Doctors, Activists Criticize Tamil Nadu's Haemodialysis PPP Plan

Madurai: The Tamil Nadu government’s initial plan to explore the possibility of implementing a Public-Private Partnership (PPP) model for hemodialysis units, inspired by Telangana’s model, has raised concerns among doctors and activists, who fear it may not yield the desired results.

The ongoing case in the Madras High Court, which seeks to improve both the quality and quantity of hemodialysis machines in government hospitals, underscores the urgency of addressing these issues. On December 4, 2024, the National Health Mission-Tamil Nadu (NHM-TN) convened a meeting to discuss the development of a "policy-driven roadmap" for hemodialysis services. Chaired by NHM-TN Mission Director A. Arun Thamburaj, the meeting aimed to establish an expert committee tasked with improving dialysis care across government hospitals. The initiative seeks to enhance the accessibility, efficiency, and quality of services, particularly in addressing the growing burden of chronic kidney diseases and the challenges patients face in accessing dialysis care.

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As per the recent media report in The Hindu, although the idea was lauded as timely, some of the key objectives of the committee—“studying and documenting the best practices available under government and PPP models for hemodialysis units, with a focus on recommending suitable modalities for effective implementation, analyzing the financial aspects of operationalizing dialysis services under the PPP model, and suggesting engagement strategies that are sustainable and efficient”—have been assumed by some doctors to be aimed at privatizing one of the most important and critical medical services.

Since the committee is tasked with evaluating the performance of both government-operated and private hemodialysis units, identifying gaps, and proposing necessary course corrections to improve service delivery, doctors argue that the root of the problem with government-run dialysis units is not necessarily inefficiency or a lack of expertise, but rather a shortage of trained personnel and modern equipment. They suggest that strengthening existing government services by increasing manpower and upgrading equipment would be a more effective solution.

Veronica Mary, a social activist based in Madurai, voiced concerns over the outsourcing of essential medical services. She pointed out that while outsourcing services like basic work and conservancy in government hospitals has already led to issues such as inadequate staff strength, involving private players in critical services would exacerbate the problems and disrupt the delivery of essential services to the public.

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Ms Mary mentioned that medical service quality can only be ensured by appointing permanent workers. According to Hindu, she further adds that in a state like Tamil Nadu, where a hemodialysis unit is present in almost all medical college hospitals, taluks, and district headquarters hospitals, only strengthening manpower and ensuring the quality of equipment is required to achieve a desirable standard.

A doctor from the state healthcare system added that the committee, which comprises 19 members, should also include public representatives, activists, and nephrologists from all district headquarters to ensure that the final recommendations are comprehensive and reflect the needs of the entire state.