NITI Aayog, which has always advocated privatisation of public health infrastructure, has been silent recently
The novel coronavirus (COVID-19) outbreak has exposed big faultlines in the Indian health system — more prominently in the public-private dichotomy. As the already overburdened public healthcare system comes together to battle out the crisis, advocates of private healthcare stand as mute spectators — or speak up to demand a bailout package.
At a time when patients are being turned away from hospitals or being asked to prove they are COVID-19 free, Federation of Indian Chambers of Commerce & Industry claimed the private healthcare sector needed liquidity infusion, indirect and direct tax benefits and fixed cost subsidies from the government.
Ironically enough, it said the pandemic caused an “adverse impact on the health of private healthcare”.
Advocates of public health system are also silent. Ever since NITI Aayog came into existence, it has been vehemently advocating privatisation of existing public health infrastructure. Only recently, it has been eerily silent.
In June 2017, the Aayog proposed a public private partnership (PPP) model to provide infrastructure to improve treatment for non-communicable diseases at district hospitals. However, it went on back foot following backlash from public health experts.
However, it came back in October the same year with a mechanism to introduce private players in district hospitals. Similarly, in January 2020, the Aayog came with 250-page document suggesting a PPP model on how private medical colleges could get control of district hospitals.
But that’s essentially what NITI Aayog has been vouching for all these years. But why blame the Aayog alone? Private healthcare facilities have been taken over in states like Madhya Pradesh, Rajasthan and Chhattisgarh to treat people infected with SARS-CoV-2 virus.
On April 19, Sanjay Kumar, a bureaucrat from Bihar government tweeted that almost complete withdrawal of private health sector in the state was palpable and thought- provoking. Private sector has 48,000 beds as compared to 22,000 in public sector.
Where is Manmohan Singh?
Former Prime Minister Manmohan Singh is credited for the liberalisation of economy in the early 1990s. He should be now asked if he ever imagined what the Indian health system has become — a system wherein the most vulnerable are forced to bargain with service providers.
Growth of Private Sector
This graph has been borrowed from a book published by Institute for Studies in Industrial Development named Private Sector in Healthcare Delivery Market in India: Structure, Growth and Implication.
Growth of private health enterprises. Source: Unit level record of 67th round of NSS
It gives a glimpse into the growth of private hospitals in India in the last few decades. It used NSSO data and showed a sharp boom in private healthcare providers after 1990–91, when Indian economy was liberalised.
Though the graph gave data only till 2008, there is evidence showing the growth of private healthcare providers continued at the same, if not a higher pace.
The worst bit is that there was extra push for privatisation but no effort whatsoever to regulate the sector. Author Shailendra Kumar wrote:
Cross‐country experiences, however, reveal that in countries which follow a pro‐market approach, claim to draw up strong regulatory guidelines for the private sector. But, in the context of the private sector in India, state has largely been a facilitator rather than a strong regulator.
On the other hand, Indians in the grip of poverty are taking their own lives due to lack of excess to affordable and good quality healthcare.
The National Crime Records Bureau data highlighted that 0.38 million people committed suicide in India between 2001 and 2015 because they lacked treatment facilities. It was around 21 per cent of the total suicides in that time.
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