The private sector falls out of the ambit of the Right to Information (RTI) Act and fails to disclose basic morbidity and mortality statistics to the government.
Published Jul 21, 2025 | 5:00 PM ⚊ Updated Jul 21, 2025 | 9:54 PM
The current PPP model is part of its effort to ‘penetrate the markets’ in tier-two and -three towns and rural areas.
Synopsis: The latest PPP model being pushed by NITI Aayog requires private entities to build medical colleges in districts because it was “impossible for either the state or Union governments to bridge the gap in health and medical education infrastructure”. Adding a cherry on top, the government will also hand over district hospitals, including land, buildings, and staff, to private entities to serve as students’ clinical experience sites.
There is ample evidence that elected representatives and bureaucrats vested with the responsibility of ensuring healthcare to citizens are failing us in every way possible, handing over taxpayers’ money and public goods to an unregulated, unscrupulous and corrupt private sector.
Its proof includes last year’s announcements by the governments of Andhra Pradesh (AP) and Karnataka that they would set up new medical colleges under the Public Private Partnership (PPP) model.
It is a sobering thought that, under the guise of upgrading hospitals and increasing the number of medical colleges, public hospitals and public land worth crores of rupees are being handed over to private entities, with the NITI Aayog at the helm.
These violations occur despite the lack of evidence that these models benefit people. Further, the National Health Policy 2017 made PPP one of its key strategies, purportedly to strengthen the public health system, after consultations of the Union government and NITI Aayog with the World Bank in 2017.
The latest PPP model being pushed by NITI Aayog requires private entities to build medical colleges in districts because it was “impossible for either the state or Union governments to bridge the gap in health and medical education infrastructure”.
Adding a cherry on top, the government will also hand over the district hospital, lock, stock and barrel, including land, buildings and staff, to the private entity to serve as students’ clinical experience sites.
In Karnataka, over 2,000 beds in nine district hospitals, worth more than ₹1,000 crore of public money, and hundreds of acres of public land, will be handed over. As if this was not enough, the Union and state would each provide 30-40 percent of the capital expenditure with a further 25 percent from each for operation and maintenance for the first five years.
Andhra Pradesh claims to have begun construction of 3,318 new buildings with ₹1,065 crore in central assistance in just one year and has also received a ₹100 crore performance incentive under the National Health Mission (NHM) and the Ayushman Arogya Mandir (AAM) initiative.
When the government is providing land, building, staff and equipment — bearing a substantial cost of capital expenditure — and also providing a part of the operational costs, it is only fair that citizens ask: Why isn’t the government investing in its own system? Why is it siphoning off taxpayers’ money into the coffers of the unregulated, unaccountable, predatory private sector?
Despite people’s resistance to this model, why is the government hell bent on going ahead? The answer lies in NITI Aayog’s policy documents, which are littered with references to business opportunities for global corporate cartels in India’s health care industry. It unapologetically refers to the Indian population as a ‘multi-billion-dollar health care market’.
The current PPP model is part of its effort to “penetrate the markets” in tier 2 and 3 towns and rural areas. If the intent and efforts of the apex policymaking body of the country is not to provide free universal health care to the suffering millions in this country but to afford access to “markets” for corporate cartels then it is no surprise that 80 percent of the households primarily depend on their “household income/savings” and 13 percent on “borrowings” to finance expenditure on hospitalisation.
Despite the litany of PPP failures in Karnataka (Karuna trust, Mother and Child hospital Udupi, Arogya bandhu scheme, Apollo OPEC Hospital, Raichur), this model takes a step further and is set to dismantle the last remaining bastion of health care for the poor and also ensure that medical education remains beyond the reach of young people from marginalised communities.
The private entity in the model is expected to reserve 20 percent of beds for free patients and can charge “competitive market rates” for the remaining 80 percent for those who can pay.
As if this is not bad enough, those with Below Poverty Line (BPL) cards have to seek authorisation to avail the free bed. We have seen with the government health insurance scheme that they are, by design, meant to make healthcare less accessible, especially to those who need them most.
Sadly, these issues are already well known and documented. Yet the government is wilfully allowing a free government hospital to morph into a profit-seeking commercial enterprise.
Although the PPP model for medical colleges may increase the number of MBBS seats, it will be unaffordable for the majority, particularly those from vulnerable communities. Constitutional mandates related to labour laws, reservation, domicile in hiring etc., will be left in limbo, thus ensuring that the medical profession continues to be within the vice-like grip of the privileged caste and class groups.
Private medical colleges are already in disrepute for unethical practices, right from how they appoint faculty to violating National Medical Council (NMC) guidelines to the quality of students who graduate. Private medical colleges are now business entities churning out half-baked “doctors” who have little commitment to medical ethics or patient care and who then go on to practice in exploitative corporate hospitals.
The government has repeatedly demonstrated its failure to hold private institutions accountable, to push for laws that protect patient rights (Karnataka Private Medical Establishments (KPME) Act), enforce agreement clauses (audits, reports, data, etc.) or protect public institutions and public land.
On the other hand, the private sector falls out of the ambit of the Right to Information (RTI) Act and fails to disclose basic morbidity and mortality statistics to the government. In effect, the government will take on a major share of the responsibilities and liabilities, while the private entity will have all the rights and profits. Patients, citizens and communities, and even local elected representatives, will only fall by the wayside.
The plan to auction 103 district hospitals (in the first phase) with a total of 29,561 beds to private entities and allow the latter to set up medical colleges turns out to be by far the most brazen of additions by NITI Aayog to the playbook on how to destroy the public health system and endanger people’s health even more.
The chief minister of Karnataka belongs to one of the oppressed communities and has risen to the present position from the ranks of progressive people’s movements. One would expect him to see reason and stop this disastrous move. However, it looks as if he is all set to betray the trust of the people who returned him to power.
If he indeed has a sense of social justice and moral courage, he will stop his government’s disastrous move. Health is a state subject. And states have the choice and right to not implement a Centre’s policy proposal. Yet, the Karnataka government, which lays claim to the legacy of Buddha, Basavanna and Ambedkar, has shamefully chosen to go ahead and implement this policy.
Karnataka, for one, should be the first state to refrain from implementing this model given that the state has the dubious distinction of being the laboratory for testing out the PPP models, all of which now constitute a litany of miserable failures, whether at the primary or tertiary level.
(Dr. Akhila Vasan is a public health researcher affiliated with Karnataka Janaarogya Chaluvali. Dr. Sylvia Karpagam is a public health doctor and researcher. Views expressed are of the authors. Edited by Majnu Babu.)
