- Ayushman Bharat is a flagship scheme of the Government of India, that was launched as recommended by the National Health Policy 2017, to achieve the vision of Universal Health Coverage (UHC).
- This initiative has been designed to meet Sustainable Development Goals (SDGs) and its underlining commitment, which is to “leave no one behind.”
- Ayushman Bharat is an attempt to move from a sectoral and segmented approach to health service delivery to a comprehensive need-based health care service.
- This scheme aims to undertake path-breaking interventions to holistically address the healthcare system (covering prevention, promotion and ambulatory care) at the primary, secondary and tertiary levels.
- Ayushman Bharat adopts a continuum of care approach, comprising two inter-related components, which are –
- Health and Wellness Centers (HWCs): In February 2018, the Government of India announced the creation of 1,50,000 Health and Wellness Centres (HWCs) by transforming the existing Sub Centres and Primary Health Centres. These centres are to deliver Comprehensive Primary Health Care (CPHC) bringing healthcare closer to the homes of people. They cover both, maternal and child health services and non-communicable diseases, including free essential drugs and diagnostic services.
- Pradhan Mantri Jan Arogya Yojana (PM-JAY): The second component under Ayushman Bharat is PM-JAY, the largest health assurance scheme in the world, which aims at providing a health cover of Rs. 5 lakhs per family per year for secondary and tertiary care hospitalization across public and private empanelled hospitals in India.
Significance of Ayushman Bharat
- The increasing life expectancy rate over 68.3 years has improved the quality of health care in India.
- Health care is an essential factor, along with other variants like income, hygiene, and nutrition.
- According to the World Health Organization, every country must invest at least 4% of the Gross Domestic Product (GDP) in their health.
- The out-of-pocket expenditure on healthcare is 40% in India.
- The Government Scheme not only covers expensive treatments but also provides quality services to all the people eligible under the plan.
- Exclusion Error: Various issues with SECC data have been pointed out by experts such as a non-transparent method of data collection, and several contradictions in the data. Similarly, Census data are outdated, and population numbers have changed over time. Hence, more reliable estimates should be used.
- Asymmetric Federalism: Several states have increased the coverage of the scheme via state schemes. This entails increased expenditure by states which choose to expand coverage, such as Kerala. However, this may be particularly hard for cash-strapped states like Bihar which depend on Union government funding more than their own resources.
- Ghost Beneficiaries: Unrelated ineligible beneficiaries are admitted based on forging a relationship with the head of the beneficiary family. The challenge that lies ahead for National Health Authority is to strengthen artificial intelligence to pick up all such instances of fraud.
- Cost: PM-JAY rates remained a mere guideline, which has either kept big hospitals at bay or has not been followed by states.
- Connectivity: Ensuring seamless connectivity in regions of turmoil like Kashmir.
- Empanelment: Empaneling hospitals in remote areas like the northeast and Leh remains a challenge.
- Inequity in access: It is a serious issue, especially for the poor who suffer from serious ailments as their illness is not “listed” among the medical packages AB PM-JAY provides for.
- Even in the previous public health insurance schemes of some states, private healthcare providers have been facing huge challenges.
- Particularly, improper procedures for empanelment, cost fixating mechanisms and inordinate delay in reimbursement to hospitals are some issues.
- Also, a proper mechanism for the standardisation of services across the spectrum is absent and the current ‘National Accreditation Board for Hospitals (NABH) certification covers only some hospitals.
Ayushman Bharat digital health mission
- Aims to create a national digital health ecosystem that supports universal health coverage in an efficient, accessible, inclusive, affordable, timely and safe manner leveraging digital technologies.
- Three key components of the Ayushman Bharat Digital Mission:
- Digital Health ID: A 14-digit unique id created using personal details like Name, mobile and Aadhar. It captures details of all health-related records such as laboratory test results, visits to doctors, illness, surgeries etc.
- Healthcare professional registry: Database of all medical professionals in both traditional and modern medicines and a unique id for all the doctors, nurses, ASHA workers etc.
- Health facilities registry: Database of all healthcare facilities such as hospitals, clinics, diagnostic labs, pharmacies etc.
- Implemented by National Health Authority under MoHFW.
PM Ayushman Bharat Health Infrastructure Mission
- Objectives: To fill critical gaps in health infrastructure, surveillance and health research – spanning both urban and rural areas so that communities are Atmanirbhar in managing such future pandemics/health crises.
- It is the largest pan-India Health Infrastructure Scheme which has been framed with a health ‘saturation approach’ at Block, District, State and National Levels.
- It aims to build an IT-enabled disease surveillance system by developing a network of surveillance laboratories at block, district, regional and national levels and at Metropolitan levels & strengthening health units at Points of Entry for effectively detecting and preventing Public Health Emergencies and Disease Outbreaks.
- The earlier scheme named PM Atmanirbhar Swasth Bharat Yojana has now been revamped as PM Ayushman Bharat Health Infrastructure Mission.
Components of the Scheme
1) Central Sector Components
- Aims Institutional Approach to Holistic Healthcare. These interventions will further strengthen India’s capacity to detect and diagnose new infections.
- Setting up of National Platform for One Health
- 12 Central Institutions as training and mentoring sites with 150 bedded Critical Care Hospital Blocks.
- Expansion of Integrated Health Information Portal to all States/UTs to connect all public health labs. (IT-enabled disease surveillance system).
- Four new National Institutes of Virology
- Setting up a Division for Research on Disease Elimination Sciences & Health as a Satellite Centre of the National AIDS Research Institute.
- Regional Research Platform for WHO Southeast Asia Region.
- 15 Biosafety Level three labs (BSL-3)
- Strengthening of the National Centre for Disease Control (NCDC), 5 new Regional NCDC and 20 metropolitan health surveillance units.
- Public health units at 50 international entry points prevent public health emergencies and disease outbreaks.
- Two container-based hospitals with comprehensive medical facilities will be always kept ready which can swiftly be mobilised by rail or air to respond to any calamity or disaster in the country.
- Health Emergency Operation Centres for effective emergency response during emergencies.
2) Centrally Sponsored Components:
- Ayushman Bharat – Health & Wellness Centres (AB-HWCs) in rural areas in 10 States (Bihar, Jharkhand, Odisha, Punjab, Rajasthan, UP and West Bengal Assam, Manipur, Meghalaya).
- AB-HWCs in Urban areas in all the States
- Block Public Health Units in 11 States/UTs (Assam, Bihar, Chhattisgarh, HP, J&K, Jharkhand, MP, Odisha, Rajasthan, UP & Uttarakhand)
- Integrated District Public Health Laboratory in all districts.
- Full range of diagnostic services in all districts. 134 diagnostics tests will be done free of cost.
- Establishment of Critical care hospital blocks in all districts with a population of more than 5 lakhs (602 districts).