Ayushman Bharat: India’s Flagship Programme

Nearly 3000 years ago, one of ancient India’s great sages Yajnavalkya composed the Shanti Sukta: “Sarve Bhavantu Sukhinah; Sarve Santu Niramayah” (May all be happy, may everyone be free of diseases). What is striking is not the prescience and universality of this invocation, but also the insight that happiness and health in a populace are inextricably interwined.

Today, as we reflect upon the journey of India as an independent nation over the last seven decades, there can be no denying the fact that a lot of potential in this sector remains unharnessed and ill-health is one of the leading causes of Indians falling into poverty. The government spends barely 1% of the GDP on health even as we are confronted with a two front war  1) rising burden of non-communicable diseases 2) control of communicable diseases and reproductive and child health issues. As a result, the citizens Out-of-Pocket (OOP) expenditure on health constitutes 62% of the total expenditure on health, placing India at 182^nd position out of 191 countries on this indicator. In fact, over 55% of this expenditure is on Outpatient care, of which drugs constitute the biggest component. 71^st round of National Sample Survey Organization (NSSO) found 85.9% of rural households and 82% of urban households have no access to healthcare insurance/assurance. Catastrophic healthcare related expenditure pushes families into debt, with more than 24% households in rural India and 18% population in Urban area have met their healthcare expenses through some sort of borrowings. This structure of health financing places a disproportionate burden on the poor families and catastrophic health expenses have contributed to an increase in poverty levels in rural and urban areas by 3.6% and 2.9% respectively.

Mindful of this reality and to plug the existing gaps in our health system, the government announced a new flagship scheme “Ayushman Bharat” in the Union Budget 2018-19.

Ayushman Bharat Programme:

On 1st February’18, the NDA Government announced two major initiatives in health sector as a part of Ayushman Bharat programme. The two initiatives: 1) Health and Wellness Centre (HWC)  2) National Health Protection Mission (NHPM).

On 23 September’18, India took a giant leap towards providing accessible and affordable healthcare to the common man with the launch of Ayushman Bharat – National Health Protection Mission (AB-NHPM) by Prime Minister Narendra Modi at Ranchi, Jharkhand.

AB-NHPM will target poor, deprived rural families and identified occupational category of urban workers families as per the latest Socio-Economic Caste Census (SECC) data covering both rural and urban population. The scheme is designed to be dynamic and aspirational and it would take into account any future changes in the exclusion/inclusion/deprivation/occupational criteria in the SECC data.

AB-NHPM is a paradigm shift from sectorial, segmented and fragmented approach of service delivery through various national and State schemes to a bigger, more comprehensive and better converged and need based service delivery of secondary and tertiary care. When fully implemented, AB-NHPM will become the world’s largest fully government financed health protection scheme. It is a visionary step towards advancing the agenda of Universal Health Coverage (UHC).

Benefits under Ayshman Bharat:

1. The AB-NHPM will provide a coverage up to Rs. 5 lakhs per family per year for secondary and tertiary care hospitalization through a network of Empanelled Health Care Providers (EHCP).
2. Over 10.74 crore vulnerable entitled families (approximately 50 crore beneficiaries) will be eligible for these benefits. There is no cap on family size and age as well as restriction on pre-existing conditions.
3. AB-NHPM will provide cashless and paperless access to services for the beneficiary at the point of service.
4. NHPM will help reduce catastrophic expenditure for hospitalization, which impoverishes people and will help mitigate the financial risk arising out of catastrophic health episodes.
5. Entitled families will be able to use the quality health services they need without facing financial hardships.

Salient Features of Ayshman Bharat:

1. Creation of 1,50,000 Health and Wellness Centres (HWCs) to bring healthcare closer to the homes of the people. These centres will provide Comprehensive Primary Health Care (CPHC) covering both maternal and child health services and non- communicable diseases, including free essential drugs and diagnostics. HWCs will play a critical role in creating awareness about NHPM.
2. The EHCP network will provide cashless and paperless access to services for the beneficiaries at both public and private hospitals. The services will include 1350 procedures covering pre and post hospitalization, diagnostics, medicines etc.
3. The beneficiaries will be able to move across borders and access services across the country through the provider network seamlessly.
4. NHPM scheme is principle based rather than rule based, allowing States enough flexibility in terms of packages, procedures, entitlements as well as other guidelines while ensuring that key benefits of portability and fraud detection are ensured at a national level.
5. States can implement the scheme through an insurance company or directly through the Trust/Society/Implementation Support Agency or a mixed approach.
6. Thirty states and UTs have signed the MoU and have started working on implementation of the mission.
7. The scheme is creating a cadre of certified frontline health service professionals called Pradhan Mantri Aarogya Mitras (PMAMs) who will be primary point of facilitation for the beneficiaries to avail treatment at the hospital and thus, act as a support system to streamline health service delivery.
8. Training  programs for State, District and PMAMs have been conducted in 27 states. A total of 3936 personnel have been trained at State, District and PMAM levels.
9. So far 15,686 applications for hospital empanelment have been received.
10. Detailed guidelines have been prepared to address the issues around potential fraudulent activities that could be committed by any individual or organization.
11. Pilot launch is taking place in specific hospitals to test the Beneficiary Identification System (BIS) and Transaction Management System (TMS). National Health Agency (NHA) has tested the software in 80 districts across 10 states.
12. Robust systems are put in place in the IT platform to ensure privacy and security of the data.

The government’s active stewardship in leveraging the potential of the mixed health system is a very welcome development. It is heartening to note the political commitment at the highest levels to transform India’s health system into an affordable, accessible, inclusive and efficient system.