Sumi Sukanya Dutta By

NEW DELHI: The idea to privatise district hospital — on which the Centre’s top think tank Niti Aayog is still trying to build consensus — was declared as the official policy of the Modi government on Saturday. Union Finance Minister Nirmala Sitharaman, in her budget speech, said that district hospitals will be attached with private medical colleges on public-private partnership mode. “Those states that fully allow the facilities of the hospital to the medical college and wish to provide land at a concession, would be able to receive viability gap funding,” said Sitharaman.

A few weeks ago the Niti Aayog had released a 250-page document on ‘Scheme to link new and/or existing Private Medical Colleges with functional District Hospitals through PPP’ for feedback from stakeholders after which a stakeholder’s meet was also held late last month. The document, among other things, said that once the district hospitals are taken over by private companies— they will have to have at least 750 beds — and nearly half the beds would be marked as “market beds” while the rest would be “regulated beds”.

The proposal, mentioned in the Budget, has raised doubts. “Since public funding is proposed through duties on medical devices, caution needs to be exercised to ensure that the privately managed public hospitals do not inappropriately overuse devices to generate revenues for their growth through this revenue stream,” said K Srinath Reddy, president of the Public Health Foundation of India. Sitharaman also announced that viability gap window will be set up for hospitals in the PPP mode.

“In the first phase, those aspirational districts will be covered, where presently there are no Ayushman empanelled hospitals.” Meanwhile, total allocation for the health sector for the upcoming financial year is Rs 69,000 crore — marking a rise of just 8 per cent from last year.

“This will not create the momentum needed for a public financing goal of 2.5 per cent of GDP by 2025, which requires a near doubling by then,” Reddy said. The allocation to Pradhan Mantri Jan Aarogya Yojana also remained static at Rs 6,400 crore. Public health expert Oommen C Kurian expressed displeasure over cutting the National Health Mission funds saying that if the government does not wake up and make substantial strategic investments in the health systems, innovative initiatives like Ayushman Bharat will also end up as a missed opportunity.

Some experts also flagged no marked increase towards strengthening primary health centre. “While few flagship initiatives such as PMJAY, Mission Indradhanush and Tb have received dedicated allocation, a stepmotherly treatment towards strengthening primary health and the growing burden of non-communicable disease is unfortunate,” said Oommen John of the George Institute of Public Health.

OTHER ALLOCATIONS

An allocation of Rs 2,100 cr has been made to the Department of Health Research in the 2020-21 Budget. The Ministry of AYUSH has been allocated Rs 2,122.08 cr for the next fiscal.