The Maharashtra government is studying the feasibility of public-private partnerships in district hospitals, following a June 2017 NITI Aayog directive that government hospitals be opened up for private investment.
Under the proposal, the state government is considering agreements with private medical colleges through which graduates and post-graduates will work at the attached district hospital for at least a year. The state government hopes to shore up the number of specialists in government hospitals and fill vacancies faster.
The idea, against which activists have expressed concern, is based on a Gujarat government PPP model in which government hospitals are attached to the Adani Education and Research Foundation.
The Maharashtra government model involves a partnership between the health and medical education departments with the former providing hospitals to government medical colleges that require showing a certain bed-strength for approval from the Medical Council of India.
In return, the medical education department provides doctors to operate the hospitals. The Chandrapur and Gondia medical colleges have been set up on these lines.
According to principal secretary (health) Pradeep Vyas, the idea is to increase the number of specialists in government hospitals. Maharashtra has a huge shortage in anaesthetists – over 60 per cent of 648 posts are vacant – and physicians – over 45 per cent vacancy in 274 posts.
“The PPP model will allow private colleges to get recognition, and give us medical staff to function. The private college will have its own building for classes,” said Vyas.
Last year, a private medical college approached the health department with a proposal to run a district hospital in Sindhudurg, but that project did not materialise.
Following a Government Resolution in January, a three-member committee is now looking at whether a similar model can be duplicated for 300-bed government-run district hospitals and private medical colleges. The committee comprises the head of the National Health Mission, the Director of Health Services and the Director of Medical Education and Research.
According to the GR, the Centre amended its rules for establishing medical colleges in 2015, which allowed medical colleges to set up 300-bed hospitals in a PPP model.
“We are yet to conduct a meeting to discuss this and submit a report,” said Dr Pravin Shingare, director for medical education and research. The report is expected by April end.
Public health experts are, however, concerned about a PPP model in public health. Dr Abhijeet More of NGO Jan Arogya Abhiyan, said, “In Gujarat’s model, the ownership of both, hospital and medical college, is with a private body. Government loses control. As it is a self-financed medical college, the fees for medical education are high. While it is great to add more medical colleges, this would prevent economically backward students from being able to afford private education.”
Others said private players in healthcare would be driven by profits. “In the GR, the government has not been specific about terms of the agreement with private colleges,” said public health expert Ravi Duggal.
In 2017, NITI Aayog CEO Amitabh Kant sent a model contract to all state governments to consider private investment to improve government health services such as diagnostics, dialysis, supportive, preventive and curative care.