|Year : 2012 | Volume
| Issue : 2 | Page : 135-137
Public-private partnership to enhance oral health in India
Sangeeta Chavan1, Umesh Kemparaj1, Om N Baghele2, Arpita Rajdha3
1 Department of Public Health Dentistry, Vishnu Dental College, Bhimavaram, Andhra Pradesh, India
2 Department of Periodontics, SMBT Dental College and Hospital, Sangamner, Maharashtra, India
3 House Surgeon, SMBT Dental College and Hospital, Sangamner, Maharashtra, India
|Date of Web Publication||4-Sep-2012|
Department of Public Health Dentistry, Vishnu Dental College, Bhimavaram, Andhra Pradesh
Source of Support: None, Conflict of Interest: None
| Abstract|| |
In spite of great achievements in oral health globally, problems still remain in many communities all over the world, particularly among developing countries. The distribution and severity of oral diseases vary within the same country or region. In India, though health care is provided individually through public and private sectors, till now the oral health has not reached its summit. One of the strategies to improve oral health is through encouraging public-private partnership (P3). P3 can play a pivotal role with each sector contributing significantly to improve oral health outcomes. One of the major advantages of encouraging P3 is that when public and private sectors come together, they overcome each other's weaknesses and work like a potent bullet to slay oral problems.
Clinical Relevance to Interdisciplinary Dentistry
- The prevention, early detection, and management of diseases of the dental, oral, and craniofacial tissues can be integrated with health care.
- To promote oral health, improve the quality of life, and eliminate oral health disparities.
- To increase the understanding of how the signs and symptoms of oral infections can indicate general health status and act as a marker for other diseases.
- To enhance oral health literacy and boost knowledge of the value of regular, professional oral health care.
Keywords: Health care, oral health, public-private partnership
|How to cite this article:|
Chavan S, Kemparaj U, Baghele ON, Rajdha A. Public-private partnership to enhance oral health in India. J Interdiscip Dentistry 2012;2:135-7
| Introduction|| |
Good oral health is not only essential for good overall health and freedom from the pain and suffering associated with oral health problems, but also influences self-esteem, quality of life, and performance at school and at work. Majority of them are unaware of this fact,and those who are aware face potential hurdles such as few health care centers, exorbitant treatment rates, dearth of professionals, and so on. To overcome these hurdles is the need of the hour.
In order to get through the above hurdles, the existing dental health care infrastructure should be understood (public/private) [Table 1].
Health care delivery is primarily the responsibility of the state and national governments, but sinking funds, heavy work burden, lack of equipments, and high absenteeism crop up as roadblocks impinging the government's efforts. In contrast to this, in India, the private sector is perceived to be easily accessible, better managed, and more efficient. The private sector provides a large volume of health services, but with little or no regulation. The private sector is not only India's most unregulated sector, but also its most potent and untapped sector, and more urban biased than its public counterpart. Urban bias means investing heavily in urban-centered health facilities, often at the expense of the larger rural population.
Its strength is its innovativeness, efficiency, and learning from competition. Along with these merits come the loopholes like use of illegitimate means to maximize profit, less concern toward public health goals, lack of interest in sharing information, creating brain drain among public sector, health staff, etc. Currently, there are 292 dental colleges existing, with a total intake capacity of around 25,000-30,000 students per year. Of these, 1500 students are from government colleges and the rest are in private sector. This scenario demonstrates the impact of commercialization on dental education.  The distribution pattern of the dental colleges across various states of India is uneven and this situation leads to uneven distribution of dentist:population ratio in the respective states. The aggregate expenditure on health sector is 5.2% of the GDP; out of this, 17% is for public sector and 83% for private sector. Hence, it is vital to promote public-private partnership (P3) for preventive, curative, and promoted services in stirring the oral health. NGOs can also join hands toward oral health promotion. Private practitioners should be given geographic area responsibility in urban setup to ensure regular school health services. 
According to World Bank 1993 report, various health reform strategies can be formulated such as: 
- Alternative financing
- Institutional management
- Public sector reforms
Among these, P3 may be one of the effective means in reaching the pinnacle of excellence in oral health. Hence, fostering a partnership for providing dental health services will help counter the negative image and bring about synergistic outputs.
P3 as defined by World Economic Forum 2005 as, "A form of agreement that entails reciprocal obligations and mutual accountability, voluntary or contractual relationships, the sharing of investment and reputational risks, and joint responsibility for design and execution." 
The various potential partners in improving oral health  are mentioned in [Table 2].
|Table 2: Potential private sector partners and their tasks in improving oral health|
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| Contributions/Role of Private Sector in P3|| |
- Planning, designing, and development of health care facilities in whole or specialty wise
- Owning and operating diagnostic services for public health systems
- Owning and operating other services like mobile clinics
| Contributions/Role of Public Sector in P3|| |
The government can generate private sector interest through initiatives such as:
- Provision of tax incentives to encourage private sector investment in health care capacity, building, education, and training
- Allowing corporate entities to venture into health care education will generate private sector interest and have an immediate impact on increasing the training capacity
| Potential Role of PPP|| |
It increases the public expenditure on health aspects and reduces regional imbalances in health, pooling resources, optimization of health manpower, community participation, and ownership. P3 brings convergence of private sector interests and public sector goals. It intends to optimally utilize and enable increased access to vast rural poor and focus on the urban poor and marginalized segments like slum dwellers, etc.
Government contributions to a P3 should not be underlooked because without its support, planning oral health excellence will be like building a castle in the air. It plays a major role in providing infrastructure (creating a post for dentist in every PHC) and provide capital subsidy in the form of a one-time grant. In some other cases, it supports the project by providing revenue subsidies, including tax breaks, or by providing guaranteed annual revenues for a fixed period.
Government can develop fiscal policies and increase taxation on harmful products like tobacco, alcohol, and cariogenic products, and exempt taxation on healthy products like sugar substitutes, fruits and vegetables, herbal products, dentifrice, and mouthwash. Prohibit selling of sweets and chocolates in the vicinity of schools.
In the current scenario, the impact of joint venture of public and private sector is schematically presented in [Figure 1].
| Advantages of P3|| |
- Its motive of improvement in overall health of the population drives growth and expansion strategy
- Efficiency in management and operations by employing technology and latest best practices
- Increased access in areas of operation and availability of round-the-clock services
- Increased flexibility and responsiveness
Oral health problems are a perennial global problem, which means a mouthful of silver for the patients and a pocketful of gold for the dentists. This wrongly conceived notion may be one of the reasons why people tend to put dental health on the backburner. To change this notion, P3, if introduced, can play a magnanimous catalytic role in achieving excellence in oral health. So, why not harness it to the fullest so as to reach the zenith?
| References|| |
|1.||Database of Dental Council of India. Cited on 2011 October 16. Available from: http://www.dciindia.org/search.aspx. |
|2.||Sunder Lal , Dinesh Paul , BM Vashisht . National Oral Health Care Programme (NOHCO) implementation strategies. Indian Journal of Community Medicine2004;Xxix:3. |
|3.||World Bank. 1993. The World Development Report; 1993. Washington DC: The World Bank. |
|4.||World Economic Forum. 2005. Building on the Monterrey Consensus: The Growing Role of Public-Private Partnerships in Mobilizing Resources for Development. |
|5.||Pine CM, Harris RC. Community Oral Health. United Kingdom: Quintessence Publishing Co. Ltd; 2007. p. 361. |
[Table 1], [Table 2]