Changing Policy Unblocks an Obstacle

India and 68 other developing countries pledged to make contraceptives available to an additional 120 million women and girls by 2020. To reach this goal, the most populous state in the country, Uttar Pradesh (UP), must make a large contribution.

The UP government turned to PSI-India to help implement the Hausala Sajheedari program, incentivizing private-sector family doctors to offer contraceptive services once available only from public hospitals. Recently, PSI-India Country Director Pritpal Marjara sat down with Amit Kumar Ghosh, a senior member of the Indian Administrative Services, to discuss what happened when they removed a market obstacle using private sector allies.

1. Why pursue the Hausala Sajheedari intervention?

India has committed to contribute 48 million new users of family planning under FP2020, which is about 40 percent of the global commitment. UP aims to contribute 26 percent of the national commitment. The public sector alone cannot achieve this task, so we need the private sector.

2. How does Hausala Sajheedari work?

Under the Hausala Sajheedari program, private sector hospitals and nursing homes can apply online for accreditation to offer family planning services. Qualified private surgeons can apply for empanelment for sterilization surgeries, which in turn indemnifies them. Once accredited, these hospitals may provide services under a standard reimbursement package from the government. The entire process — from application, verification, accreditation, reporting service data/MIS upload, submission of claims and reimbursement of claims — has been simplified online through a web portal.

The State Innovations in Family Planning Services Project Agency (SIFPSA), an autonomous body under the Ministry of Health in UP, is responsible for implementing Hausala Sajheedari under the government of the UP. PSI led the technical assistance and worked with SIFPSA and other development partners such as like the Uttar Pradesh Technical Support Unit (UPTS), Marie Stopes International (MSI), Hindustan Latex Family Planning Promotion Trust (HLFPPT), Parivar Seva Senstha (PSS), among others, to  streamline government guidelines, conceptualize, design and develop the web portal, and train state and district health personnel.

3. How will this help India reach its FP2020 goals?

The Hausala Sajheedari program was formally launched by the Chief Minister of UP in April 2015 and in less than one year we saw over 717 private sector hospitals accredited and about 550 private sector surgeons empaneled. The private sector performed about 34,000 tubal ligations and about 2,000 non-scalpel vasectomy procedures for men in the state, which is about eight percent of the state’s overall contribution. This is a 16-fold increase in a short period. The accredited facilities have reported over 25,000 insertions of intrauterine contraceptive devices, 9,700 women using injectables, 13,000 women receiving oral contraceptives, and over 34,000 men receiving condoms. I believe over 1,000 private hospitals can be accredited in the state. If the potential is fulfilled, it will be substantial contribution from the private sector to the global goals.

4. What’s next?

We have received positive feedback from the National Ministry of Health and several state governments on this intervention, and inquiries about replication to other geographies.

We have forged partnerships with professional bodies like the Indian Medical Association and Federation of Obstetric and Gynecological Societies of India. Hausala Sajheedari has become a template of success for public-private partnerships in providing family planning services in Uttar Pradesh and rest of the country. This program provides an innovative way to connect public programs with private sector capacities to achieve universal coverage.

This article is part of an ongoing conversation about #MakingMarketsWork in Impact Magazine No. 22 “Are We Thinking Big Enough” issue. Join in the conversation with @PSIImpact.

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Photo Credit: Gurmeet Sapal