Rajasthan a laboratory for privatisation of public health services

Rajasthan appears to be turning into a laboratory for privatisation of public health services. Four different strategies to privatise all tiers of public health care are being mooted.

  1. 30 PHCs have been handed over to WISH (Wadhwani Intitiative for Sustainable Health) Foundation. The MOU is not readily available but it seems that the Government is not providing any money for the PHCs given to WISH Foundation. The foundation is using its own money to run these PHCs. Twenty out of thirty PHCs have been sub-contracted to Karuna Trust. WISH Foundation plans to introduce new age technologies in the PHCs such as health ATMs — a kind of tele-medicine. Their plan is to showcase the effectiveness of these gadgets and systems for Government to eventually buy them for all other PHCs.
  1. A notice inviting tenders (NIT) has been floated with request for proposal for 300 PHCs to be run by private entities under the scheme “Run a PHC”. Last date for submission of bid documents was 31st August which has been extended till 14th September. The RFP can be seen at http://www.rajswasthya.nic.in/407%20Dt.%2023.07.2015%20Revised%20Tender.pdf and the list of PHCs with additional terms and conditions can be seen at http://www.rajswasthya.nic.in/432%20dt%2027.08.2015%20website.pdf

 

– Examination of 300 PHCs to be run on PPP mode reveals that quite a lot of these are within municipal limits of towns or within 5 kms. radius of towns. A lot of these are on national or state highways and very few in remote areas. So, the claim of the Govt. that they would hand over only those PHCs which are in remote areas and govt. finds difficulty in posting staff has been proved wrong.

– The targets laid out in the RFP to be accomplished are quite ambitious and cannot be attained. Therefore anybody bidding with the objective of making money out of the venture would find it extremely difficult. It is not clearly stated in the bid document whether there will be deductions if targets are not met but a lot of activities listed have been assigned certain weightage.

– The bid document allows that the successful bidder can introduce additional services including diagnostics, however the charges of these can be fixed after consultation and approval of the Government beforehand. This is the place from where profits can be generated even while incurring a loss in the main contract and this profit could be huge. The document does not specify what these additional services would be and who will pay the charges. Our understanding is that these charges would be levied on the patients. The document is silent on whether patient belonging to the BPL category would need to pay for the additional services. Possibly, these services could be ECG, ultra- sonography or even X -rays. Services could include services of specialists, which are otherwise not within the mandated functions of a PHC.

  1. It is learnt that CHCs Manoharpur and Kotputli have been handed over to NIMS University which runs NIMS Medical College & Hospital and Nursing College in close vicinity. The CHC Gudamalani in Barmer district has been transferred to Cairn Energy which has sub contracted it to C.R.D. Health care Pvt. Ltd. There is a plan is to hand over the CHC Sanganer to Mahatma Gandhi Pvt. Medical College & Hosptal. These CHCs appear to have been handed over without any financial allocation. It seems that private medical colleges would utilise these health facilities as adjuncts to their private medical colleges and thus save huge amounts on setting up hospitals attached to the colleges.
  1. Dainik Bhaskar on 4th September has carried the news that the CM of Rajasthan has signed a MoU with the National Insurance Company for health insurance of up to Rs. 3 lacs for certain kinds of medical ailments for about 1 crore families of the state. Total amount to be spent by the Government under this scheme is Rs. 350 crores annually. Corporate hospitals such as Medanta, Fortis, Apollo etc. have been lobbying hard for such an insurance scheme. Rajasthan Govt. could not do it last year because it did not have money but launched it this year as more untied money is available from the Centre owing to higher allocation of tax money under new formula which has been made available by the centre by cutting on central funds allocation for health and education.