Engaging the public & private sectors in data sharing to improve maternal and newborn health in Uttar Pradesh, India

Abstract

Background The private for-profit health sector in India delivers around 80% of outpatient treatment and 60% of hospitalisations, and includes more than three quarters of human resources for health. The sector includes solo doctor clinics, small hospitals and big corporate hospital chains, as well as many informal providers. The formal private health sector has grown rapidly without regulatory frameworks and quality assurance. Quality of care is variable and there is lack of adherence to standard treatments, protocols or pricing. Limited information is shared with public health information systems. Aim To develop an engagement strategy with the private for-profit health sector in Uttar Pradesh, India. The broader underlying goal is to develop and pilot a district level Data Informed Platform for Health (DIPH) for improved local health decision-making in maternal and child health including both the public and private health sectors. Methods We reviewed literature, and examined national plans and programme documents to identify lessons from successful public-private engagements for maternal and child health and collate key policies related to the private health sector in India. We sought inputs from 27 national, state and district level stakeholders for developing a strategy to engage with the private sector for a DIPH. Findings In India, public-private partnerships for service delivery and financing represent a key area of engagement with the private sector, especially for maternal and child health. Examples include the Merrygold network, a clinical social franchise, and the Sambhav voucher scheme, in which poor households can exchange vouchers for health services in selected city hospitals in Uttar Pradesh. Engagements related to data recording and reporting from the private health sector have been less successful. There are gaps in reporting even notifiable diseases like Tuberculosis. There is limited data available on the private sector at the national level. Legal provisions can facilitate data exchange and synthesis: a binding legal framework may be available when the Clinical Establishments Act, passed by the Indian Parliament in 2010, is implemented. Proposed engagement strategies Stakeholder consultations suggested that before the Clinical Establishments Act is implemented, the private sector might best be engaged by: 1.Relationship building among key private and public sector stakeholders. 2.Sensitisation of private and public sector groups and individuals with the concept of a DIPH. 3.Inclusion of selected private sector players in the DIPH 4.User-friendly data collection and management. 5.Provision of both financial and non-financial incentives to encourage