Gujarat has done very well in some sectors but with its health indicators still lagging behind, will it be the blueprint for the rest of India? By Raelene Kambli
Gujarat’s model of development has been talked about time and again. With its focus on inclusive and sustainable development, Gujarat has been touted as one of the finest growth stories in the recent times among the Indian states. Strategies such as the implementation of e-governance schemes has cut red tape at the ground level, while decentralisation of government services, modernisation of towns and villages etc., have painted a picture that speaks of high economic growth. In fact, the NDA government’s electoral campaign emphasised on development and cited the Gujarat model as an example earlier this year. This in turn, led the entire country to bring PM Narendra Modi to power. But, lately the Gujarat model seems to be under the scanner by economists, academicians and politicians and there seems to be two sharply differing schools of thought. While some applaud its achievements others call it a mirage created by great propaganda.
Well, the real story goes like this. The kind of impression we have had about the state of Gujarat is that of wide roads and lush agricultural fields. Parts of Ahmedabad, Rajkot and Jamnagar resemble a tier-I, metropolitan city. This is the Gujarat that has seen unparalleled economic growth–between 2004 and 2012. But if you take a look beyond the growing opulence, a different picture emerges. According to the Raghuram Rajan Committee Report on a Composite Development Index for Indian States, Gujarat’s human development indicators (HDI), Gujarat ranks 12th among the rest. The report was published last year and stated that Gujarat’s performance on HDI did not match its growth rates. It revealed that pivotal sectors such as education and healthcare in Gujarat still lags behind several other Indian states.
As Dr Rajeev Boudhankar, VP, Kohinoor Hospital points out, Gujarat is listed with Meghalaya, Chhattisgarh, Uttar Pradesh, and Orissa where more than 40 per cent of children are underweight. He says, “If we consider households using adequately iodised salt by state, Gujarat is listed with other states where usage is between 40-59 per cent only – Rajasthan, Tamil Nadu, Karnataka, Uttarakhand, Jharkhand, Chhattisgarh, Haryana, Maharashtra, Punjab etc., are doing far better on this count. If we consider Vitamin A supplementation for children between age 12-35 months (per cent of youngest children given Vitamin A supplements in the last six months), Gujarat is lacking behind Bihar and West Bengal. It scores only between 20-29 per cent and is in company of states like Madhya Pradesh, Delhi, Uttarkhand, Gujarat, Punjab, Meghalaya, Karnataka, Sikkim, Jharkhand, Andhra Pradesh and Orissa. Another interesting finding is percentage of women between the age group of 15-49 years who are ‘too thin’. In 13 states, more than 35 per cent of women are ‘too thin’ and this includes Gujarat. 50-59 per cent of women between 15-49 years are anaemic in Gujarat, more than in Maharashtra at 40-49 per cent, the lowest prevalence of anaemia for both women and men is in Kerala.”
Also, the 2013 report of the Comptroller and Auditor General (CAG) of India and the state government’s own admission reveal high numbers of malnourished and underweight children in the State. The report states that every third child in Gujarat is underweight. The auditor also pointed out that as opposed to 75,480 anganwadi centres needed in Gujarat, only 52,137 had been sanctioned and only 50,225 were functional. It observed that 1.87 crore people are deprived of the benefits of Integrated Child Development Services (ICDS).
Moreover, figures from the Union Ministry of Health and Family Welfare indicate that the shortage of doctors at public health centres (PHC) in Gujarat was 34 per cent while the national shortfall is 10 per cent. However, in the last two to three years, Gujarat has set the stage for improvement in areas of health and education.
Regaining lost ground
In the past couple of years, the government has been taking confident strikes to improve its healthcare system within the state. JP Gupta, Commissioner of Health, Medical Services and Medical Education informs, “The Gujarat health sector is on the path of recovery. In the last five years we have made significant strides in bringing down the maternal mortality rates (MMR) and infant mortality rates (IMR) rates. We have also managed to improve our sex ratio in the last five years. Moreover, we have introduced the Mukhyamantri Amrutum (MA) Yojana for providing tertiary healthcare treatments to below poverty line (BPL) population of Gujarat. MA Yojana provides quality medical and surgical care for the catastrophic illnesses involving hospitalisation, surgeries and therapies to the BPL families through an empanelled network of private as well as government hospitals. The total sum assured for the BPL family is Rs 2 lakh per family per annum on family floater basis. Five members (including head of the family) of a BPL family is covered under MA Yojana. Rs 300/- per hospitalisation, with a ceiling of maximum Rs 3,000/- per year, shall be reimbursed as transportation cost to the beneficiary.”
As per Bipul K Jha, Senior Consultant, Healthcare Practice, Frost & Sullivan, “The Gujarat healthcare system sector has seen significant growth in the last two years as a result of innovative state policies, inter-departmental schemes, and improvement in the quality and access of healthcare facilities. State has invested heavily on healthcare infrastructure by opening new hospitals for infectious diseases, two eye hospitals, four mental hospitals, 26 subsidiary hospitals and a total of 112 grants in the hospitals. Government has also been proactive in maintaining quality by undertaking NABH, NABL accreditation. This has restored community confidence in the government healthcare sector.”
Ramnath V, Director-BD Medical-Medical Surgical Systems, India further informs that the government of Gujarat has promoted an inclusive system of healthcare where industries, hospital chains and government seek to collaborate to provide access. He mentions some of the initiatives that facilitate this environment:
- Government is encouraging the PPP model to improve availability of healthcare services and provide healthcare financing. PPPs to upgrade IT services for telemedicine super-specialities in cardiology, neurology, ortho, eye and kidney with leading worldwide chains are also being encouraged
- The benefit of section 10 (23 G) of the IT Act has been extended to financial institutions that provide long-term capital to hospitals with 100 beds or more
- The benefit of section 80-IB has been extended to new hospitals with 100 beds or more that are set up in rural areas; such hospitals are entitled to 100 per cent deduction on profits for five years
- Incentives and tax holidays are being offered to hospitals and dispensaries providing health travel facilities
In addition to this, till recently, doctors in rural areas were free to practice in private hospitals after paying a bond of Rs 1.5 lakhs. Nevertheless, the government has now increased the bond to Rs 5 lakhs and has added 2,000 MBBS seats in the state. The plan allocation under health has been increased by 24 per cent in the state budget for 2013-14 to address some of these shortfalls.
Push for private players
On one hand, the Gujarat government has come up with initiatives that can help enhance the current public healthcare system, on the other hand it has opened avenues for private players to invest in the state. Major cities like Gandhinagar, Ahmedabad, Surat, Rajkot and Vadodara have seen significant investments in healthcare. Some of the other major private players in the market are Shalby Hospital, SAL Hospital, Medisurge Hospital, Krishna Heart Institute and Sterling Hospital. Sterling Addlife India is the largest chain of corporate hospitals in Gujarat which owns and manages five centres in the cities of Ahmedabad, Vadodara, Rajkot, Mundra and Bhavnagar. Some of the cities in Gujarat where hospital groups are planning to set up are Mundra, Jamnagar, Bhavnagar, Kutch and Anand. Some of the groups interested in Gujarat healthcare market are Bombay Hospital, Artemis Healthcare, Global Hospitals, etc. Ramnath, informs, “Several chains of hospitals are setting up infrastructure in Gujarat. Fortis, Shalby, Sterling and Apollo have plans to set up large hospitals in the Gujarat International Finance Tech City (GIFT) – Gandhinagar. With Ahmedabad becoming the hub of medical tourism, several hospital chains are making a beeline to develop health infrastructure. Global hospitals are planning to invest and bring their expertise to the cities of Rajkot, Vadodara and Surat. Vadodara, Ankleshwar and Bharuch/ Vapi enjoy a strong foothold in the pharma manufacturing space.” Amol Naikawadi, Joint MD – Indus Health Plus, chips in saying, “Other major players such as Columbia Asia Hospital, Zydus Cadila Healthcare, Wockhardt Hospitals and Narayana Healthcare have also entered the market. Indus Health Plus itself has tied up with many of these private sector players to offer preventive healthcare packages to the people of Gujarat.”
Jha adds, “Recently, Apollo Hospitals and Sanofi joined hands to open clinics across India, eyeing Gujarat in its phase II plans. Some of the healthcare groups planning to enter the Gujarat market are Indus Healthcare and Ambaji Hospital. Sterling Group of Hospitals and India Home Health Care (IHHC) together formed Asilia Home Healthcare to cater to home healthcare services segment in Gujarat.”
Sharing Wockhardt Hospitals’ plans for Gujarat, Anupam Verma, President, Wockhardt Hospitals says that the Wockhardt group has been quite bullish on the Gujarat healthcare sector. In the next couple of years the group is planning to expand its reach in the state.”
While healthcare providers are setting up shops in Gujarat, healthcare IT providers are also exploring the sector. Munish Daga, CEO, Remedinet Technologies, says, “Gujarat healthcare sector is slowly growing. The health indicators are getting better and so we find a lot of scope for business there. Especially, in the private space, we have already started partnering with hospitals to provide healthcare IT solutions to these healthcare institutes. We are also trying to strike a partnership with the government of Gujarat.”
Well, encouraging private players is a good idea, but how much difference would this make? And can this promise sustainable growth for the sector? Moreover, will this be enough to better the health indicators of the state?
Healthcare for all
The Gujarat government says it has an answer to these questions. And it is private public partnerships (PPPs). Gupta assures that the government has been taking every effort to make healthcare accessible and affordable to the people of Gujarat.
Frost and Sullivan lists down some government PPP schemes that have been fruitful in the betterment of the healthcare services within the state. They are as follows:
Chiranjeevi Yojna: Joint collaboration between the government of Gujarat and private gynaecologists for BPL patients for services like normal delivery, emergency delivery, obstetrics and neonatal care.
Bal Sakha Yojna: Under this scheme, all babies born to BPL mothers in the State (approximately 3,00,000 births per annum) will be covered for neonatal care by partnering pediatricians, including care in their neonatal intensive care unit (level 2 ) at no cost to the beneficiaries.
Centre of Excellences under the PPP model: Centers like Institute of Kidney Diseases and Research Centre (IKDRC), U.N. Mehta Institute of Cardiology and Research Centre and Gujarat Cancer Research Institute are government funded institutes, administered by various private organisations (Rogi Kalyan Samiti) and have effectively delivered quality services.
Ambulances: A PPP initiative between the Government of Gujarat and GVK Emergency Management and Research Institute (EMRI) has a total fleet of 525 ambulances in urban as well as rural areas. ‘Khilkhilat’ is a free drop back facility service, post deliveries in a government health facility.
Chief Minister Services of Experts at Treatment Unit (CM–SETU): To address shortage of specialists, the scheme has been launched by the State, wherein experts from private institutes like gynaecologists, physicians, surgeons, orthopedicians, pediatricians, ophthalmic surgeons, anaesthetists, ENT surgeons, dermatologists, psychiatrists, radiologists and pathologists are outsourced to provide specialist services and the patients’ treatment cost is borne by the State Government.
Improving faith of existing system: Subsidies to private practitioners for institutionalising deliveries 104: The medical emergency call centre where citizens of Gujarat would be able to call up 104 and get treatment/ medicine for general health problems.
Medical education initiatives under PPP model: Upcoming medical colleges with leading corporate groups in Gujarat; setting up Public Health Foundation of India (PHFI) in Gujarat for training and education.
Some of the other schemes positioned at different levels of healthcare needs are School Health Program (SHP) and Sickle Cell Anemia (SCA) Control Program, apart from the national health programmes.
BD on the other hand is also working with the Gujarat government. Ramnath mentions some of the areas in which BD has partnered with the government:
- With Indian Institute of Pediatrics (IAP) and support from the Government of Gujarat launched the IAP booklet on Safe Injection Practices at Ahmedabad in 2012. The Mayor of Ahmedabad, Secretary of Medical Education and several key high officials who promote patient safety participated in the inauguration. This knowledge has since been imparted to many doctors and nurses in Gujarat.
- In last two years, they conducted Hepatitis awareness campaigns in Ahmedabad, Vadodara, Surat and other cities with IAP, NSS and Government of Gujarat on the occasion of World Hepatitis Day.
- With support of the Government of Gujarat, BD has also been successful in enhancing safety awareness messages for the healthcare workers across medical colleges and hospitals
On the anvil
Gupta goes on to say that the Government of Gujarat in the years to come will continue to focus on improving IMR and MMR rate. He says that the government plans to come up with a scheme where they will supply iron and calcium supplements to women and children the overcome the burden of malnutrition within the state.
Initiatives taken so far are certainly commendable. But can this act as a blueprint for progress in India? Does the Gujarat model truly set an example for the rest of the country? Or is it being too optimistic to expect that the Gujarat model can be replicated in the rest of the country? We ask the experts….
Industry speak
Dr Boudhankar takes a neutral stand on this. But he also believes that the Gujarat model may not be replicable. “Healthcare is a state subject. Our country is like a continent by itself with States having their own health related problems. Solutions too will be differently adapted to the local environment, culture and social needs. Hence, one model cannot be a ‘fit- for- all-sizes’, he opines. On the contrary, Ramnath, feels that the Gujarat health system seeks to adopt best practices in improving access to the people; thereby becoming a model for others to follow.
All said and done, despite all its efforts, Gujarat still has certain hurdles to cross. Shortage of trained manpower, increasing real estate and electricity costs, lack of fast track implementation of announced initiatives and standard of governance in the hospitals are some of the challenges that Jha identifies for both government and private players in Gujarat.
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