The Ministry for Health and Family Welfare has said that it will respond to the Niti Aayog’s draft agreement proposing terms by which district hospitals across the country could be opened to private participation in the treatment of non-communicable diseases. As reported, the government policy think tank sent a letter to states in June proposing a model by which private companies could potentially bid for 30-year leases over parts of district hospital buildings and land to set up 50-bed or 100-bed hospitals in district headquarters.

In its letter asking states for their views on the matter, Niti Aayog said the model contract had been prepared jointly with the Union health ministry and with the World Bank as a technical advisor.

But an official in the health ministry said that the department was involved only in early discussions, before the final draft was prepared. “The final draft that was shared by Niti Aayog was not vetted up front by the ministry,” this person said. “We shall also be sending our comments on the draft.” contacted Niti Aayog for comment about this conflicting version but senior officials did not respond to phone calls and messages. The article will be updated when a response is received.

The health ministry official accepted that the department had, in principle, agreed that the private sector should play a role in treating non-communicable diseases but claimed it was not involved in detailing the conditions laid down in the model contract agreement. could not independently ascertain this.

The official added that the health ministry is not averse to involving the private sector in public healthcare. “We had only agreed to it [the idea of involving private sector] at a more generic level,” he said. “In principle, one may not have an issue. But the terms and conditions of this nature will have to be neatly designed.”

It is also evident from the National Health Policy 2017 that various arms of the Bharatiya Janata Party-led government are on the same page, in principle, on providing a greater impetus to the private sector health industry.

The policy states: “The health policy recognises 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.” The policy advocates “building synergies” with not for profit organisations and the private sector.

Before the National Health Policy could be finalised, Niti Aayog and the health ministry had disagreed on how much space the government should cede to the private sector in the critical public health sector.

The model contract agreement now shared by Niti Aayog in June with states is built on a generic contract for “brownfield hospitals” available on a website run by the department of economic affairs. The contract is titled “Greenbook for Brownfield Hospital – 25 02 2014”. The World Bank, on its microsite for public-private projects, also provides a link to this document.

States resist

Meanwhile, the Tamil Nadu government has opposed the contract’s proposal to hand over government land and resources to private providers for 30 years.

“The Tamil Nadu government strategy is a health insurance model and a health systems strengthening model,” said Dr J Radha Krishnan, secretary for health and family welfare in Tamil Nadu.

Another health official from the state explained the problems with a 30-year agreement. “I want to improve my government hospitals,” he said. “If I hand it over, how will I improve them? Even if I do not have money now, I may have money later to improve them.”

He said, “The state believes in continuum of care, where primary, secondary and tertiary level of healthcare is intricately linked.”

The Niti Aayog model, he added, would create a compartmentalisation of these services in Tamil Nadu, which is not desirable. He also pointed that the state government itself was planning to expand services in the areas into which the Niti Aayog wants the private sector to step. Tamil Nadu has approved opening of 13 state-funded district chemotherapy centres or cancer treatment and 11 cathlabs where heart ailments are diagnosed.

The health insurance model, where some services that the state does not have resources to provide are strategically purchased by the private provider, has checks and balances, he said.

“We want to create a strong government healthcare system and a private healthcare system complementing it,” he explained.

The health ministry official spoke to said that the model contact would be more useful for states in North India, Central India and West India. “States such as Tamil Nadu already have robust care for people with noncommunicable diseases in their district hospitals,” he said.

Several other states that contacted said they had not yet formulated a formal response to the document. Senior health officials from Tripura, and Karnataka claimed they have not yet received the document.

With health being a state subject under the Constitution, the response of states are expected to vary. For instance, Dr K Bhandari, secretary for healthcare, human and family welfare in Sikkim, said that his state’s districts are too small for projects on a public-private partnership mode. “Our population is just over six lakhs,” he said. “It will not be profitable for the private sector.”