Impact of Public Private Partnerships on Healthcare Delivery in India

This paper seeks to evaluate the efficacy of Public Private Partnerships in making quality healthcare accessible at all levels in India. The reasons why governments across the world are embracing PPPs to deliver healthcare have been examined. The policy framework that has been developed in India for enabling PPPs has been described by tracing important developments. The paper then looks at three selected healthcare projects implemented in the PPP mode: (i) Chiranjeevi Yojana (ii) Mukhyamantri e-Eye Kendram, and (iii) Rashtriya Swasthya Bima Yojana. Taken together, these schemes represent different types of PPP projects from different parts of the country. Based on their evaluation, certain problem areas have been identified which emphasise the need for monitoring and expanding the scope of PPPs to reduce the medical expenses of the poor. Policy recommendations based on this analysis have been offered.

Introduction: Why PPPs in healthcare?

A long-held notion about social infrastructure was founded on a (false) dichotomy between the public and private sectors. The public sector, it was argued, existed for making basic services such as education and healthcare affordable to the common people. The private sector existed for those who could afford to pay more and did not depend on the state’s welfarism. This traditional understanding has proven to be ill-informed in the face of the stark limitations of the public sector. 

The reality in case of healthcare, evidence suggests, presents a contrasting picture. The poor are greatly dependent on the private sector to meet their healthcare requirements while public healthcare remains concentrated in urban areas. The poor are, in fact, inclined more towards the use of private healthcare service providers for reasons of accessibility and quality. However, in this process, they often have to resort to taking loans at high interest rates to settle hospital bills (AfDB-WITS 2017, 38).

The private sector has grown to cater to the needs of the bulk of the Indian population. It has built a presence that the public healthcare system cannot conceivably match or compete with. Therefore, governments have been compelled to accept private healthcare as an integral of national healthcare systems (Mitchell 2008, 5). The policy stance that arose out of this acceptance is one that favours cooperation with private healthcare providers, to facilitate the reach of healthcare delivery as well improve the quality of healthcare available to people.

The drive to integrate private players into public healthcare programmes has also been reinforced by the commitments undertaken by developing countries receiving aid from international financial institutions to expand the scope of the private sector. Speaking of global institutions, the World Health Organisation has as one of its founding principles, ‘universal health coverage’ i.e., universal access to healthcare. This principle has also been incorporated as one of the Sustainable Development Goals. Public-private cooperation is seen as vital for the attainment of this objective. 

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Author: Aditya Srinivasan, student of Jai Hind College, Mumbai