Introduction
The Niti Aayog, in cooperation with the World Bank, has developed guidelines for Public-Private Partnership (PPP) in providing health services in district hospitals. These guidelines have been created to bolster efforts in prevention and treatment services for non-communicable diseases (NCDs), which include Cardiac Sciences, Oncology, and Pulmonary Sciences. The focus here is on district hospitals serving tier 2 & 3 cities. Leveraging PPP to fight NCDs will be pivotal in ensuring the availability of necessary health services at the district level.
Background on Non-Communicable Diseases in India
Over the years, the number of cases of non-communicable diseases (NCDs) contributing to the country’s overall disease burden has increased. However, district hospitals have primarily focused on communicable diseases along with reproductive and child health, leading to an underdeveloped capacity for managing NCD cases. Currently, patients typically have to travel extensively to access medical services for NCDs due to urban bias in private healthcare availability, especially secondary and tertiary care, which leans towards Tier-1 cities.
To address this, the Ministry of Health and Family Welfare (MoHFW) launched the National Programme for Prevention and Control of Cancers, Diabetes, Cardiovascular Diseases and Stroke (NPCDCS) in 2010. This initiative aims to build healthcare capacity at various levels, support diagnosis and cost-effective treatment, and encourage prevention, early diagnosis, treatment, operational research, and rehabilitation.
Details of NITI Aayog Guidelines
Under the new guidelines, PPP Units will be set up in District Hospitals. These units will cover the prevention and treatment of three key NCDs: Cardiovascular diseases, Cancers, and Pulmonary Diseases. The type of services these units will provide includes emergency management of acute syndromes, medicinal/conservative management for COPD, Bronchial Asthma and Bronchoscopy, and palliative care related to oncology.
The private partner will be responsible for investing in the facility’s upgradation/building and equipping while also managing operations and service delivery. Meanwhile, the government will provide physical space & other infrastructure in an ‘as-is-where-is’ condition along with support facilities and hospital amenities.
Four PPP Models Under NITI Aayog Guidelines
| PPP Model | Description |
|---|---|
| Management of Contract | The private partner is brought in by the state government for 10-15 years to equip the facility, manage the operation and hire human resources. The government reimburses the private partner. |
| Purchasing of Services | The government identifies medical and surgical procedures for the private partner to perform for a period of one to three years. The government pays or co-pays the costs. |
| Build, Operate and Transfer Model | The private partner gets the vacant land from the government for thirty years or more to finance the project. |
| Co-location Model | The government allows the private partner to set-up a separate facility within an existing government hospital premise for a duration of 15 years. The private facility can charge patients a ‘User Fee’. |
This is the Current Situation with PPP in Healthcare
Under these models, a single partner or a group of private partners will offer all services at the PPP facility. This innovative approach to health services aims to provide a sustainable solution to the rising burden of non-communicable diseases in India’s tier 2 & 3 cities.
