Health sector is the lifeline for a nation’s wellbeing. It is the sum total of the health of its citizens, communities and settlements in which they live. The Pakistani healthcare sector has emerged as one of the most challenging sectors as well as one of the largest service sector industries in the country. The health care system in Pakistan consists of public sector, private sector, and an informal network of care providers. The Pakistani health sector operates in a largely unregulated environment, with minimal controls on the type of services to be provided by whom at what cost and in what manner. This is further complicated by the usual Pakistani tendency to lack of standardization and minimal compliance though there are norms and guidelines. 

In most of the developing countries, certain weaknesses and gaps in the government health systems have been hampering the achievement of improved health outcomes. Public sector in Pakistan has been deficient in the capacity to deliver equitable and quality health services and thus has been grossly underutilized. Health systems are expected to serve the population needs in an effective, efficient and equitable manner. To provide proper & good quality healthcare, there can be two ways to strengthen the health sector, one: a substantially improved public system and second: regulation of the private entities. “Partnership of both”, a third way, can be a best solution. Since many years, international and local Non-Governmental Organizations (NGOs) have endeavored to fill the gaps in health service delivery, research and advocacy. Non-profit organizations have relatively performed better and achieved the results because of the flexible planning and the ability to design population based projects on health education, health promotion, social marketing, community development and advocacy. Involving the NGOs for health system strengthening may eventually contribute to create a healthcare system reflecting an increased efficiency, more equity and good governance in the wake of the Millennium Development Goals.

The Sindh Public Private Partnership (PPP) Act was passed in 2010 under which the government and its agencies have been entrusted with the power to enter into agreements and arrangements with private parties for designing, financing, operating and maintaining different projects. In other words PPP is an arrangement between the government and a private business for the provision of public assets or services through investment and/or management by the private sector for a specified period of time. PPP unit of the Sindh health department conceived a project aimed at providing improved health delivery services to the people called “Public Private Partnership Contracts in Health” and had issued tenders in December 2013. The authorities invited ‘expressions of interest’ from interested NGOs with good reputation and around 30 showed their interest in the project. Subsequently, the requests for proposal (RFPs) were issued to 12 interested organizations, from which five were finalized. Four NGOs were to maintain, improve and run health facilities while the fifth was responsible for running community ambulance services. 

Specifically, If we would like to see the footprints of PPP model in the rural areas of Sindh, we can see that NGOs keep aim to strengthen the healthcare infrastructure by (i) establishing healthcare institutions (ii) enhancing capacity building of healthcare providers (iii) fulfilling healthcare needs of specific groups like women, children, elderly and vulnerable local communities, (iv) dealing with specific healthcare issues (v) promoting health rights and Implementing preventive health programs and managing health administration etc. 

Basic Health Units (BHUs), Rural Health Clinics (RHCs), Taluka Headquarters Hospital (THQ) and District Headquarters Hospital (DHQ) are the prime stakeholder of healthcare setup in interior Sindh, their role & functions seem unable to work fully or properly until the resolving of their basic concerns like unavailability of human resources, improper and delayed funds, insufficient percentage of allocated budget, transportation, capacity building of entire staff, benefits, facilities and rewards from the employer are the highlights to be focused. In PPP model NGOs have taken administrative control of such healthcare facilities but they often found facing enormous difficulties due to insufficient, improper and delayed availability of desired funds.  

 NGOs face multiple challenges, in Public Private Partnership program the majority of NGOs have experienced difficulties in getting enough, and continuous funding in order to do their work. Additionally, most of the non-Profit organizations have a high level of dependency of funds, if they don’t receive funds as per their agreement with the government, so in this situation NGOs would not be able to perform their operational activities and ultimately their performance or progress graph will badly be hurt. Without having funds, it will be difficult for non-profit organizations and their employees to reach their aim and fulfill purpose of their existence. 

As PPP model entails clearly defined allocation of risk between partners and payments to the private sector linked to pre-determined benchmarked measureable performance standards. Therefore, NGOs should be more careful and transparent in all their financial activities. Most NGOs rely completely on funding and therefore having proper accounting systems in place becomes all the more important. Non-Profit organizations need to be accountable to the funds provider who supports the social welfare causes. With proper systems in place NGOs can keep track of their expenditures and submit timely reports to the government. This would lead to enhanced trust between Public and Private Partners, thereby increasing the chances of NGOs getting a continuous support from their partner.  Furthermore, proper finance systems will also help the NGOs maintain financial reports and showcase their entire spending to the regulatory bodies as per the agreed terms. With excellent finance management, NGOs enhance their image that enhances its value and making them more credible. By framing well defined financial plans and policies NGOs also earn good reputation within its community. They can also improve their current position and look forward to gain trust, faith and reliability. Accuracy & transparency in each act will not leave chances for the NGOs to be “Objected” by the government.

PPP model can assume an important role in the development of healthcare sector in Pakistan and this program can expand its scope for better services to the deserving people, If PPP’s healthcare projects are successful to meet their objectives they will definitely be helpful in removing apprehensions regarding the concept in the country pertain to the partnership. Success of the projects will also open new ways for enhancing the scope and the coverage of such collaborations in the country to deliver sustainable development efficiently. Provincial governments are looking forward to working with private organizations under the PPP model to effectively respond to development needs. However the relationship between the government and NGOs has yet to grow mature, smooth, and trouble-free. nevertheless, one of the most important steps to overcome the difficulties in PPP model is identifying what are challenges that an organization is facing, and the areas where there is a room to improve, after identifying these key areas public sector’s authorities can design a plan to improve, and hopefully overcome the obstacles private partners are facing. Most importantly, on-time provisioning of funds to the non-profit organizations will be quite essential in achieving the desired goals.