Uttar Pradesh crucially important for Ayushman Bharat success

Team INCLUSION
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Uttar Pradesh holds the key to success for any pan-India scheme as one in every six Indians belongs to the state. Ayushman Bharat has given much needed attention to the healthcare services, which has been in the very bad shape due to neglect by successive governments. TEAM INCLUSION highlights the impact and challenges of Ayushman Bharat scheme in the state

The country’s most populated state Uttar Pradesh is crucially important for the success of Ayushman Bharat scheme. The state has the highest number of deprived people in the country. Nearly 6 crore people in the state are eligible for the scheme. As per the 2011 Socio-Economic and Caste Census data and deprivation criterion, 1.18 crore households are eligible for the scheme. This is 36.35 per cent of the total 32.4 million households in the state. 
 
Public health insurance scheme is a greenfield project for the Government of Uttar Pradesh (GoUP). This is the first time such scheme is being implemented in the state. It has made remarkable progress in just one year.
 
The scheme has been rolled out in all 75 districts of the state. Special efforts have been made to enrol the eligible beneficiaries under the scheme. Ayushman Pakhwara was organised in all 75 districts of the state in the month of July 2019. Activities carried during the fortnight programme included on-ground screening of patients, generating golden cards and resolving grievances. Ground level screening camp was organised in the month of September. 
 
Village-based camps have been organised to ensure that all the eligible beneficiaries are issued the golden cards, which is required to avail the Ayushman Bharat insurance benefits. On an average of 36,400 cards were issued daily in the state during the month of January 2019 through 37,143 Common Service Centres (CSCs) and 1,611 Empanelled Health Care Providers (EHCPs). The state has taken a number of steps to further boost the momentum of issuing the golden cards. 
 
Condition of public health infrastructure has not been satisfactory in the state. Poor are the worst hit. Better coordination between the central and state government has given hope for betterment in the health of health infrastructure in the state. “Now the poor will not have to beg for treatment of their family members. The scheme will also create employment opportunities. The Centre has also decided to constitute national digital health authority and will spend 2.5 per cent of GDP on health sector,” Rajnath Singh, then Union Home Minister, had said while launching the Ayushman Bharat scheme on 23 September 2018 in Lucknow. Singh is now Defence Minister in Modi Government II.
 
New Scheme
Chief Minister Yogi Adityanath government has launched a new scheme called Mukhya Mantri Jan Arogya Abhiyan (MMJAA) to provide benefits to the households who are genuinely deprived but inadvertently missed out in the 2011 Socio-Economic Caste Census deprivation categories. According to a report published in Business Standard, the number of such households is over 800,000. These households have been identified by the Uttar Pradesh government using the same deprivation criteria as listed in the 2011 SECC.
 
Starting 1 March 2019, these families are being provided the same coverage as they would have received under the Ayushman Bharat scheme. The cost of providing services to these additional number of households are to be borne fully by the state government, while for the Ayushman Bharat beneficiaries centre contributes 60 per cent of the total cost. 
 
Under the Ayushman Bharat beneficiaries are pre-determined as per the deprivation criteria. The SECC provides deprivation data. It has identified 14 parameters on the basis of which household is considered deprived. It categorises households based on various aspects of their socio-economic status – housing, land-holding/landlessness, educational status, status of women, the differently able, occupation, possession of assets, SC/ST households, incomes, etc. There is no provision of adding new beneficiary under the Ayushman Bharat scheme.
 
Fraud Control
The biggest challenge for a scheme to be successful in Uttar Pradesh is to counter the multi-fold fraud issues that may arise on a regular basis, depriving genuine beneficiaries of their rights. The state has taken a number of steps to keep frauds in check. 
 
A large number of CSCs have been deactivated on complaints of irregularities. Responding to a question in the Parliament in July this year, Union Minister of State for Health, Ashwini Choubey said 903 CSCs have been deactivated. Out of this 900 are in Agra district and 3 in Pilibhit district. “cards were found to be issued to non-beneficiaries by CSCs without following due diligence,” the minister had said.  
 
The State Health Authority (SHA) has set up a panel of super specialist doctors from AIIMS for referral claim check and fraud detection. The panel has been mandated to check and flag unspecified approved cases; provide input on specialist and super specialist cases such as oncology; and detection of suspected high-profile fraud cases. 
State anti-fraud unit conducts regular surprise field visits to detect frauds and ensure that the services are provided without any hassle to the genuine beneficiaries. A large number of hospitals have been issued show-cause notices and 70 hospitals have been put on watch list for violation of norms. 
 
Way Forward
With Ayushman Bharat healthcare has got due attention in the state after decades of neglect by the successive government. Per capita expenditure on health in Uttar Pradesh is among the lowest in the country. There is a huge shortage of hospitals and healthcare professionals in the state. The condition of most of the public healthcare facilities is bad. In order to make Ayushman Bharat a success it is imperative that the condition of health infrastructure is improved. Private hospitals need to be encouraged, but there is need for better planning and monitoring.

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