India has a long history of community driven Private-Public Partnership
On going to the bank to consolidate a PPF account, we realised that we needed to initiate a four step process. With one official per branch, who needed to man their desk, it would be impossible to complete the process in one visit unless some of us lent a helping hand. With bank papers in our hands, we went from counter to counter, gathering signatures and print outs till the job was done. Only in few other countries would the bank staff have broken protocol and given us access to anything but the final document. Here a little bit of participation with the public sector processes and the customer was sent back with the job completed. Given the volume of work that needed to be done, especially before ‘computerisation’ this was the only pragmatic way to deal with scale.
This native Indian model of Public Private Partnership, where the public service proves inadequate and is supplemented by the private – in this case the consumer filling in the supply gap. The consumer thus plays two roles in this particular PPP model. The dual role is not uncommon – a builder of a toll road could well use the road as a consumer and pay their share of the charges too. What is different here is that the process could not have been completed on time, to the mutual satisfaction of both the supplier and consumer without this partnership.
The school bus or canteen provision that is supplied by a private sector profit making enterprise in a government school or hospital could also be termed PPP. Recently, the government eased the path to PPP in building secondary schools in India by claiming precedent – Government aided schools. The government aided fee paying schools use a combination of resources – subsidised land and grants from the government, investment via its trust and promoters and fees from the consumers of the school facilities.
Some called it ‘jugaad’ – and this was the beginning of process innovation to deal with inadequate provision in the license raj era. Go to any government office and the chances are that in dealing with people, the officers are likely to co-opt the services of their customers. Wherever the state interacts with the public, there is a chance that efficient provision has an informal element of participation.
In some cases, a part of the process is formally with the consumer. Either by design or by practice, medical record keeping has remained in the private, personal domain in India. In many countries doctors keep medical histories of their patients. Here, even if the doctor has been treating you for years, the responsibility of safekeeping and updating the medical ‘file’ lies with the patient and their family. Just like that a huge chunk of the administrative cost of medical care to the masses lies with the private sector – again the consumer.
This works well in many ways, not just the cost. The records are easy to access, unlike in the UK, where you have to pay a fee to get a copy after a wait of a few days. Privacy is not necessarily demanded or delivered here, but with each patient holding on to their own records, many of them typed up or handwritten – the chances of privacy violation are lower. (This is not a case for decentralised hand written record keeping). The biggest virtue here is that the process and judgement of the medical episode is more transparent for the patient, their loved ones and the customer. They have access and the ability to influence the treatment simply because all information is in their hands. Of course the customer retains mobility – they can move doctors and hospitals as their records are not stuck in some administrative morass. Many of these are not bulky physical files any more, if the patients can afford it. The electronic transfer of records between diagnostic testing centres, patients and doctors is smooth and seamless, always keeping the paying customer at the centre and in control of the process.
In a way, some retail corruption is also an example of a grassroots PPP model. The government provides a service that is often under resourced or poorly designed. Let us assume that either is due to a lack of finance, which leaves a gap in the service standards. The customers as a community evolve a process, hire the people and agree a price with the provider. Like a market, everybody has free access to the service at a price. The system responds to customer needs, both individually and as a group – say a poor old teacher may get a discount, or may not have to pay a top up fee. An extra fee may speed up the process. Agencies and intermediaries, with or without the corruption element increase the inclusiveness of government services. For example, if the government processes require literacy, or are not enabled for all, that part of the job is performed by the private sector for a price.
Better known models of PPP were brought in for large scale projects. India’s toll roads are a very good example of change that was speeded up (relatively speaking) due to legitimate PPP models supported by governments and an opportunity to make profits. Much of the change we have seen has been led by social enterprises, themselves serving social good while not eschewing profits. In education the ASER report has even collected statistics where none existed, as the government failed in their job. That data is now being used to drive public policy and practice.
Community driven PPP may start at a small scale but has the virtue of being tested rigorously. Its evolutionary nature makes the design far more flexible than a top down approach can ever hope to achieve. Innovations such as the Delhi Traffic Police seeking to involve and inform the public via social media may be the start of a long lasting partnership for social change and economic gain that is led by the community. Maybe, it is these community led public private partnerships that will be the face of the reforms we want to see.