Abstract
In most countries of the world, financing as well as provision of health services has historically involved both public and private sector actors. The nature of relationship between these two may lie anywhere along the following broad spectrum: (1).
- Parallel activities: This represents a situation where the two sectors coexist with little contact between each other, and providing different sets of services to different sectors of the population. One example of this would be the activities of, and population groups served by, private sector traditional healers for mental illnesses as compared to publicly provided psychiatric services under the western system of medicine.
- Competitive activities Activities in the public and private sectors have similar objectives, cater to the same clientele and compete with each other. This may result expanded choices for users and greater efficiency for both sectors, or represent a wasteful duplication of activities.
- Complementary activities Activities or services from the public and private sectors complement each other either geographically and in term of population coverage, or in terms of range of services provided, e.g. primary care by the public sector and specialist care by the private sector. This may happen incidentally – as for example when the public sector is unable to invest in specialist services. However, it is increasingly the result of specific policy decisions by government to promote the participation of the private sector. For example, governments may choose to play a regulating or financing role, leaving the provision of most curative services to the private sector.
- Collaborative activities Public and private sector actors work together on the basis of shared objectives, strategies and agreed monitoring and evaluation criteria, usually through the formation of a new joint entity for implementation (1).
This paper focuses on the last two types of relationships described above: public and private sectors working complementarily or collaboratively in the health sector. While these kinds of relationships between the public and private sectors in health are not new, the 1990s has witnessed the development of specific kinds of complementary and collaborative relationships between the two sectors, known as ‘public-private partnership’ (PPP). This has been associated with the growth of ideological and policy support for the idea that public and private sector should work together.