Explaining what ‘non-governmental’ means, two bureaucrats clarified it meant both NGOs as commonly understood as charitable organisations as well as private for-profit organisations.
New Delhi: In a policy shift, the government has changed the focus of two key chapters in the National Health Policy (NHP) 2017. While the contents of the chapters have remained broadly the same, the titles of the chapter have been changed from being only about public partnership with the ‘private sector’ to being with the ‘non-governmental sector’.
The term ‘non-governmental sector’ stands out because, speaking to the press after raising the NHP in Parliament, health minister J.P. Nadda spoke about the need for ‘strategic partnerships’ but specifically with the private sector. “In primary and secondary centres, we will try to give facilities ourselves but where we can’t, we will engage the private sector,” he said. With regards to free drugs and diagnostics at district level facilities, he said, “Where there are gaps, we will go for strategic purchasing. Where we can’t facilitate, we will engage the private sector. Financial support will be ours and where we lack we will take help.”
The government has in fact already engaged the private sector around the country for diagnostic facilities.
The draft policy chapters were titled “Private sector in health” and “Financing of healthcare/ Engaging the private sector”. In the final policy, this has been revised to read, “Non-Government sector in Health” and “Collaboration with Non-Government Sector/Engagement with private sector”.
However, explaining what ‘non-governmental’ means, two senior bureaucrats clarified that it meant both NGOs as commonly understood as charitable organisations – as well as private for-profit organisations. This is a shift from the 2015 draft’s focus on simply the private sector. In fact, NGOs found no mention in the draft policy. The final policy takes into account over 5,000 suggestions that came in on the draft.
“There are many good and committed NGOs working in the area of health. We would like to use them for complimenting the public sector,” a senior bureaucrat clarified. “In secondary and tertiary hospitals, we will collaborate with the private sector on insurance. Strategic purchasing would be used for large insurance schemes like [Rashtriya Swasthya Bima Yojna], so that we can negotiate a good rate on behalf of the population. To minimise moral hazards, we would start with not for profit organisations and then profit organisations.”
The new policy notes that “there are many critical gaps in public health services which would be filled by ‘strategic purchasing.’ Such strategic purchasing would play a stewardship role in directing private investment towards those areas and those services for which currently there are no providers or few providers.” In some cases, it says this strategic purchasing would be “a short term strategy till public systems are strengthened.”
Although the term ‘non-governmental organisation’ is explained as pertaining to both profit and non-profit organisations, some ambiguity remains as the contents of the chapters refer to for-profit organisations, lifting almost directly from the draft policy. The terms ‘non-governmental organisation’ and ‘private sector’ are used interchangeably.
For example, the first chapter speaks about how the government has built a positive environment for the private sector healthcare industry over 25 years. This was done through subsidised land allocation, lower direct taxes and customs duty exemptions for equipment, among other measures. This has made India the second biggest destination for investments in health. Nearly 70% of the rural and urban population uses private healthcare.
The second chapter is more inclusive and discusses collaborations with not-for-profit organisations and with the CSR activities of for-profit organisations. However, it also says that the government will undertake strategic purchasing with private sector organisations in areas where the private sector will want a substantial return on investment.
It invites the private sector in the areas of primary, secondary and tertiary healthcare, urban healthcare, capacity building, skill development, CSR, mental health, disaster management, immunisation, disease surveillance, tissue and organ transplantation and health information systems. In practical terms, this would include diagnostics, ambulance, safe blood, rehabilitative, palliative and telemedicine services, mental healthcare, managing of rare and orphan diseases and medical research. The policy also invites the private sector in control of TB and HIV co-infection.
Abhay Shukla, a member of the Jan Swasthya Abhiyan, has questions: “With this policy, how do you differentiate where it is talking about which sector? In India it is not straightforward. Healthcare providers suddenly become charitable when they want land, and private when they are asked to provide care. We cannot build a model based on this, because there is no assurance that the private sector will actually provide care out of their CSR, as the policy suggests.”
According to Soumitra Pathare, a member of the government’s mental health policy group, “Including mental health under strategic purchasing is an acknowledgement of the deficiencies in the public health system. Collaborating with not-for-profit and for-profit organisations in unreached areas is good news and fits in with the National Mental Health Policy.” India finalised the National Mental Health Policy in 2014.
The policy will only take on full meaning once these ideas are developed into schemes that carry financial and legal approvals. There have been good examples of private sector partnerships like Gujarat’s Chiranjeevi scheme of 2006, where private hospitals were paid in advance for conducting 100 deliveries (normal or caesarean). “However, the private sector only works for business, so it must make business sense to them,” says Shailaja Chandra, a former secretary in the health ministry.