How public-private partnerships could be the booster dose for India’s healthcare ecosystem

This article is brought to you thanks to the collaboration of The European Sting with the World Economic Forum.

Author: Neelima Dwivedi, Executive Director, Public Policy, Communications & Market Access, MSD, Ruma Bhargava, Country Lead, Healthcare, World Economic Forum

• The two biggest challenges affecting healthcare in India are affordability and accessibility, with urban and rural experiences varying greatly.
• COVID-19 catalyzed healthcare collaborations between public and private sectors as never before in diagnostics, technology and treatment.
• Experience shows that public-private partnerships could be used to improve healthcare delivery across India, particularly in more rural areas.

The two most prominent challenges in the sustained availability of equitable healthcare for all are affordability and accessibility. However, the COVID-19 pandemic has shown how public-private partnerships could address both issues for India’s rural communities.

Official figures highlight just how big these two hurdles are. To address affordability, the Indian government spends a mere 2.1% of GDP on healthcare compared to 9.7% across OECD countries, with more than half (55%) of healthcare expenditure coming out from the pockets of citizens.

With the total population of the world’s second most populated country estimated to be 1.4 billion, this financial burden pushes 55 million Indians into poverty every year.

When it comes to accessibility, India’s rural and urban populations have diametrically opposite experiences of healthcare. Urban residents, who account for just 28% of India’s population, have access to 66% of the country’s hospital beds, while the remaining 72% of the rural population have access to just one-third. Furthermore, 67% of doctors in India practise in urban areas.

Pandemic prompted collaborations on healthcare

But, during the recent COVID-19 pandemic, something rare happened. The pandemic catalyzed both the public and private sectors leading to collaborations like never before in diagnostics, technology and treatment for saving lives.

The synergies that were seen in the management of COVID-19, are unprecedented. The CoWin portal, a technology-backed public-private portal for the world’s largest COVID-19 vaccination drive in India, is the best example.

The pandemic has shown us strong evidence that by working together, the public and the private sectors can take quality healthcare to the last mile a lot faster and a lot more affordably.

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At this juncture, it would be a massive failure on the part of the healthcare fraternity if we do not further explore the feasibility of such public-private partnerships (PPPs) in managing other deadly diseases that threaten humanity.

The private sector now has a rare opportunity to fundamentally redefine its relationships with health systems, healthcare providers and patients.

Success of PPP model in Indian healthcare

The PPP model has met with reasonable success in India over the past decade, backed by a slew of policy initiatives. The setting up of a public-private partnership appraisal committee has streamlined appraisals and approvals of projects, in addition to bringing in greater transparency and competitive bidding processes.

In 2021 alone, India received US$7.7 billion of committed investments across 25 projects, the largest in the South Asia Region. Whereas most countries in South Asia Region saw a sharp drop in PPI compared to 2020, India saw a 49% increase in private investment commitments.

As the resources are being pledged for PPP projects, it remains equally important that these initiatives are practically curated according to situations on the ground and aim for realistic outcomes.

Here are three ways that PPP projects can help address the problems of accessibility and affordability in rural Indian healthcare:

• Expertise: The private sector provides 58% of hospitals and 81% of doctors in India and this expertise pool is predominantly urban-centric. The public sector, in turn, has the basic last mile infrastructure in terms of sub-centres and primary health centres to reach the remotest populations. Making the private sector services and expertise available in these public health facilities could be a game changer.
• Technology: Technology is the primary driver for ensuring accessibility and affordability in many cases, including this scenario above. There is a reason why specialist resources are urban-centric, and we cannot afford to wait till this distribution goes on to become universal. Technology is the tool to be harnessed to take the urban expertise to rural settings with minimum physical movement of the patient or of the specialist. Telemedicine initiatives are a strong case in point, the national teleconsultation service eSanjeevani being an apt example.
• Efficiency: The PPP model can ensure that the existing medical infrastructure and resources be leveraged though optimum utilization, at an affordable cost to the end user.

There are already some PPP initiatives that are making good use of either one or more of the above-mentioned elements in their strategy and have either made or are making good progress towards the intended impact.

Pune Municipal Corporation’s recent Vaccine on Wheels programme, for example, aims to increase immunization in India through an equitable, affordable and convenient vaccination service for all by creating hospital-like sterile setups near their communities providing vaccination services.

Yeshasvini Cooperative Farmer’s Health Insurance Scheme, which was initiated by Narayana Hrudayalaya, Bangalore’s super speciality hospital and the Karnataka government, is a landmark initiative that has come as a great boon to the farmers in the state.

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How is the World Economic Forum enabling an inclusive global health ecosystem?

How do we ensure every person has equal access to the highest standards of health and healthcare?

The World Economic Forum’s Platform for Shaping the Future of Health and Healthcare leverages a data-enabled delivery system and virtual care, from precision prevention to personalized care delivery. It works to preserve health, enable access to care, accelerate sustainability of healthcare systems, as well as prepare and respond to epidemics.

• The Forum actively supports global vaccine delivery, launching Gavi, the Vaccine Alliance, and contributing to saving more than 13 million lives over 20 years, and contributing to COVAX having delivered more than 1 billion COVID-19 vaccines worldwide.
• Through its COVID Action Platform, the Forum and its partners provided solutions to navigate the COVID-19 pandemic worldwide, launching more than 40 initiatives to protect lives and livelihoods.
• In collaboration with the Global CEO Initiative on Alzheimer’s Disease, the Forum launched the Davos Alzheimer’s Collaborative to accelerate progress on discovery, testing and delivery of interventions for Alzheimer’s.
• In partnership with Deloitte, the Forum developed a Global Governance Toolkit for Digital Mental Health to support lawmakers in developing successful policies on technology for mental health.
• The Forum’s Global Coalition for Value in Healthcare is working to create a more sustainable and equal healthcare industry. Its first value-based healthcare innovation hubs in the Netherlands, Portugal, Wales and Denmark are working to eliminate ineffective spending on global health.
• The UHC2030 Private Sector Constituency, hosted by the Forum, released a statement highlighting the role the private sector can play in achieving universal health coverage.

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Members can avail themselves of free surgery costing up to INR125,000 ($1,545) and INR200,000 for multiple surgeries and in urban Yeshasvini, the maximum limit of treatment per person for single admission is INR175,000 and for multiple admission is INR250,000 in the same year.

The Arogya Raksha scheme in Andhra Pradesh is another insurance scheme initiated by the state government, in collaboration with New India Assurance Company and private clinics wherein. End-to-end cashless services for 1,059 diseases under secondary and tertiary care are being provided through 400 government and corporate network hospitals.

Public-private partnerships can turn around healthcare

To conclude, we must re-emphasize that if used judiciously and well-curated to local settings and needs, the PPP projects can quickly turn around the prevalence of quality healthcare in resource-constrained settings in an affordable way.

Still, the current scenario is at a nascent stage, and a lot of distance is still to be covered. The need of the hour is to move from a transient basis of collaboration and instead establish a long-term mutually beneficial partnership model.

This will enable long-term relationships that can lead to sustainable improvements in health systems.