Context: The Fifteenth Finance Commission has called for a greater role for public-private partnerships to ramp up the health infrastructure and scale up public spending on health from 0.95% of GDP to 2.5% by 2024.

Concerns raised by the 15th Finance Commission

• Poor health spending: The total spending of around 0.95% of GDP is not adequate in relation to the commitments under the National Health Policy of 2017. 
• Skewed health infra: While India doesn’t have adequate health infrastructure but the poorest States have the worst health infrastructure. 
• Contractual jobs for doctors: Doctors in many States are engaged on a contract basis and there is a need to improve their working conditions. 

Recommendations by the Finance Commission

A working PPP relationship with the private sector: To achieve better healthcare parameters, public-private partnerships must be considered “in a holistic way” instead of the current situation where the government only turns to the private sector in times of emergency.

• A working relationship can be built only if the trust deficit that exists [between industry and government] now is bridged. 
• Public expenditure should focus on primary health care at the panchayat and municipality level.
• Public private partnership (PPP) refers to an arrangement between the government and the private sector, with the principal objective of providing public infrastructure, community facilities and other related services.

Improving doctors’ conditions: Substantial improvements needed in the working conditions for doctors in government hospitals.

• The creation of an Indian Medical Service cadre as envisaged in the Civil Services Act of 1951.
• The govt. must raise public spending on health from 0.95% of GDP to 2.5% of GDP by 2024.
• Greater attention on the role of paramedics and frontline health workers in countering the pandemic
• The primary health centres must be the central focus of public outlay. The private sector participation can be at other levels of speciality and at levels where they are better placed due to their innovative skills.

Issues in the Health Sector

• India’s general government expenditure on healthcare as a percent of GDP was just 1.0% in 2017, according to the World Health Organisation (WHO) data, placing it at number 165 out of 186 countries in terms of government expenditure on healthcare.
• Skewed availability of healthcare across India as poorer States have the worst facilities.
• In terms of access and quality of health services, India was ranked 145 out of 195 countries in a Lancet study published in 2018, below countries like China (48), Sri Lanka (71) Bhutan (134) and Bangladesh (132).
• Availability of trained epidemiologists is an issue due to low salary and job insecurity in the health system.
• There should be one epidemiologist per 0.2 million population. An epidemiologist is a technical person to guide and monitor the process of contact-tracing, marking containment zones and isolating suspected cases.
• India’s expenditure on R&D as a percent of GDP has continued to remain stagnant at 0.7% of GDP for three decades, with the public sector accounting for 51.8% of national R&D expenditure.
• This compares to around 2.8% of GDP for the USA, 2.1% of GDP for China, 4.4% of GDP for Korea and around 3% for Germany where the dominant sector by spending on R&D is the private sector.

Road Ahead

• Although the government has made several interventions in the health sector including National Medical Commission, National Digital Health Mission, Ayushman Bharat, etc. But it bear real fruits only when we club Public with Private to avail utmost benefits in terms of "last mile aid to people".