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Chhattisgarh government's proposal to outsource diagnostic services do not appear to be tailored to meet the needs of people. A Central government team that visited the state to look into the matter has raised many questions about the state government's initiative.
The Centre sent a team on March 5 to Chhattisgarh to assess the model and give recommendations. The team found that there are many problems in implementing the plan and that outsourcing diagnostic facilities is not the best option.
The team members included Dinesh Baswal, official from maternal health department of Union Ministry of Health and Family Welfare (MoHFW), Anand Bang, senior consultant (public health planning) with National Health Systems Resource Centre (NHSRC) of MoHFW and Jitendra Sharma, senior consultant (health care finance and technology) with NHSRC.
The team in its report about the public-private partnership (PPP) model adopted by Chhattisgarh government says the reasons for outsourcing diagnostic services are unclear. “This Government of Chattisgarh has a PPP policy with the approval of the Cabinet and has been published. Nevertheless, it is unclear as to at what levels there were discussions within the health department and the steps followed pertaining to the translation of such a Cabinet approved policy into a specific proposal for outsourcing diagnostics.”
The report says there is also no statement in the government policy about the specific public health need for which the PPP was mooted. “The existing statement is an informal one that salaried workers have no incentive to do this work, or that there are significant number of vacancies and hence this PPP is essential. Both reasons are not substantiated by evidence as observed in the field,” states the report.
The report also highlights problems with private medical practice and health workers and says the state government's PPP model is not the best solution for the existing problems. The PPP policy mandates a scoping and feasibility study to determine the need, the possibilities and the package, but the results of no such studies are currently available, says the Central team's report.
The visiting team observed that the PPP model has a possible risk of false claims, denial of services and unfair intervention. By permitting a private diagnostic provider to set up facility inside a public health facility http://www.downtoearth.org.in/content/public-s-private-peeve and allowing to charge patients of the district facility (through RSBY card) and general patients who come to the facility at market rates can lead to dual commercial practice, the report says.
The Chhattisgarh model also carries the possible risk prescription of unnecessary tests, the report states.
The government of Chattisgarh has proposed a Public Private partnership for outsourcing diagnostic services from Public health facilities in the state from 2013 – 14 and issued requests for proposal (RFP) from private diagnostic services. The first round of tendering failed to attract bids for the tribal districts http://www.downtoearth.org.in/content/private-firms-show-no-interest-chhattigarhs-invite-set-diagnostic-facilities-tribal-and-remo. Subsequently, the documents were re-drafted to club unattractive (read non-lucrative) districts with attractive districts, and tenders were called again. The last date for this tender was March 16. Now bidding process has been completed. But protests by health activists still continue.