DNA India
05 July 2010
By Deepa Suryanarayan

SevenHills Hospital at Marol, a whopping 1,500–bed super speciality hospital – inaugurated by President Pratibha Patil on Sunday – is the city’s newest entrant in the healthcare sector. It is also the Brihanmumbai Municipal Corporation’s latest experiment into the much–touted Public Private Partnership (PPP) model, which, if found to be successful, might change the way healthcare needs are taken care of in the city. DNA speaks to Ravi Duggal, healthcare activist associated with Janswasthya Abhiyan (People’s Health Movement) on the feasibility of the PPP model in health care in a city like Mumbai

Do you think the PPP model can work in the Mumbai scenario?
I am a little apprehensive about the success of the PPP model as I am not aware of a single PPP model in the health care sector that has been 100% successful so far. It has found sporadic success in Gujarat, where private gynaecologists were involved to provide maternity care to expectant mothers. In the past, most PPP models have been used by the private sector to milk the state. There has been no regulation and no monitoring done to ensure that the beneficiaries of the subsidies adhere to their promises of offering subsidised services to poor and needy patients.

In Mumbai, many private hospitals are registered as trusts, which are not–for–profit companies. There is a very clear liability on them to reserve beds for charity. However, since there is neither accountability on the part of hospitals nor enforcement from government agencies, this is not followed.

Can you recall past examples of the times the PPP model has not succeeded?
Mumbai’s GT Hospital was the first to be taken up for the PPP model, in the late nineties, after which we set up a committee for the protection of public hospitals. The government’s plan was to give away the entire responsibility to the private hospital but, after our protests, they evolved a new plan where it would be jointly owned and a certain number of beds and facilities reserved for BMC.

However, there have been so many examples where the PPP model has failed. No action has been taken by the Delhi government against Apollo Hospital despite a high court order, following an enquiry committee’s investigation report pointing out discrepancies.

The pulse polio campaign in Mumbai, where private doctors were empanelled to provide the vaccine were found to be charging a fee to deliver the vaccine to patients, despite the fact that the BMC was already paying remuneration.

Has the PPP model worked abroad?
Organised health care systems, like in Europe and Canada, can broadly be called PPP models, where the financing is controlled by the public sector, while the delivery of healthcare is done by private sectors. But, there too, they are regulated, audited and there is a complete and thorough check on their practice.

How can we make the PPP model work?
What is really needed is a regulatory body like Securities Exchange Board of India or Insurance Regulatory and Development Authority, which functions as a judiciary, can adjudicate, demand full accountability and take people to task when promises are not honoured. The current Medical Council of India is not up to the task. Another thing is that both the public and private health sectors should be governed by the same rules.