aSome experiences of the PPP model in the health care sector gives credence to these misgivings. An editorial in the Indian Journal of Medical Ethics points out the case of the Delhi Government and Apollo Hospital Group partnership under the PPP model to establish a multidisciplinary, super speciality hospital on “a no profit no loss” basis. The Delhi government ended up leasing prime property to the Apollo Hospital Group (AHG) on a token payment of one rupee a year, to set up the Indraprastha Hospital, which was inked in 1988. By the terms of this agreement, 15 acres of land and Rs 16 crores were provided in return for which, the AHG agreed to provide free services to patients occupying at least one third of its 600 beds and to 40 per cent of those seeking outpatient care. AHG was legally bound to provide specified services in return for a substantial financial subsidy to the company, which it failed. The same scenario happened with other players who entered into the PPP modus operandi with Max, Fortis and Wockhardt lobbying with the government for concessions while promising free or subsidized treatment for a percentage of patients, eventually empty promises. The twelfth report of the Public Accounts Committee 2004-2005 which deals with allotment of land in Delhi at concessional rates to hospitals in fact observed, “Ultimately, what was started with a grand idea of benefiting the poor turned out to be a hunting ground for the rich in the garb of public charitable institutions.”
The allocation of financial resources for health to the private players on the other hand have meant that government hospitals have had to cope with a decline in support for their infrastructure, getting less qualified personnel, and low appeal from the people, except the poorest. This is not to totally say that PPP models should be done away with for there are other engagements that have worked but notably where NGOs with a ‘no profit’ standing principle have become the partner to Government to launch health research and other mechanisms. On the international level, there is the example of the World Health Organization (WHO), as a global PPP model which is funded through the UN system by contributions from its member states. WHO`s work has in fact involved more collaboration with NGOs and the pharmaceutical industry, as well as with foundations such as the Bill and Melinda Gates Foundation and the Rockefeller Foundation. But the worry in Manipur over the PPP model comes from the fact that main players in the private hospital sector are mostly centered on high end treatments while Government health care system is bogged down by apathy and the practice of Government employed doctors giving their time and attention to additional work hours in private hospitals. There is also the matter of giving legitimacy to private hospitals in the state once it comes on the board as a partner of the Government and looking the other way when it comes to their totally private hospitals and clinics operating out of bounds by not incorporating bio safe disposal systems for medical waste and locating themselves in residential areas. There can be no distinct a black and white stand on the PPP move in the health sector for Manipur. Instead, a proactive discussion on how best the model can be shaped and what mechanisms must be put in place to ensure that the citizens do not get left out of getting better health care at cheaper and convenient methods needs to be worked out.