Public Private Partnerships have been implemented in India to help improve the performance of the public health sector. The experiences of implementation have been a mixed bag with some successes. There have been concerns during implementation about the designs not accounting for disparate motivations, ambiguous roles and risks to partners that affect the management, sustainability and ultimately the services. A study was conducted to understand the designs of three Public Private Partnerships addressing reproductive health needs of women at primary and secondary health care level in rural Gujarat. These partnerships were with a corporate body, a Non-Government Organisation and with private empanelled gynaecologists respectively. Review of data and relevant documents from the government and private partners and in-depth interviews with select key informants were conducted. The Government of Gujarat has drafted elaborate conceptual framework and guidelines for Public Private Partnership. Yet, the non-competitive selection of partners, conflict of interest, lack of commitment and attention to standards of care and insufficient monitoring and accountability mechanisms all point towards weaknesses in design of these models. Implementation without fidelity to the purpose and design of the PPP and un-addressed risks to partners make these partnerships vulnerable to exploitation and un-sustainable in the original format. The study highlights the need for thorough review of partners and evaluation of existing models to ensure that the potential benefits of PPPs are not frittered away at the altar of weak designs and lack of monitoring.