The Vasundhara Raje government in Rajasthan has begun the process of entering into a partnership with the private sector for running Primary Health Centres and sub-centres across the state. The decision has triggered fears that ‘handing over’ these health facilities to private players would result in large scale retrenchment of government staff, while transferring infrastructure and equipment and raising the cost of healthcare for the poor.
An almost similar move to outsource diagnostic services in health facilities by the Chhattisgarh government in 2013 had to be put on hold pending a “fresh look”. The Chhattisgarh government had invited private players to run diagnostic services at publicly-funded health facilities to enhance efficiency and facilitate delivery of services. However, the move had to be put on hold within some months with the government saying that the public-private-partnership (PPP) required a revisit. The “gaps need more scrutiny” and “we have to figure out a mechanism to monitor private players in remote areas,’” the government had said then.
Then there were issues of regulating private players as they could use government premises to market their services to outpatients.
In Rajasthan, the government plans to enter into partnership with all kinds of private entities and individuals and not just with not-for-profit bodies. Any agency, person and even individual doctors can apply to run the Primary Health Centres (PHCs) and their corresponding sub-centres. When the cabinet approved the proposal in June, it had decided to allow PPP in just 90 of the 2,088 PHCs and associated sub-centres located in far-off, hard-to-reach areas and those regions with poor health indicators.
Curiously, the Request for Proposal (RFP) does not talk about any criteria for selection of PHCs for which agencies can apply, thus keeping it entirely open to the whims and wishes of the applicants to choose PHCs based on convenience of operation and other interest. This contradicts the earlier justification of the government for introducing PPP “only to cater to defunct and poorly functioning health facilities.” The initially attached list of 90 PHCs has been removed from the RFP issued by the government.
Geographically the largest state in India, Rajasthan has 568 Community Health Centres, 2088 Primary Health Centres and 13,227 sub-centres. The government has already handed over three community health centres; two of these in Jaipur to NIMS private medical college and one CHC in Barmer to CRD Health Care Private Limited. Apart from this, 31 PHCs and about 150 sub-centres have also been given to an organisation named Wish Foundation.
Describing the move as “astonishing and dreadful”, the Jan Swasthya Abhiyan and other civil society organisations from the state have demanded its revocation. “The decision is questionable because whichever private sector organisation bids the lowest to get the tender to run PHCs would only do so with the motive of earning profit. In order to do that, the quality of health care would be compromised,’’ says Chhaya Pachauli of JSA.
Providing quality health services to all citizens is the duty of the government for which national health policies have been drafted and must be implemented. Handing over these facilities to the private sector could become the biggest barrier in providing quality health care services, she says.
The RFP document also allows applicants to provide “additional services”, for which patients will be charged. This opens a window to the private sector to earn extra money from the poor.
The government’s argument that the private sector can provide better primary health care in comparison to public institutions is not supported by any evidence. On the contrary, it has been observed that many government doctors are providing good services in hard to reach and difficult areas. This goes to show that the government is simply looking for ways to to evade its responsibility for providing quality health care to its citizen, the Jan Swasthya Abhiyan says.
“If the government hands over large number of PHCs and Community Health Centres to the private sector, then what would happen to all the medical, paramedical and other staff currently posted at these health facilities?” asks Pachauli. “This move of the government is confirmation that no recruitment for public services us going to take place, which will force paramedical staff to work on a grossly low pay scale and would further degrade the quality of health services.”