Interventions in Telangana, Karnataka should be replicated elsewhere for better health outcomes

Given clear political direction and funds, governments can deliver. That is the message I got in my two recent visits to Bengaluru and government facilities in the Sangareddy district of Telangana state. In both cases, I came back inspired by how much is being achieved for so little, restoring my belief in the fact that for India, both public and private have to work together and policymakers must continue to repose trust and faith in the public sector.

Karnataka has been a pioneer state. Way back in 1998, it was the first state to come up with a community-based health-insurance model under which wage losses of the poor undergoing inpatient treatment were reimbursed. In 2003, Dr Devi Shetty worked with the government to launch Yeshasvini, the health-insurance model that has since been modified and replicated nationwide. Since then, Karnataka has come up with a plethora of insurance schemes covering all age groups. The attempt, now,  is to merge all schemes into one in order to leverage its market power to buy quality services at affordable rates. On an average, Karnataka is currently providing high-end tertiary-care services at about Rs 50,000 per head on an average through a network of over 180 hospitals. The strategy intelligently consists also of incentivising its own hospitals as well, thereby providing a bulwark against any attempts of private hospitals to hold the government to ransom for increasing rates. This was seen in a strike of private hospitals a few months back, where public hospitals helped reduce disruption to patient care by doubling output. The government is now coming up with a law to have all hospitals display the rate cards. This is likely to enable greater transparency and will be a milestone in helping assess quality and price.

In Telangana, the government is heavily investing in strengthening the quality of service in public hospitals in terms of infrastructure, hygiene and over all care. Peoples’ response to the multipronged strategy — comprising good quality care, courteous treatment, cash incentive of Rs 12,000, a delivery kit consisting of 26 items for the newborn valued at Rs 2,000, and free transport — has been overwhelming. In the last six months, institutional deliveries in public hospitals have seen a steady climb from 30 per cent to 41 per cent with beneficial implication on C-section rates that are about 21 per cent in government hospitals compared to three times in private.

Most inspiring is the Special Newborn Care Units (SNCU)  in district hospitals. The Sangareddy District Hospital, for example, with its 20 ICU beds for babies weighing less than one kg, has been a major turning point in saving lives. Free treatment available for children born in a public or a private hospital saves the family Rs 10,000 per day as charged in a private hospital. These SNCUs established since 2009 in 546 district hospitals have treated over 6 lakh infants that would otherwise have died. This development has been a game-changer and is likely to impact on reducing neonatal mortality.

The question is not whether public healthcare is bad and private institutions are good, but of according priority to health, increasing budgets, and providing quality care to all in equal measure. Public policy needs to factor in all the stakeholders and formulate policies in accordance with the strengths and capacities of each sector. A clarity in objectives, policy design, financing systems, and incentive structures are a prerequisite. Policy requires to be based on evidence and an understanding of the institutional framework consisting of values, organisation of service delivery, availability of human resources, and current disease burden. Merely privatising public assets is a lazy option and can be suicidal in the long run. Clearly, Karnataka seems to have achieved a balanced approach through its two-pronged strategy — using mid-level profit-oriented private, not-for profit and charitable hospitals alongside public hospitals, and strategically purchasing only those services that are unavailable in the public sector and are cheaper to procure from the private. Undoubtedly, a non-commercial private institution has huge potential in terms of spread and capacity as compared to profit-driven corporate hospitals that only accounts for 3 per cent of the private sector.

Delhi needs to learn and build policy along these lines. There is a huge potential and hope in the future with states beginning to take responsibility for the health of their people.

The author is former Union secretary, Ministry of Health, GOI, and author of Do We Care? India’s Health System