Global actors and local 'partnerships': a case study of USAID's Sambhav scheme in Uttar Pradesh, India

There was a large increase in development aid for health during the Millennium Development Goal era, and growing awareness of the importance of donor priorities in determining how that aid is used. The research described in this chapter focused on a case study of the US Agency for International Development’s (USAID) Sambhav scheme: a voucher programme which contracted private hospitals in cities in Uttar Pradesh to provide maternal and reproductive health services to people living in slums. The research examined how USAID’s priorities manifested in the design of the Sambhav scheme, and considered how the public–private partnership was enacted in the city of Lucknow. The findings reveal a process of USAID-sponsored healthcare commercialisation played out through the development of public–private partnerships. In practice, ‘partnership’ meant the government sent free vaccines and contraceptives to private hospitals while community workers discouraged families from visiting government hospitals. Voucher users missed out on cash incentives available at government hospitals and were charged for ‘additional’ services at participating private hospitals. Dissatisfaction with payment rates among hospital managers meant women requiring more complicated forms of care were referred on to government hospitals or other private hospitals. These experiences raise questions regarding the wider effects of such ‘partnerships’ on health systems and out-of-pocket expenditure.