Accelerating the Pace of Achieving UHC in India with Private Sector Engagement
Stronger public private linkages hold the promise to boost efficiency, reach and innovation in health care, taking us that much closer to achieving national health priorities.
India is fortunate to have an already robust private health sector. After 2002, more than 70% of all hospital beds added in India were added within the private sector. The government has also recognized the strategic role that private sector players can occupy in enabling universal health coverage (UHC). This has been emphasized in the National Health Policy 2017, which focuses on the strategic purchase of secondary and tertiary care services as a short-term measure to supplement the health system in critical areas.
Given this reality, the task before India’s health care system is to ensure private sector players’ alignment with the nation’s UHC goal and to identify steps to achieve maximum impact and outcomes. There are five ways that the government can work with the private sector to accelerate the pace of UHC:
Skilling for quality: A key element of the UHC promise is access to quality services. The private sector can contribute significantly towards this goal by self-regulation and adoption of certification and accreditation initiatives that focus on quality. Why is this important? Consider this -- about half of India’s babies are born at private facilities and yet the Maternal Mortality Ratio (MMR) stands at 113, well above the SDG 3.1 target of 70. This indicates gaps in the quality of care offered at private facilities.
Quality assurance is a big challenge in the health ecosystem as private health care providers are typically fragmented and unregulated. There are accreditation processes such as National Accreditation Board for Hospitals and Healthcare Providers (NABH) for the private sector, however, NABH is more aligned to large facilities. Providers in lower volume facilities find it difficult to meet NABH standards, creating a need for accreditation models that cater to the requirements of smaller private facilities in Tier 2 and 3 towns - enabling them to shift to evidence-based protocols.
In the context of maternal care, programs such as Manyata, are highly relevant for India. As a quality certification, it recognizes private maternity providers for meeting national quality standards for maternity care and is endorsed by the Federation of Obstetric and Gynecological Societies of India (FOGSI). It also upskills providers such that they adhere to standard maternal care protocols and are also equipped to manage C-sections and high-risk pregnancies.
Making quality care affordable: An unregulated health sector has a consequential impact on affordability and, subsequently, access. Only about 44% of the population is covered by some form of insurance which means a majority of healthcare costs – estimated at 70% – are funded by patients through out-of-pocket spending. The health care ecosystem will benefit if there is increased insurance coverage for smaller facilities in rural areas. To achieve this, there needs to be wider adoption of quality certification. Government-recognized accreditation will encourage insurance providers to partner with small private health care facilities that are able to demonstrate better quality of care. This will lead to a wider insurance umbrella that can support more people to get access to quality care.
Promoting innovation: Technology can be a substantial enabler for UHC. The private sector has access to tech expertise which can bridge the gap of inadequately skilled resources. Bangladesh is experimenting with a bangle loaded with sensors that helps pregnant women monitor their health. Project ECHO is a digital hub-and-spoke model that links less skilled health workers with more specialized ones. The field worker gets support in making diagnoses and monitoring health status. This increases scale and reach while promoting the use of best practices in care. The Safe Delivery App provides birth attendants with clinical guidelines on basic obstetric care. These digital solutions can drive improvement in maternity care outcomes and are examples of how private tech can support public health systems to deliver on scale and reach.
Innovative funding is another example of how the private sector effectively leverages resources to achieve impact. For instance, the Utkrisht Development Impact Bond is a financing plan that focuses on maternal and newborn health outcomes in Rajasthan which has one of the highest maternal mortality rates in India. It is supporting improved quality of maternal care in about 440 small facilities. Such innovations feeding into the health ecosystem do wonders to increase and improve accessible, affordable, high qualityhealth coverage.
Plugging critical data gaps: A weak link in the health ecosystem is the availability of credible and accurate data. This is a key area where private sector players can step up and contribute to a national data repository. Availability of data can help guide policy making at the highest levels and also provide a roadmap for investments in health care. Take, for instance, reporting on maternal deaths. If there is improved reporting of deaths from private sector and tertiary institutions, it can help identify gaps at different levels and enable the government to take appropriate corrective measures, such as sensitizing service providers to improve accountability.
Apart from direct reporting, there are other sources of data that can be correlated, such as data from consumer feedback mechanisms, like Mera Aspatal, which provides feedback on public hospital services, and Together for Her, a private sector initiative for maternal care. This capture of consumer voice can provide an important input to the data picture – enabling health care facilities to provide better quality of services. Clearly, the need of the hour is for a national policy on health data sharing and creation of a health data repository.
Demonstrating proof of concept: The private sector has a lot more flexibility, vis-à-vis the public sector, to experiment, innovate, and pilot health care models in the field. Working in small pockets, the private sector can refine pilot models for effectiveness – demonstrating proof of concept for governments to adopt and scale to achieve wider reach and better outcomes.
A standing example of this is LaQshya-Manyata, the Maharashtra state government’s adoption of the Manyata certification programme, which is being implemented in all districts of Maharashtra. It will train hundreds of service providers on 26 standards of maternal care, benefitting women from low and middle-income communities.
Therefore, in order to fast track India’s UHC mission, and to truly meet the objective of “health for all,” the government needs to systematically integrate the private sector in the country’s health care ecosystem. Stronger public private linkages hold the promise to boost efficiency, reach and innovation in health care, taking us that much closer to achieving national health priorities.