Bhopal: The Madhya Pradesh government has approved a pilot project to operate 18 Community Health Centres (CHCs) in Rewa, Dewas and Guna districts through an outsourcing model. The government’s stated rationale is that a severe shortage of doctors, particularly specialists, has affected healthcare delivery in rural and remote areas, and participation by private institutions could help bridge this gap.
However, the decision has also raised several important questions.
Will treatment at these government health centres continue to remain free? On what terms will private institutions be selected? Who will exercise administrative control over doctors and other staff? How much will the government pay private operators? Who will receive revenue generated through Ayushman Bharat claims? And, most importantly, if a patient is denied timely treatment or suffers due to medical negligence, who will be held accountable?
Clear answers to many of these questions are yet to emerge in the public domain.
What Has the Government Approved?
The Madhya Pradesh Cabinet has approved a pilot project for operating a total of 18 Community Health Centres in Rewa, Dewas and Guna districts through an outsourcing system.
The government has presented the initiative as an experiment aimed at improving healthcare services and addressing the shortage of doctors. Based on information currently available in the public domain, selected private institutions may be required to arrange doctors and other essential human resources for these centres.
However, the precise nature of the model will become fully clear only after the final tender, Request for Proposal (RFP), contractual terms and service-level conditions are made public.
Why Does the Government Need Private Participation?
The most important reason cited for the move is the acute shortage of specialist doctors.
Recent reports indicate that specialist availability at Community Health Centres in Madhya Pradesh remains critically low. The state’s rural healthcare system has long faced shortages of surgeons, physicians, gynaecologists, paediatricians and other specialists.
This manpower crisis forms the core of the government’s argument for involving private institutions.
But it also raises a fundamental question: if the government has been unable to fill sanctioned medical posts for years, will private operators be able to deploy specialist doctors in the same remote and difficult locations?
Private Operation for Five Years?
Media reports have indicated that selected private agencies could be given responsibility for operating these health centres for a period of five years.
If the final tender document retains this duration, the arrangement would go beyond short-term manpower outsourcing and could amount to a long-term operational model.
That makes several questions particularly important.
How much administrative autonomy will a private operator receive during the five-year period? Will it independently determine doctors’ salaries? Will it have the authority to recruit and remove employees? Can the contract be terminated midway if performance is poor?
These issues require clear public disclosure.
Will Government Hospital Buildings Be Handed Over to Private Institutions?
Available reports suggest that government assets are likely to remain under government ownership. The state may continue to provide buildings and certain essential resources, while private institutions could assume responsibility for operations and human resources.
If the final model follows this structure, describing the decision simply as a “sale of government hospitals” would be inaccurate.
More precise terms would be “management outsourcing”, “private operation”, or—depending on the final contractual structure—a “PPP-based operational model”.
Who Will Charge Patients?
This is perhaps the most sensitive question surrounding the entire proposal.
Community Health Centres are a critical part of the public healthcare system, particularly for rural and low-income populations. They provide services related to maternal and child health, deliveries, emergency treatment, general medical care, diagnostics and referrals.
If operations are transferred to private institutions, the government must clearly specify:
- Will OPD services remain completely free?
- Can admitted patients be charged?
- Will pathology and diagnostic tests attract fees?
- Will medicines continue to be provided free of cost?
- Will existing maternity and delivery services remain unchanged?
- Which services, if any, may attract user charges?
- Will private operators be permitted to introduce additional paid services?
Until the tender and contractual terms are publicly available, definitive answers to these questions may not be possible.
Who Will Receive Ayushman Bharat Revenue?
This is a major financial question.
If treatment at these centres is provided under Ayushman Bharat or other government-funded health insurance schemes, who will receive the claim revenue?
Will the money go to the government?
Will it go to the private operator?
Will there be a revenue-sharing arrangement?
Or will the private institution receive a separate fixed management fee?
Understanding this aspect is essential to assessing the actual commercial and financial model behind the operation of the 18 health centres.
How Will Private Institutions Be Selected?
Available information suggests that private operators are likely to be selected through a tendering process. But the method of selection will be crucial.
Will contracts be awarded primarily on the basis of the lowest financial bid, commonly known as L1?
Or will the government also evaluate availability of doctors, hospital-management experience, track record in rural healthcare, quality standards and financial capacity?
Healthcare is not an ordinary supply contract. If the responsibility is awarded primarily to the lowest bidder, there could be risks to service quality.
Where Will the Doctors Come From?
The government’s entire policy experiment is based on the argument that private participation can help address the shortage of doctors. This makes one question unavoidable: where will private operators find specialist doctors?
If the government itself has struggled to attract specialists to remote locations despite reportedly offering highly competitive monthly remuneration in some recruitment efforts, what mechanism will private operators use?
Will doctors be employed full-time?
Will they be visiting consultants?
Will specialist availability be shown through telemedicine arrangements?
Could the same doctor be placed on the roster of multiple centres?
Will biometric attendance be mandatory?
Will genuine 24×7 emergency coverage be available?
The final contract should contain measurable and enforceable answers to these questions.
Who Will Be Accountable?
Consider a situation in which a pregnant woman does not receive timely access to a gynaecologist. An accident victim is denied emergency care. A diagnostic test is delayed. Or a critically ill patient is not referred to a higher centre in time.
Who will be responsible?
The private institution?
The district health administration?
The Chief Medical and Health Officer?
The state government?
Or the individual doctor?
If the facility retains a government identity and operates from a government building while day-to-day management is handled by a private entity, accountability must not be allowed to become blurred.
What Will Happen to Existing Government Employees?
Another important issue concerns government doctors, nurses, paramedical staff, pharmacists and other employees already posted at the 18 CHCs.
Will they continue working at the same facilities?
Will they come under the administrative control of the private operator?
Will they be transferred elsewhere?
Will government and privately hired employees work in parallel within the same premises?
The answers matter not only for employees but also for continuity and quality of patient care.
What Information Needs to Be Made Public?
For a meaningful public debate on the pilot project, the government should disclose at least the following information:
- The complete names and locations of all 18 Community Health Centres.
- Sanctioned and filled doctor posts at each centre.
- Annual OPD and IPD patient load at each facility.
- Duration of the private operator’s contract.
- The government payment mechanism.
- Whether private operators will be allowed to charge patients.
- Who will receive revenue from Ayushman Bharat and other insurance claims.
- Minimum mandatory staffing and specialist requirements.
- Conditions governing 24×7 emergency services.
- Performance indicators and penalty clauses.
- Legal responsibility in cases of clinical negligence.
- Provisions for termination of contracts in case of poor performance.
The Larger Question: Healthcare Reform or the Beginning of Privatisation?
The government views the decision as an experiment to address doctor shortages and improve healthcare delivery. Critics, however, may see it as a step towards privatisation of public healthcare services.
The actual picture will emerge only from the final tender and contractual terms.
If private institutions can provide specialist doctors, better diagnostics, emergency care and improved services to rural patients without imposing additional financial burdens, the model could prove significant.
But if government buildings, public resources and state-funded medicines are placed at the disposal of private operators while patients face higher charges, accountability weakens, or the actual availability of doctors does not improve, serious questions will arise.
For now, transparency is essential.
The list of the 18 health centres, tender documents, financial model, patient rights and accountability framework for private operators should be placed clearly in the public domain.
This may not remain merely an administrative experiment involving 18 health centres. Its success—or failure—could influence the future direction of Madhya Pradesh’s public healthcare system.
Editor’s Note: This report is based on currently available government information and publicly reported media accounts. Several key aspects of the operational model may become clearer once the tender/RFP and final contractual terms are made public.
