Role of public-private partnerships to enhance the health care delivery system during the pandemic COVID-19

Development and economic growth are based on a healthy nation. A lot of attentions are needed to improve health conditions by providing necessary facilities through better infrastructure and medical professionals. Public health facilities continue to face staff shortage as over 85% specialist doctors, 75% doctors, 80% laboratory technicians, 53% nursing, and 52% ANM (auxiliary nurse midwife) short across states.¹ At the same time when the prevalence of infectious diseases has increased worldwide over a period. Outbreaks have frequently been occurring, but every outbreak does not reach global pandemic level as the novel coronavirus (COVID-19) has.² Although the number of COVID-19 cases are gradually increasing in India, experts have warned that this spread will lead to a rapid and massive increase in demand for health facilities.³ India's healthcare infrastructure is incapable of dealing with today’s crisis. In India, there is a significant shortage in the availability of beds in hospitals. It is only in recent years that India increased its bed capacity from 0.7 beds per thousand, in 2011, to 1.13 today.⁴ According to data from the National Health Profile-2019, we observed there are 7,13,986 total government hospital beds available in India; however, it is still insufficient to deal with this crisis. There are only 118 governments approved laboratories in India capable of performing COVID-19 tests so far.⁴

Under-investment in the public healthcare system is a big challenge for India in COVID-19 restraint planning. Due to the limited public spending on healthcare, private investments could play a pivotal role in bridging financial and managerial deficits. The free market economy has driven private sector investments in healthcare in the last few years. Therefore, these services have remained out-of-reach to most Indians. We can implement public, private partnerships to deal with the crisis. Public-Private Partnership (PPP) refers to long-term contractual alliances between public and private sector agencies, and that must be targeted towards financing, designing, implementing, and operating infrastructure facilities to provide services traditionally provided by the public sector.⁵ Several health facilities have started functioning under the PPP model in different states. It can be well taken as excellent opportunities for PPPs in healthcare and which can stimulate the health status of the people disease-ridden due to COVID-19 in our country.

Why PPP? Firstly, because around 80% of expenses are from out-of-pocket for availing health services. Due to this, debilitating effects are seen on the poor people of the country. Even if the government provides free or nearly free health services, poor households spend a significant part of their income on transport and drugs, which is almost 70% of the total out-of-pocket expenditure, secondly, due to lack of infrastructure and resources to handle this pandemic situation.⁶ Lastly, the economic burden on India's government due to lockdown shows a lousy impact on new investments, such as new infrastructures, laboratories, resources like medicines, PPE, and human resources. The commercial behaviour of the private health sector is because of its quality services, and capacities to invest in healthcare. The government can utilize this by making public, private partnerships in healthcare delivery system.

For patients who are found to be COVID-19 positive, they need isolation wards, and intensive care and ventilators are required for critical cases. Currently, almost all suspected cases of coronavirus are referred to government hospitals. For suspected cases, testing should be done in labs by using COVID-19 testing kits. Additionally, we have a crisis in government laboratories. There are private labs, which are now authorized to conduct tests, and companies making self-testing kits. Even the developed countries in Europe and North America are facing challenges concerning resources. So far, there will be a considerable impact on India to fight with this pandemic with the current number of resources and infrastructure. But to fulfil the future needs public sector alone cannot manage and control the pandemic. Hence public, private partnerships can reduce the burden in handling the COVID-19 pandemic.

An analysis of various facts and figures was taken to depict the present scenario of health services. The government alone cannot meet the current healthcare needs, the private sector under the umbrella of the PPP schemes for infrastructure, capacity development, and delivery essential. The private participants are included not only in managing the healthcare system, but also in the financing role of the public sector in healthcare. To estimate the impact of PPPs on a wide scale then public participation is necessary to involve at a central or state government level.

Under the provisions of section 135 of the companies Act 2013 and requirements laid down in the companies (CSR policy) rules, 2014, 2% of the average profit of the company will be allocated for CSR activities by all corporate sectors preceding three financial years.¹ As we know, many CSR activities are done by the corporate companies; this can also be utilized now in improving health facilities, which are needed to handle COVID-19 pandemic by making partnerships with public sectors PPP in healthcare. Creating more awareness about CSR for corporate hospitals and their contribution as CSR funds can be helpful in this economic crisis. Planning the PPP’s must be done by prioritizing the needs and conducting a cost-benefit analysis to provide access to healthcare services. Hence, mutually beneficial activities like PPP in this COVID-19 pandemic with accountability lead to flattening of the curve to some extent.

REFERENCES

1. 1. Ranganadhan S. Public-private partnership in health sector-opportunities for better health care delivery. IOSR J Nursing Health Sci (IOSR-JNHS). 2018;7(4):25-33.
2. 2. Grover A, Gover M. Long-term Impact of COVID-19 Pandemic on Healthcare Scenario in India; 2020. Available at: https://www.expresspharma.in/amp/guest-blogs/long-term-impact-of-covid-19-pandemic-on-healthcare-scenario-in-india.
3. 3. Singh P, Ravi S, Chakraborty S. COVID-19: Is India’s health infrastructure equipped to handle an epidemic? 2020. Available at: https://www.brookings.edu/blog/up-front/2020/03/24/is-indias-health-infrastructure-equipped-to-handle-an-epidemic.
4. 4. Roser M, Ritchie H, Ospina OE, Hasell J. Coronavirus Pandemic (COVID-19). Our World in Data. Available at: https://ourworldindata.org/coronavirus-testing-source-data. Accessed on 26 May 2020.
5. 5. Ramakrishnan D. Public Private Partnership (PPP) in Indian Health Care. Available at: SSRN: https://ssrn.com/abstract=2186897orhttp://dx.doi.org/10.2139/ssrn.2186897. Accessed on 8 November 2012.
6. 6. Rao N. Who is paying for India’s healthcare? The Wire; 2018. Available at: https://thewire.in/health/who-is-paying-for-indias-healthcare.