The National Integrated Tertiary Health Care Enhancement Program (NITHEP) presents a strategic vision to strengthen India’s tertiary health care system through digital integration, strong clinical governance, public private partnerships, and centralized procurement. Proposed by Prof (Dr) Sarat P Chandra, Head of the Department of Neurosurgery at the All India Institute of Medical Sciences, the program aims to improve efficiency, quality, and accessibility of advanced health care services across the country.
Strengthening India’s Tertiary Health Care Ecosystem through Digital Integration, Clinical Governance, Public-Private Partnerships, and Centralized Procurement
1. Executive Summary
India’s tertiary health care system faces persistent challenges including fragmented medical records, variable clinical practices, uneven access to tertiary services, inefficiencies in procurement, and lack of standardized mechanisms to assess and incentivize clinical quality. These challenges result in duplication of investigations, increased out-of-pocket expenditure, suboptimal clinical outcomes, and inefficient utilization of public resources.
This White Paper proposes the establishment of the National Integrated Tertiary Health Care Enhancement Program (NITHEP) as a flagship national initiative to systematically reform and strengthen tertiary health care delivery. The program is designed around five core policy pillars:
- Aadhaar-linked National Health Records
- Clinical Value Score (CVS) Framework for Medical Professionals
- National Clinical SOP Repository and Mobile Application
- Indian Health Service (IHS) through Public-Private Partnerships (PPP)
- National Online Procurement Portal for Medical Equipment and Consumables
NITHEP aims to improve continuity of care, enhance quality and accountability, expand tertiary care capacity, and significantly reduce inefficiencies and delays in procurement and service delivery.
2. Background and Rationale
Tertiary health care in India is delivered through a combination of central and state government institutions, autonomous medical institutes, and private sector hospitals. While India has made significant progress in expanding insurance coverage and primary-secondary care access, tertiary care remains constrained by:
- Fragmented and non-interoperable medical records
- Absence of standardized, nationally enforced clinical pathways
- Limited transparency in clinical outcomes and provider performance
- Capacity constraints in government tertiary institutions
- Lengthy and inefficient procurement and tendering processes
In alignment with the objectives of Digital India, Ayushman Bharat, and the Ayushman Bharat Digital Mission (ABDM), there is a strategic opportunity to establish a unified tertiary care reform framework under NITHEP.
3. Policy Objectives
The primary objectives of NITHEP are to:
- Ensure seamless continuity of tertiary care through interoperable digital health records
- Establish standardized, evidence-based clinical governance
- Promote transparency and quality through objective clinician performance metrics
- Expand equitable access to tertiary care through structured public-private collaboration
- Improve efficiency, cost-effectiveness, and timeliness of procurement
4. Policy Pillar I: Aadhaar-Linked National Health Records
4.1 Policy Proposal
Establish a unified, Aadhaar-linked National Electronic Health Record (NEHR) system to create a lifelong longitudinal health record for every citizen.
4.2 Key Policy Features
- Unique Health ID linked to Aadhaar
- Interoperable Electronic Health Record architecture
- Integration with public and empanelled private tertiary hospitals
- Centralized, secure, cloud-based data infrastructure
4.3 Scope of Data
- Laboratory and diagnostic investigations
- Radiology and imaging
- Prescriptions and medication history
- Discharge summaries
- Surgical and procedural records
- Chronic disease registries
4.4 Governance and Data Protection
- Patient consent-based data access
- Role-based access controls
- Mandatory audit trails
- Compliance with applicable data protection and privacy legislation
4.5 Expected Outcomes
- Reduction in duplication of investigations
- Improved clinical decision-making
- Enhanced continuity and coordination of care
- Strengthened public health surveillance and outcomes research
5. Policy Pillar II: Clinical Value Score (CVS) Framework
5.1 Policy Proposal
Establish a nationally governed Clinical Value Score (CVS) framework to assess, benchmark, and recognize the clinical contribution and outcomes of medical professionals.
5.2 Components of CVS
The CVS shall be a composite, risk-adjusted index incorporating:
- Clinical Volume: Number of patients and procedures
- Experience and Qualifications: Years of practice, certifications, academic roles
- Clinical Outcomes: Risk-adjusted morbidity, mortality, complication and readmission rates
- Patient-Reported Outcomes and Satisfaction
- Continuing Medical Education (CME) and skill upgradation
5.3 Policy Applications
- Credentialing and privileging
- Performance-based incentives
- Institutional benchmarking
- Quality accreditation and public reporting (in regulated format)
5.4 Safeguards
- Case-mix and complexity risk adjustment
- Independent third-party audits
- Anti-gaming and data integrity controls
6. Policy Pillar III: National Clinical SOP Repository and Mobile Platform
6.1 Policy Proposal
Develop and maintain a National Clinical SOP Repository accessible through a dedicated mobile application and web portal.
6.2 Scope
- Diagnostic algorithms
- Medical and surgical treatment protocols
- Emergency care pathways
- Perioperative and postoperative care standards
- Drug dosing and safety protocols
- Infection prevention and control guidelines
6.3 Platform Features
- Specialty-wise categorization
- Offline access capability
- Regular evidence-based updates
- Multilingual support
- Integration with EHR systems for clinical decision support
6.4 Expected Outcomes
- Reduction in unwarranted variation in care
- Improved patient safety and quality
- Capacity building for junior clinicians
- Strengthened adherence to national standards
7. Policy Pillar IV: Indian Health Service (IHS) – PPP Framework
7.1 Policy Proposal
Establish the Indian Health Service (IHS) as a national tertiary care network through structured Public-Private Partnerships.
7.2 Structure
- Empanelment of eligible private tertiary hospitals
- Standardized PPP contracting framework
- Integration with government referral and financing mechanisms
7.3 Key Features
- Standardized service packages and pricing
- Government-funded care for eligible beneficiaries
- Shared use of infrastructure and human resources
- Joint clinical governance and quality oversight
7.4 Expected Outcomes
- Expansion of tertiary care capacity
- Improved access in underserved regions
- Optimal utilization of private sector expertise
- Reduced burden on government tertiary institutions
8. Policy Pillar V: National Online Procurement Portal
8.1 Policy Proposal
Establish a National Healthcare e-Procurement Portal for centralized, rate-contracted procurement of medical equipment, devices, implants, and consumables.
8.2 Key Features
- Centralized rate contracts negotiated at national level
- Online catalog of approved and quality-certified products
- Direct ordering by government and empanelled IHS hospitals
- Real-time inventory and order tracking
- Vendor performance monitoring
8.3 Expected Outcomes
- Elimination of delays due to repeated tendering
- Reduced procurement costs through bulk negotiation
- Improved availability of critical equipment and consumables
- Enhanced transparency and reduced administrative burden
9. Institutional Framework and Governance
- Establishment of a National NITHEP Mission Directorate
- Inter-ministerial coordination with MeitY, NHA, and state governments
- Technical advisory committees for clinical, IT, and procurement domains
- Independent quality and audit bodies
10. Phased Implementation Roadmap
Phase I: Policy and Legal Framework
- Enabling legal and regulatory amendments
- Notification of national standards and governance structures
Phase II: Digital and Institutional Infrastructure
- Development of NEHR, SOP platform, and procurement portal
- Capacity building and training
Phase III: Pilot Implementation
- Selected states and tertiary institutions
- Pilot of IHS-PPP model
Phase IV: National Scale-Up
- Progressive onboarding of all states and empanelled private hospitals
- Full national rollout
11. Financial and Economic Considerations
- Central budgetary support
- Convergence with existing schemes (Ayushman Bharat, ABDM)
- PPP-based capital and operational investments
- Long-term cost savings through efficiency gains and reduced duplication
12. Monitoring, Evaluation, and Accountability
- National key performance indicators (KPIs)
- Periodic independent evaluations
- Public reporting of system-level outcomes
- Continuous policy refinement based on evidence
13. Conclusion
The National Integrated Tertiary Health Care Enhancement Program (NITHEP) represents a strategic, system-wide reform to modernize India’s tertiary health care sector. By integrating digital health records, standardized clinical governance, transparent performance metrics, structured public-private collaboration, and centralized procurement, NITHEP will enhance quality, equity, efficiency, and sustainability of tertiary health care services in India.
This White Paper is submitted for consideration as a framework for national policy formulation and phased implementation.