PPP Model & Free Dialysis in India Explained: A 2026 Guide

Understanding the PPP Model in Healthcare

The PPP model in healthcare is a public-private partnership where government and private providers share responsibility for essential medical services. In dialysis care in India, this structure aims to decrease the overall cost of dialysis and make it accessible to the masses.

What Makes the PPP Model Different?

Under the PPP model, the government provides hospital space, utilities, and policy oversight. Private partners supply dialysis machines, water systems, trained staff, and operational control.

Core Principles of the PPP Model

The PPP model operates on risk sharing, cost accountability, and measurable outcomes. Private partners invest in equipment and assume operational responsibility within government premises. Moreover, 63.33% of dialysis centres operate under PPP, while 13.33% remain purely government-run ¹.

How the PPP Model Works in Dialysis

Under the Pradhan Mantri National Dialysis Programme (PMNDP), private providers operate dialysis units within district hospitals under fixed-term contracts. The government reimburses eligible beneficiaries per dialysis session, depending on state agreements.

Benefits of the PPP Model in India

The PPP model expands dialysis access without full public capital investment. Moreover, PMNDP supports 1,704 dialysis centres across 751 districts, improving reach in underserved areas ². The structure reduces out-of-pocket burden for economically vulnerable patients.

PPP vs Traditional Infrastructure Models

Unlike highway BOT projects, healthcare PPP focuses on service delivery against asset transfer. Operational control is what private partners maintain throughout the contract term. The strategy allows equipment upgrades and service standards for better dialysis experiences.

Government Oversight and Quality Control

State health departments issue SOPs for infection control and water quality testing. District authorities conduct periodic inspections and monitor patient safety metrics. Grievance redressal systems help maintain accountability within the PPP model.

Dialysis Cost in India 2026: What You Need to Know

Dialysis treatment costs in India vary widely by city, facility type, and frequency of sessions (Government vs private), creating major financial stress for kidney disease patients.

Here are some of the key cost factors for dialysis in India:

• Private dialysis sessions in India typically range from ₹1,500 to ₹4,000 per session, though high-end facilities may charge more.
• Patients usually require dialysis two to three times per week, meaning monthly treatment costs often surpass ₹18,000 – ₹50,000.
• Government and charity centres often charge less, as low as ₹750 per session in some metros, such as Mumbai.
• Non-medical expenses such as travel, food, and income loss add substantial indirect costs to the overall burden.
• Without subsidy or insurance, annual direct costs can easily exceed a family’s income, leading to financial hardship.

Here’s a tabular representation for dialysis costs in 2026:

Note: Delhi, Mumbai, Chennai, and Bengaluru tend toward higher per-session charges than smaller towns. A third session each week increases annual bills by tens of thousands. Insurance coverage and government schemes (e.g., Ayushman Bharat) can reduce out-of-pocket burden but often have sublimits that still leave gaps.

PMNDP: India’s Largest Free Dialysis Initiative

The Pradhan Mantri National Dialysis Programme (PMNDP) aims to ensure free dialysis for patients who cannot afford chronic kidney disease treatments. It works under the National Health Mission and focuses on district-level access across India.

• Launched in April 2016, PMNDP provides free hemodialysis services through district hospitals, with gradual nationwide expansion under central and state coordination.
• The programme follows three operational approaches: PPP-operated centres, fully government-run units, and hybrid models chosen by individual states.
• PMNDP now includes both hemodialysis and peritoneal dialysis, allowing home-based treatment options in selected states.
• The “One Nation-One Dialysis” system linked to ABHA enables portability, so you can access services across districts without having to restart registration.
• The programme addresses the treatment gap for India’s estimated 2.2 lakh new ESRD cases annually, especially among economically vulnerable families ³.

Now that we have a better understanding of PMNDP, let’s explore who is eligible for free dialysis in India.

Who Is Eligible for Free Dialysis in India?

Free dialysis eligibility depends on your State policy and the centre model under PMNDP. You need proof of identity, clinical need, and scheme status.

Here are some of the critical factors that need evaluation before accessing free dialysis in India:

Income and scheme status

Some States use income or ration card status to determine free access. Delhi’s PPP Dialysis Project gives free dialysis if your annual family income is up to ₹3 lakh. Other States may use NFSA categories or local criteria, so you must check the State PMNDP process.

Residency rules

Residency rules vary by State and centre contract. Delhi requires more than 3 years of Delhi residence for its PPP pathway ⁴. Other States may not use the same rule, so avoid a one-rule assumption.

Clinical need

A nephrologist must confirm kidney failure. Many patients start dialysis with a GFR <15 mL/min/1.73 m² with uraemia signs ⁵. Your centre may ask for recent lab reports and a referral note.

Documents you usually need

Most centres ask for Aadhaar and basic address proof. Delhi also accepts the NFSA card or the income certificate for free access. PMNDP systems link your record with ABHA for patient entry on the portal.

Link with PM-JAY and State schemes

PM-JAY targets about 10.74 crore families and offers coverage up to ₹5 lakh per family per year ⁶. Your State may add its own health scheme layer, so you should ask the centre desk.

Here is a tabular representation to quickly map your eligibility criteria depending on different states of India:

Also read: From Dialysis to New Life: How Dialysis Improves Life Expectancy.

How PPP Dialysis Centres Operate: The Win-Win Model for Patients and Providers

The PPP model in dialysis combines public hospital infrastructure with private operational expertise to expand access while maintaining service standards.

Here are some of the comprehensive insights into its operation:

• Private partner role: Private providers install dialysis machines, water purification systems, supply consumables, and deploy trained nephrologists, nurses, and dialysis technicians within government hospital premises.
• Government contribution: The State provides space inside district hospitals, electricity, water supply, and reimbursement for eligible beneficiaries under PMNDP agreements.
• Reimbursement structure: Government pays per-session rates to private partners for eligible patients, while centres may treat paying patients to maintain operational sustainability.
• Quality monitoring: Contracts require adherence to infection control protocols, water testing norms, staff ratios, and periodic audits by district health authorities.
• Risk-sharing model: Private partners manage equipment and staffing risks, while the government ensures patient flow through scheme-backed demand, creating the core benefits of PPP model in India.

In West Bengal, several PPP-operated dialysis units function within government-linked frameworks, and patients often compare facilities when searching for the best dialysis centre in Kolkata, such as Eskag Sanjeevani and other district-level providers.

Challenges and Future of the PPP Dialysis Model in India

The PPP model has expanded dialysis access across India, yet gaps in the workforce, quality control, and treatment continuity still affect outcomes.

Challenges

Here are some of the key challenges for PPP models:

• Urban–rural imbalance: Dialysis centres remain concentrated in cities, and many patients travel long distances for treatment, increasing the risk of dropout and fatigue. National reports confirm uneven geographic distribution despite district-level rollout.
• Workforce shortage: India has over 3,000 practising nephrologists, with approximately 400 new specialists joining the workforce annually ⁷. Despite this, the country faces a significant shortage, with roughly 2,600 to 3,000 specialists catering to a population of 1.34 billion.
• Quality variation: Studies report inconsistent adherence to water-testing protocols and dialysis adequacy standards across centres, suggesting gaps in monitoring.

Future Direction

Here’s how PPP models can shape the future of dialysis in India:

• Home dialysis expansion: Greater use of peritoneal dialysis can reduce travel burden and facility overload while maintaining clinical effectiveness when supervised properly.
• Digital tracking through ABHA: The national digital health linkage enables portability and improved tracking of treatment records, supporting continuity across states.
• Preventive focus: Stronger diabetes and hypertension control at the primary care level can reduce ESRD incidence, which is more cost-effective than expanding late-stage dialysis.

Also read: Kidney Failure Treatments: A Complete Patient Guide.