The Health Sector in India

2008

Dr Suneeta Singh
Amaltas Consulting Pvt Ltd
Organization of the module
 Structure of the sector
 Public
 Rural
 Urban
 Private
 Policy framework
 Data locations

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Organization of the module
 Case studies in planning
 Immunization
 HIV
 Diagnostic services
 Innovation, implementation and
supervision

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India
 Estimated 1.2 billion people
 Second most populous country in the
world accounting for 17 percent of
the world’s population.
 Vast in terms of geography
 Organised into 35 states and union
territories
 More than 600 districts each with an
average population of 2 million
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Central/state distribution
 Central government: undertakes
programs of national health
importance such as TB control, HIV
prevention, immunization etc.
 State governments: responsible for
delivery of health services
Have an architecture of public health
institutions

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Health care provision
 Responsibility of state governments
 Increasing pressure to deliver good
quality services, both from the
people-at-large as well as from
central government
 The new development is:
 Resources available
 Willingness to experiment

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Hierarchy of public health institutions
in a state

DH

CHC

PHC

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Policy framework for Health
 11th Five Year Plan (2007-12) of the
country is currently in progress and is
committed to promote broad-based and
inclusive growth designed to reduce
poverty.
 Proposes support for a National Rural
Health Mission (NRHM) which will ensure
quality health care in rural areas where
over 70 percent of the population lives.

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National Rural Health Mission
 A managerial framework for the health and
family welfare sector in rural areas, launched in
2005.
 Proposes to address gaps in provision of
effective health care in the least developed
areas of the country; create a common
architecture for all health care programmes ……
and facilitate the participation of the not-for-
profit and for-profit sectors more fully in
achieving desirable health outcomes.

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Private provision
 Analysis shows that the private sector in
India provides approximately 50% of all
inpatient care and up to 80% of outpatient
care.[1]
 Keeping these analyses in mind, several
Indian policy documents speak of the need
to co-opt the private sector to meet the
commitments of the government to the
people of India on public health.

[1] Peters, David H., Abdo S. Yazbeck, Rashmi R. Sharma, G.N.V. Ramana, Lant H. Pritchett and Adam Wagstaff. 2002.
Better Health Systems for India’s Poor: Findings, Analysis, and Options. Washington, DC: The World Bank.

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Task force on PPP
The task force on Public Private Partnerships
of the NRHM:

“….There is scope for partnerships with

nongovernmental providers for public health
goals given the large private sector in India.
However, the group recognised the plurality
and diversity of the profit and not for profit
sectors in terms of size and distribution across
rural-urban areas and States. It also
emphasized the importance of regulating the
private sector at all levels if care …..”

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Task force …
The task force suggested that the
following specific tasks that may be
outsourced to private sector
 Ambulance/transport services

 Capacity building of manpower on

specific skills
 RCH programme component delivery

 Ancillary services like laundry,

security and diet of patients
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PPP in health in India
 Has been attempted for the past 10
years or so, gathering momentum in
the last 5-7 years although earliest
example can be found in the ’60s with
the social marketing of condoms
 Began through design features in
national programs
 In state programs, began initially in
respect of provision of non-clinical
services
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Language of PPP in India
 Contracting in: hiring of individual(s) to
provide service in government run facility
 Contracting out: hiring of private entity to
deliver services on a stand alone basis
 Subsidy: providing public funds support to
recipient or supplier for service delivery
outcomes
 Leasing/rental: use of public facilities to
private entity

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PPP contracts currently in place:
 West Bengal: Project: Health Programme, 2007
onwards; Area/Segment: Emergency Medical Services /
Diagnostic Services / Drugs / Health Centre
Management;
 Mumbai, Maharashtra: Project: Super Specialty Hospital;
Area/Segment: Hospital Setup and Management
 Gujarat: Andhra Pradesh; Project: Emergency Medical
Research Institute (EMRI); Area/Segment: Emergency
Medical Services
 Arunachal Pradesh & Karnataka: Project: Karuna Trust -
Management of PHCs; Area/Segment: Health Centre
Management

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PPP contracts …
 Karnataka: Project: Rajiv Gandhi Super Specialty
Hospital; Area/Segment: Hospital Setup and
Management
 Gujarat: Project: Hospital Management & Information
Services (HMIS); Area/Segment: Information Systems
 Bihar: Project: Generic Drug Shop; Area/Segment:
Pharmaceuticals
 Assam: Project: Boat Clinic for River Islands;
Area/Segment: Mobile Medical Unit
 Uttar Pradesh: Project: Merrygold Health Network;
Area / Segment: RCH Services

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In diagnostics …
 Uttar Pradesh: Project: The Bal Mahila Chikitsa aum
Prasuti Griha (BMC & PG) - Maternity & Child Care
Centre Aligunj Lucknow: round-the-clock Diagnostic
facilities
 West Bengal: Project: Diagnostic facilities in Rural
Hospitals and Block PHCs for X-ray, USG, Pathological
examinations, November 2004 onwards
 West Bengal: Project: Establishment of CT scan
machines in Medical Colleges & Hospitals
 West Bengal: Project: Establishment of MRI Unit in
Medical Colleges & Hospitals
 Bihar: Project: Radiology Services in partnership with
government

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Performance feedback
 Performance has been mixed partly due to the need
to ‘invent’ the relationship on the part of both
government and the private entity. Some difficulties
have arisen due to:
 Lack of detailed policy documents with accompanying
procedures, protocols, regulations, incentives and
mechanisms
 Proxy litigation by interested groups blocking progress and
inadequate legal safeguards and professional assistance to
seek legal redress
 Lack of clear identification of sites and their announcement
before inviting partnership proposals
 Lack of single window clearance facilities within the
government for various statutory requirements that the
private partners need before investment and
Implementation can begin

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