Editorial Analysis: Co-op hospitals a good idea but expanding healthcare will need govt to invest a lot more

Co-op hospitals

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Co-op hospitals
Co-op hospitals

India’s weak overall healthcare :

  • India’s public health expenditure is low:
    • The government—both the Centre and the states—accounts for only a third of the annual overall healthcare expenditure in the country.
    • India’s public spending on health as a percentage of GDP, at just 1.29%, compares poorly with the OECD average of close to 9%.
  • Shortage of healthcare personnel:
    • India is also facing a shortage of healthcare personnel in the country, with 0.6 doctors per 1,000 population and 2.2 nurses for each doctor, against the WHO recommendation of 1 doctor per 1,000 population and three nurses per doctor.
  • Large inequalities across states in health metrics:
    • There exist sharp divides between the states on healthcare metrics.
    • Bihar, for instance, has a doctor-population ratio of just 0.26, and a functioning, government-run healthcare facility (up to the secondary level) for every 10,222 people (against the India average of one for every 6,752 people).
    • At the end of March last year, the country’s rural areas were facing a shortfall of 18,000 specialists at community health centres.

Covid again highlighted the need for healthcare delivery to the grass-roots:

  • The ongoing pandemic has brought into focus the need to strengthen health infrastructure in rural areas.
  • It would have been a major disaster had India’s hospitalization demand due to Covid-19 been high.
  • It has also been observed that many cooperative hospitals are facing a lack of credit support.

Ayushman Sahakar scheme for cooperative health infrastructure:

  • Taking inspiration from the successful work cooperatives have done in the healthcare sector in Kerala, the central government recently launched the Ayushman Sahakar scheme.
  • It seeks to involve co-operatives in creating healthcare infrastructure in the country.
  • Ayushman Sahakar loans can be used to set up primary healthcare facilities, medical and dental education infrastructure, diagnostic centres, pharmacies, wellness centres, Ayush centres, etc.
  • Under the scheme, NCDC will extend term-loans totalling Rs 10,000 crore to cooperatives to set up healthcare infrastructure in rural areas.
    • National Cooperative Development Corporation (NCDC) is a statutory body under the Ministry of Agriculture & Farmers Welfare.
  • Objectives:
    1. Assist cooperative societies to provide comprehensive healthcare including education, services, insurance and related activities.
    2. Assist  promotion of AYUSH facilities by cooperative societies.
    3. Assist cooperative societies to  meet the objectives of National Health Policy.
    4. Assist cooperative societies to  participate in the National Digital Health Mission.
Ayushman Sahakar scheme is a good step but much more needs to be done:
  • While Ayushman Sahakar scheme is a good step, a lot more needs to be done if the government is to deliver basic healthcare access to all.
  • Access to basic healthcare is treated as a primary governance deliverable, even a right, by many nations.

Link medical colleges to district hospitals:

  • In a 2011 report for the Planning Commission, Dr Srinath Reddy had recommended linking medical colleges to district hospitals to dramatically lower costs of medical education, and ensure a greater supply of doctors in rural areas.

Set up nursing schools:

  • Dr Srinath Reddy had also recommended setting up of nursing schools in under-served states.

Leverage technology and teleconsultation:

  • Technology and teleconsultation also represent a huge opportunity in extending healthcare reach.
  • However, for this to be successful, the government will have to invest in equipping PHCs and CHCs.


  • Covid-19 infections in rural areas are rising —they now account for a fifth of India’s infections.
  • This makes strengthening public healthcare in rural areas an important, not just for now, but also future pandemics.
  • Cooperative hospitals will address this need to some extent, but the governments at centre and states must take responsibility for providing most of the meaningful healthcare access.

Also Read: CDC to launch Ayushman Sahakar scheme to fund co-operative healthcare facilities

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