Public-Private-NGO Partnership in Health Services: Review, Assessment and Recommendations from a Focused Study in the Central Region of Nepal

Abstract

Background: The government of Nepal has felt the need for a clear cut policy for public-private-NGO collaboration in the health sector for maximizing the access to health services. The public-private-NGO mix should be oriented towards addressing the fundamental questions of how to uplift the health status of the people by mixing the public-private-NGO and how to improve access to all types of health services to the poor. This study is thus carried out to review the existing situation of public-private-NGO partnership in the provision of health services in the central region of Nepal. Methods: The study was based on both primary and secondary data. Both qualitative and quantitative information were collected through administration of pre-tested questionnaire in two public hospitals and five private hospitals in Kathmandu and Lalitpur. Data processing was performed using excel. Qualitative information obtained was coded and organized in accordance with appropriate themes to facilitate analysis and recommendations. Results: The share of expenditure made out of pocket to purchase services from the private sector providers was 35% in Nepal in 1996. The share of the expenditure of development partners and donors was about 14%. Starting from two private hospitals and nursing homes in 1985, the number had increased to 104 by 2004 in Nepal with 71% of them in Kathmandu. The percentage of I/NGO working in health sector was 8% of the total I/NGOs which fell to 2.2% in 2001. The four United Mission to Nepal hospitals alone claimed of providing 29% of all outpatients and 22% of all inpatient care in Nepal. The patient load was 4.24 and 2.55 times higher in public hospitals compared to private hospitals for outpatient and inpatient category. The cost of services was high in private hospitals compared to public hospitals. It was found that several I/NGOs are providing health services to the people in the rural and urban areas of Nepal however it was not mandatory for them to operate in regions allocated to them by the government. Conclusions: The role of public sector in provision of health services is changing. There is need to recognize the two aspects of public-private-NGO partnership: firstly collaboration for the improvement in the health status of the population, secondly collaboration in health system (working under one roof) Keywords: health services; partnership; private sector; public-private-NGO collaboration; public sector.