-charge of Private Health Facilities
  • Office bearers of The Federation of Obstetric and Gynaecological Societies of India (FOGSI)
  • Office bearers of the Indian Medical Association (IMA)

Background: There exists a trust deficit between the public and the private sector. Hence, the private sector does not readily engage with the government in providing health services including FP. Moreover, the process of empanelment of providers and accreditation of facilities is tedious. Among key concerns of the private sector is the delay in reimbursement by the government for the FP services provided by them. It is important to address such concerns to enable engagement of the private sector in providing quality FP services, since the government alone cannot meet the burden of serving the whole population.

Accreditation and empanelment are processes by which the Department of Health and Family Welfare enters into a mutual agreement (an MoU) with the private sector to purchase FP and other services. This MoU describes the role of private providers in terms of FP services to be provided. It also describes the role of the Health Department and the terms of the payment (advances and reimbursements) to be made within a defined timeframe by the Health Department to the private facilities and the providers. Further, it enables clients of sterilization to receive compensation for their wage loss.

Empanelment also makes a provider eligible for an insurance coverage under the government FP Indemnity Scheme (FPIS). The objective of the FPIS is to indemnify all the beneficiaries of sterilization, as well as the doctors and the health facilities (public, accredited private and NGO) conducting sterilization operation, in the unlikely event of death/failure/complication following the sterilization operation. This also provides for coverage in case of court cases. Knowledge of this protection is key to motivating private providers and facilities to provide FP services.

Under the EAQ project of Population Services International (PSI), accreditation and empanelment of private facilities and providers has been co-facilitated with the National Health Mission (NHM), Uttar Pradesh (UP) and State Innovations in Family Planning Services Project Agency (SIFPSA), through a simple, fast and convenient web-based portal (www.hausalasajheedari.in).This portal serves as a single-window solution for the providers and facilities to complete the process of accreditation and empanelment.

Government Guidelines on Accreditation and Empanelment:

  • A minimum of two private facilities should be accredited per block.
  • For Uttar Pradesh, Rupees 3000 is available for tubectomy and vasectomy services in accredited facilities. Out of this amount, Rs 2000 goes to the facility for both the male and female sterilisations). In other states, the amount may vary.
  • The client who accepts sterilization service will be paid Rs 1000 as wage loss compensation from the facility. User fees, drug costs, dressing costs, and any other incidentals shall not be charged to the client.
  • Government Order (GO) #143 and Mission Parivar Vikas (MPV) GO should be referred for both accreditation and empanelment.

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.

Period # Accredited # Empanelled # FST # NSV # IUCD # DMPA
Dec-2015 177 176 8957 205 566 831
Jun-2016 494 471 26595 926 11299 5869
Dec-2016 691 528 46809 2439 45546 18652
Jun-17 796 634 71566 3623 76267 26106

*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

Role Responsibility
CMHO/CDMO/CMO
  • Plan and budget for the empanelment and accreditation of private providers and facilities
  • Advertise the process
  • Generate demand for accreditation and empanelment
  • Guide DQAC to perform the assessment of the applicant facilities
  • Review and obtain approval of accreditation from the District Health Society (DHS)
  • Ensure timely release of funds
DPM
  • Promote FP accreditation and empanelment during visits to the JSY accredited facilities
  • Follow-up on the process of accreditation and empanelment and update CMHO
  • Seek support from CMHO to address bottlenecks in the process
Private Facility and Provider
  • Submit the application along with all the requisite documents
  • Support the DQAC during the assessment process
ASHA
  • Publicize the facility and services (post the accreditation) among community members
  • Provide feedback to the Medical Officer about the services of the accredited facility

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.

Cost Element FMR Code Source
Costs of convening meetings to publicize the accreditation and empanelment schemes A.3.5.2 ROP 2017-18, NHM-UP
Case based compensation to private facilities and providers

A.3.1.3., A.3.1.4

A.3.2.2, A.3.2.3 & A.3.2.4

ROP 2017-18, NHM-UP
Cost for branding of accredited facilities B.10.3.3.1 ROP 2016-17, NHM-UP
Engaging pvt providers for FP (Training and QA expenses) B.13.2.2 ROP 2016-17, NHM-UP
Enhance pvt sector contribution in FP B.13.2.3 ROP 2016-17, NHM-UP

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 (supported by BMGF), Health of the Urban Poor (supported by USAID) and Expanded Access and Quality (EAQ) to broaden method choice in Uttar Pradesh (supported by BMGF). 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.