India needs PPP for robust healthcare

Although the Indian government is the largest healthcare spender, more than 70 per cent of the country’s healthcare services are provided by private players. However, the effectiveness of this system is hampered by deep mistrust between the public and private sector. One way to address this mistrust is by generating more evidence on how to incentivise for-profit organisations to help meet public healthcare goals.

In recent years, promising examples of public-private partnerships have emerged, demonstrating that challenges in this area can be overcome. These include privately managed, government-contracted ambulance services across most Indian states, patient-provider support agency that help manage tuberculosis (TB) cases in more than 300 districts, and the involvement of thousands of private hospitals and clinics in delivering Covid-19 vaccines.

Drawing parallels from private sector engagement for management of NCDs, India could also leverage the private healthcare sector for early detection and monitoring, as it grapples with communicable diseases. Early detection can lead to swift, non-invasive treatments, and improving the private sector’s capabilities can strengthen public health infrastructure for comprehensive screening.

Tackling tuberculosis: A case in point
TB remains a significant challenge in India, both in terms of diagnosis and treatment adherence. In 2023, around 25.55 lakh TB cases were reported. India’s goal of becoming TB-free by 2025 faces substantial hurdles, primarily due to difficulties in patient adherence to anti-TB treatment (ATT).

Key obstacles to adherence include the high pill burden, side effects, forgetfulness, missed doctor appointments, transportation costs, lack of social support, and poor communication between patients and healthcare providers. To address these challenges, the Indian government introduced Fixed Dose Combination (FDC) drugs in 2017 under the Revised National TB Control Program (RNTCP). These drugs, which combine multiple TB medications into a single pill, simplify treatment, improve adherence, reduce drug resistance, and streamline TB management. FDCs have become a cornerstone of India’s TB control efforts, supported by global organisations like the World Health Organisation.

The Patient Provider Support Agency (PPSA), a third-party organisation, works closely with the private sector to offer services such as sample collection, access to free government FDCs at private healthcare facilities, and patient counselling. However, the PPSA faces challenges in coordination, data management, patient tracking, resistance from private providers, and low uptake of FDCs.

Need for public-private collaborations
Recently, a collaboration between the PPSA and a for-profit organisation showed promise. These companies provide services such as drug delivery, sample collection, patient counselling, and online consultations. For instance a pilot project, assessed by the Indian School of Business’s Max Institute of Healthcare Management, explored the impact of this collaboration on FDC uptake in Surat and Ahmedabad, Gujarat. Under the pilot, PPSA services remained intact, while the for-profit partner delivered FDCs directly to patients’ homes. Patients uploaded their prescriptions online and received monthly refills, along with reminder calls.

The results were encouraging: patients reported a preference for the convenience and privacy of home delivery, leading to a significant rise in FDC uptake. The willingness of private providers to share e-prescriptions reduced the need for monthly travel to clinics, ensuring continuous medication use.

According to a report by the Indian School of Business, the percentage of patients prescribed FDCs by private providers increased from 42.46 per cent to 55.89 per cent during the pilot. Public health workers employed by the PPSA played a critical role in educating patients, ensuring medication adherence, reducing stigma, and coordinating care.

The need for evidence and innovation
This example highlights the importance of generating more evidence on the impact of existing private sector engagement models, while also exploring novel approaches to healthcare delivery. As India undergoes an epidemiological shift from acute, communicable diseases to NCDs and chronic conditions, new models for private sector engagement are essential. These models should focus on population health management, care continuity, and value-based approaches to healthcare financing and delivery. Moreover, technological advancements in artificial intelligence and data science can enhance the effectiveness and reach of these partnerships.

As of today, India’s healthcare system stands at a crossroads; by fostering collaboration between the public and private sectors, it can build a more robust, responsive system that benefits both patients and providers. News18