By Raju Kumar
BHOPAL: The Madhya Pradesh government has approved a pilot project to operate selected Community Health Centres (CHCs) in the districts of Rewa, Dewas and Guna through an outsourced management system. According to the state cabinet, the arrangement will be implemented in centres where most doctor positions have remained vacant for a long period. The government argues that the move will improve access to healthcare at the local level and reduce the need for patients to travel to district hospitals for the treatment of minor ailments. The project will run for five years, after which it will be evaluated. If the results are found satisfactory, the model may be extended to other Community Health Centres across the state.
Jan Swasthya Abhiyan Madhya Pradesh, along with several public health organisations, has questioned the government’s decision. They have urged the government to reconsider the move. Their argument is that while the problem has been correctly identified, the proposed solution raises serious concerns. If Community Health Centres are suffering from shortages of doctors and specialists, the priority should be to address those shortages rather than hand over the management of public institutions to outsourced agencies. The debate, therefore, extends beyond a few health centres in three districts. At its core lies a larger question: should weaknesses in public healthcare be addressed by strengthening government institutions or by gradually transferring their operations to private entities?
Madhya Pradesh’s healthcare system already faces multiple challenges. Recent findings from the National Family Health Survey indicate that malnutrition remains a major concern, while non-communicable diseases such as obesity, diabetes and cardiovascular ailments are also on the rise. Several maternal and child health indicators continue to require significant improvement. In such a situation, the need to strengthen the public health infrastructure becomes even more pressing.
According to Rural Health Statistics, the state faces a shortfall of 4,134 sub-health centres, 1,045 primary health centres and 245 Community Health Centres. At the same time, large numbers of positions for doctors, specialists, nurses and paramedical staff remain vacant. The shortage of specialists at Community Health Centres often results in patients being referred to district hospitals for treatment that could otherwise be provided locally. In many rural areas, district hospitals are located 100 to 200 kilometres away, causing delays in treatment and adding to the burden on patients and their families.
This is the context in which the government’s latest decision has emerged. But Communist Party of India (Marxist)argue that shortages of doctors and specialists should be addressed through regular recruitment, better deployment policies, incentives for rural service and investments in strengthening public institutions. In their view, transferring operational responsibility to external agencies cannot be regarded as a long-term solution to systemic deficiencies.
This is also not the first attempt in Madhya Pradesh to involve private entities in the management of public health institutions. In 2015, a similar experiment was undertaken at the Alirajpur District Hospital and the Jobat Community Health Centre. According to Jan Swasthya Abhiyan, the initiative failed to deliver the expected outcomes and did not lead to any significant improvement in healthcare services, eventually forcing the government to abandon the model. A similar controversy arose in 2024 when the state proposed linking district hospitals with medical colleges under a public-private partnership model. Medical associations and civil society groups then expressed concerns that such measures could weaken the public healthcare system.
For this reason, many critics see the current decision not as an isolated administrative experiment but as part of a broader trend towards increasing private participation in public healthcare. Their concern is that if the model is eventually declared successful, it may be expanded further across the state.
Healthcare cannot be viewed in the same way as an ordinary market service. Like education, it is a sector in which the state is expected not only to regulate but also to provide essential services. India’s constitutional framework places a responsibility on the state to improve public health and ensure access to healthcare. Decisions affecting public health institutions, therefore, cannot be assessed solely in terms of administrative convenience.
There is no denying that shortages of doctors, the absence of specialists and management inefficiencies are real challenges. The question, however, is whether the solution lies in filling vacancies and strengthening institutions or in transferring their management to private operators. If schools face a shortage of teachers, the answer is not necessarily to privatize schools. If police departments face staffing shortages, police stations are not handed over to private agencies. In the same way, the long-term solution to problems in public healthcare lies in strengthening institutions, filling vacancies and improving infrastructure and services.
In a state such as Madhya Pradesh, where a large section of the population continues to depend on government hospitals, this debate assumes even greater significance. The challenges facing the healthcare system are real, and there are no easy solutions. Yet in the long run, the most reliable system will be one in which the government strengthens its own institutions, expands specialist services, fills vacant posts and sustains public confidence in the healthcare system. After all, the true test of a welfare state lies not merely in launching schemes, but in ensuring that public institutions remain capable, accessible and accountable to the people they are meant to serve. (IPA Service)
