From TB to pandemics, private healthcare proves its worth. Can India scale the model?

India's private healthcare sector represents one of the most significant yet underutilised strategic assets. Private clinics, hospitals and labs serve nearly 70% of patients and constitute over 60% of the country's medical infra. The sector also provides nearly 87% of initial primary care services. A promising step by GoI to utilise these services has been the flagship, Ayushman Bharat. Through PM-JAY, it is providing health insurance coverage to economically weaker sections and senior citizens. Additionally, in primary care, the scale-up of Ayushman Arogya Mandirs has ensured that primary care reaches people closer to their homes.

However, as we move forward, there is an opportunity to expand access to primary healthcare services further - and the private sector can play a central role. Harnessing its capacity would be a prudent move and could help build a resilient and responsive health system.

The pandemic underscored the critical importance of this integration. When testing needs surged, private laboratories were among the first to step in, dramatically expanding access to diagnostic services in close coordination with public health authorities. The Bhilwara model proved this in real time: by commandeering four private hospitals during the pandemic, we rapidly scaled up containment efforts, transforming existing infrastructure into strategic national capacity. What could have taken months to build from scratch was achieved within days - because the infrastructure existed, and we had the foresight to mobilise it.


Another great example of such an integration can be seen in India's National Tuberculosis Elimination Programme (NTEP). According to Indian Council of Medical Research (ICMR), 50% of India's TB patients first seek care in the private sector. Over the past decade, India has improved TB care in the private sector through supportive regulations and provider incentives for case notification on Ni-kshay, the country's patient management system. A key innovation was the introduction of Patient Provider Support Agencies (PPSAs) to engage private providers and streamline services for diagnosis and drug delivery. These measures have helped drive TB notifications from the private sector up from 7% of the national total, in 2014, to 36% in 2024.

This approach is also cost-effective. Studies from India and other high-burden TB countries show that procuring services from the private sector is often cheaper than building new public infra. The Rajasthan Consensus study found that improving private sector TB care delivers the highest social and economic returns - ₹179 per rupee spent - across all sectors assessed.

To build on these gains and enable a seamless integration between the public and private sectors, we must also embrace technology - particularly digital tools that can support last-mile service delivery and real-time payments.

One such innovation is e-RUPI - a simple digital voucher system launched by Narendra Modi in 2021. In Darbhanga and Mumbai, pilots using e-RUPI allowed patients presumed to have TB to get free chest X-rays at private labs. Patients received an SMS or QR code that is instantly redeemable, without cash or even a bank account.

The pilot saw over 4,400 vouchers issued, with a redemption rate of 74% - many within an hour - and nearly half used by women. Real-time, paperless payments encouraged participation from private healthcare providers, who previously experienced delays in receiving funds despite delivering the services.

The pilot demonstrated the use case in reducing delays in diagnosis and out-of-pocket expenditure. UP ran a similar initiative for maternal health, issuing more than 14 lakh e-RUPI vouchers to ensure pregnant women could get ultrasound at private centres.

By establishing transparent protocols, equitable pricing mechanisms, robust digital infrastructure and prompt payment systems, we can scale partnerships with private providers in a sustainable and mutually beneficial manner. This will not only enhance access and quality but also preserve precious public resources by avoiding duplication and enabling more efficient use of existing assets.

India's private health infrastructure is a vast and largely untapped asset. Strategic utilisation of this resource will not only accelerate our progress towards TB elimination but also build a more resilient and efficient health system for the future.

(The writer is former secretary, GoI)