Welfare mechanism

Aadhaar-Based Payment System (ABPS) Mandatory for NREGS

Context: Central government has notified that from January 01, 2024, all wages under the Mahatma Gandhi National Rural Employment Guarantee Act (MGNREGA) scheme must be paid through an Aadhaar-based payment system (ABPS). However, some state governments have opposed this move.

About NREGA Aadhaar-based payment system (ABPS):

  • It is a method of disbursing payments to MGNREGA workers using their unique 12-digit Aadhaar number as their financial address.
  • Under this system, workers’ Aadhaar numbers are linked with their job cards as well as their bank accounts, this account must be connected to the National Payments Corporation of India (NPCI) mapper.
  • Under Mahatma Gandhi NREGS, APBS is in use since 2017.
  • The system was initially made mandatory from February 1, 2023. However, through several extensions, the Centre allowed this requirement to persist until December 31, 2023. As no further extensions were granted to states beyond December 31, the ABPS became mandatory from January 1, 2024.
  • The government grant exemptions on a "case-by-case basis" if any gram panchayat experiences "technical issues" or Aadhaar-related problems until the resolution of the underlying issue.
  • Aim is to streamline wage payments and ensure transparency, reducing the chances of fraud.

Benefits of ABPS:

  • Ensuring that payments are made to the rightful beneficiaries, reducing the chances of fraud and corruption and eliminating intermediaries.
  • Reduces paperwork, minimizes delays, and ensures a faster and more streamlined disbursement of wages.
  • Encourages financial inclusion by promoting the use of bank accounts.
  • Digital records make it easier to track and audit payments.

Challenges associated with ABPS:

  • Deletion of job cards: 7.6 crore job cards deleted since April 2022 due to discrepancies between the two documents, the Aadhaar and the job card, such as different spellings of workers’ names.
  • Right to work (Article 41): Compelling the use of ABPS with more than one-third of the total MNREGA registered workers rendered ineligible will inevitably lead to the denial of the right to work.
  • Exclusion of workers: Till December 2023, 12.7% of these active workers are still not eligible due to technological adeptness or a lack of proper documentation.
  • Active workers are those who have worked for at least one day over the last three financial years.
  • Privacy concerns: Mandatory linking of Aadhaar to NREGS payments raises privacy concerns, as it involves collecting and storing biometric and personal information.

Women in MGNREGS

Context: As per the Periodic Labour Force Survey (PLFS), published by the Ministry of Statistics and Programme Implementation, Women participation in the Mahatma Gandhi National Rural Employment Guarantee Scheme (MGNREGS) was the highest in 10 financial years.

Women participation in MGNREGS:

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  • The rates of participation of women in the MGNREGS, defined as women person-days out of the total in percentage.
  • The proportion of women person-days in the total touching 59.25% in 2023-24, 57.47% in 2022-23 and 54.82% in 2021-22. 
  • The lowest percentage of women participation in the NREGS over the last 10 financial years was recorded in 2020-21 at 53.19%. 
  • The southern states like Kerala (89%), Tamil Nadu (86%), Puducherry (87.16%) and Goa (72%) have recorded women participation rate of over 70%, it has been hovering around 40% or below in northern states like Uttar Pradesh and Madhya Pradesh over the years.
  • In 2023-24, 5 states/UTs with the lowest women participation rate under NREGS are: UTs of Jammu and Kashmir (30.47%) and Lakshadweep (38.24%), Uttar Pradesh (42.39%), Madhya Pradesh (42.50%) and Maharashtra (43.76%). 
  • In rural areas, the female Labour Force Participation Rate (LFPR), increased to 30.5% in 2022-23 from 18.2% in 2017-18. 

Impact of MGNREGA on Women Empowerment

  • Economic Independence: It has provided women in rural areas with opportunities for wage employment, that contributed to their economic independence as MGNREGA provides at least 100 days of wage employment.
  • Reduced Gender Wage Gap: It mandates equal wages for men and women for the same work, helped in reducing the gender wage gap and promoting equity in income distribution.
  • Social Empowerment: Women have gained visibility and recognition in their communities, increased social standing can contribute to a positive shift in societal attitudes towards the role and capabilities of women.
  • Health Benefits and Skill Development: Income generated through MGNREGA can be invested in improving the health and education of women and their families.
  • Reduction in Distress Migration: It has helped in mitigating distress migration by providing employment opportunities locally. This is particularly significant for women who may have been left behind in rural areas while male family members migrate in search of work.

Reason for low participation of women in several states: 

  • Absence of safe transportation facilities :The distance between work sites and women's homes can be a deterrent, especially in the absence of reliable and safe transportation facilities.
  • Lack of Childcare Support: The absence of childcare facilities at work sites may pose a challenge for women with young children, making it difficult for them to participate.
  • Lower Wage Rates: MNREGA wage rates (set by centre) of at least 17 of the 21 major states are even lower than the state minimum wage for agriculture, discouraging women from participating in the scheme.
  • Delayed payment of wages: Delayed payment of wages, particularly for women who may face financial constraints.
  • Socio-cultural Norms: Deep-rooted gender norms and stereotypes in certain regions may limit women's mobility. Further,  Women often have significant domestic responsibilities, which can limit their ability to participate in MGNREGA. These may include childcare, eldercare, and household chores that are traditionally ascribed to women​.
  • Safety Concerns: Concerns about safety and harassment at work sites can deter women from participating.
  • Health Issues: Health-related constraints like being Anaemic  can also impact women's ability to engage in labour-intensive work typically offered under MNREGA.

Suggestive measures to ensure high participation of women in MGNREGS: 

  • Recommendations given by Parliamentary Standing Committee on Rural Development and Panchayati Raj: 
    • The long-standing demand for increasing wages must be address through suitable linkage to the inflation index.
    • The committee has suggested that the government must take measures for better promotion of “women-centric works” through creation or linking of existing livelihood projects under the scheme.
    • Ministry of Rural Development needs to bridge the wage disparity among states by notifying a uniform wage rate structure.
    • It recommended increasing the guaranteed days of work under the scheme from 100 to 150 days to deal with exigencies arising from natural calamities.

About Mahatma Gandhi National Rural Employment Guarantee Act: 

Introduced in: 2005.

Nodal ministry: Ministry of Rural Development (MRD).

Aim: For improving the purchasing power of the people living in rural areas. Primarily semi or unskilled work was given to people living below the poverty line in rural India. Also aims to guarantee the 'right to work' (Article 41).

Mandate: To provide at least 100 days of guaranteed employment in a financial year to every rural household whose adult members volunteer to do unskilled manual work at the statutory minimum wage.

Key features of the act: 

  • It is a demand-driven wage employment programme and resource transfer from the Centre to the states is based on the demand for employment in each state.
  • Adult members of rural households submit their name, age and address with a photo to the Gram Panchayat, for job card.
  • The registered person can submit an application for work in writing (for at least fourteen days of continuous work) either to Panchayat or to Programme Officer.
  • If work is not provided within 15 days of applying, applicants are entitled to an unemployment allowance. 
  • The employment will be provided within a radius of 5-km. And if it is beyond 5-km, extra wage will be paid.
  • Women are guaranteed one third of the jobs made available under the MGNREGA.
  • The people in coordination with local administration conduct the social audits, whose objective is to ensure public accountability.

Bonded labour: The Modern Slavery

On May 1, the world commemorates International Labour Day to honour the dignity of work and workers’ rights. However, the stories of millions trapped in bonded labour in India cast a dark shadow. 

India abolished bonded labour in 1975. The government plans to release and rehabilitate 1.84 crore bonded labourers across the country as part of its 15-year vision extending until 2030.

Relevance of the Topic: Mains: Bonded Labour: Reasons for Persistent Bonded Labour in India; Government initiatives to end bonded labour.

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About bonded labour

  • Bonded Labour System (Abolition) Act 1976, defines ‘bonded labour system’ as the system of forced labour under which a debtor enters into an agreement with the creditor that he would render service to him either by himself or through any member for a specified or unspecified period, either without wages or for nominal wages.
  • The traditional form of bondage or forced labour in India are known as Adiyamar, Baramasia, Kuthia, Lakhari, Munjhi, Mat, Munish system, Nit-Majoor, Sewak, Sewakia, Seri, Vetti. 

Bonded labour in India:

  • According to Global Slavery Index, In 2021, around 11 million people in India were in modern slavery, which includes forced labour, debt bondage, forced marriage, other slavery and slavery-like practices, and human trafficking.
  • National Crime Records Bureau data, in 2021, 592 cases (96% against SC/ST) were registered under the Bonded Labour System (Abolition) Act.
  • According to 2018 data from the Union Ministry of Labour and Employment, of the 3.13 lakh bonded labourers rehabilitated in the country, 1,404 were from Maharashtra. 
  • The top three States on the list were Karnataka (66,281), Tamil Nadu (65,573), and Uttar Pradesh (42,279).

Initiative to end bonded labour:

Constitutional Provisions:

  • Article 21: Right to Life and Personal Liberty.
  • Article 23: Prohibition of traffic in human beings and forced labour.
  • Article 39: State to secure the health and strength of workers, men and women, and to see the tender age of children are not abused and that citizens are not forced by economic necessity to enter avocations unsuited to their age or strength.

Government’s initiative:

  • Bonded Labour System (Abolition) Act 1976: This act, which renders bonded labour a form of modern slavery, is illegal in India.
    • It establishes Vigilance Committees at the district, sub-division, and block levels to oversee the implementation of the act.
    • Vigilance committees advise District Magistrate (DM) to ensure the provisions of this Act are properly implemented.
    • Under the Act, it is the responsibility of State governments to identify, release and rehabilitate the bonded labour.
  • Central Sector Scheme for Rehabilitation of Bonded Labourer, 2016: To provide financial and non-financial support once they are issued bonded labour release certificates by district magistrates or sub-divisional magistrates (DM or SDM). 
    • Provide immediate financial support of Rs 30,000 to the rescued labourer. It also includes Rs 1 lakh for a male worker, Rs 2 lakh for each woman and child, and Rs 3 lakh for transgender persons or women and children in extreme cases.
    • The beneficiaries are also entitled to non-cash assistance including land allotment for a house, allocation of agricultural land. etc.
  • Preparation of Fifteen - Year Vision Document (2030), Seven Year Strategy Document (2017-18 to 2023-24) and Three-Year Action Plan (2017-18 to 2019-20) of the Ministry of Labour & Employment on Total Abolition of Bonded Labour: 
    • To identify, release and rehabilitate an estimated 1.84 crore Bonded Labourers.
    • To strengthen the prosecution machinery and reaching 100% conviction rate.
    • To deal with the altered forms of bondage such as organized begging, forced prostitution, forced marriage, forced recruitment for insurgency activities, domestic service, etc. under the BLS (A) Act.
  • Code on Wages, 2019: Makes universal the provisions for minimum wages and timely payment of wages for all workers in India.
  • Ratification of ILO Abolition of Forced Labour Convention, 1957: Aimed at eliminating all forms of forced or compulsory labour.
  • Initiatives of the National Human Rights Commission: Organized a National Level Seminar and Workshops conducted in Bonded Labour prone States like Gujarat, Karnataka, Maharashtra, Haryana and Uttar Pradesh. 

Reason for persistent bonded labour in India:

  • Migration and informal sector job: Laborers migrate from rural to urban areas and in the informal economy, where labour protections are often lacking, they become vulnerable to exploitation and forced labour.
  • Low wages: According to Report of the National Commission on Labour, 2002, if earnings and wages are below the statutory minimum wage and workers have to live by borrowing, the condition of the workers slide into bondage.
  • Caste system: The deeply entrenched caste system in India has contributed to social hierarchies and discrimination makes them more susceptible to exploitation and bonded labour.
  • Debt bondage: Trapped in bonded labour due to poverty, individuals accrue debts owed to employers with exploitative interest rates and unfair working conditions can make it impossible for them to repay the debt, leading to a cycle of bondage and passes on to family members. 
  • Lack of education and awareness: Limited access to education and awareness about labour rights contribute to the perpetuation of bonded labour.
  • Under-resourced judiciary & police force: Lack the manpower, infrastructure, and training required to effectively investigate, prosecute, and adjudicate cases of bonded labour, this resource deficit creates loopholes in the implementation of anti-bonded labour laws.
  • Landlessness: By limiting economic opportunities, reducing bargaining power, and ineffective implementation of laws.

Measures to end the bonded labour:

  • Establish National Portal on Bonded Labour for welfare entitlements and monitoring mechanism of rehabilitation, irrespective of the jurisdictional aspects (Parliamentary committee).
  • Increase corpus funds for sensitive districts by centre and timely issuance of release certificates by state government to access rehabilitation assistance.
  • Regular surveys in sensitive districts to identify and eradicate bonded labour and awareness campaigns
  • Convergence of bonded labour rehabilitation scheme with others schemes like MGREGA, at the Union and state levels to monitor benefits to workers.
  • Encourage businesses to incorporate anti-bonded labour policies into their Corporate Social Responsibility (CSR) initiatives.
  • Modifying the working conditions by implementing robust legal frameworks that prohibit and penalise bonded labour practices, while also adhering to minimum wage standards.

Neerja Chaudhary v State of M.P (1984), where the Supreme Court expressed anguish over the indifference of the government towards the rehabilitation of released bonded labourers.

India has sufficient laws and policies to address the issue of the Bonded Labour System, eradicating this social scourge requires changing the psyche of society and dispelling feudal thinking that unfortunately still persists. This shift will contribute to achieving Target 8.7 of the Sustainable Development Goal, which aims to end forced labour, human trafficking, and child labour.

Need to reform current Social Justice policies

Context: With the ascent of neo-liberal economic development, the conventional support that Dalits and Adivasis received from state institutions has derailed. Therefore, there is a need to frame new social justice policies with an Ambedkar touch.

What is social justice and its need?

  • It is the equitable distribution of social, material and political resources to all citizens. It is the balancing wheel between the haves and the have not’s. 
  • It aims towards creating political, economic and social democracy, ending class and caste distinctions. 
  • It combines the principles of socialism with the personal freedom granted by democracy.
  • It involves measures taken for the advancement of the depressed and disadvantaged classes of society to balance the Indian society.
  • Backward communities and women have suffered for centuries because of denied equality, education and other opportunities, creates walls and barriers of exclusiveness, so social justice involves the creation of a just and fair social order.

B. R. Ambedkar view on social justice

  • According to him, social justice is a means to create an ideal or a just society. For him, caste was the principal axis of discrimination in Indian society. This was main reason for discrimination, poverty and ostracization of a large section of population, particularly the depressed classes.
  • He advocated for constitutional socialism, inter-caste marriages and conversion to Buddhism as a means to end the hold of caste on the mindset of Indians.
  • As a chairman of the Drafting Committee of the Constitution, he advocated for fundamental rights for all citizens with positive discrimination in favour of scheduled castes and positive obligation on the state in the form of Directive Principles of State Policy to ameliorate the conditions of the marginalised. 
  • For him, a just society is a casteless society, based on the principles of social justice and a combination of three components: liberty, equality and fraternity. 
  • Liberty: The essential conditions that make liberty real were: social equality, economic equality and access to knowledge. 
  • Equality: It means all men are of the same essence, all men are equal and everyone is entitled to the same fundamental rights and to equal liberty.
  • Fraternity: There are two forces prevalent in society such as Individualism and fraternity. Individualism produces anarchy. He believed that it is only fraternity which prevents anarchy and helps to sustain the moral order among men. 
  • Ideal society is based upon two fundamental principles
    • Individual: The aim and object of society is the growth of the individual and development of his personality. Society is not above the individual.
    • Terms of associated life between members of society: Must be regarded by consideration founded on liberty, equality and fraternity.
  • It provides moral sensibilities to institutions and makes it responsible towards the diverse population.

Steps taken related to social justice in India: 

Constitutional Provision: 

  • Preamble: The terms Justice,Liberty,Equality,Fratnerity were inserted in the Preamble.
  • Article 14: Right to Equality
  • Article 15: Prohibition of discrimination on grounds of religion, race, caste, sex, or place of birth.
  • Article 16: Equality of opportunity in matters of public employment.
  • Article 17: Abolition of Untouchability.
  • Article 46: Promotion of educational and economic interests of Scheduled Castes, Scheduled Tribes, and other weaker sections.
  • Article 335: Claims of Scheduled Castes and Scheduled Tribes to services and posts.
  • Article 340: Appointment of a Commission to investigate the conditions of backward classes
  • Article 341: Authorises the President to declare certain castes and classes as Scheduled Castes in a state or a union territory.

Government initiatives related to social justice in India: 

Social Empowerment

  • Protection of Civil Rights, 1955 : To prescribe punishment for the preaching and practice of Untouchability for the enforcement of any disability arising therefrom and for matters connected therewith.
  • Scheduled Castes and Scheduled Tribes (Prevention of Atrocities) Act, 1989: To prevent atrocities and hate crimes against the scheduled castes and scheduled tribes.
  • Prohibition of Employment as Manual Scavengers and their Rehabilitation Act, 2013: To eliminate unsanitary latrines, prohibit the employment of manual scavengers and the hazardous manual cleaning of sewer and septic tanks.

Education empowerment:

  • Beti Bachao Beti Padhao Scheme: To address the declining child sex ratio and promote the education and empowerment of girls in India.
  • Eklavya Model Residential School: To empower tribal communities through education and bridge the gap between tribal and non-tribal populations.
  • Scheme For Residential Education For Students in High Schools in Targeted Areas (SHRESHTA): To improve educational and socioeconomic conditions of the target group i.e. Scheduled Castes with a view to upgrade skill.
  • PM Young Achievers Scholarship Award Scheme for Vibrant India (PM YASASVI): To award scholarships to eligible candidates belonging to Other Backward Class (OBC), Economically Backward Class (EBC), and De-Notified, Nomadic & Semi Nomadic Tribes(DNT/SNT) categories.

Economic empowerment: 

  • Stand-Up India Scheme: To promote entrepreneurship among women and scheduled castes and tribes.
  • National Scheduled Castes Finance and Development Corporation (NSFDC): For financing, facilitating and mobilizing funds for the economic empowerment of persons belonging to the Scheduled Castes families living below double the Poverty Line.
  • Pradhan Mantri Dakshta Aur Kushalta Sampann Hitgrahi (PM-DAKSH) Yojana: National Action Plan for skilling of marginalized persons covering SCs, OBCs, EBCs, DNTs, Sanitation workers including waste pickers.

Why do we still need social justice policies despite having them in place for more than 70 years?

  • The dominance of social elites in implementing social justice policies results in socially marginalized groups having only a tokenistic presence in the realm of power and privileges.
  • Decline in traditional support for Dalits and Adivasis with the rise of neo-liberal economic development.
  • There is also an issues of societal norms, biases, and stereotypes that perpetuating social injustice. These biases are deeply ingrained in society and can manifest in various forms, including systemic racism, sexism, homophobia, and xenophobia.
  • The neglect by the neo-liberal market towards the aspirations and the demands of marginalized communities has made the market enterprise more exploitative and closer to a crony capitalist mode.

Issues in Social Justice policies:

  • Social justice policies in India have been reduced to only ameliorating caste. This has created following concerns:
    • In place of creating a casteless society, the grip of caste on consciousness of Indians has become even more pronounced. This has resulted into even middle castes to demand reservations on caste basis. For ex. Maratha, Jats etc.
    • Also, a small sections among the backward and Dalit population have appropriated and vast majority continue to lead a life of penury and marginalisation. This minor elite continue to reclaim and appropriate the social justice policies despite claiming the benefits of reservation over multiple generations. For ex. Meenas in Rajasthan.
    • Discrimination and marginalisation can also be on other axes. For ex. Based on location, gender, income, dress, food habits etc. Addressing these have not been a priority in our social justice policies.
    • Social Justice policies in India have been mostly a remit of the state. For ex. Reservation in public employment or educational institutions. However, for results to come, especially after the LPG reforms there is a need for a whole of society approach.
    • State address socially marginalised groups as the passive recipient of the state’s welfare packages.

Reform in Social Justice policy 

  • A one-size-fits-all approach might not address specific challenges faced by different groups. A balanced approach is required combining both targeted and universal strategies.
  • Need of social engineering technique which is an attempt to change society in order to deal with social problems, behavioural change, and attitudes for positive change.
  • It is required that the new social justice policies be expanded to the private economy, with a focus to democratise the working classes and to reduce poverty.
  • There is need for ethical corrective measures like investigation and analysis, accountability and disciplinary action to make institutions more democratic, representative and closer to the claims and the desires of marginalised social groups.
  • Need for a new framework of social justice along with more affirmative action and new policies against social discrimination and make sure that their equitable participation in the diverse spheres of development.
  • There is need for national, regional or micro level index to capture several of the dimensions of discrimination to preserve the social balance in various spheres of society.
  • Set up an equal opportunity commission to look into grievances groups like minorities (Sachar committee).
  • Diversity-based incentive system at micro level institutions and social spaces to meet the goal of increasing diversity are rewarded. Similarly, a system of disincentives should be devised such that institutions that do not make adequate effort to increase diversity are penalised. 
State government initiatives related to social justice:  

Ladli Behna scheme in Madhya Pradesh: Under it, Rs 1,250 per month was given to poor women beneficiaries.
Kalaignar Magalir Urimai Scheme in Tamil Nadu: Under which Rs 1,000 is transferred per month to women above the age of 21 with a household income of less than Rs 2.5 lakh.
Mahalakshmi scheme in Telangana: Which offers women and transgender persons free travel on state-run non-AC buses.
Gruha Lakshmi scheme in Karnataka: A monetary aid of Rs 2000 has been decided to provide to the head woman of the family on a monthly basis.  

Pradhan Mantri Awas Yojana (Urban)

Context: The Centre has advised States and Union territories to display the “standard logo” of Pradhan Mantri Awas Yojana- Urban (PMAY-U) in all houses constructed under the scheme.

About PMAY-U: 

  • Launched in: 2015
  • Nodal ministry: Ministry of Housing and Urban Affairs (MoHUA).
  • Objective: To provide all weather pucca houses to all eligible beneficiaries in the urban areas of the country through States/UTs/Central Nodal Agencies.
  • Eligible beneficiaries: Economically Weaker Section (EWS)/Low Income Group (LIG), Middle Income Group including the slum dwellers.
  • Coverage: Covers the entire urban area of the country, i.e., all statutory towns as per Census 2011 and towns notified subsequently, including Notified Planning/ Development Areas.
  • Components: Implemented through four verticals:
    • Beneficiary Led Construction/ Enhancement (BLC): 
    • Affordable Housing in Partnership (AHP)
    • In-situ Slum Redevelopment (ISSR): 
    • Credit Linked Subsidy Scheme (CLSS): 
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Initiative of this scheme

  • Affordable Rental Housing Complexes (ARHCs) for Migrant Workers/ Urban Poor: A sub-scheme under PMAY-U to provide ease of living to urban migrants/ poor in Industrial Sector as well as in non-formal urban economy to get access to dignified affordable rental housing close to their workplace. 
  • CLSS Awas Portal (CLAP): A common platform where all stakeholders are integrated in real time environment. The portal facilitates processing of applications along with tracking of subsidy status by beneficiaries. CLSS tracker has also been incorporated in PMAY(U) mobile App and UMANG platform.
  • ANGIKAAR- A campaign for change management: Focuses on adopting best practices such as water & energy conservation, waste management, health, sanitation and hygiene for PMAY(U) beneficiaries.
  • Technology Sub Mission (TSM): It facilitates adoption of modern, innovative and green technologies and building materials for faster and quality construction of houses.
  • Global Housing Technology Challenge - India: To identify and mainstream a basket of innovative construction technologies from across the globe for housing construction sector that are sustainable, eco-friendly and disaster-resilient. 
  • Expected completion: December 2024 with all verticals, except CLSS.
  • Significance: The Mission promotes women empowerment by providing the ownership of houses in name of female member or in joint name.
  • Preference has also been given to differently abled persons, senior citizens, SCs, STs, OBCs, Minority, single women, transgender and other weaker & vulnerable sections of the society. 
  • All houses under PMAY-U have basic amenities like toilet, water supply, electricity and kitchen. 

Pradhan Mantri Janjati Adivasi Nyaya Maha Abhiyan (PM-JANMAN)

Context: The Union Cabinet has approved Pradhan Mantri Janjati Adivasi Nyaya Maha Abhiyan (PM JANMAN) scheme.

About PM-JANMAN

PM janman scheme
  • Announced in: Budget 2023-24
  • Launched in: 2023
  • Outlay: 24,104-crore
    • Centre’s share: Rs 15,336 crore 
    • States share: Rs 8,768 crore.
  • Aim: To provide a number of facilities to Particularly Vulnerable Tribal Groups (PVTGs).
  • Features of the scheme: This scheme comprising Central Sector and Centrally Sponsored Schemes to focus on 11 critical interventions through 9 Ministries including Ministry of Tribal Affairs. 
  • Interventions are: provision of pucca houses, road and telecom connectivity, drinking water and sanitation, access to education and health, construction of Anganwadi Centers and Multipurpose Centers.
  • The Ministry of Ayush will set up Ayush Wellness Centre to PVTG habitations through mobile medical units.
  • The Ministry of Skill Development and Entrepreneurship will facilitate skill and vocational training in PVTG habitations, multi-purpose centres and hostels as per suitable skills of these communities.

About PVTG: 

  • It is a classification used in India to identify certain tribes or communities that are considered to be at a particularly high risk of extinction or facing extreme socio-economic marginalization
  • Tribal communities are often identified by some specific signs such as primitive traits, distinctive culture, geographical isolation, shyness to contact with the community at large and backwardness.
  • In 1973, the Dhebar Commission created Primitive Tribal Groups (PTGs) as a separate category, which are less developed among the tribal groups.
  • In 2006, the Government of India renamed the PTGs as Particularly Vulnerable Tribal Groups (PVTGs)

Criteria for identification of PVTGs

  • Pre-agricultural level of technology  
  • Low level of literacy 
  • Economic backwardness   
  • A declining or stagnant population accordingly.
  • India has ST population of 10.45 crore as per 2011 census, out of which 75 communities located in 18 States and the Union Territory of Andaman and Nicobar Islands have been categorized as PVTGs. 
  • Among the 75 listed PVTGs the highest number are found in Odisha (13), followed by Andhra Pradesh (12).

MGNREGS & Social Audit

Context: Out of the 34 States and union territories only six have completed social audit of works done under the Mahatma Gandhi National Rural Employment Guarantee Scheme (MGNREGS) in more than 50% of gram panchayats

More about findings

  • Other than Kerala the only States to cross the 50% mark are Bihar (64.4%), Gujarat (58.8%), Jammu and Kashmir (64.1%), Odisha (60.42%) and Uttar Pradesh (54.97%).lx6d3oQ2DMl8mQFJ n368Adoo6HUsvsuu15zwTZvV 1TZbCuJC9L7tecVSaBV2sv1dE5Xzyym7O1 fbKBJPslairzerAL6V4Lljod31W8CVI cI L3zUiPiVY6cbTnQsq0quF1xRWCfSF Kwgf361A
  • Only three States have covered 40% or more villages Telangana (40.5%), Himachal Pradesh (45.32%) and Andhra Pradesh (49.7%). 
  • The numbers are really low in Madhya Pradesh (1.73%), Mizoram (17.5%) Chhattisgarh (25.06%), and Rajasthan (34.74%). 
  • Kerala is the only State to cover 100% gram panchayats.

About social audit

  • It is a way of measuring, understanding, reporting & ultimately improving an organization’s social & ethical performance i.e. it serves as an instrument for the measurement of social accountability of an organization.
  • It is a process which allows end users to scrutinize the impact of developmental programs.
  • It helps to narrow gaps between vision/goal and reality, between efficiency and effectiveness. It is a technique to understand, measure, verify, report on and to improve the social performance of the organization.
  • The concept gained significance after the 73rd Amendment of the Constitution.

MGNREGA and Social Audit 

  • The Mahatma Gandhi National Rural Employment Guarantee Act provides for a central role to ‘Social Audits’ as a means of continuous public vigilance. 
  • Section 17 of the MGNREGA act says the gram sabha “shall monitor the execution of works”. Each State has social audit units which are supposed to work independent of the implementing authorities.
  • The auditing standards laid down by the Comptroller and Auditor General, every Social Audit Unit is entitled to funds equivalent to 0.5% of the MGNREGA expenditure incurred by the State in the previous year. 
    • The audit involves quality checks of infrastructure created under the MGNREGA, financial misappropriation in wages, and checking for any procedural deviations.
  • A process is to be conducted in every Gram Panchayat (GP) at least once in six months, involving a mandatory review of all aspects.
  • Rule 4 of Audit of Schemes Rules, 2011 stipulates that each State Government shall identify or establish an independent organization, “Social Audit Unit” (SAU) to facilitate conduct of the Social Audit of MGNREGS works. 
    • This Social Audit Unit may be either a Society or a Directorate, independent of the implementing departments/agencies
    • The work may also be outsourced to an outside agency, preferably an NGO which is not involved in the planning and implementation of the Scheme but possesses adequate experience of having worked in rights and entitlement-based programmes.

Indian Sign Language

Context: Sarah Sunny becoming the first deaf advocate to use Indian Sign Language (ISL) to argue a case in the Supreme Court.

About Indian Sign Language

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  • It is the primary sign language used by the deaf and hard of hearing community in India. It is a visual-gestural language that employs a combination of handshapes, facial expressions, and body movements to convey meaning. 
  • It is not only a means of communication for the hearing-impaired, but a is a symbol of their pride and identity. 
  • The Rights of Persons with Disabilities (RPwD) Act 2016 recognises sign language as a means of communication which is especially useful for communication with persons with hearing disability. 
  • The Act further mandates governments to promote use of sign language to enable persons with hearing disability to participate and contribute to their community and society.

Initiatives to promote sign language

  • UN's International Day of Sign Languages: Celebrated annually on September 23, this day is dedicated to raising awareness about the importance of sign languages and promoting their use in various spheres of society. To protect the linguistic identity and cultural diversity of all deaf people and other sign language users.
    • In 2018, as part of the International Week of the Deaf, the International Day of Sign Languages was observed for the first time.
    • September 23 was picked to celebrate the World Federation of the Deaf (WFD) established in 1951.
    • Theme of 2023: A World Where Deaf People Can Sign Anywhere.
  • The Billion Readers (BIRD) initiative: To ensure daily and lifelong reading practice for a billion people in India by adding Same Language Subtitling (SLS) on mainstream entertainment content on television and streaming platforms. 
    • SLS is the idea of subtitling audio-visual (AV) content in the ‘same’ language as the audio to serve one vision “Every Indian, a fluent reader”.
    • SLS was conceived for mass reading in 1996 at the Indian Institute of Management, Ahmedabad (IIMA). 
  • Indian Sign Language Dictionary: To remove communications barriers between the deaf and hearing communities as it is focused on providing more information in Indian sign language. 
    • Its aim is to give Deaf people the constitutional right as well as the opportunity of freedom of expression and also bringing them into the main stream of the society. 
    • Developed by Indian Sign Language Research & Training Centre (ISLR&TC).
    • The ISL dictionary consists of words of many categories like everyday terms, legal terms, academic terms, medical terms, and technical terms.
    • 1st edition of the ISL Dictionary programme launched in 2018, 2nd edition in 2019 and 3rd edition in 2021.

About ISLRTC

  • To promote the use of Indian Sign Language as educational mode for deaf students at primary, secondary and higher education levels.
    • To carry out research through collaboration with universities and other educational institution in India and abroad to promote, propagate and upgrade Indian Sign Language.
  • It was established under the 11th Five Year Plan (2007-2012). Earlier, it existed as an autonomous center of the Indira Gandhi National Open University (IGNOU), Delhi.
  • Later, in 2015, it became a society under the Department of Empowerment of Persons with Disabilities under Ministry of Social Justice and Empowerment.

Pradhan Mantri Awaas Yojana - Gramin

Context: According to surveys done in 2022, more than 80 per cent of Pradhan Mantri Awaas Yojana-Gramin beneficiaries spent over Rs 1.50 lakh to construct houses under the scheme, higher than the allocated Rs 1.20 lakh for rural areas in plains and Rs 1.30 lakh in hills, 

About PMAY-G

  • Background: Indira Awaas yojana (IAY) has been restructured into PMAY-G.
  • Launched in: 2016.
  • Type of scheme: Centrally Sponsored Scheme.
  • Nodal ministry: Ministry of Rural Development.
  • Budgetary allocation: 13,000-crore.
  • Objective: To ensure the provision of pucca housing for all individuals who are homeless or living in dilapidated houses in rural areas except Delhi and Chandigarh by 2024, instead of the previous goal of 2022.
  • Target: Construction of 2.95 crore houses by March 2024.
  • Funding pattern: Shared between Central and State Governments in the ratio 60:40 in plain areas and 90: 10 for North Eastern and Himalayan States.
  • Eligible Beneficiaries: All the houseless households living in zero, one, or two-room houses with kutcha walls and kutcha roofs. Criteria for Automatic/Compulsory Inclusion
    • Households without shelter
    • Destitute/ living on alms
    • Manual scavengers
    • Primitive Tribal Groups
    • Legally released bonded labourer.
  • Selection of Beneficiaries: Through a three stage validation - Socio Economic Caste Census 2011, Gram Sabha, and geo-tagging.
  • Benefits: Financial Assistance of ₹ 1,20,000 per unit for plain areas, and ₹ 1,30,000 per unit for hilly areas, difficult areas, and Integrated Action Plan districts.
    • Can avail of institutional finance (loan) of up to ₹ 70,000 at 3% lower interest rate.
    • The minimum size of the house shall be is 25 sq m including a dedicated area for hygienic cooking.
    • In convergence with Swachh Bharat Mission-Gramin (SBM-G), get financial assistance of up to ₹ 12,000 for the construction of toilets.
    • In convergence with MGNREGA, the beneficiary is entitled to employment as unskilled labour at ₹ 90.95 per day for 95 days.
    • In convergence with Pradhan Mantri Ujjwala Yojana, one LPG connection per house is provided.
    • Payments are made electronically directly to bank accounts or post office accounts that are linked to Aadhaar.
  • Exclusion: Candidates that have: 
  • motorised two wheeler, three-wheeler, four-wheeler and agriculture equipment or fishing boat, Kisan Credit Card (KCC) with a limit greater or equal to Rs.50,000, at least one member that is employed with the government or earning more than Rs. 10,000 per month, that pays Income Tax, professional tax or owns a refrigerator or landline phone connection.

Social Safety Net

Context: Around 53% of all the salaried workforce does not have any social security benefits in India, Says the Periodic Labour Force Survey Annual Report 2021-22.

Social safety nets are non-contributory transfer programs generally targeted to the poor or those vulnerable to shocks, e.g. 

  • Cash transfers are either targeted or not, either conditional or not.
  • Food or other in-kind distribution. 
  • Public workfare jobs.
  • General price subsidies, e.g., for food or fuel.
  • Fee waivers for essential services such as health or education.

Importance of Safety nets 

  • Safety nets enable households to make better investments in their future.
  • Safety nets help households manage risk e.g., health risk.
  • Safety nets help communities create assets.
  • Safety nets help governments make beneficial reforms that improve growth prospects.

Status of Safety Nets in India

  • According to the Periodic Labour Force Survey Annual Report 2021-22, around 53% of all the salaried workforce does not have any social security benefits in India.
  • In India only 1.9% of the poorest 20% quintile of India’s workforce has access to any benefits. 
  • Gig workers, or approximately 1.3% of India’s active labour force, rarely have access to any social security benefit. 
  • Mercer Global Pension Index (2021 MCGPI) ranked India at 40 out of 43 countries. 

Steps taken by Government 

The government has put in place economic safety nets comprising the world’s largest free food program, direct cash transfers and relief measures for small businesses: 

  • Barbell Strategy: The government opted for a “Barbell Strategy” that combined a bouquet of safety-nets to cushion the impact on vulnerable sections of society, with a flexible policy response based on a Bayesian updating of information. 
  • Creation of Fund: The National Social Security Fund was set up for unorganised sector workers, with an initial allocation of just ₹1,000 crore to support schemes for weavers, rickshaw pullers and bidi workers etc. 
  • Push for Digitisation: Government has giving push to reduce human interference to reduce the corruption and get the benefits of social security scheme to citizen e.g., e-Shram platform has enabled the enrolment of approximately 300 million workers while expanding coverage of accident insurance (of ₹2 lakh cover) and disability (of ₹1 lakh cover).
  • Cash transfer: Under Pradhan Mantri Kisan Samman Nidhi (PM-KISAN) a transfer of Rs 6,000 per year in three instalments has been provided.
  • Food security:
    • Pradhan Mantri Garib Kalyan Anna Yojana was launched to provide additional free-of-cost food grains to National Food Security Act (NFSA) beneficiaries 5 kg per person per month, over and above the regular monthly NFSA foodgrains.
    • One Nation One Ration Card: to ensure PDS benefit for people in transit, especially migrant workers.
    • Ujjawala Scheme: under the scheme the target was to release 8 Crore LPG Connections to the deprived households by March 2020.
  • Employment Security 
    • Pradhan Mantri Garib Kalyan Rojgar Abhiyaan (PM-GKRA) was launched for immediate employment & livelihood opportunities to returnee migrant workers.
    • Mahatma Gandhi National Rural Employment Guarantee Scheme (MGNREGS): It aims to enhance livelihood security in rural areas by providing at least 100 days of wage employment in a financial year to at least one member of every household whose adult members volunteer to do unskilled manual work. 
    • Aatmanirbhar Bharat Rojgar Yojana (ABRY) was launched to reduce the financial burden of the employers and encourages them to hire more workers, implemented by EPFO.
  • Housing 
    • Pradhan Mantri Awas Yojana - Gramin and Urban: To achieve the objective of providing “Housing to All” by the year 2022.
  • Credit
    • PM SVANidhi Scheme to provide working capital loan to urban street vendors to resume their businesses.

Challenges 

  • Low Budgetary Allocation: The budgetary allocation by the government has always been limited E.g., In national social security fund, the amount was a pittance when compared to a requirement of over ₹22,841 crore as estimated by the Centre for Budget and Governance Accountability. 
  • Increasing Burden: It is estimated that the cost of providing social protection to the poorest 20% of the workforce would be in trillions, a cost of approximately 0.69% of GDP in FY20.
  • Accessibility: Approximately 91% of India’s workforce works in the informal sector which lacks access to social security. 
  • Coverage: While the Code on Social Security (2020) merged existing social security legislation, it dealt fundamentally with formal enterprises and did not cover informal ones.
  • Compliance Burden: Presence of a complex process to register for social scheme and low awareness is leading to less coverage e.g., e-Shram puts the burden of registration on informal workers, who are required to furnish a self-declaration and share their Aadhaar card.
  • Complex and Confusing Processes: The existing social security framework has become complex, with overlapping areas of authority between the State and Centre, and confusing definitions being used such as between a platform worker, an unorganised worker and someone who is self-employed.
  • Migrant Worker: Migrant workers often face discrimination and suspicion from authorities in their working area, which hinder the effective utilisation of the schemes by them.

Global Practices 

Brazil’s General Social Security Scheme 

  • It is a contribution-based scheme, substituting income loss for a worker and his family, whether in partial or full. 
  • This covers any situation due to an accident at work, a disability that prevents the worker from working, death, an illness/medical treatment etc. 
  • Even income loss that occurs due to a worker being imprisoned is covered by the low-income insured. 
  • Unemployment insurance is paid from worker support funds, and health care is covered through the Unified Health System. 
  • The Constitution itself has established that if there is a lack of funds, the National Treasury will step in.
  • Social security benefits can be availed of with a simple phone call or a visit to a bank, with no requirement to submit endless documents.

Way forward 

  • For Worker: 
    • For formal workers the government should expand employer and employee contribution under the Employees’ Provident Fund Organisation (EPFO) system. 
    • For informal workers with meaningful income, whether self-employed or in an informal enterprise, partial contributions can be elicited.
    • Government should persuade informal enterprises to formalise and expand their total contribution to the fund.
  • Unemployed Individual: For those who are unemployed or have stopped looking for work, or do not earn enough, the government should step in to make provision for employment and provide for the social security initiatives. 
  • Easy and Wholistic Coverage: Greater support is required for financing social security for most of the India’s labour force.
    • There should be a push for a pan-India labour force card and an expansion of existing successful schemes such as the Building and Other Construction Workers Schemes to other categories of workers. 
    • Such expansion requires a loosening of existing restrictions on benefit portability, having a 90-day mandatory cooling period, as well as a more straightforward registration process.
  • Domestic Worker: Special provisions should be made for domestic workers owing to their uncertain employment. The government should promote the idea of organised domestic worker association.
  • Strengthening Existing Schemes: Government should also strengthen the existing schemes, for example the Employees’ Provident Fund (EPF), the Employees’ State Insurance Scheme (ESI), and the National Social Assistance Programme (NSAP), with budgetary support and expansion of coverage. 
  • Raising Awareness: Government should give a more significant push to raise awareness about social security to ensure that more workers are aware of the available benefits.
    • Organisations such as the Self-Employed Women’s Association which run Shakti Kendras (worker facilitation centres), may be funded to run campaigns to provide greater information on social security rights, along with services and schemes that the government offers.

With occupations becoming more on-demand and hire/fire rules growing, India's workforce is becoming increasingly job insecure. To ensure that the rewards of growth trickle down while providing a sense of social stability, policymakers must abandon supply-side tweaks in favour of measures that promote equitable growth. 

Global Initiative on Digital Health: G20 Summit

Context: India, in collaboration with the World Health Organization (WHO), will launch the Global Initiative on Digital Health as part of the ongoing G-20 summit.

Global Initiative on Digital Health 

Need of Such Initiative

  • To align the digital health initiatives of country.
  • To reduce duplication and optimise impact of digital health initiatives
  • To provide information on the funding levels in the country in Digital Health. 
  • To reduce the gaps in domestic and external investment in digital health, particularly for low and lower-middle income countries.
  • To provide a global platform that can respond to the complex digital health ecosystem.

The GIDH, the first such global initiative aimed at data convergence, interface of health platforms and investments in the digital health space around the globe, will be a WHO Managed Network (“Network of Networks”) that will promote equitable access to digital health by addressing challenges such as duplication of efforts and “products-focused” digital health transformation through a focus on four foundational pillars:

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  1. Country Needs Tracker - ensuring digital health investments are informed by country priorities.
  2. Country Resource Portal – identifying traditional as well as innovative resource opportunities, enhancing transparency and reducing risk of duplication while enabling a standards-based prospective and retrospective analysis of resourcing gaps in digital health. 
  3. Transformation Toolbox – quality assured tools and resources that strengthen country capacity and autonomy to manage their national digital health transformation journey.
  4. Convening and Knowledge Exchange - promoting strengthened collaboration and knowledge exchange across global, regional, and national networks in digital health.

Aims of GIDH 

  • Align efforts to support of the Global Strategy on Digital Health 2020–2025
  • Support quality-assured technical assistance to develop and strengthen standards-based and interoperable systems aligned to global best practices, norms and standards
  • Facilitate the deliberate use of quality assured digital transformation tools that enable governments to manage their digital health transformation journey

Expected output in the period 

  • Country needs for technical support will be systematically captured and made accessible to development partners through a standardized Country Needs Portal.
  • A platform will be created to announce and identify resources and gaps in financial and in-kind commitments in digital health available to countries, development partners and technical partners.
  • Countries will have timely access to routinely updated tools to measure maturity of the enabling environment for digital health, track digital health initiatives, guide the development and updating of digital health related strategies and policies, and identifying quality-assured digital solutions. 
  • There will be continuous cross-network knowledge exchange between existing global, regional, and national communities of practice, coalitions and more institutionalized within the WHO.

Expected Outcomes from the Initiative

  • Increased transparency and alignment on availability and reporting of digital health resources and unfunded priorities.
  • Improved alignment, collaboration, and knowledge exchange on standards based and deliberate technical assistance between countries, development and technical partners supporting national digital health transformation.  
  • Strengthened enabling environment for sustained whole-of-government approaches to national Digital Health Governance. 
  • Increased technical and financial support for the accelerated achievement of the WHO’s Global Strategy on Digital Health 2020 – 2025 and its next phase. 
  • Strengthened country ownership of quality assured investments in digital health implementation needed to sustainably accelerate national health priorities.

Benefits of Digital Health space for India

  • Inclusiveness: It will provide equal opportunity of access to better health facilities and outcomes to all citizen of India.
  • Respect: As it decreases human contact and provides individual digital autonomy, it increases consideration for human dignity, privacy and law.
  • Human flourishing and centeredness: Designed for human benefit with accountability for outcomes which will promote social good with sustainable growth.
  • Collaboration: It promotes interoperability to facilitate co-working and co-development in the health sector.
  • Accessibility: It provides for a simple, reliable and affordable healthcare alternative which increases the accessibility of health services to every section of Indian society.
  • Sustainability: It also aligns with the best practices of zero-carbon, zero-waste economy in the process and provides sustainable alternative for future.
  • Harmony: As it provides flexibility in adoption it leads to use of digital health initiatives by governments and businesses in good faith without exploiting or provoking conflicts.

A global platform which can respond to the complex digital health ecosystem by aligning investments, strengthening the enabling environment and enhancing quality assured technical support while promoting countries’ autonomy in their digital health transformation journeys can only reduce the global burden of disease while increasing the promotion between the states.

Five years of Ayushman Bharat (AB-PMJAY)

It has two components which are complementary to each other.

  • First component: Under this 1,50,000 Health & Wellness Centres (HWCs) will be created to deliver Comprehensive Primary Health Care, that is universal and free to users, with a focus on wellness and the delivery of an expanded range of services closer to the community. 
  • Second component: Pradhan Mantri Jan Arogya Yojana (PM-JAY) which provides health insurance cover of Rs. 5 lakhs per year to over 10 crore poor and vulnerable families for seeking secondary and tertiary care.
Five years of Ayushman Bharat (AB-PMJAY)

Provisions of PMJAY

  • The scheme is the world’s largest publicly funded health assurance scheme providing a health cover of Rs 5 lakh per family per year for secondary and tertiary care hospitalisation to the bottom 40 per cent of the population of India.
  • Costs of diagnostics and medicines are covered up to 3 days prehospitalization and 15 days posthospitalization and all preexisting conditions are covered.  
  • The Ayushman Card is like a pre-paid card worth Rs 5 lakh, which can be used to avail free treatment at more than 27,000 empanelled hospitals.
    • Every hospital must provide Pradhan Mantri Arogya Mitras (PMAMs) to assist beneficiaries.
  • This scheme has interstate portability.
  • Aadhaar-based authentication for card creation and registration for treatment has been mandated under the scheme.
  • The scheme is administered by the National Health Authority (NHA) which reports to the Ministry of Health and Family Welfare.
    • The NHA has a governing board with representatives from the central government, domain experts, and states.
    • NHA's call center contacts beneficiaries post-discharge (48 hrs) to assess treatment, followed by a second call (15 days) to check prognosis.
  • It is an inclusive scheme as it includes transgender individuals among its beneficiaries. Approximately 50 packages were designed, specifically for the community, including offerings like Sex Reassignment Surgery (SRS).
  • Under the scheme the National Anti-Fraud Unit (NAFU) designs, implements and oversees anti-fraud initiatives.
    • There are Anti-Fraud Units at the state level as well.

Five years of Ayushman Bharat

Achievements 

  • Nudging of state: The scheme has nudged the states/UTs, who are accountable for ensuring effective public health as it is a state subject, to extend it to more beneficiaries.
  • Effective fiscal management: it has reduced out-of-pocket expenditure (OOPE) and led to efficient utilisation of the government budget by reducing revenue losses.
  • Bridge the gap: The scheme has bridged the shortfall between healthcare providers and service-takers by uniting them through government channels.
  • Reduction in treatment cost: Treatment costs within AB-PMJAY are half compared to outside care, saving over Rs 1 lakh crore. 
  • Spirit of Inclusiveness: Notably, 48% of treatments are by women, and transgender individuals are also beneficiaries of the scheme. Service isn't denied if a beneficiary lacks an Ayushman card.
  • Regularisation of process: To bring out the participation of private service providers, health benefit packages (HBPs) covering all in-patient treatment have been revised five times in the last five years.
  • Early Claim settlement: Efforts are being made to settle the claims within a defined standard of 15 days. A few states like Uttarakhand have brought down the claims settlement time to less than seven days.
  • Reward to Hospitals: Efforts are being made to reward hospitals with a trustworthy record with an upfront payment of 50 per cent of the claim amount immediately after submission of claims, without adjudication.
  • Interoperability: Beneficial for migrants, especially in emergencies, the scheme aids the poor and marginalized. Its design mitigates healthcare access challenges for these sections through interoperability.
  • Effective Monitoring: End-to-end digital service delivery eliminates bias. NHA uses internal monitoring and a public dashboard for transparent day-to-day scheme tracking.
  • Fraud management: Establishment of institutions like NAFU has decreased the frauds in registration, verification and insurance claims.
  • Use of technology: The NHA has been using Artificial Intelligence (AI) and Machine Learning (ML) technologies to detect suspicious transactions/potential frauds.

Issues 

  • Regional disparity: There is significant interstate variation in the quality of the infrastructure of health centers as well as the quality of care provided in them, with the better governed states doing better than the rest.
  • Future Fiscal Burden: More focus has been given to insurance scheme but as coverage grows, hospitalization rates may rise, raising claims ratios and premiums. Insurers need profitable business, as higher premiums strain government finances. 
  • Infrastructural and man-power issues: Ten percent of Public Health Centers (PHCs) lack doctors, 56% of SCs lack staff washrooms, 73% lack separate washrooms, and 36% of PHCs lack gender-segregated facilities.
  • Process and Outcome Gap: Data gaps for process and outcome indicators hinder improvement and patient-centricity in healthcare. Bridging this gap is crucial for identifying areas to enhance care delivery.
  • Compliance Burden: Traveling to distant hospitals for medication significantly lowers compliance by over 80% in rural India, due to effort and expenses involved.
  • Double Charging: Publicly Funded Health Insurance Schemes (PFHIS) are prone to double charging, where the hospital makes the patient pay for some or all services/medicines/diagnostics which are covered under the PFHI and also claim the reimbursement from the PFHI.
  • Information Asymmetry: The inherently hierarchical nature of medical care provision coupled with its complexities amplifies the stark information asymmetries between the provider and the patients. Low awareness seems to lead to low utilization.
  • Outpatient Care: it does not cover outpatient care which accounts for between 40% and 80% of OOPHE and is a significant cause of increasing health expenditure and subsequent impoverishment.
  • Induced Demand: Several media reports have documented the phenomenon of supplier-induced demand in poorly regulated markets dominated by private insurers. 
  • Upcoding: Upcoding is the practice of fraudulent medical billing in which the bill for a medical service is more expensive than it should have been based on the service that was performed.

Issues highlighted by Comptroller and Auditor General of India (CAG) 

  • CAG has revealed that nearly 7.5 lakh beneficiaries were linked with a single cellphone number under PMJAY.
  • Hospital Empanelment and Management:
    • CAG included private hospitals performing procedures reserved for public hospitals.
    • There are hospitals with pending penalties amounting to multiple crores of rupees. 
    • Issue of fraudulent database errors.
    • Spending money on ineligible beneficiaries.
    • Shortages of infrastructure, equipment and doctors at empanelled hospitals.
    • Cases of medical malpractice.
  • Beneficiary Identification and Registration: According to the report, in the absence of adequate validation controls, errors were noticed in beneficiary databases, such as invalid names, unrealistic date of birth, duplicate PMJAY IDs, and unrealistic size of family members in a household.
  • Claims Management: 
    • It said that patients earlier shown as “dead” continued to avail treatment under the scheme.
    • Parallel transaction management systems by some states which has resulted in a possibility of overlap of beneficiaries of PMJAY with the beneficiaries of State specific schemes
  • Financial Management: The instructions of Government of India to track the expenditure flow through Public Financial Management System had not been fully complied with by NHA and State Health Authorities (SHAs).
  • Monitoring and Grievance Redressal: Many states have not formed or delayed the formation of SHAs, Anti-Fraud Cell, or Claim review committees.

Suggestions for improvement 

  • To realise the scheme’s full potential, the National Health Authority (NHA) along with its counterparts in the states should aim to provide every possible beneficiary with an Ayushman Card.
  • State governments which have not formed the SHAs, Fraud cells etc. should consult and through dialogue the bodies should be constituted to improve the interoperability of the scheme.
  • The issue of upcoding, dead patients availing benefits, double charging should be addressed by reducing information asymmetries and increasing the awareness of the people.
  • Parallel transactions management system creates ambiguities in management and ensuring accountability, states and Centre should come up with a unified and transparent system.