Is Provision of Healthcare Sufficient to Ensure Better Access? An Exploration of the Scope for Public-Private Partnership in India

Document Type: Original Article

Authors

1 DumDum Motijheel Rabindra Mahavidyalaya, Kolkata, West Bengal, India

2 Surendranath College, Kolkata, West Bengal, India

Abstract

Background
India’s economic growth rate in recent years has been fairly impressive. But, it has been consistently failing to make considerable progress in achieving health related Millennium Development Goal (MDG) targets. Lack of coherence between provisions and utilization becomes the face of the problem. Inadequacies in outreach, access and affordability coupled with escalating healthcare costs have aggravated the problem. Here the application of PublicPrivate Partnership (PPP) model seems to have enormous potential to ease the impasse.
 
Methods
This paper tries to find the gap between the provisions and access in healthcare. The paper attempts to construct a Health Infrastructure Index (HII) and Health Attainment Index (HAI) for different states of India. Considering the presence of regional variations found in health infrastructure and attainment among the states, two states, viz. Maharashtra (MAH) and West Bengal (WB) have been chosen. Then contributions of health programs like Rashtriya Swasthya Bima Yojana (RSBY), National Rural Telemedicine Network (NRTN) and Fair Price Shops (FPS), all PPP initiatives, have been assessed for both the states by carrying out comprehensive benefit-cost analysis.
 
Results
The health infrastructure for population per unit area captures the outreach/delivery issue and the health attainment reveals the true scenario about how far the infrastructure has been accessed by the people; and the gap between the two, as the paper finds, is the root of the problem. The combined effect of RSBY and NRTN will leave both MAH and WB higher benefits in terms of  health attainment. The contributions of RSBY and NRTN have been assessed for both the states by carrying out comprehensive benefit-cost analysis. FPS comes up with immense benefits for WB. It is yet to be implemented in MAH.
 
Conclusion
The outreach and access problems arising from deficiencies in infrastructure, human resources and financial ability are expected to be well-addressed by the spread of RSBY and NRTN jointly. The FPS mechanism under PPP initiative can be an effective tool in solving affordability problem by reducing the cost of treatment.

Keywords

Main Subjects


  1. Nath A. India’s progress toward achieving the millennium development goals. Indian J Community Me2011; 36: 85-92. doi: 10.4103/0970-0218.84118
  2. Towards achieving Millennium development Goals – India. Social Statistics Division, Ministry of Statistics and Programme Implementation, Government of India; 2013. Available from: http://www.mospi.nic.in
  3. The World Bank: World Health Organization National Health Account Database [internet]. Avaailable from:   http://data.worldbank.org/indicator/SH.XPD.TOTL.ZS
  4. The World Bank [homepage on the internet]. Available from: www.who.int
  5. National Health Profile 2005. Central Bureau of Health Intelligence (CBHI), Directorate General of Health Services, Ministry of Health & Family Welfare,  Government of India India [internet]. Available from:  http://cbhidghs.nic.in/index2.asp?slid=1208&sublinkid=944  
  6. Sample Registration System. [internet]. 2013. Available from:  http://www.censusindia.gov.in/2011-common/Sample_Registration_System.html.
  7. National Sample Survey Organization [internet]. Available from:  http://mospi.nic.in/Mospi_New/Admin/publication.aspx
  8. National Family Health Survey (NFHS-3). Volume I. India: 2005–06.
  9. Census of India. [homepage on the internet]. 2001. Available from:  http://censusindia.gov.in
  10. RSBY [homepage on the internet]. Available from: www.rsby.gov.in
  11. Bagchi S. Telemedicine in Rural India. PLoS Med 2006; 3: e82. doi: 10.1371/journal.pmed.0030082
  12. Lahiri K. Telemedicine, e-Health and Health related IT enabled Services: The Indian Situation. Globsyn Management Journal (GMJ) 2014; 7( 1 and 2).
  13. Government of West Bengal [homepage on the internet]. Available from: http://westbengal.gov.in/
  14. Government of Maharashtra [homepage on the internet]. Available from: https://www.maharashtra.gov.in/
  15. Duggal R, Dilip TR, Raymus P. Health and Healthcare in Maharashtra: A Status Report.  CEHAT, Mumbai; 2005.
  16. Chhattisgarh Health Portal [homepage on the internet]. Available from: http://www.cghealth.nic.in
  17. Article by Dr. Samit Sharma [internet] www.rmsc.nic.in/knowledge/generic%20note.pdf.
  18. Chatterjee M. Indian Women, Health, and Productivity, Policy, Research and External Affairs: Women in Development, WPS 442. Population and Human Resources Department, The World Bank; 1990:
  19. Dutta A. Nyajjyo Mulyer Osudh Sotti Khoroch Komacche (Article in Bengali). Anandabazar Patrika; 2015.
  20. Margit S. Fair Price Medicine Shops in West Bengal An Interesting Price Discovery Mechanism. Economic and Political Weekly 2015: L(2). Available from: http://www.epw.in/reports-states/fair-price-medicine-shops-west-bengal.html