Imagine a state where your right to basic healthcare hangs by a thread, all because leaders chose shortcuts over building a strong public system. That's the stark reality facing Andhra Pradesh today, and it's time we dive into why reclaiming control over healthcare could change everything for its people.
Let's start with the basics: the Indian Constitution guarantees everyone the right to health and medical care as part of Article 21, which protects life and personal liberty. This means the government isn't just encouraged—it's obligated—to step up with health facilities. Other sections, like Articles 39(e) and (f), 41, and 47, reinforce this by urging the state to protect workers' health, ensure access to medical services, and improve overall public well-being. But here's the harsh truth from Andhra Pradesh's story after its split from Telangana in 2014: these promises can crumble quickly if not fiercely guarded.
Right after the bifurcation, Andhra Pradesh's healthcare took a massive hit. The state lost top-tier hospitals, medical training spots, seasoned doctors and teachers, and essential support staff to the other side. Adding insult to injury, the incoming government in 2014 ramped up reliance on private companies through outsourcing. Over the next five years, up to 2019, they didn't launch even one new medical school, advanced specialty unit, or significant public health center. Instead, they rolled out 26 public-private partnership (PPP) initiatives that handed over everyday tasks—like ferrying expectant mothers or handling deceased individuals—to private firms, along with basics such as blood work, imaging like CT and MRI scans, care for newborns, and kidney dialysis treatments.
This shift even touched the nation's crown jewel in public health: vaccinations. Bringing PPPs into urban primary health centers threw a wrench into routine immunization drives. For beginners, think about it this way—vaccinations are like an invisible shield against deadly diseases, and India's pulled off miracles by wiping out smallpox, polio, and tetanus in mothers and babies. But if public systems weaken, old threats like polio could creep back, and progress on beating measles, rubella, TB, or hepatitis B gets stalled. It's a risky move that could undo decades of hard-won victories.
The diagnostics world tells a similar tale. Simple, low-cost tests that any basic lab could handle are now mostly run by these PPP setups. This sparks big worries: how do we keep patient info private and secure? Costs skyrocket for the public purse, and shady dealings—like under-the-table payments—can creep in, eroding trust.
Take a real-world case from a public hospital in Kadapa district, where CT and MRI services went private. One day, they cranked out over 100 scans, draining nearly Rs 1 lakh from state funds just to pay the operator. That's wild—even bustling hubs like Gandhi Hospital, Osmania General, or NIMS in Hyderabad rarely see that volume. And for what? When government teams handle these scans in-house, they're not only budget-friendly but also let experts spot regional health trends, fine-tune treatments, and even bring in some revenue to reinvest. We saw this pay off big in 2023, with new CT and MRI facilities opening at medical colleges in Nellore, Ongole, Kadapa, and Srikakulam—proving the state can deliver when it commits.
But here's where it gets controversial: should essential health services be profit-driven at all? It's crucial for Andhra Pradesh's leaders to prioritize making these accessible and cheap for everyone, shielding folks from private greed and aiming for top-notch health standards as a basic right. The only way to nail this? A fully government-owned and -run public healthcare network.
Digging deeper into PPP pitfalls, those contracts often lock in for decades—think 30 years or more. The current government's draft for PPP medical colleges? A whopping 33 years, with an option to tack on another 33. That means generations could be stuck outsourcing instead of building self-sufficient public options that truly serve people better, like integrating care seamlessly or responding to local needs.
Look at dialysis as a prime example of why government control wins. Even with specialized kidney departments and teaching hospitals in place, many public spots still outsource this life-saving treatment. Critics have slammed PPP-run dialysis for cutting corners on quality—like skimping on hygiene or equipment maintenance—which directly harms patients' health and recovery.
Yet, when the state rolls up its sleeves, magic happens. In Uddanam, Srikakulam district—a hotspot for kidney issues—the government set up a 64-machine dialysis center that was so efficient, it started performing transplants just six months after opening. That's a shining example of how public setups can outpace private ones in speed, quality, and impact.
The same mixed signals pop up with Special Newborn Care Units (SNCUs). These are vital for fragile infants needing intensive monitoring, yet statewide, including in medical colleges brimming with child specialists, they're handed to PPPs. Setting one up is straightforward: basic ICU gear and a pediatrician on hand—resources Andhra Pradesh has plenty of. In sharp contrast, consider the 2021 launch of Padmavathi Paediatric Heart Hospital in Tirupati. Under the Arogyasri health scheme, it's handled 4,300 intricate heart surgeries and 20 transplants in three years, matching global elite standards. Stories like this are rare gems in India's post-independence history, showing what unwavering government dedication can achieve.
And this is the part most people miss: the COVID-19 crisis laid bare the power of public institutions. Government hospitals shouldered the heaviest load, scaling up heroically for everything from oxygen support and ventilators to drugs like Remdesivir and Tocilizumab, plus ongoing maternity and surgical needs. Their edge? Massive bed capacity, loyal medical teams, and the agility to adapt on the fly—features private outfits often can't match in a pinch.
These stories drive home a simple truth: government-led healthcare delivers elite results; pulling back leads to slippage. PPPs started as NITI Aayog's tool to boost lagging states by filling gaps, not replacing core duties. But in Andhra Pradesh, they've morphed into stand-ins for essential functions. Contrast that with powerhouses like Tamil Nadu and Kerala, perennial top performers in health metrics. They keep PPPs to a minimum, thriving on full state oversight. It's proof positive that public health soars under government stewardship.
Overdepending on PPPs isn't just about money—it's a systemic trap. These programs often work in isolation, siloed from the broader network, leading to patchy data that muddles disease tracking and resource planning. Once hooked, escaping is tough: long contracts breed dependency, leaving vital services in private grip for ages.
Every district deserves its own government medical college and hospital, acting as the command center for local health ops. Far beyond training docs or healing patients, these hubs orchestrate everything from village clinics to advanced care, ensuring smooth referrals and holistic planning. Without them, the system flounders. Recent scares—like COVID, the Uddanam kidney crisis, Vijayawada's diarrhea epidemic, or the puzzling illnesses in Thurakapalem—scream that public health can't be outsourced from government watch.
A solid referral pathway—from rural outposts to top hospitals and follow-ups—keeps care flowing without hiccups, tracks health data accurately, and slashes personal costs. That's why India's central government pushes for a medical college per district. But PPP-run ones? Profit trumps all, diluting education quality, patient safety, and accountability—who's to blame when things go wrong, the state or the partner? The private player cashes in, but citizens forfeit their constitutional health rights.
The 2019 government got this right, launching a bold push to beef up infrastructure. Of 17 planned medical colleges and hospitals, five are now running, two more got the green light for admissions. Plus, in 2023-24, government colleges boasted near-perfect faculty staffing—almost 100%—versus 50-60% in private ones and 68% even at AIIMS Delhi. Impressive strides!
But now, the 2024 administration is flipping the script, planning to PPP out 10 medical colleges. It's heartbreaking—these are mid-build, and a bit more funding could finish them as public assets. If this goes through, those 10 districts lose forever their chance at a state-run health flagship, dooming local care to private whims.
Andhra Pradesh boasts facilities and talent on par with Tamil Nadu and Kerala, the health index leaders. The gap? Pure resolve. Those states shun mega-PPPs for robust public frameworks. Andhra Pradesh could follow suit, delivering cheap, superior care—if it treats health as a sacred constitutional duty, not a marketable good.
What do you think—can PPPs ever truly serve the public good, or are they a slippery slope to inequality? Share your takes in the comments: agree that Andhra Pradesh should go all-in on government control, or see a middle ground? Let's discuss how to protect this vital right for everyone.
Dr. B Chandrasekhar Reddy is a veteran neurologist and ex-chairman of the Andhra Pradesh Medical Services and Infrastructure Development Corporation.
These opinions reflect the author's perspective alone.
