Half Full Or Empty?

Transparency and accountability should be the core of any PPP initiative in the healthcare sector.

- Krisha Mathur

The healthcare sector in India is largely dominated by the private sector, both in terms of delivery and preference. The National Health & Family Survey 2016 found that almost half of the rural and urban population prefer private providers over government facilities, most of which are plagued by poor facilities and inadequate staff. On the other hand, high-quality private facilities are largely limited to urban areas, and are fast becoming unaffordable. The recent Fortis Hospital case, among many others, where a family was allegedly billed ₹15 lakh for the treatment of their seven-year-old child brought to light the greed and predatory pricing of the private sector.

In rural areas, private facilities remain largely fragmented and are mostly present at the block and district levels, with varying levels of quality. These providers are also expensive, and often not trained adequately. An October 2016 study by World Bank shows that an average villager in Madhya Pradesh has access to 11 healthcare providers but 49 per cent of these providers have no formal medical training. In terms of usage, the picture is even more stark: 77 per cent of all primary care visits are to providers who do not have any formal medical training.*

However, if you look at the situation as a glass half full, the private and public sector have complementary skills, especially in the context of reaching the last-mile rural population. The public healthcare system is a large and pervasive three-tier system, (see image below) with subcentres (SCs) (1 for 5,000 population) staffed by an auxiliary nurse-midwife (ANM) being the designated first point of care. In addition, there are public health centres (PHCs) ( 1 for 40,000 population) with facilities for a wide variety of diagnostic tests, minor procedures, and a pharmacy. On the other hand, the private sector can bring in innovation, latest technology, and more effective and efficient delivery mechanisms proven at scale.