With increase in demand and expectations for improved health care services, coupled with resource constraints in the public sector, the Health & Family Welfare Department coordinated with the private sector in Public Private Partnership (PPP) mode of operation for delivery of quality health care services in West Bengal from 2001-02. In January 2006, the department published the ‘Policy for Public Private Partnership in the Health Sector’ outlining various ways in which the diverse segments of the private sector can be engaged with the government for expeditious achievement of desired health outcomes. A Strategic Planning and Sector Reform Cell (SPSRC) was also formed in April 2008 for framing policy options and strategic approaches in this direction. Apart from the SPSRC, the department has a PPP cell under it. The department started PPP projects in various aspects of health services like establishing of medical colleges and hospitals (MCH), setting up investigation/ diagnostic centres at various levels of hospitals, installation of pipe lines and supply of medical gases in bigger hospitals and MCHs, starting ambulance services for patients in need, starting fair price outlets of medicines, etc. Operations in the following five major PPP initiatives, selected on the basis of their significance in improvement in patient care and operational maturity, were subject to audit assessments vis-à-vis the critical success factors as prescribed in the PPP Policy. 1 Diagnostic 1) CT-Scan and Magnetic Resonance Imaging (MRI) facilities Services 2) Diagnostic units in Rural Hospitals/ BPHCs 2 Supply of Oxygen I.P. through Pipe Line System 3 Establishment and Operation of KPC (Kali Pradip Chaudhuri) Medical College and Hospital 4 Emergency Transportation (Ambulance) Services 5 Establishment of three Mechanised Laundry Units under PPP mode Records of five Medical Colleges and Hospitals (MCHs), Chief Medical Officers of Health (CMOHs) of five districts and seven hospitals in Kolkata and five districts in the State covering a period from 2009-1042 to 2013-14 were covered for this study. These units were involved in running the above PPP projects and were selected on the basis of random sampling. Besides, 28 Diagnostic units set-up at rural hospital/ BPHC level in four selected districts were also test-checked. The audit observations are discussed in the subsequent paragraphs.