The NITI Aayog proposal to hand over district hospitals with 750 beds to private medical colleges, citing the public-private-partnership (PPP) arrangements in Karnataka and Gujarat, has come under severe criticism from health activists and doctors, who feel it will further compromise quality and access to healthcare, mainly for the poor. They have demanded that the move be dropped without further consultation.
The Centre’s top think tank recently released for feedback from stakeholders a 250-page document on “scheme to link new and/or existing private medical colleges with functional district hospitals through PPP”. A stakeholders’ meet to discuss this is slated to be held on Tuesday. Such district hospitals need to have at least 750 beds, of which nearly half will be “market beds” and the rest will be “regulated beds” for free patients.
Citing a dire shortage of qualified doctors, the NITI Aayog document states that it was practically not possible for the Union and State governments to bridge the gaps in medical education with their limited resources and finances. “This necessitates formulating a PPP model by combining the strengths of public and private sectors. Such a model will augment medical seats and also rationalise the costs of medical education,” the document states.
However, health activists and doctors are worried that such a model could transform district hospitals from public service-oriented healthcare centres into profit-oriented ones. The Jan Swasthya Abhiyan (JSA) has demanded that the proposal be dropped immediately without any further consultation.
“District hospitals are the final port of call for the poor. This policy will further compromise quality and access to healthcare, mainly for poor patients. With only half of the beds made available for the poor, there will be a huge demand for free beds. The management will be only interested in giving care to paying patients and their primary motive will be making a profit. Instead [of this move], district hospitals should be converted into public medical colleges or attached to new such colleges,” said Abhay Shukla, national convener of JSA.
‘A disastrous move’
Sundararaman T., global coordinator of People’s Health Movement, termed the move disastrous. “Patients will need an authorisation certificate to avail free services, while the private entity managing the district hospital will be entitled to demand and charge appropriate hospital charges based on the market competitive rates from other patients. This will mean allowing the private entities to turn our district hospitals into revenue-generating enterprises,” he said. Dr. Sundaraman is the former executive director of the National Health Systems Resource Centre.
M. Madan Gopal, former Principal Secretary, Health and Family Welfare, Karnataka, during whose tenure the ‘Arogya Bandu’ scheme was initially scrapped, said the State’s PPP arrangements have not been successful in the past. “Going by past experience, I do not think the NITI Aayog proposal will be cleared. There are a lot of practical issues. What will happen to the existing government staff in district hospitals? Will they come under the private entity? Who will handle medico-legal cases? Many such things will arise,” he said.
Sylvia Karpagam, a public health expert who has extensively studied the PPP healthcare model in the State, questioned why policy-making does not use the basis of evidence. “The Karnataka model for both primary and tertiary care has been critiqued many times and yet, it is constantly projected as a good model. The contract signed by the government for a tertiary care PPP in Raichur was terminated two years later, in May 2012, because of poor governance and the lack of accountability and a grievance redressal mechanism at the hospital,” she said.
