Not all is well with public-private partnership in the health sector, if a recent decision of the department is a prognosis.
The Health Department has decided to do away with the Arogya Bandhu scheme under which it had partnered with non-governmental organisations, charitable trusts and private medical colleges to run 52 of its primary health centres (PHCs) with financial assistance from the government. It has decided to take the PHCs back into its fold.
The decision follows a series of complaints of non-compliance of rules, misuse of funds, lack of accountability, and failure to provide quality service to patients by the organisations running these PHCs.
That apart, a study done by the Institute of Health Management and Research (IHMR) has also noted that there is not much difference between the services provided by the NGOs and the government in running the PHCs. The expenses of running the PHCs, including building maintenance and salary of staff, are given by the government to the NGOs.
Health Minister U.T. Khader told The Hindu that NGOs such as Karuna Trust also function in other States and receive huge funds from donors. “As per rules, all donations should be routed through Arogya Raksha Samiti of the PHCs. While this is not done, the donations are not even disclosed to the government,” he said.
“On evaluation, we have also found that there is no accountability, and some of the NGOs do not even have the required number of doctors and paramedical staff. The NGOs have employed AYUSH doctors and untrained nurses in some PHCs. Why should the government pay them for such sub-standard services?” he asked.
Health Commissioner P.S. Vastrad said patients were unable to get birth and death certificates from the PHCs under the PPP as the doctors appointed by them are retired professionals. Besides, these PHCs have also been found to neglect national health programmes, he said.
This is the second PPP scheme that has been wound up by the government. The scheme involving mobile health clinics, which was also run under PPP, was done away with earlier.
Arogya Bandhu was conceptualised to ensure that PHCs in interior parts of the State (15 km away from State highways where IMR and MMR is poor) be run by the participating NGOs. “However, some influential people running the NGOs got the rules diluted and took up PHCs in urban areas, including Bengaluru,” said another official in the Health Department.
This scheme involved eight medical colleges and eight NGOs and charitable institutions.
NGOs, colleges deny charges
Denying the government’s charges, representatives of NGOs and medical colleges said they had developed the services of non-performing PHCs and made them fully functional. “It is unfortunate that the government is taking them back without even a discussion with us,” said a representative of Sapthagiri Institute of Medical Sciences and Research Centre. This college has now obtained an interim stay order from the Karnataka High Court on handing over of the Kanasavadi PHC in Doddaballapur taluk, which they are running.
H. Sudarshan, who runs Karuna Trust said Arogya Bandhu had become a successful PPP model and was being emulated in Arunachal Pradesh, Meghalaya, Manipur, Odisha and Rajasthan. “It is unfortunate that the State where it had started, is now winding it up,” he said, denying charges of lack of transparency and unaccountability.
Banking on rural service?
Top officials in the Health Department said with the government making one-year rural service mandatory for medical students in July 2015, the department is confident of resolving the perennial problem of shortage of doctors. “Although there is a stay on the rural service rule, we are hopeful there will be a solution to the problem soon, and all PHCs can be run with our own staff,” a top official in the department’s planning division said.
U.T. Khader, Health Minister: “On evaluation, we have found that there is no accountability and some of the NGOs do not even have the required number of doctors and paramedical staff. They have employed AYUSH doctors and untrained nurses in some PHCs. Why should the government pay them for such sub-standard services?”
H. Sudarshan, Karuna Trust: “The charges are baseless. We run 26 PHCs and in five of them we have also built infrastructure. The Gumballi PHC in Yelandur taluk, the first centre that was handed over to us in 1996, has got NABH accreditation and 14 others have got ISO certification. Our priority is to provide quality care, and they should have called for a meeting if they had any issues.”
