How public-private partnerships could be the booster dose for India’s healthcare ecosystem

The two most prominent challenges in the sustained availability of equitable healthcare in India for all are affordability and accessibility. However, the COVID-19 pandemic has shown how public-private partnerships could address both issues for India’s rural communities.

Official figures highlight just how big these two hurdles are. To address affordability, the Indian government spends a mere 2.1% of GDP on healthcare compared to 9.7% across OECD countries, with more than half (55%) of healthcare expenditure coming out from the pockets of citizens.

With the total population of the world’s second most populated country estimated to be 1.4 billion, this financial burden pushes 55 million Indians into poverty every year.

When it comes to accessibility, India’s rural and urban populations have diametrically opposite experiences of healthcare. Urban residents, who account for just 28% of India’s population, have access to 66% of the country’s hospital beds, while the remaining 72% of the rural population have access to just one-third. Furthermore, 67% of doctors in India practise in urban areas.

But, during the recent COVID-19 pandemic, something rare happened. The pandemic catalyzed both the public and private sectors leading to collaborations like never before in diagnostics, technology and treatment for saving lives.

The synergies that were seen in the management of COVID-19, are unprecedented. The CoWin portal, a technology-backed public-private portal for the world’s largest COVID-19 vaccination drive in India, is the best example.

The pandemic has shown us strong evidence that by working together, the public and the private sectors can take quality healthcare in India to the last mile a lot faster and a lot more affordably.

At this juncture, it would be a massive failure on the part of the healthcare fraternity if we do not further explore the feasibility of such public-private partnerships (PPPs) in managing other deadly diseases that threaten humanity.

The private sector now has a rare opportunity to fundamentally redefine its relationships with health systems, healthcare providers and patients.

The PPP model has met with reasonable success in India over the past decade, backed by a slew of policy initiatives. The setting up of a public-private partnership appraisal committee has streamlined appraisals and approvals of projects, in addition to bringing in greater transparency and competitive bidding processes.

In 2021 alone, India received US$7.7 billion of committed investments across 25 projects, the largest in the South Asia Region. Whereas most countries in South Asia Region saw a sharp drop in PPI compared to 2020, India saw a 49% increase in private investment commitments.

As the resources are being pledged for PPP projects, it remains equally important that these initiatives are practically curated according to situations on the ground and aim for realistic outcomes.

Here are three ways that PPP projects can help address the problems of accessibility and affordability in rural Indian healthcare:

There are already some PPP initiatives that are making good use of either one or more of the above-mentioned elements in their strategy and have either made or are making good progress towards the intended impact.

Pune Municipal Corporation’s recent Vaccine on Wheels programme, for example, aims to increase immunization in India through an equitable, affordable and convenient vaccination service for all by creating hospital-like sterile setups near their communities providing vaccination services.

Yeshasvini Cooperative Farmer’s Health Insurance Scheme, which was initiated by Narayana Hrudayalaya, Bangalore’s super speciality hospital and the Karnataka government, is a landmark initiative that has come as a great boon to the farmers in the state.

Members can avail themselves of free surgery costing up to INR125,000 ($1,545) and INR200,000 for multiple surgeries and in urban Yeshasvini, the maximum limit of treatment per person for single admission is INR175,000 and for multiple admission is INR250,000 in the same year.

The Arogya Raksha scheme in Andhra Pradesh is another insurance scheme initiated by the state government, in collaboration with New India Assurance Company and private clinics wherein. End-to-end cashless services for 1,059 diseases under secondary and tertiary care are being provided through 400 government and corporate network hospitals.

To conclude, we must re-emphasize that if used judiciously and well-curated to local settings and needs, the PPP projects can quickly turn around the prevalence of quality healthcare in India in resource-constrained settings in an affordable way.

Still, the current scenario is at a nascent stage, and a lot of distance is still to be covered. The need of the hour is to move from a transient basis of collaboration and instead establish a long-term mutually beneficial partnership model.

This will enable long-term relationships that can lead to sustainable improvements in health systems.