Public private partnerships and implications for health care provision: The case of Global Fund and HIV and AIDS in India

Background/ Rationale

Public Private Partnerships have been heralded as an innovative and effective policy alternative to public only and private only financing and management of health care. Its rationale draws on a number of factors including resource pooling, efficiency and management skill advantages claimed for the private sector.

However the evidence base on partnerships is thin, limited to individual success stories of global partnerships meeting country specific objectives. Little attention is given to the interface between them i.e. processes triggered by global institutions at country level and their implications for local management of disease programmes.

Purpose

This paper draws on the findings of a study undertaken to address this gap in the literature. It argues that global institutions have triggered diverse actors with conflicting agendas to come together in multiple arrangements in response to availability of surplus funds. This gives rise to a number of structures which begin to assume a life of their own, leveraging resources and acting as conduits of power and advancing personal interests.

The paper examines how partnerships are enacted at country level highlighting the role of Global Fund, a global health initiative, in the implementation of the national AIDS programme in India. It highlights varied actions and processes through which actors tend to legitimise their existence and maintain their sovereign boundaries. It concludes with a discussion on the effect of this forced marriage of arrangements tracing its impact on four programme aspects- quality, sustainability, coordination and human resources.

Methodology

A mix of qualitative and ethnographic approaches informed the study findings. Multiple sources of data (in-depth interviews with policy-makers and implementers, documentation, observation of delivery points) were used to develop converging lines of enquiry through multiple triangulations.