Niti Aayog Frames PPP Guidelines for District Hospitals | 18 Oct 2018

Niti Aayog, along with technical assistance from the World Bank, has formed guidelines for Public-Private Partnership (PPPs) for providing health services in district hospitals.

• The documents have been designed to supplement efforts for provision of prevention and treatment services of non-communicable diseases (NCDs) related to Cardiac Sciences, Oncology, and Pulmonary Sciences at the district hospitals in tier 2 & 3 cities.
• PPP for NCDs in district hospitals will play a pivotal role in ensuring the availability of the services at the district headquarters.

Background

• The contribution of non-communicable diseases (NCD) to the overall disease burden in the country has increased over the years. But district hospitals in the country have focused mainly on communicable diseases and reproductive and child health. As a result of which the capacity for handling NCD cases by district hospitals has not been adequately developed.
• Presently, in India patients have to travel long distances for availing medical services for NCDs due to urban bias in the availability of private health care, especially secondary and tertiary care which is skewed towards Tier-1 cities.
• National Programme for Prevention and Control of Cancers, Diabetes, Cardiovascular Diseases and Stroke (NPCDCS) was launched by the Ministry of Health and Family Welfare (MoHFW) in 2010.
• One of the objectives of the programme is to:
  • Build capacity at various levels of health care for prevention, early diagnosis, treatment, Information Education Communication (IEC) and Behaviour Change Communication (BCC), operational research and rehabilitation.
  • Provide support for diagnosis and cost-effective treatment at primary, secondary and tertiary levels of health care.

NITI Aayog Guidelines 

• PPP Units will be established in District Hospitals
• The model covers the prevention and treatment of three Non-Communicable Diseases- Cardiovascular diseases, Cancers and Pulmonary Diseases.
• The scope of services:
  • Oncology: Palliative care, Medicinal /Conservative Management (including Chemotherapy, Growth Inhibitors & Hormone Therapy)
  • Pulmonology: Emergency Management of acute syndromes, Medicinal/Conservative Management for COPD, Bronchial Asthma and Bronchoscopy.
  • Cardiology: Emergency Management of acute syndromes, Medicinal/Conservative Management, and Angiography/Angioplasty.
• All these services in PPP facility will be offered by a Single partner or a single group of private partners.
• The private partner will invest in upgrading/building and equipping the facility and responsible for operational management and service delivery.
• The government will provide physical space & other infrastructure in ‘as-is-where-is’ condition, provide support facilities and hospital amenities.
  • Four PPP models—Management of Contract, Purchasing of Services, Build, Operate and Transfer Model or a Co-location Model—have been proposed.
  • In the Management of Contract model, the state government will bring in a private partner for a period of 10-15 years of investing in equipping the government facility, hiring human resources and managing the facility, while the government will reimburse the private partner.
  • In the Purchasing of Services model, the state government will identify medical and surgical procedures that a private partner, will carry out and the government will pay or co-pay the costs. This will be for a period of one to three years.
  • In the Build, Operate and Transfer Model, the private partner will have the vacant land offered by the government for thirty years or more and will finance the project.
  • The Co-location model will involve government allowing a private partner to set-up a separate facility through private investment within an existing government hospital premise for a duration of 15 years with a renewal option and it will allow the private facility to charge patients.
• ‘User Fee’ can be charged by the private entity from patients.