View: For good healthcare, India needs a more responsive public and more responsible private sector | Economic Times

In a mixed health system that has evolved by default rather than design, all available healthcare resources have to be optimally utilised to provide services to everyone, based on need rather than paying ability. That is the prime objective of Universal Health Coverage, a target of the Sustainable Development Goals, which we have committed to deliver by 2030. This commitment demands efficient and equitable service provision, with the public sector leading the way and private and voluntary sectors playing a supportive role. Across the world, the pandemic has reinforced the case for a strong and efficient public sector in providing health services to all sections of people. Whether in testing, contact tracing, treatment or research, public health services and publicly funded institutions have led the way. Even the vaccine development process has emerged from foundational science of publicly funded research and trials of drugs and vaccines have received substantial funding and scientific leadership from government funded agencies.In India too, the pandemic response has been led by public institutions – from field-level public health measures and early mobilisation of hospital capacity to development of innovative paper-based diagnostic tests and indigenous vaccine development. An under-resourced public sector battled against odds to give a valiant response, from the slums of Mumbai to AIIMS in Delhi.The public sector has a mandated commitment to deliver primary care, while it is optional and unattractive to the organised private sector which prefers to operate in the more constricted but financially rewarding arena of advanced hospitalised care. The unorganised private sector is heterogenous and scattered, with no accountability or assurance of appropriate care. Even for secondary care, tier II-III cities in several states are unable to offer eligible private hospitals for accreditation to government-funded health insurance schemes while neglected district hospitals can provide those services if upgraded. There certainly are deficiencies in public health services. They must be corrected with higher public financing, expanded workforce, improved infrastructure and governance. The private sector can be encouraged to play a supportive role, with clearly defined deliverables and unambiguously framed accountability measures. For India’s mixed health system to serve better, we need a more responsive public sector, a more responsible private sector and a more resourceful voluntary sector. (The writer is President, Public Health Foundation of India)