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Submitted by Mathew george on
Proabably a good opportunity (NRHM) in the midst of counters (Pvt sector) I strongly agree with Rajeev on the scope of NRHM in strenghtening public sector. The context in which the current health service system is that which is dominated by the private sector in terms of utilisation not necessary among the poor but among others. In other words, the "baggage" of private sector which has changed the nature and characteristics of health service system is obvious even in the NRHM strategy of identifying PPP as an option which has its inherent presumption that public sector hospital cannot deliver. This bias is also obvious in the initial results of RSBY implementation wherein empanellment of hospitals has been in favour of the pvt sector which you mention as the "competition of markets" and the options of either perfrom or wither away. The comment from Lant also can be read from the influecne of the philsophy of new public management where efficiency becomes the keyword. But I like the metaphor of military troops but I feel that it is true of public sector. In every initiative of public sector strengthening there is some component of private sector getting into which I feel will 'rout' the public sector and can be traced back to the policies of the govt and in the reasons for the growth of private sector. It becomes difficult to coexist both public and private sector at least in the delivery of basic health services wherein the environment in which both function in terms of the problems faced, type of regulatory services differ and therefore can't have fair competition from a market point of view. Rather there should be clear demaraction of the kind of services that are of the monopoly of the public which should be basic and even if pirvate sector need to be brought in then with specific regulations and only specific services at the secondary and tertiary level. It is time to refine NRHM in its conceptualisation and identify those favouring private sector as well as joining hands with RSBY as something innovative need to be closely scrutinized in terms of accountability at various levels. Here when we talk of accountability and performance based financing, one should be cautious in setting the performance indicators like 'institutional delvery' in JSY. Where safe deliveries, the real indicator are far from those being institutional....