The highest attainable standard of health is a fundamental right of every human being. In this context, universal access to healthcare assumes prime importance. However, healthcare delivery poses a significant challenge for policymakers in India.
A severe lack of resources means that there is only one doctor per 1,700 citizens in India, well below the minimum ratio of 1:1,000 stipulated by the WHO. There are also only 1.3 beds per 1,000 population, significantly lower than the other BRIC economies and the WHO guideline of 3.5 beds per 1,000 population. In rural areas and smaller towns of India, even basic health services remain inaccessible. Given the sorry state of affairs it is no surprise then that India continues to lag behind poorer neighbors like Bangladesh, Sri Lanka and Nepal in terms of child mortality. For every 1,000 children born in India between 2011 and 2015, 48 died on average every year before reaching the age of five, according to the World Bank. Equally alarming is the fact that a quarter of the world’s neonatal deaths and 15% of maternal deaths happen in India.
It is pertinent to note here that despite the fairly rapid pace of economic growth that India has experienced in the last 20 years, public health spending in the country is only about 1% of GDP. This compares to 3% in China, 4.1% in Brazil and 8.3% in the US.
Inadequate government spending on healthcare and lack of access to health insurance pushes almost 3% of India’s population into indebtedness and bankruptcy every year. To address this situation, the government needs to come forward and take proactive steps to implement a universal healthcare program that ensures basic healthcare services for everyone with minimum financial burden being passed on to the patient.
India needs a universal healthcare program that hinges on affordability and access. This calls for existing public health infrastructure to be revitalized, new medical centres built and modern ICT-based telemedicine technology to be leveraged for addressing the demand-supply gaps in terms of doctors and health facilities. There is an urgent need therefore for public health spending in India to be raised to at least 2.5% of GDP as well as Public Private Partnership (PPP) models in healthcare to be promoted.
PARTNERING TO MAKE HEALTHCARE ACCESSIBLE
The government alone cannot meet the healthcare infrastructure and capacity gaps in Tier II and Tier III cities as well as rural areas, and this makes private participation a must. While it’s true that some PPP projects attempted earlier have failed, clear policy guidelines can ensure the successful implementation and sustainability of healthcare PPP models in future.
The prerequisites should include agreed upon scope of work, legal and regulatory framework, resources pooling and management, transparency and accountability, suitable policies and a commitment to public good. It is necessary that PPPs ensure that government services are delivered in an economical, effective and efficient manner. The role of the government should be proactive and it should identify areas in National Health Programs, diagnostic and curative services where partnerships are possible. The government should also develop working guidelines based on successful experiences of different states besides framing quality guidelines with professional help from organizations that already have experience in preparing quality assurance tools. Lastly, smart business models need to be put in place without which it will be difficult for private players to achieve reasonable returns on investment.
It is encouraging to see that the NDA government is looking seriously at PPP models for improving healthcare access to the country’s 1.2 billion people and lessen the healthcare burden on the common man. At a time when the federal government is examining ways to implement healthcare initiatives under the PPP model in a time bound manner, states like Rajasthan have already set the ball rolling.
THE RAJASTHAN EXPERIENCE
The Vasundhara Raje government in Rajasthan has partnered with the private sector for running Primary Health Centres (PHCs) and sub-centres across the state. Rajasthan, which is geographically the largest state in India, has over 500 Community Health Centres, over 2,000 PHCs and over 13,000 sub-centres. Several PHCs, which are located in remote areas, are now being run on a PPP model. The terms of the PPP engagement are simple. While the state government will provide the necessary infrastructure, medicines, equipment and operational costs, the private operator would provide doctors, paramedics and other staff, free outpatient services and 24-hour emergency services. These PHCs are already reporting encouraging results as the improvement in cleanliness and availability of staff and medicines have led to a jump in the number of patients being treated.
The Rajasthan government has also launched a health insurance scheme to provide medical coverage of up to Rs 3 lakhs to each citizen and is expected to cover nearly 70% of the state’s population.
Health insurance is an area where PPP arrangements have been successful. The Yeshasvini Co-operative Farmer’s Healthcare Scheme, a PPP scheme involving Narayana Health and the Karnataka government, offers coverage of over 800 surgical procedures to farmers and their family members. Yeshasvini is one of the largest self-funded healthcare insurance schemes in the country. Neighboring Andhra Pradesh runs the Arogya Raksha Scheme in collaboration with the New India Assurance Company and with private clinics. The scheme, which is fully funded by the government, provides hospitalization benefits and personal accident benefits to citizens below the poverty line.
TOWARDS A HEALTHIER FUTURE
The new Companies Act of 2013 mandates corporates to spend 2% of their profits on CSR activities. The government can take this opportunity to partner with the private sector for taking healthcare delivery to the next level. It will lead to a huge improvement in healthcare delivery in India through a combination of good infrastructure, latest technology and the best available medical expertise. If PPPs are need based and customized to local circumstances, they clearly have the potential to drastically change the healthcare landscape in India.
PPPs can thus be a 'win-win' arrangement in which diverse actors with varied motivations and philosophies work together to contribute to the health of the people and the development of the country.
This piece was first published in the print version of TImes of India on May 5th, 2016