Source: Asia Development Bank
A public–private partnership (PPP) is a long-term contract between a private entity and a government entity, for providing a public asset or service. It has emerged as a strategic approach in health care, enabling governments to deliver quality medical services efficiently by leveraging private sector expertise, financial resources, and technological advancements. The public partner is typically responsible for project development and planning, providing access to land and utilities, ensuring regulatory compliance, and conducting contract monitoring. On the other hand, the private partner is typically responsible for design, construction, and infrastructure development, bringing in investment and operational expertise, and driving innovation to enhance service efficiency and quality.
PPPs help address challenges facing health care systems, such as inadequate infrastructure, workforce shortages, financial constraints, and service delivery gaps, by bridging critical gaps in infrastructure, service delivery, and management.
Different countries have tailored PPP models to address their unique health care needs. The impact of PPPs is particularly significant in addressing the challenges faced by low- and middle-income countries, where health care access and quality are constrained by financial and human resource limitations. For instance, India has demonstrated significant progress in PPP-based health care service delivery, particularly in areas like super specialty hospital development, dialysis services, diagnostic networks, telemedicine initiatives, and medical institutes. Meanwhile, Uzbekistan is actively exploring PPP models to strengthen its health care infrastructure and service provision, with growing emphasis on leveraging private sector participation in tertiary care, diagnostics, and hospital management. The following case studies highlight key lessons from health care PPPs in India and Uzbekistan, showcasing successful models and practical insights for effective implementation
Upgradation of district hospitals to medical college and hospitals, Uttar Pradesh, India
Uttar Pradesh, the most populus state of India, faced a critical shortage of medical professionals and tertiary care facilities, particularly in underserved districts. Of the 39 districts lacking medical colleges, 23 were established with state funding. To further bridge the gap, the government launched the “One District, One Medical College” initiative that involves the upgrading of district hospitals to 16 new medical colleges under a PPP model. Of these facilities, four medical colleges are being developed under state incentive schemes, while the development of three medical colleges (based on Design-Build-Finance-Operate and Transfer PPP Model) is supported through Viability Gap Funding.
Figure 1: Project Structure Using the Design-Build-Finance-Operate and Transfer Model
Over the next 5 years, the project is expected to
- improve access to medical education, addressing the shortage of trained professionals;
- expand tertiary care services in underserved regions;
- enhance healthcare infrastructure by adding 6,700 beds;
- enhance workforce availability by adding 1,600 doctors and more than 10,000 clinical workforce; and
- provide affordable care by providing free inpatient department beds for underserved patients, free essential medicines for government-supported patients, and free outpatient department-related diagnostics; and ensured affordable rates for other patients.
NephroPlus Dialysis Project in Uzbekistan
Uzbekistan faced a severe shortage of dialysis centers, leading to high patient mortality and limited access to treatment, especially in remote areas. Existing facilities were overburdened and patients often had to travel long distances for care. To address this, dialysis services are being implemented through a PPP model across three regions in Uzbekistan (Karakalpakstan, Khorezm, and Tashkent), ensuring high-quality care, advanced technology, and cost-effective treatment for patients with renal diseases. The project follows a Build-Operate-Transfer model with a concession period of 10 years.
From 2021 to 2025, the project achieved the following:
- provided over 300,000 treatments across three regions;
- reduced patient mortality by 40% since May 2021;
- trained and recruited more than 300 clinical nurses and doctors through the NephroPlus Academy;
- enabled a total savings of $9.8 million for the government; and
- reduced by 15% country-level Hepatitis C patient count.