We are happy to present 'the report of the study on Structure and Dynamics of the private health sector. The study is based on data on private and public health care institutions in Andhra Pradesh. To address the policy concerns raised at the beginning of the study, we have supplemented findings from the field study with review of literature from India and abroad. The study was commis- sioned by the Government of India Ministry of Health1 and funded by The World Bank2.

The study was commissioned in August 1999 and was expected to be com- plete by April 2000. Unfortunately the study has taken more time than we had planned. Various factors are responsible. The data collection from private health care institutions, many of which do not practice systematic recording of infor- mation took longer than we had anticipated. In many cases we had to revisit the health care institutions to further clarify obvious inconsistency in information collected during the first round of the survey. The study involved collection of data in six different questionnaires. Summarising the information and data analy- sis took much more time than we had planned. Our study resources and time constraint did not permit collection of information on all policy issues of con- cern. So we had to review the literature and search for evidence and informa- tion on many of these policy questions. We feel the wait is worth the result. The extra time has allowed us to present a more comprehensive report. We hope that the report will meet the requirement of the Central Ministry of Health and Family Welfare, Departments of Health in various State Governments in gen- eral and the Government of Andhra Pradesh in particular.

We are grateful to Ms Sujatha Rao, Joint Secretary to Government of India for her encouragement and support. The help and support from Dr. David Pe- ters, and Dr. GNV Ramana at the World Bank Delhi office was crucial in design- ing and implementation of the study. We also benefited from discussions with other investigators, who participated in various aspects of a set of studies on private health sector simultaneously commissioned by the Government of India with funding from the World Bank. These are; (a) VR Muraleedharan, at Foun- dation for Sustainable Development, Indian Institute of Technology, Chennai; (b) Sunil Nandaraj, at the Centre for Enquiry into Health and Allied Themes, Mumbai (c) Rama V. Baru, at the Centre for Social Medicine and Community Health, JNU, Delhi, (d) Prof. S. Chakraborty at the Indian Institute of Manage- ment (11M), Lucknow. All the above persons participated in a workshop at the Institute of Health System from 15-16 February, 2000, to helped us develop the study design. We are grateful to Prof. Chakaraborty and his team at the 11M Lucknow, who organised a workshop in their campus from 20-21 September, 2000, to facilitate the data analysis process.

Implementation of the study involved a team of people in IHS and help of many other people. In addition to the effort of the team members, collaborators and others listed at the end of the report, we would like to thank all the health care institutions, owners, managers and their personnel for their help in provid- ing us with information about their respective institutions.