Public–Private Partnerships in Healthcare

In India, the central and state governments have had several arrangements with the private sector for the provision of healthcare for almost two decades, and in recent times the NITI Aayog too has emphasised the need for these (Rajasulochana and Maurya 2020). The National Health Policy, 2017 acknowledges the presence of the large private sector and suggests ways of engaging with it to achieve universal health coverage and a stewardship/regulatory role of the government in the mixed system of public–private providers (GoI 2017: 21). Even globally, the engagement of government with non-state partners has been a critical element of health system reforms in lower- and middle-income countries (Rao et al 2018).

However, concerns have been raised both in India and globally on the implications of public–private partnerships (PPPs) for healthcare access and equity, including issues of transparency and acc­ountability, high costs and user fees, transfer of public funds to private entities, fragmentation of services and weakened health worker rights (Tizard and Walker 2018; Gideon and Unterhalter 2017; Kotecha 2017; Hall 2015). The ethical implications of PPPs have also been questioned (Prasad and Sengupta 2019). Evidence from different states of India points to mixed performance of PPPs. Studies have shown that while the PPPs led to increase in services in some cases, in most there were problems. Reports highlight issues, such as irregularities in functioning, corruption, problems in quality of services, affordability and access, existing in-house services becoming dysfunctional, lack of accountability and systems of monitoring and grievance redressal, and the private agencies facing similar challenges as the government (Khetrapal et al 2019; Baru and Nundy 2008; Karpagam et al 2013; Roy 2017; Roy and Gupta 2011; Venkat Raman and Björkman 2009).