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Public Private Partnership in Bihar provides high quality health services at low cost

Jun 17, 2016

State-of-the-art dialysis centres showcase how partnerships between the Government and the private sector can be an alternative model for affordable and efficient health care.

Dialysis Patient

Bhagalpur: Seventy-six year old Diwakar Prasad Singh from Tilka Manjhi in Bhagalpur is a kidney patient. Prasad, who retired from the health department after serving for more than three decades, is now struggling with his own health with the daily challenge of bearing the exorbitant expenses of hemo-dialysis services.

Little did Singh know that almost all his life-savings would be lost in getting dialysis sessions that cost Rs 40,000 per month including travel expenses to big cities like Patna, Delhi, Kolkata or Lucknow. But, the Hemo Dialysis Centres (HDCs) run by the government through a public private partnership (PPP) model has made his life easier as the cost of dialysis sessions at these centres has been fixed at Rs 1,500 per session which is almost half of the rates charged by private hospitals.

Singh tells how the state-of-the-art dialysis facility at the Jawahar Lal Nehru Medical College and Hospital (JLNMCH), Bhagalpur, has not only saved him and many other patients from the high expenses of travelling to far-off cities but also the painful experience of travelling in their condition. “I need at least two dialysis sessions every week. The cost of dialysis itself is too high but the cost of travelling compounds the financial burden, thus making it impossible for a retired person like me. The availability of a local centre in Bhagalpur run by B. Braun Medical India (a subsidiary of the German medical and pharmaceutical company) has helped me save more than half of my expenses,” he says.

In a bid to make the health services more affordable in Bihar, the government has entered into a contractual partnership with private companies that provide services at subsidised rates to the users. The Bihar Technical Assistance Support Team (BTAST) provides technical assistance to these centres in the form of identification of the private partner for running these centres. The HDCs are an example of service provision through this PPP model. Round-the-clock services are being provided by HDCs across Bihar through the government district hospitals and medical colleges at 17 locations, in partnership with B. Braun Medical India.

These centres provide dialysis sessions at subsidised rates with the facilities available in 13 district hospitals and four medical colleges located in 17 districts. The HDC initiative is the first of its kind PPP model for providing low cost services to kidney patients in Bihar. According to the incidence rate of end-stage renal disease in Bihar, there are more than 22,000 patients who are suffering from kidney related ailments. These centres come as a great relief to many of these patients.

Vishakha Sharma, a 45-year-old kidney patient from Narayanpur village in Bhagalpur, says that the B Braun centre has given her a new confidence for undergoing dialysis sessions. Vishakha confides how the kidney disease had crippled their financial condition. She says: “More than the disease or even threat to my life, I was terrified of the expenses and financial burden on my family because of me. My husband, who hardly earns Rs 6000 per month, got very worried. Looking at the expenses at the private hospitals, I wished to skip some dialysis sessions to save money. But with the affordable dialysis treatment at the B Braun centre, I have regained some mental strength.” Earlier, Vishakha had to spend nearly Rs 24,000 on the recommended eight dialysis sessions each month and this cost has now been halved.

Kumud Kumar Sharma, her husband, says, “I am a landless person without any regular income. The B Braun centre has come as a big help, but government should help patients through grants for providing free services at such centres to patients who are from households that are Below Poverty Line (BPL).”

Ashish Kumar, from Amarpur in Banka district, has been undergoing dialysis treatment for the past three years. He is unemployed and dependent on his mother for the weekly expenses for dialysis treatment. Kumar, who has been availing the services at the B Braun centre since May 2015, explains that there is difference in the quality of services provided by the B Braun centre and other private facilities. “This centre not only has a thorough regime related to hygiene, but it also follows international standards for the management of dialysis machines which results in better service to the patients,” he says.

The centre follows the standard protocols for dialysis sessions and maintenance of the facility which is evident from the practice of using distilled RO (reverse osmosis) water for treatment purposes, a practice that may not be as rigorously followed at other centres. Besides, the centre also has a good practice of bio-medical waste management that is at par with global standards.

Dr R C Mandal, Superintendent, JLNMCH, Bhagalpur, feels that these HDCs are reaching out to greater number of people having renal diseases. “There is no other such facility in Bhagalpur outside the hospital premises that provides quality services at half the market rates,” he says. Talking about the free dialysis facility available through the Government at the JLNMCH, Bhagalpur, Dr Mandal avers that it is over-burdened with the patients and that can imply long waiting time. “The B Braun run dialysis centres have helped in taking off the load from the government facility by offering low-cost services to patients and with the use of latest equipment,” he says. Dr Mandal also adds that the PPP model for dialysis patients is a welcome step as it also deals with the challenge of shortage of trained manpower in the public health sector who are skilled to provide these services.

Dr Vijay Kumar, Civil Surgeon, Bhagalpur, believes that low-cost options in the health sector can be a solution for the high demand in such services. He says, “The end result is to serve the common man without pinching the patient’s pocket. If that is achieved through the PPP model, why not?” However, whilst supporting the B Braun run dialysis centres, Dr Kumar also cautions that such centres should function in a transparent and equitable manner. “The services should be available to people without breaking the queue and, that too, without any discrimination,” he says.

The centres are being run by B Braun with support from State Health Society, Bihar. There is an agreement for setting up 24 dialysis centres under the PPP model, out of which 17 are already operational. The Bhagalpur facility that was inaugurated on March 24, 2015, has a maximum capacity of 20 machines and provides round the clock service. At present, it caters to 12 patients in two shifts in 24 hours.

In addition to supporting this significant healthcare service, the government can further strengthen it.

Sandeep Kumar, an official from BTAST, feels that the government should explore the possibility of funding the treatment of BPL patients by having a budgetary provision for them as repeated dialysis sessions can be financially draining.

Arun Prakash, Regional Programme Manager, District Health Society, Bhagalpur, also feels that dialysis should get subsidy support from the government on other ailments like cancer, kidney transplant and heart disease. “Swasth Bima Yojna or Health Insurance Scheme by Bihar Government (Social Security Scheme for Patients) has a limit for each family through a provision of smart card with an upper limit of Rs 50,000. This kind of assistance should also be extended to dialysis patients by accrediting agencies like B Braun under this assistance scheme,” he says.

Abhishek Kumar, Assistant Manager, B Braun Dialysis Centre, JLNMCH, Bhagalpur, reports that there is a special focus at the centre for minimising blood related infections like HIV. “We have a separate ward for people who are at the risk of such infections. However, we are facing certain bottlenecks like the availability of doctors in smaller places like Banka. The government can help us in making such centres more successful,” he says.

However, the key achievement of these centres is that they provide high quality services at low cost, thereby showing that partnerships between the Government and the private sector can be an alternative model for improving access to health care.

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