UNIVERSALIZING ACCESS TO QUALITY
Primary healthcare reforms based on PPP model and
integrating medical students in the socio-corporate sector
National Institute of Technology Karnataka
India suffers a shortfall of 2.6 million health workers.
0 50 100
Percentage of health
spending funded by public
Physicians per 10000
Nurses per 10000
Hospital beds per 10000
Infant Mortality Rate per
1000 live births
OECD average India
Disgruntling facts about the Indian primary healthcare
Shortage of primary healthcare centres as envisaged in the
12th Five Year Plan. Only 23,109 PHCs as opposed to the
proposed number of 40,000.
Severe shortage of doctors, nurses, paramedics. To live up
to expected standards, the number of doctors across India
are to be doubled (from 700,000 to 1.5 million), nurses
tripled (from 800,000 to 2.5 million) and paramedics
quadrupled (from 2.5 million to 10 million).
Very high infant mortality rate due to lack of access to
maternity wards, primary healthcare centres. India’s infant
mortality rate is 44.6 deaths/1000 live births as opposed to
the OECD average of 4.6!
People prefer private sector healthcare, even in rural areas,
in spite of various government subsidies. According to
National Family Health Survey-3, the private medical sector
remains the primary source of health care for 70% of
households in urban areas and 63% of households in rural
Shortage of ambulance services in government hospitals.
According to an AIIMS study, 28% of SOS calls are ignored
due to a shortage of ambulances.
Indian healthcare statistics against OECD averages
Outline of the three point solution proposed:
1. A public-private partnership model: private healthcare
providers are granted incentives to set up new Primary
Health Care Centres, with a special focus on remote rural
2. Students of private medical colleges are sent to various
Primary Health Care Centres, as interns, on a short term basis
to address the shortage of medical staff.
3. Students of government-run medical colleges are assigned
the responsibility of organizing awareness programs
regarding primary health facilities, sanitation and other
related issues; along with the help of NGOs. Students of
private colleges are encouraged to do the same.
1. A Public-Private Partnership model: private healthcare
providers are granted incentives to set up new Primary Health
Care Centres, with a special focus on remote rural areas.
70% of urban population & 63% of
rural population of India uses
private based healthcare facilities.
The inefficiency of the
public healthcare facilities
has led to the inception of
the idea of ‘Public-Private
A 20 member committee
comprising retired IAS and
IRS officers, headed by a
retired Supreme Court
This model is based on the
agreement that, 51% of
voting equity rights will
always be reserved by the
The central government
allocates the funds to
A ‘centralised body’ is
set up to initialise,
manage, monitor, co-
ordinate with state and
The central body is to
survey and assign
The private ‘sector’
framework of the model
and daily management
are under the private
Profit balance is to be
tilted in favour of the
Functions of the public and private sector
The required ‘governing’ bodies
The ‘agreements’ regarding
• 1.’Allocation’ of land/ infrastructure.
• With subsidised rates
• 2.The share of ‘profits’ are decided; the private partner is
granted a slightly higher share of profits.
• Direct corporate tax benefits
• 3. Discussions about ‘funding’ of the program.
‘Part-investment’ by the private partner. The investment
will be made at subsidised prices (‘incentives’)
The allocated funds are utilised,
and the ‘PHC’ is set-up.
The ‘P-P-P model’ based
Primary Health Care centre
‘Centralised Body’ - Governing
Private ‘managerial’ body
• ‘Organisational’ management
• ‘Daily’ management
Subsidies are provided
for the people who avail
the services, & the
process is aided by the
Aadhar Card scheme’
SCHEME of IMPLEMENTATION
2. Students of private medical colleges are sent to various Primary
Health Care Centres, as interns, on a short term basis to address
the shortage of medical staff.
• This proposal of sending private
medical college students to intern
at PHCs adheres to two problems:
• Severe shortage of staff at
rural PHCs. PHCs cater to
basic healthcare issues, and
the contribution of medical
interns would thus be
• Lack of practical skills
amongst medical students.
to shortage of
running of and
• Each state government has these primary functions:
A. To classify the PHCs of its state according to staff shortage as:
i. Sufficient staff
ii. Slight shortage of staff
iii.Severe shortage of staff
and to submit a report of the same to the central body.
B. Students are to be assigned to PHCs, preferably nearby their colleges. Severely
understaffed PHCs are to get 2 medical interns, slightly low on staff PHCs are to get 1
intern, and sufficiently staffed PHC do not require any intern.
• The central body is to coordinate with the private institutions and take the
responsibility of the overall governing of the internship program.
• Students are to get a stipend of Rs. 30,000/month and are to serve in the PHCs for a
period of 2 months, which is part of the 1 year mandatory internship.
18 states were identified for special focus by the NRHM in India. The model
shall retain this provision and the PHCs will be set up accordingly.
3. Students of government-run medical colleges are assigned the
responsibility of organizing awareness programs regarding primary health,
sanitation and other related issues; along with the help of local NGOs.
Students of private colleges are encouraged to do the same.
Interact with the local NGO setup & find out the core problems in
that particular community and bring out awareness
Awareness programmes like street plays, puppet shows, putting
up billboards, school visits and organizing small games for young
Preventive health care awareness is crucial. Also special focus on
woman and child health awareness programmes
Students must give a strong emphasis on Information, Education
including hygiene education and effective communication for
behaviour change of locals along with involvement of Panchayati
Raj Institutions (PRIs).
Students should make localities aware of the problems due to
open defecation such as diseases like diarrhoea and try in helping
them create better facilities for defecation
Twice a year a group
of students from
knowledge of the local
language are sent to
the district to spread
awareness among the
local village people
Private college student
participation can be
encouraged by giving
issued by the government
under the programme.
INDIA BRAZIL SRI
MALI RUSSIA CHINA
Per Capita Public Spending on
(Report from World Bank metadata)
₹16 bn for sending students as interns to
• 45,000 interns will be paid ₹30,000 a month
₹200 mn for organizing awareness programs
• 3000 students in groups of 15 will be sent for
awareness programs to rural areas
₹200 bn for government subsidies and
incentives to establish PHCs under PPP model
• 10,000 new PHCs to be set up
₹2 bn to set up a central body to supervise and
• Setting up the 20 member centralized body
₹373.33 bn has been allocated
for public healthcare in the 2013
union budget. Our proposal aims
at an increase to ₹600 bn in line
with the 12th five year plan
A major restructuring of budget will increase per capita public healthcare spending from US$ 21
(as envisaged in the budget) to US$ 34.
The interns from private medical colleges serving in PHCs will address the severe shortage of
staff in the public healthcare system.
As a result the annual budget required for public healthcare will have to be increased to ₹600 bn.
By sending students to rural areas, the medical community will play a more direct role in
improving the quality of primary healthcare.
The PPP model will instil a sense of socio-corporate responsibility amongst private healthcare
The setting up of10,000 new PHCs at target locations, will improve accessibility to healthcare .
Challenges and risks Mitigation factors
Government might be hesitant to fund the
As per the latest budget the government has
already proposed a hike in public spending on
healthcare from 1.6% to 2.2%
Initially corporate sector may not be attracted
to the proposal.
Incentives and long-term benefits
Low co-operation in volunteering from private
college students for awareness campaigns
Government issued certificate, awards.
Non-medical specific corporate houses can
enter this partnership to avail the gain.
Proper auditing under the central body