| The Gujarat government’s Malaria Control Society hires private agencies to disseminate information about the disease. In Jaipur, Sawai Man Singh Hospital run by the state government has allowed a private agency to run its drug store round the clock.
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| The Orissa government has allowed an NGO to run two of its primary health centres. It has also hired Sulabh International for upkeep of the toilets in GB Hospital.
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| The Government of India has signed deals with private doctors and NGOs to run the TB programme in 14 sites across the country.
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| The Planning Commission is now looking at prospects of mainstreaming some of these models of partnerships between the government, the private and the non-profit sector for providing healthcare in the Eleventh Five Year Plan period. The proposals have been made by a working group set up by the Commission.
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| The sick primary health centres in the countryside which have no doctors or pharmacists would be targeted first for the partnership treatment if the recommendations are incorporated in the Plan.
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| The report of the working group on public-private partnership in healthcare suggests that the government health clinics that need to be contracted out are those which have a large number of vacancies for a long period, high absenteeism, and consistent low performance on all reproductive and child health (RCH) indicators.
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| “Some states are more prepared for contracting out services compared to others. Fear of losing jobs and perceived shrinking role of the government in the health sector are the main reasons for resistance. Advocacy efforts are required in those states where resistance levels are high for contracting out services,’’ it says.
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| The report says that the contracting out of existing services and infrastructure can happen in four ways.
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| First, the government can hand over the clinic, equipment, budget and personnel to an agency. Second, it may hand over just the clinic and equipment and money but allow the agency to choose its people. Third, the government may hand over the clinic and machines but allow the agency to follow its own system. Finally it may give the agency total freedom in having its own staff and system.
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| The report is silent on user charges.
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| The report looks at 17 different kinds of partnerships to take healthcare to more and more people in the rural areas and to the poor sections of the society.
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| These include, contracting out clinics to private sector, hiring private doctors and other personnel on contract, tieups with corporates, NGOs and cooperatives, handing vouchers to beneficiaries and so on.
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| The report admits at the outset the limited reach of the public sector healthcare system. It says that private sector provides 78 per cent of the treatment in rural areas and 81 per cent in the urban areas. The use of public healthcare is lowest in the states of Bihar and Uttar Pradesh.
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| The report says the deals with private providers could be for a single service or on a long-term basis. The partnerships could be struck in providing services, providing information and awareness, infrastructure and capacity building.
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| In service partnerships, there could be large-scale hiring of private doctors and nurses on contract — a trend already started by the National Rural health Mission.
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| It would also include social marketing of products like contraceptives and oral rehydration solutions through NGOs or private players, and using private or NGO vans to provide medical healthcare. Private vehicles, buildings, as well as private trainers are recommended by the working group.
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| However, the group lays emphasis on the importance of the government as a partner in any kind of deal.Vidhya Das of the Orissa-based NGO Agragamee, who was part of the working group, is sceptical and says that entry of private players would cut off the rural poor further from health care.
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| “Private parties always work for profits. What is going to be the ceiling on user charges once the clinics are handed over to the private agencies?” she asks.
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| She says that the appointment of illiterate community women under the National Rural Health Mission as health providers is already an example of the government shirking its responsibility. Now more is coming, she adds. |
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