Over the last several years, the 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 privatization 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 This was met with widespread protests and opposition from people in these districts, following which the decision was withdrawn.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 privatize 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 privatization of district hospitals?

The PPP model involving the handover of district hospitals to private medical college operators includes these major components:

A private entity offers to build 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 is the NITI Aayog recommendations from 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 on public health. While the 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 significantly 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 profit-making, significantly limiting access to beds for free patients. These patients also face burdensome documentation and paperwork just to access basic care, which was previously free and available to all.Even free category patients may be charged high rates for diagnostics (e.g., Rs. 140 – USD 2 – for a basic blood test), and reimbursement processes are complex and largely ineffective.Although free beds are promised, the lack of availability of such beds is a common excuse used to deny care, pushing patients toward unaffordable private hospitals.Patients often have to pay extra for ancillary services (such as food, lodging, and transport), even though they are supposed to receive free care.Private entities are not required to cross-subsidize care using 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 the major costs for free category patients.

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

Zero evidence for the 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 canceled after it grossly violated various conditions and terms, and was re-nationalized by the state government (see more 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 centers, has been repeatedly canceled and restarted due to poor outcomes.The major PPP for running cancer care centers in Karnataka (2019–2023), involving Narayana Health, was marred by understaffing, equipment failures, and continued rural exclusion despite large public investments.

The emerging statewide campaign against privatization

Sarvatrika Arogya Andolana Karnataka (SAAK) took the lead in sending out an appeal to a wide range of progressive networks and organizations 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 the proposed PPPs. It was pointed out to these movements that the various marginalized communities they represent now face a major threat to healthcare access due to this move by the Karnataka government.

On May 17, 2025, an online meeting was conducted with all the networks, where a brief orientation was given on the issue at hand, and a broad-based coalition of organizations was formed, termed the “Campaign Against Privatization (PPP) of District Public Hospitals in Karnataka.” Since the Karnataka budget document for 2025–26 mentioned that Kolar District Hospital would be handed over through the PPP model during this year, the campaign decided to begin with a protest action in Kolar. It was decided that a rally would be held in Kolar on June 6, 2025.

The Kolar protest – broad mobilization

“We have a right to access free services, and public hospitals must work toward 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 organized on June 6, 2025, under the banner of the “Campaign Against Privatization (PPP) of District Public Hospitals in Karnataka,” condemning the government’s decision to privatize the public district hospital in Kolar district. Representatives from around 10 districts across the state participated, including farmers, workers and women’s groups, human rights activists, Dalit organizations, gender and sexual minorities, as well as student and youth organizations.

The march began at the Press Club in the city and proceeded to the District Hospital (SNR Hospital). During the rally, protesters raised slogans opposing the privatization of public hospitals and expressed their anger at the government’s decision. A short public meeting was held on the hospital premises, highlighting the dangers of PPPs while raising awareness among the people who had come to the hospital for services.

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

“Public hospitals are the lifeline of the poor and marginalized, and it is the duty of the government to protect them. Instead of strengthening these hospitals, the governments are busy privatizing 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 organizer, said: “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 District Surgeon Dr. Jagadish. Following this, teams comprising representatives from across the state and local groups submitted petitions to the state government through Deputy Commissioner Ravi and District Health Officer Srinivas.

Dr. Shanthamma, who received the petition from the campaigners, stated that they had no information about the privatization of the public hospital and said 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: “We will discuss this issue of privatization with the state government and will bring it to the Chief Minister’s attention by forwarding the petition submitted.”

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

The campaign against the privatization of district hospitals in Karnataka continues, inspired by previous struggles and informed by experiences like the re-nationalization of a major public hospital in Raichur. There, the PPP model failed spectacularly, and popular protests forced the state government to return the hospital to public control.

Back to public: The failed hospital PPP and re-nationalization 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 shortcomings 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 the contract. Services meant for BPL patients were underutilized – only 25% of inpatients and 15% of outpatients were from the BPL category, despite the region’s BPL majority. Key contractual clauses, such as the provision of nephrology and gastroenterology services, were unfulfilled.

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 pressured 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, significantly raising their monthly wages.

In brief, the Raichur hospital PPP was a disaster, marked by underutilized capacity, inequitable access for BPL patients, unfulfilled service commitments, and lack of transparency. The multi-dimensional failures of the Raichur model carry broader 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 privatization models.

This article was co-authored by SAAK activists Sowmya, Shantamma, Babu Reddy, and Shashiraj. It was first published on the Jan Swasthya Abhiyan website as part of the “Health on the Frontlines” blog series.

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