• Sowmya, Shantamma, Babu Reddy and Shashiraj, Sarvatrika Arogya Andolana Karnataka

“The state government is playing with the lives of people. It is robbing poor people of the services available in the public hospital. Public hospitals must prevail, hence we oppose privatisation.”

Chennamma, Raitha Sangha representative, anti-privatisation struggle in Kolar

Over the last several years, Karnataka government has repeatedly announced that they intend to hand over district public hospitals to private establishments, under the guise of setting up medical colleges in Public-private partnership (PPP) mode. In 2022, the previous state government had proposed PPP-based privatisation of nine district hospitals. This was met with widespread protests and opposition from people in these districts, following which the decision was withdrawn. However the current state government is now proposing PPPs to privatise district hospitals in eleven districts – Tumakuru, Davanagere, Chitradurga, Bagalkote, Kolar, Dakshina Kannada, Udupi, Bengaluru Rural, Vijayapura, Vijayanagara, and Ramanagaram. This is being opposed by a broad-based popular campaign led by Sarvatrika Arogya Andolana Karnataka (Movement for Universal Health Systems in Karnataka, SAAK).

What is the proposed PPP model for privatisation of district hospitals?

The PPP model involving handover of District hospitals to Private medical college operators, includes these major components:

• A private entity offers to builds a medical college on government land, which is leased for 99 years at a highly subsidized rate.
• The government hands over the public district hospital to the private party for long-term operation and maintenance.
• The private entity is expected to further develop the hospital using government grants.
• Contracts are awarded not based on technical expertise, but on who offers the lowest grant demand or highest premium in bids—often benefiting politically connected corporations. (e.g., Adani took over GK General Hospital in Gujarat in 2009).

One key factor pushing many state governments (including Karnataka) to promote PPPs are the NITI Aayog recommendations since 2019. NITI Aayog claims that “it is practically not possible for the Central/State Government to bridge the gaps in the medical education with their limited resources and finances”. With this justification, states are handing over the government district hospitals to private establishments. But the reality is that most state governments and the Union government have continually spent very low amounts for public health. While National health policy 2017 proposes that states must spend at least 8% of their total budget on health, Karnataka is spending only 4.8% of its total budget on public health and medical education. The Union government has allocated less than 2% of the total Union budget for Health and family welfare, which is also grossly inadequate. Hence the solution for expansion of medical education would be to majorly step up public health spending and to start more public medical colleges (joined with existing district hospitals), rather than handing over these important public institutions to commercial operators.

What are the serious problems faced by poor patients due to PPP schemes?

• Patients are divided into “free” and “paid” categories. Private entities prioritize their profit making, majorly limiting access to beds for free patients. These patients also face burdensome documentation and paperwork just to access basic care, which was earlier free and available for all.
• Even free category patients may be charged high rates for diagnostics (e.g., Rs. 140 for a basic blood test), and reimbursement processes are complex and largely ineffective.
• Although free beds are promised, lack of availability of such beds is a common excuse to deny care, pushing patients towards unaffordable private hospitals.
• Patients often have to pay extra for ancillary services (like food, lodging, transport), even though they are supposed to be given free care.
• Private entities are not required to cross-subsidize care using the revenue from paid patients. Instead, they bill the government through insurance schemes like Ayushman Bharat – PMJAY, thus profiting from paid patients while the government bears all major costs for the free category patients.

These kinds of privatisation arrangements turn out to be ‘Win – Win’ situations for the commercial operators. However governments land up giving concessional land, handing over district hospitals, and then also paying further for the treatment of the ‘free’ patients. Unfortunately various parties which have come to power in the state have continued such policies which damage public interest, being driven by neoliberal dogmas despite there being no evidence for the efficacy of such PPPs.

Zero evidence for efficacy of the PPP model There is no evidence that PPPs have improved access for the poor—in fact, they often worsen it. Several examples from Karnataka highlight this: – The PPP contract with Apollo for OPEC Hospital in Raichur was cancelled after it grossly violated various conditions and terms and re-nationalised by the state government (see box below). – The Udupi maternal and child hospital had to be taken back by the government, due to poor management by the private operator. – The Arogya Bandhu scheme, involving private operators running primary health centres, has been repeatedly cancelled and restarted due to poor outcomes. – The major PPP for running cancer care centres In Karnataka (2019–2023) involving Narayana Health was marred by understaffing, equipment failures, and continued rural exclusion despite the large public investments.

The emerging statewide campaign against privatisation

Sarvatrika Arogya Andolana Karnataka (SAAK) took the lead in sending out an appeal to wide range of progressive networks and organisations across the state, such as garment workers unions, informal sector workers, gender and sexual minorities, dalit groups, farmers movements and other movements, highlighting the dangers of proposed PPPs. It was pointed out to these movements that the various marginalised communities which they represent now face a major threat to health care access due to this move by the Karnataka government. On 17th May 2025 an online meeting was conducted with all the networks, where brief orientation was given on the issue at hand, and a broad-based coalition of organisations was formed, termed the ‘Campaign against privatisation (PPP) of district public hospitals in Karnataka’. Since the Karnataka budget document of 2025-26 mentioned that Kolar district hospital would be handed over through the PPP model during this year, the campaign decided to start with a protest action in Kolar. It was decided that a rally would be taken out in Kolar on June 6th 2025.

The Kolar protest – broad mobilisation, people give message to officials

“We have a right to avail free services, and public hospitals must work towards this. We need a public medical college and hospital, we do not want to become dependent on private facilities.”

Shantamma, women’s rights activist speaking during the Kolar protest

A protest march was organised on 6th June 2025, under the banner of ‘Campaign against privatisation (PPP) of district public hospitals in Karnataka’, condemning the government’s decision to privatise the public district hospital in Kolar district. Representatives from around 10 districts from across the state participated, including farmers, workers and women’s groups, human rights activists, dalit organisations, gender and sexual minorities, as well as student and youth organisations.

The march began from the Press club in the city and continued up to the District hospital (SNR Hospital). During the rally, protesters raised slogans opposing the privatisation of public hospitals and expressed their anger at the government’s decision. A short public meeting was held in the hospital premises, highlighting the dangers of PPP while raising awareness among the people who came to the hospital to get the services.

Speaking during the meeting, Naryanaswamy from Balli Balaga Krushikara Vedike Chintamani said that “Only people who have money can access services from private facilities. People like us can obtain health care access at affordable rates only from public facilities”.

“Public hospitals are the lifeline of the poor and marginalised and it is the duty of the government to protect them. Instead of strengthening these hospitals, the governments are busy privatising them. This will have adverse effects on the poor. The governments must safeguard public facilities and strengthen them with better infrastructure and staffing” opined Shashiraj, a poet and community leader.

Babu Reddy, a youth organiser, said that “government healthcare services are critically important for the poor and those in distress. Destroying such a system and handing it over to private entities amounts to denying the poor their right to health. It is as if the government itself is strangling its people. Therefore, all district hospitals should be upgraded, and free healthcare must be ensured for the poor.”

A memorandum was later submitted to Dr. Shanthamma, a doctor at the district hospital, on behalf of the District Surgeon Dr. Jagadish. Following this, teams comprising representatives from across the state and local groups submitted petitions to the state government through the Deputy Commissioner Ravi and District Health Officer Srinivas.

Dr. Shantamma who received the petition from the campaigners stated that they do not have any information about the privatisation of the public hospital, and said that she would convey the message to the state administration and forward the memorandum presented to her. While receiving the petition, Deputy Commissioner Mr. Ravi said that “we will discuss this issue of privatisation with the state government, and will bring it to Chief minister’s attention by forwarding the petition submitted.”

Subsequently, on 5th July 2025, the activists also participated in a dialogue organised with the State health minister by a television channel Suvarna News, and raised the issue of PPPs with the minister. The minister again typically responded that “PPP is not privatisation, people are going to get better facilities, staff and services through these arrangements.”

The campaign against privatisation of district hospitals in Karnataka continues, inspired by previous struggles and informed by experiences like the re-nationalisation of a major public hospital in Raichur. Here the PPP model failed spectacularly, and popular protests forced the state government to return the hospital to public control. (See box)

Back to Public: The failed hospital PPP and re-nationalisation in Raichur

The Rajiv Gandhi Super Speciality Hospital (RGSH) in Raichur, set up with OPEC assistance, was handed over to Apollo Hospitals in 2002 under a PPP model with the stated aim of providing advanced tertiary care. However, reviews revealed serious shortfalls in the privatization model. Despite a 350-bed capacity, only 154 beds were functional, and just 40 beds were earmarked for Below Poverty Line (BPL) patients, far below the 140 beds mandated by contract. Services meant for BPL patients were underutilized—only 25% of in-patients and 15% of out-patients were from the BPL category, despite the region’s BPL majority. Key contractual clauses, such as provision of nephrology and gastroenterology services, were unfulfilled.

Apollo reported no profits over nearly a decade, and the government had to compensate this corporate for operational losses. This experience dramatically exposed how such PPPs often fail both equity and efficiency, leaving poor patients underserved, while draining public funds and undermining public accountability.

From PPP failure, to reclaiming and revival under public management

After the PPP contract with Apollo Hospitals expired in June 2012, the Karnataka government declined to renew the agreement. As a result, the hospital was shut down. High-end equipment lay idle, and over 285 staff observed a “black day” protest in June 2012. This was followed by a prolonged agitation during 2013-14 by hospital workers, health employees, and local community members, which pressurised the administration to re-establish public management of the hospital. Finally in April 2015, the Karnataka Minister of State for Medical Education formally reopened the hospital under full public management, while also inaugurating new infrastructure. Former Apollo-employed staff were absorbed into government payrolls, raising their monthly wages significantly. In brief, the Raichur hospital PPP was a disaster, linked with underutilized capacity, inequitable access for BPL patients, unfulfilled service commitments, and lack of transparency. The multi-dimensional failures of the Raichur model carry wider lessons about the inherent structural problems of such PPPs. This experience of reopening and expanding the hospital under public control, demonstrates how public pressure and community mobilization can reclaim public healthcare institutions from failing privatisation models.

(This article is based on the collective experience and inputs by activists of Sarvatrika Arogya Andolana Karnataka. Assistance in drafting and editing has been done by Prasanna Saligram.)