Ayushman Bharat: Breaking Health Barriers

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TOPIC: General Studies 2

• Issues relating to development and management of Social Sector/Services relating to Health
• Development processes and the development industry the role of NGOs, SHGs, various groups and associations, donors, charities, institutional and other stakeholders

Presently, India is in a state of health transition. The country is not just confronting infectious diseases such as tuberculosis, malaria, dengue, H1N1 pandemic influenza and antimicrobial resistance; but also the emerging problem of chronic non-communicable diseases such as cardiovascular diseases, diabetes, cancer which are now the leading cause of mortality. Climate change, globalization, urbanization and changing lifestyles are further fueling this transition. This has resulted in the health infrastructure undergoing severe strain.

Nearly 60 million people are pushed into poverty every year. Finance Minister Arun Jaitley, while announcing the National Health Protection Scheme said, “Lakhs of families borrow or sell assets to receive inpatient treatment and the government is concerned about the consequent impoverishment of poor and vulnerable families”

Ayushmaan Bharat – An attempt to transform India’s Healthcare Map

Innovative and path-breaking scheme in the history of public health in India. It may have a transformative impact if implemented in an effective and coordinated manner.

• Aim: To make path-breaking interventions to address health holistically, in primary, secondary and tertiary care systems
• Objective: Prevention + Promotion (Health & Wellness)
• Full proof mechanism while allowing States to accommodate the existing schemes, keeping the flavour of Digital India intact

Budget States:

• Rs 52,800 crores for the health ministry, up from Rs 47,352 crore during the previous year signifying an increase of 11% (yet as a percentage of the GDP, it is still among the lowest in the world)
• Increase the levy of health cess from 3 to 4%

Two major initiatives:

• Health and Wellness Centre: Foundation of India’s health system
  • 1.5 lakh centres will provide – comprehensive health care, including for non-communicable diseases and maternal and child health services, provide free essential drugs and diagnostic services
  • The budget has allocated Rs.1200 crore for this flagship programme
  • Contribution of the private sector through CSR and philanthropic institutions in adopting these centres is also envisaged.

• National Health Protection Scheme:

• • Will cover over 10 crore poor and vulnerable families (approximately 50 crore beneficiaries)
  • Coverage of up to ₹5 lakh a family a year will be provided for secondary- and tertiary-care hospitalization (50 crore beneficiaries)

Facts:

• Data of families will be derived from the SECC Data
• Increase in Health budget over the previous one: Approximately 11.50%

Ayushmaan Bharat Vs. Rashtriya Swasthiya Bhima Yojana: The new scheme builds on the already existing Rashtriya Swasthya Bima Yojna (with the entitlement of up to Rs 30,000 per annum for diseases requiring hospitalization) but has a bigger outreach plan.

Implementation model:

• Insurance Model – Public or Private
• Trust Model – Found effective in states like Andhra Pradesh

Ayushmaan Bharat can be a Game Changer only if:

• Collaboration is the key: The Central government collaborates successfully with State governments and the industry, and focusses aggressively on the operational and implementation aspect of these initiatives. Government and industry should develop partnerships with the focus on improving the coverage and providing access to quality healthcare services to the people.
• Capacity building of the existing resources: Increased capacity-building of the resources at hand during policy formulation.
• Technology: Strong emphasis on the adoption of technology by the entire healthcare ecosystem to provide accessible and affordable patient care to the last mile of the country.
• Role of States: State ownership and commitment of them is critical as the states are expected to agree for 40 per cent share under the NHPS (Health: State subject). Also, absorptive capacity of States needs to be increased.
• Clarity on the Services being provided: More clarity on the kind of services that will be provided by government health facilities and for which conditions patients will have to use private parties and what mechanisms are being thought of.
• Price matters: Establishment of uniform pricing systems for various health interventions, including diagnostics and medicines, and making them transparent by displaying them in hospital premises.
• Community Engagement: Continuum of care system needs to be established by linking institutions or hospitals, with health centres and the community. Community engagement is thus crucial in planning and implementation of the programme and in ensuring that the health and wellness centres and the primary health centres are responsive to the needs of the community.
• Special Unit to measure success, course correct: For effective implementation, an independent body or unit may be set up within the Ministry of Health & Family Welfare to plan, coordinate, and provide technical backstopping to states, including in capacity building and development of standards and guidelines for the programme. Such a unit will ensure uniform and systematic approach to programme implementation across the country.

Connecting the Dots:

1. “Only healthy people can build a strong and prosperous nation”. Comment.
2. Can Ayushman Bharat prove to be a game changer? Discuss.