Opinion | Why India needs public-private partnerships in healthcare

Latest update:November 03, 2024 01:59 pm IST

By promoting collaboration between the public and private sectors, India can create a more robust and responsive system that benefits both patients and healthcare providers.

New models of engagement with the private sector are important, the authors write.

Although the Indian government is the largest funder of healthcare, more than 70 percent of healthcare services in the country are provided by private companies. However, the effectiveness of this system is hampered by deep mistrust between the public and private sectors. One way to combat this mistrust is to collect more data on how to incentivize for-profit organizations to help achieve public health goals.

Promising examples of public-private partnerships have emerged in recent years, demonstrating that challenges in this area can be overcome. These include private ambulance services under government contract in most Indian states, a patient and provider support agency that helps treat tuberculosis (TB) cases in more than 300 districts, and the participation of thousands of private hospitals and clinics in the provision of vaccines against Covid-19. .

Drawing parallels with private sector participation in the fight against NCDs, India could also leverage the private health sector for early detection and monitoring as it combats infectious diseases. Early detection can lead to rapid and non-invasive treatment, and improved private sector capacity can strengthen the public health infrastructure for comprehensive screening.

Fighting tuberculosis: a case study

Tuberculosis remains a major problem in India, both in terms of diagnosis and treatment adherence. In 2023, about 25.55 thousand cases of tuberculosis were reported. India’s goal of becoming tuberculosis-free by 2025 faces major hurdles, primarily due to difficulties in patient adherence to anti-tuberculosis treatment (ATT).

Key barriers to medication adherence include pill burden, side effects, forgetfulness, missed appointments, transportation costs, lack of social support, and poor communication between patients and health care providers. To address these issues, the Government of India introduced fixed-dose combinations (FDCs) in 2017 under the revised National Tuberculosis Control Program (RNTCP). These drugs, which combine multiple TB drugs into one tablet, simplify treatment, improve adherence, reduce drug resistance, and optimize TB treatment. FDCs have become the cornerstone of India’s efforts to control TB, supported by global organizations such as the World Health Organization.

The Patient Provider Support Agency (PPSA), a third-party organization, works closely with the private sector to offer services such as sample collection, access to free government FDC in private healthcare settings and patient counseling. However, PPSA faces challenges in coordination, data management, patient tracking, resistance from private providers, and low FDC utilization.

The need for public-private cooperation

Recently, collaboration between PPSA and a commercial organization has shown promise. These companies provide services such as drug delivery, sample collection, patient counseling and online consultations. For example, a pilot project evaluated by the Max Institute of Healthcare Management of the Indian School of Business examined the impact of this collaboration on the implementation of FDC in Surat and Ahmedabad, Gujarat. During the pilot, PPSA services remained unchanged, with a commercial partner delivering FDC directly to patients’ homes. Patients uploaded their prescriptions online and received monthly refills as well as reminder calls.

The results were encouraging, with patients reporting a preference for the convenience and privacy of home birth, which led to a significant increase in FDC use. The willingness of private providers to share electronic prescriptions has reduced the need for monthly trips to clinics, ensuring continued medication use.

According to a report by the Indian School of Business, the percentage of patients prescribed FDC by private providers increased from 42.46 percent to 55.89 percent during the pilot project. Community health workers employed by PPSA played a critical role in patient education, treatment adherence, stigma reduction, and care coordination.

Need for evidence and innovation

This example highlights the importance of collecting more data on the impact of existing models of engagement with the private sector, as well as exploring new approaches to health care delivery. As India undergoes an epidemiological transition from acute infectious diseases to NCDs and chronic diseases, new models of private sector participation are needed. These models should focus on population health management, continuity of care, and value-based approaches to health care financing and delivery. Moreover, technological advances in artificial intelligence and data science can improve the effectiveness and reach of these partnerships.

Today, India’s healthcare system is at a crossroads; by promoting collaboration between the public and private sectors, it can create a more robust and responsive system that benefits both patients and healthcare providers.

Amanjeet Singh writes at the intersection of health and public policy; Samriddhi Gupte is a senior fellow at the Max Institute of Healthcare Management at the Indian School of Business. The views expressed in the article above are personal and belong solely to the author. They do not necessarily reflect the views of News18.