Understanding Indian Health Reforms: How India Can Lead the Way for Africa and Bangladesh

In the backdrop of the recent India-Africa Summit 2015 that brought fifty African heads of state to India, we organized a capacity building program and study visit for policymakers from Ethiopia, Kenya, and Tanzania, as well as Bangladesh. The capacity building program, Managing Markets for Health, introduced policy levers and tools that policymakers can use to guide healthcare markets toward improved health outcomes for the public. The course helped participants understand how mixed markets work in the healthcare sector and how to influence them.

In the study visit that followed, we introduced policymakers to effective health financing reforms in India. We looked at public private partnerships and publicly financed health insurance programs. We brought the policymakers to the Dr. NTR Vaidya Seva Scheme (formerly known as Rajiv Aarogyasri Scheme), the GVK Emergency Response Management Institute, and LifeSpring Hospitals.

India has struggled with financing healthcare. Out of pocket expenditures are high and public spending on health is low. Despite these challenges, India has done tremendously well in terms of taking its own steps toward universal health coverage through government sponsored programs such as the National Health Mission and Rashtriya Swasthya Bima Yojana. Some states, like Telengana (formerly part of Andhra Pradesh), have taken the initiative to implement their own health insurance programs, without depending on insurance companies.

The NTR Vaidya Seva Scheme, a state sponsored health insurance program, has been lauded for offering free tertiary care services in state of the art facilities to families living below the poverty line. The office of the trust that manages the program was our first stop on our study visit. The program is well run, with effective processes. The program uses a robust information technology platform, provides coverage to a vast population, effectively engages private sector providers, and strengthens public sector facilities. These are some of the many reasons that we chose the program for the visit. The program uses an evidence backed information system that runs on software developed by one of the leading information technology companies in India. Other unique features include the use of community health workers called Aarogyamithras or Vaidyamithras and health camps to generate large scale awareness about program eligibility and benefits.

Dr. Andrew Mutava Mulwa, the chair of the County Health Executives at the Federal Ministry of Health in Kenya, was amazed at the scale of the claims management operations and other functions of the Dr. NTR Vaidya Seva Health insurance program. In Kenya, only twenty percent of the population is covered under health insurance, whereas in Andhra Pradesh, almost eighty percent of the population is covered under the health insurance program. Dr. Mulwa was amazed at the different levels of checks and balances in the claims management system. The checks and balances in place protect against fraud and help prevent errors in claims processing, while still allowing for an efficient turnaround time. Dr. Mulwa mentioned that the Kenya National Hospital Insurance Fund is facing challenges with monitoring the program effectively and that Kenya would like to learn more about the claims management practices of the Dr. NTR Vaidya Seva program.

Our next step was Lifespring Hospitals, a chain of hospitals in Hyderabad that provides maternity care to women from low income families. The hospitals are managed as a public private partnership. Vijaybhaskar Srinivas, a senior executive at LifeSpring, explained how the hospitals are managed. The hospitals are a joint venture of an agency of the Indian government, HLL Lifecare Ltd. (formerly known as Hindustan Latex Limited), and the Acumen Fund, a social venture capital fund based out of the United States. The objective of the venture was to provide low cost maternity care services to the urban poor. Many low income countries struggle to provide high quality maternity care in urban settings. The policymakers from Ethiopia and Tanzania were interested in how they might learn from the LifeSpring model to provide similar services for the urban poor in their own countries.

The next day, we made our final stop on the study visit at the GVK Emergency Management and Research Institute. The Institute provides and manages emergency response services in several states, through public private partnership. Under this partnership, state governments provide one hundred percent of the financing, including both capital and operational expenses. GVK, the parent corporate body, invests in providing leadership and developing the information technology. Dr. Ramana Rao, head of the Emergency Medicine Learning Center and Research at the Emergency Management and Research Institute, told us that the Institute responds to thirty million emergencies and saves one million lives each year. The Institute operates 9,488 ambulances across India.

According to Dr. Wilson Gachari, head of the Emergency Preparedness and Response Unit in the Kenyan Ministry of Health, Kenya is facing considerable challenges in providing of emergency response services. These challenges include lack of adequate number of ambulances, trained personnel, and communications channels. Kenya needs technical assistance to address these challenges at both the national and regional levels. The public private partnership structure of the GVK Emergency Management and Research Institute provides a model for how Kenya can improve its emergency response services.

According to the delegates from Bangladesh, there are only limited public private initiatives in the health sector in Bangladesh. Bangladesh has no strategy to engage with the private sector and not been able to develop a strategic action plan to support public private partnerships. Though the Ministry has established two dialysis centers in Dhaka in partnership with the private sector, the government must gain more experience in contracting mechanisms. Bangladesh is eager to learn in much more detail about Indian experiences with contract management for public private partnerships.

The Way Forward

Knowledge partnerships in the health sector help exchange ideas and good practices in how to improve the quality, delivery, and access to health services for poor. In the coming months, our team will work with these three African countries and Bangladesh. We will provide technical assistance on priority areas that they have set. Given the current atmosphere of broader engagement between Africa and India, we look forward to further cooperation with Africa and Bangladesh to support stronger health systems.

Many of these nations are in the initial phases of launching their health insurance programs and can learn from the experiences of India, and the research generated about these experiences. ACCESS Health International has documented many studies on health financing and summarized the findings to help support productive discussions. We also hope to stimulate opportunities in which we in India can learn from other countries and their experiences. We anticipate that this study visit will be the first of many discussions and formal engagements to share knowledge about health financing reforms.