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      Camel in the tent 

Allowing district hospitals to be attached 
to private medical colleges is problematic

As the Centre pushes to attach medical colleges to existing district hospitals in the public-private partnership (PPP) mode, to ostensibly address the shortage of doctors in the country, the question is: does it understand the nature of the camel that it is
planning to allow into the tent? Finance Minister Nirmalala Sitharaman, in the Union Budget speech, introduced the proposal and stated that those States that fully allow the facilities of the hospital to the medical college and wish to provide land at a concession would be eligible
for viability gap funding. Several details are already available in the public domain, as part of the plan, first proposed by NITI Aayog. It argues that it is practically
not possible for Central and State governments to bridge the gaps in medical education with their limited resources and finances, necessitating the formation of a PPP model, "cumbining the strengths of both sectors"

This would augment the number of medical seats avail able and moderate the costs of medical education. Experts have argued that the NITI Aayog has not given sufficient play to the role of the district hospital as thep of primary health care in every State. Allowingprivate parties to operate and maintain the districthospital and provide healthcare services could seriously dent public health services. It is problematicthat the NITI Aayog envisages the creation of free patients versus others, because this will create a new catgory of havenots.A workingdraftofthe concessionaire agreement indicates that the private firm "can demand,collect and appropriate hospital charges from patients". There is understandable opposition to thescheme in States such as Tamil Nadu that have a robustpublic health care system, and a medical college innearly every district. These States are naturally loath toturning over a key unit in their health-care network,which is running reasonably efficiently, to the privatesector motivated by profit rather than public interest.

Ultimately, eternal vigil will be the price of going forthis new mode. While creating quality medical profes.sionals for the country should definitely be on any government's to-do list, destabilising people's access to an affordable public health services, will be disastrous.

Viability gap funding is provided for projects that the government does not find commercially viable because of long gestation periods, and relatively minor revenue flows, and involves PPP, but this instant situation calls for pause, health its square in the State's welfare role.

The government must consider raising health-care spending beyond the usual under 2% of GDP, and ensure more resources are available to provide free, qual unity health care to all. If it does stay in its path of giving the private sector some control over district hospitals, it will do well to be wary of the camel in the tent.