India Leans on Private Sector to Fight Noncommunicable Disease

By Vikram Albrecht —

Children undergo medical checkups and screenings at school in Bangalore, India. Source: Trinity Care Foundation | CSR Projects in India’s flickr photostream, used under a creative commons license.

Noncommunicable disease (NCD) is the leading cause of death in India. Faced with this new challenge, back in 2010 the Central Government launched The National Programme for Prevention and Control of Cancer, Diabetes, Cardiovascular Diseases and Stroke (NPCDCS) as an attempt to promote change through community engagement, implement diagnostic screening at all levels of delivery, and provide support for cost-effective treatment. However, due to poor management and underutilization, the NPCDCS has yet to create any significant change in NCD prevalence. Almost 10 years later, the central government has begun to turn to the private sector to address its own shortcomings.

Insufficient Progress of NPCDCS

Since its announcement, the NPCDCS has implemented state NCD cells in all 36 states and union territories and almost 400 districts. At the district level, over 2,000 community health center NCD clinics have been established. These are vital for local level intervention because unlike viral diseases, NCDs often lack outward expression and require consistent screening as a preventative measure. However, as per the states’ 2017 reports quoted by the Directorate General of Health Services, only around 22 million people attended these clinics and 17 million people attended health outreach camps for screening. This implies that between 2016-17, the NPCDCS screening programs reached just shy of 3 percent of India’s total population.

This low rate of engagement is attributable to a variety of issues including insufficient awareness and a lack of available professionals. A case study conducted in the Udupi district of Karnataka in 2017 found that the community’s misconceptions of chronic illness significantly hurt its effectiveness. Since the public was not aware that these problems require consistent consultations, they may only have visited the NCD cell once or not at all. A survey of the public in the same study also found high rates of skepticism regarding the quality of care provided by the government. On top of these concerns, NCD center staffers complained about the need to fill vacant posts at NCD cells and hire more trained medical professionals rather than contracted MOs who can only stay for months at a time. The lack of availability of medical officers perpetuates this issue of inconsistent care in a field where regular follow-ups are key to handling the rise of chronic disease.

Another reason for poor implementation is underfunding. The NPCDCS budget is inadequate and does not provide for enough medicines and treatments required by the public. While total funding across all of India’s states for 2014-2015 was $30.4 million, an almost 200 percent increase from the previous year, this pales in comparison to the funding given to communicable disease (CD) programs. Even though they impact a much smaller portion of the country’s population, the government provides more funds to fight CDs, allocating almost $3 billion towards their several different programs handling malaria, dengue, leprosy, and tuberculosis. This is counterintuitive considering that NCDs cost more than communicable diseases for treatment, longer hospital stays, and overall care administered. By underfunding the NPCDCS, the Indian government is failing to protect its people’s health.

Leaning on the Private Sector

The establishment of the NPCDCS represents the government’s acknowledgement that NCDs are a problem for India. However, the lack of funding and support for this program pushes the populace towards the unregulated private sector for chronic illness care. Taking a cue from the patients, the government is following this move by looking towards the private health sector to strengthen the NPCDCS’s response to the epidemic of noncommunicable diseases. According to NITI Aayog, by operating out of existing private hospitals, this plan will expand NCD services to everyone regardless of location, socioeconomic background, or insurance scheme. Services offered will include using these hospitals to offer clinical and clinical support services, integrating the private sector’s specialists into primary health centers (PHCs) and sharing services with private district hospitals.

While this new public-private partnership (PPP) to support NPCDCS is still in its beginning stages, the World Health Organization has presented several studies that demonstrate the usefulness of incorporating the private sector into NCD-focused initiatives. The private sector brings capacity building, investment funding, and increased efficiency to programs that lack this type of support. Through a public-private partnership, the central government will improve access to quality NCD screening as well as diagnostic and treatment services for chronic illnesses in district hospitals.

A report from NITI Aayog concluded that the shortage of health infrastructure and human resources has caused around 75 percent of the total population of India to seek healthcare from the private sector; NCD care is no exception. The private sector offers more consistent care from medical officers, more specialists, shorter wait times, and more resources, as reported by the National Council of Applied Economic Research. Just last month, the central government adopted a state-level NCD screening program that uses PPPs in Andhra Pradesh and Telangana in order to expand access to rural women. Instead of allocating the necessary funds to support the public sector through the NPCDCS, the government plans to lean on the private sector in a renewed effort to reduce the high prevalence of noncommunicable disease in India. While widespread results remain to be seen, successful state-level initiatives indicate that incorporating the private sector into the NPCDCS will aid India’s fight against noncommunicable disease.

Mr. Vikram Albrecht is a research intern with the Wadhwani Chair in U.S.-India Policy Studies at CSIS.

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