A/HRC/14/20/Add.2 A role for public-private partnerships? 55. The government of Gujarat, in consultation with others, has developed an initiative to provide free birth care to poor families through contracts with private obstetricians practising in rural areas. Known as Chiranjeevi Yojana (meaning a scheme to provide long life to mothers), a pilot study (five districts) was launched in 2005 and, on the basis of positive results, the initiative is now being introduced throughout the state (25 districts). The state contracts with private obstetricians to provide skilled birth attendance, including emergency services, to women living in poverty. The obstetricians are paid about US$ 45 per delivery, irrespective of the type of delivery. The cost is small compared with the state’s health budget, and the scheme is widely promoted by governmental health workers. More than 840 private obstetricians are now enrolled and it is reported that access to skilled birth attendance and EmOC for women living in poverty has substantially improved.32 This experience suggests that, in some circumstances and with proper institutional arrangements, public-private partnerships have a positive role to play in enhancing access to skilled birth attendance and EmOC for disadvantaged individuals and communities. The human rights responsibility of private practitioners to enhance access 56. In the above paragraphs we have signalled some of the positive contributions private practitioners are making to enhance access for disadvantaged individuals and communities. These contributions are important and welcome. In the Indian context, however, they are extremely modest.33 As already observed, for example, the Government needs 6,000 appropriately trained health professionals to ensure that 2,000 community health centres can provide EmOC. While there are only 700 such specialist obstetricians in government service, there are over 20,000 specialist obstetricians in the private sector – and they could be doing much more than they are presently doing towards meeting the serious deficit in EmOC, especially in rural and disadvantaged areas. 57. Deriving from the Universal Declaration of Human Rights and elsewhere, private practitioners have a human rights responsibility to provide modest, predictable and sustainable assistance to public facilities in rural and underserved areas. Presently, the great majority of private practitioners in India are not discharging this important human rights responsibility. While they must decide how best to remedy this situation, they could, for example, provide their services to the public authorities for one day a month at governmental rates of pay for the duration of the National Rural Health Mission (2005– 2012). Of course, the government authorities have a corresponding duty to ensure that such contributions are supported by the necessary facilities and equipment, so that they have maximum impact. Although private practitioners must decide how to proceed, for the great majority of them business as usual is not an option. Because arrangements such as these do not provide long-term solutions to a complex, systemic, workforce problem, the conclusion of the present section suggests an additional way forward. 4. Conclusion: health workforce strategy and plan of action 58. In India, generally speaking, doctors and their associations and councils are politically powerful and have an urban and private sector bias. When considering health workforce issues, it is extremely important that this general orientation is kept firmly in 32 33 14 D. Mavalankar and others, “Indian public-private partnership for skilled birth attendance”, Lancet, vol. 371, No. 9613 (February 2008), p. 632. Here the focus is on private practitioners working for profit, rather than those working in a not-forprofit situation, for example, in non-governmental organizations. GE.10-12866