Study flags major flaws in public-private healthcare projects in Maharashtra
The state-wide study, conducted by Pune-based Support for Advocacy and Training to Health Initiatives (SATHI), found that many PPP projects were marred by political interference, lack of transparency, weak monitoring, and governance failures. The findings have been published in the Journal of Community Systems of Health on July 23, 2025.
The research, titled 'Unpacking the politics and publicness of healthcare public-private partnerships', was carried out by Dr Shweta Marathe, Deepali Yakkundi, Dr Abhijit More, and Dr Dhananjay Kakade. Using an exploratory, qualitative approach, the team mapped 40 hospital-based PPP projects that were active between 2017 and 2023 and studied six projects in detail in cities such as Pune and Mumbai.
Moreover, data was collected through 25 interviews with stakeholders, document reviews, and a rate comparison of 20 healthcare services. The study applied principal-agent theory to analyse the public-private relationship and evaluated PPP performance using publicness criteria developed by David MacDonald and Greg Ruiters.
According to the study, decision-making in public hospitals was mostly limited to municipal bodies, with no involvement of the state health department. Local political influence often prioritised commercial interests over public health goals, while bureaucratic support was restricted to addressing short-term challenges like doctor shortages and budget constraints.
During the study, out of the 40 PPP projects studied, 24 were run by for-profit agencies with long contracts with a tenure of 10 to 30 years. The absence of effective monitoring led to issues such as non-compliance with contracts, employment of under qualified staff, and irregular service delivery.
Furthermore, despite having sufficient resources, many projects reported low patient footfall. Researchers found that while some PPPs helped improve access to services, their charges made them unaffordable for the poor and marginalised. Besides, rates for diagnostic and clinical services in PPP-run facilities were three to fifteen times higher than those charged in public hospitals.
'On paper, PPPs are meant to ease the burden on the public system and expand access, but in practice they are often inaccessible to those who need them most,' the study observed.
Dr Marathe said that, despite several municipal corporations adopting the PPP model and their numbers increasing significantly, there is no dedicated cell to monitor such cells. 'Having a dedicated cell for the PPP projects will bring more transparency and governance in the projects. The charges for the healthcare facilities were compared with public hospitals like Sassoon General Hospital and KEM Mumbai,' she said.
The research concluded that while PPPs have the theoretical potential to strengthen healthcare delivery, structural reforms, robust governance, and stricter regulation are essential to ensure they serve the public interest. They stressed the need to strengthen the public health system itself to guarantee affordable and equitable healthcare.
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