A promising idea for basic public health reform

The Punjab government is all set to undertake a new public health initiative. To begin with, rural health centres (RHCs) and basic health units (BHUs) in the six low performing districts are to be outsourced to the private sector, and later the project is to be extended to other parts of the province at tehsil and district levels. The idea has already started to generate interest with some critics arguing that the primary responsibility for education and healthcare lies with the state. And there is concern that outsourcing basic health facilities would be detrimental to the wellbeing of ordinary people. Those employed in the existing RHCs and BHUs may also take to public protests for fear of losing jobs once the private sector takes over these health facilities. But a closer look at the proposed outsourcing plan inspires optimism.

As it is, the existing system has failed to deliver. It makes sense therefore to try a new idea to make the health centres in rural areas and small towns fully functional. Contrary to the general impression that these centres are to be completely taken over by the private sector, the government is to retain substantial control. As per details, bidding is to be invited from interested firms to contract out RHCs and BHUs in the selected districts. The annual budget of the outsourced facilities will be handed to qualifying firms, which would be bound to retain the government staff. The normal government service rules would apply to doctors, nurses and paramedics in these health facilities. However, if the performance of any staff member is found to be less than satisfactory, the new management would be able to transfer him/her to a hospital other than that run by the same firm. And the new administration would be free to hire new staff on its own terms and conditions, and salary packages in order to make the public health facilities fully functional. This model in fact has been successfully tried in the government-run schools in Punjab.

Public/private partnership seems to be the best way forward to enhance efficiency of the basic health system as long as the government takes care of the important issues involved. First, of course, the process of granting contracts to private parties must have complete transparency. Second, there should be checks in place to ensure service delivery. It is good to note that third party evaluation is part of the outsourcing plan. The soon-to-be-elected local bodies, hopefully, would also have some sort of an oversight role. Equally important is the need to make the health facilities economically accessible to the poorer sections of society. The private firms are expected not only to raise the quality of service but also the cost of treatment. It is imperative therefore that the government tries and keeps the cost in check. It should also consider introduction of a health insurance scheme for the poor through provision of premium to insurance companies.