Several organisations oppose Karnataka’s move to privatise district hospitals

“Instead of bettering the district hospitals, Karnataka’s move will worsen the existing conditions. It will not help the rural population,” he added.

Government is cheating the poor

Karnataka Janaarogya Chaluvali, Ambedkar Sene, Bhoomi Vasathi Horata Samithi, Yuva Munnade and several other Dalit organisations recently held a news conference in Chitradurga to express anguish over the move to privatise district hospitals.

Chigateri District Hospital, Davangere, is one of the district hospitals that has been chosen by the state government to operate under the PPP model. (Supplied)

“We came to know that several meetings have been going on and the state government has finalised the PPP model for Chigateri Government Hospital in Davangere and Chitradurga district hospital,” Yadav Reddy, District Unit president of Swaraj India, told reporters.

“On the pretext of renovating and merging the district hospitals (with medical colleges), the government has decided to lease out the land, building, staff, and equipment to a private organisation for at least 60 years. We are against it,” he added.

‘Disastrous plan’

District hospitals provide the main indicators of health in the state, Seethappa pointed out. There are no goals set for private entities to achieve within a stipulated time frame.

Explaining, he further said: “We don’t know what will happen to maternal and infant mortality rates. District hospitals play an important role in improving these indicators.”

Once private players take over the hospitals, only a specific number of beds would be set aside for providing free treatment. “The rest will be paid ones. Which private entity is interested in promoting free beds,” he asked.

Previous PPP models failed to reserve three or 10 percent of the beds for the poor. “The poor and vulnerable sections will be denied access to healthcare once the hospitals are privatised. Currently, all beds are free and accessible to the poor. But privatising hospitals will restrict such access,” he added.

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Niti Aayog’s move condemned

The Niti Aayog has defended its pro-privatisation policy. It pointed to the “success” of government-private partnerships in Karnataka to further expand such models.

“The Niti Aayog is imposing them on state governments after ignoring strong evidence against such models. By doing so, the Central government is deliberately betraying and deceiving the people. The previous government in Karnataka had rejected the policy. But the present government is pursuing it,” the protesters said.

Meanwhile, condemning the move, EAS Sarma, a former bureaucrat from Andhra Pradesh, wrote to the Niti Aayog in October. Inducting private agencies into district hospitals would progressively weaken the vast social security cover that the latter has been providing. Private agencies are known to exploit such an opportunity to maximise their profits in every possible way, he said.

Representational image (Wikimedia Commons).

“Even if the PPP arrangement were to be governed by a well-defined agreement between the State Health Department and the private agency, the latter, usually having political clout, would invariably tend to have an asymmetric dominance in implementing the terms of the PPP contract,” he argued.

“Promoters of many private hospitals have their labs, and patients are forced to undergo tests at exorbitant rates,” he pointed out.

Call for strengthening district hospitals

Citing examples of failed PPP healthcare models in several states such as Gujarat, Maharashtra and Chhattisgarh, he said the Niti Ayog did not appear to have learnt lessons from experience.

He cited a scholarly article by Manoj Mohanan, et al, in The Bulletin of the World Health Organisation in March 2014 to buttress his argument.

“The Directive Principles of the Constitution require the state to discharge its welfare obligations, which include ‘to raise the level of nutrition and the standard of living and to improve public health’ (Article 47). Providing social security in healthcare for low-income households is an important part of these obligations. Such a social security cover is presently provided, among others, by the district hospitals,” he told South First.

EAS Sarma demanded the Centre and states invest more in the health sector to expand the network of district hospitals. Explaining, he said the governments should strengthen the hospitals by providing technical, financial and infrastructure facilities, hiring adequate medical and paramedical personnel, and making them accountable for the quality of healthcare services.

“Privatisation of even some of the services in hospitals won’t help. Privatisation introduces cost barriers for the poor, which they cannot overcome,” he said.

He warned that if states went ahead with implementing the PPP model in district hospitals, it would set in motion a regressive process of dismantling a crucial social security cover that has been providing free healthcare services to the poor. “It cannot be reversed easily,” Sarma added.

Districts identified

Karnataka has identified nine districts — Kolar, Bagalkot, Chitradurga, Tumakuru, Udupi, Dakshina Kannada, Davanagere, Bengaluru Rural, and Vijayapura — to hand over government-run district hospitals to private entities and attach them to the new medical colleges. The district hospitals will then be run on a PPP basis.