29-Jul-2022: Initiatives for ensuring healthcare in tribal areas

There are various Government/Non-Government institutional mechanisms and survey agencies which generate data on tribal healthcare on a periodic basis. Rural Health Statistics (RHS) provides details of infrastructure and human resource in tribal areas. National Family Health Survey (NFHS) provides details on major health indicators about maternal and child health among Scheduled Tribes. Census of India provides population and household details including Tribal areas.  National Sample Survey provides household surveys on various socio-economic subjects.

The Expert Committee on Tribal Health titled, “Tribal Health in India: Bridging the Gap and a Roadmap for the Future” came in 2018 which gives details on the status of tribal health. The Report of the Committee pieces together the health status of the tribal populations, did a detailed analysis of the health situation in tribal areas, maps out the disease burden, discusses the challenges in areas of infrastructure, facilities, Human resource, financing, participation in planning etc., and makes recommendations for improving health outcomes for tribal populations.  The main recommendations of the Committee include – strengthen access to comprehensive primary healthcare by establishing health and wellness centres, provide insurance for access to secondary and tertiary care; enhance human resource via community health officers/mid-level healthcare providers, enhancing capacities/roles of ASHA, task sharing and shifting etc.; community mobilization and IEC; use of technology to increase access to health services; strengthening school health program; integration of tribal health practitioner in primary care; increased financing for tribal health, for instance through Tribal Sub Plan (TSP).

The NHM focuses on universal approach and hence all the Health and Family Welfare Schemes run under the umbrella of NHM is applicable and available in all the States/UTs including Odisha. Under the National Health Mission (NHM), financial and technical support is provided to States/UTs to strengthen their health care systems including setting-up/upgrading public health facilities and augmenting health human resource on contractual basis for provision of equitable, affordable healthcare to all its citizens particularly the poor and vulnerable population in the tribal areas based on requirements posed by the States in their Programme Implementation Plans (PIPs) within their resource envelope.

Various supports under NHM for better healthcare for beneficiaries in tribal areas are as follows:

• Ayushman Bharat- Health and Wellness Centres (HWCs) are established by transforming the Sub-Health Centres (SHCs) and Primary Health Centres (PHCs), as part of the Ayushman Bharat - the flagship programme of Government of India, to deliver twelve packages of Comprehensive Primary Health Care (CPHC) that includes preventive, promotive, curative, palliative and rehabilitative services which is universal, free and close to the community.
• The population norms for setting up Health Facilities in vulnerable areas are relaxed. Against the population norms of 5,000, 30,000 and 1,20,000 for setting up of SHC, PHC and CHC, the norm is 3,000, 20,000 and 80,000 respectively in vulnerable areas such as remote, tribal, desert and hard to reach areas.
• Under NHM, States/UTs have been given flexibility to deploy Mobile Medical Units (MMUs) to provide a range of health care services for the population particularly living in remote, in-accessible, un-served and under-served areas, as per the needs identified by the respective States/UTs.
• To minimize the Out-of-Pocket Expenditure incurred on health services, National Free Drugs Service Initiative and National Free Diagnostic Service Initiative have been rolled out.
• The ASHA programme guidelines provide for recruitment of ASHA at habitation level in hilly, tribal and difficult areas. (Well below the national norm of one ASHA at a population of about 1000).
• Government of India is supporting states in implementation of National Ambulances Services under NHM for free transportation of sick patients to the health facilities. States are free to place these ambulances at a lower population norm or as per time to care approach so that these ambulances are easily accessible by all.
• Further, all tribal majority districts whose composite health index is below the State average have been identified as High Priority Districts (HPDs) and these districts receive more resources per capita under the NHM as compared to the rest of the districts in the State.

19-Jul-2022: Achievements made under NRHM and NUHM

National Health Mission (NHM) envisages achievement of universal access to equitable, affordable & quality health care services that are accountable and responsive to people’s needs. NHM encompasses its two Sub-Missions, the National Rural Health Mission (NRHM) and the National Urban Health Mission (NUHM). The main programmatic components include Health System Strengthening in rural and urban areas, Reproductive-Maternal- Neonatal-Child and Adolescent Health (RMNCH+A) and Communicable and Non-Communicable Diseases.

Public Health & Hospital is a State subject, hence, the responsibility of strengthening public healthcare system, especially to rural & vulnerable population, including strengthening of existing health/ medical facilities lies with the respective State/ UT Governments. Under National Health Mission (NHM), Ministry of Health & Family Welfare, Government of India provides financial and technical support to States/UTs including support for health/ medical facilities, upto District Hospital level, based on the proposals submitted by States/UTs in their Program Implementation Plans (PIPs). Government of India provides approval for the proposals in the form of Record of Proceedings (RoPs) as per available resources.

Government of India extends supports to states to expedite the process of creating health infrastructure as per Indian Public Health Standards. These standards include norms for services, infrastructure, human resource, diagnostics, equipment, medicines etc.

Under Ayushman Bharat, the existing Sub-health Centres (SHCs) and Primary Health Centres (PHCs) are transformed into AB-HWCs to deliver twelve packages of Comprehensive Primary Health Care (CPHC) that includes preventive, promotive, curative, palliative and rehabilitative services which is universal, free and close to the community. Another essential component of Ayushman Bharat Health & Wellness Centres (AB-HWCs) is the roll out of tele-consultation services through ‘eSanjeevani’. This platform provides telemedicine services for the communities through a hub and spoke model which connects AB-HWCs (spokes) to District Hospitals/Medical colleges (Hubs) for specialist consultation services. Teleconsultation services are aimed to improve access of specialist services to the communities, especially in the rural areas.

Further, following steps have been taken for strengthening healthcare systems to cater to future healthcare needs:

• “Emergency Response and Health Systems Preparedness Package – II (ECRP-II)” for Rs. 23,123 Crore, including Central Component, was approved by Cabinet to extend support to the States/UTs for establishing District Paediatric Units (including Oxygen Supported beds and ICU beds) in all the Districts of the Country. Besides, support is also provided to increase the availability of ICU beds in Government health facilities. Maintaining buffer stock of essential medicines required for effective COVID management, in addition to provision for required drugs and diagnostics, is also supported. Support is also available for establishing field hospitals (100 bedded or 50 bedded units), wherever required.
• PM Ayushman Bharat Health Infrastructure Mission (PM-ABHIM) with an outlay of Rs. 64,180 crores till 2025-26 envisages increased investments in public health and other health reforms to provide better access to health in rural areas by i) Strengthening of Health and Wellness Centres in villages and cities for early detection of diseases; ii) Addition of new critical care-related beds at district level hospitals; iii) Support for Block Public Health Units (BPHU) in 11 high focus States; and iv) Integrated district public health laboratories in all districts.
• The recommendations of 15th Finance Commission (FC-XV) w.r.t Health Grants through Local Governments announced in Union Budget 2021-22, addresses the gaps in Primary Healthcare facilities.
• The Pradhan Mantri Swasthya Suraksha Yojana (PMSSY) aims at correcting regional imbalances in the availability of affordable tertiary healthcare services and to augment facilities for quality medical education in the country. The Scheme has two components, namely, (i) Setting up of All India Institute of Medical Sciences (AIIMS); and (ii) Upgradation of existing Government Medical Colleges/ Institutions (GMCIs). So far setting up of 22 new AIIMS and 75 projects of upgradation of GMCIs have been approved under the Scheme in various phases. The setting up of AIIMS contains Medical College, Nursing College, Hospital, Trauma Centre, Emergency, Blood Bank, ICU, Diagnostic & Pathology, Research etc. Upgradation of GMCIs under PMSSY broadly involves construction of Super Speciality Block (SSB) and/ or Trauma Centre/ or other facilities and/ or procurement of medical equipment.
• Under the Centrally Sponsored Scheme (CSS) , ‘Establishment of new medical colleges attached with existing district/referral hospitals’, establishment of 157 medical colleges has been sanctioned.

12-Feb-2021: Healthcare Scheme for SC/ST Women

“Public Health and Hospitals” being a State subject, the primary responsibility to provide quality healthcare in public healthcare facilities including to SC/ST category women and their children lies with the respective State Governments.

To address the healthcare challenges, particularly in rural areas, the National Rural Health Mission (NRHM) was launched in 2005 to supplement the efforts of the State/UT Governments to provide accessible, affordable and quality healthcare to all those who access public health facilities. Currently, NRHM is a sub-mission of National Health Mission (NHM).

The States are given flexibility to propose specific interventions for SC/ST areas and beneficiaries including for women and their children and are supported under National Health Mission, based on their proposals.

NHM support is also provided for provision of a range of free services including for SC/ST women and children, related to maternal health, child health, adolescent health, family planning, universal immunization programme and for other major diseases such as Tuberculosis, vector borne diseases like Malaria, Dengue and Kala Azar, Leprosy, etc.

Other major initiatives supported under NHM include Janani Shishu Suraksha Karyakram (JSSK) (under free drugs, free diagnostics, free blood and diet, free transport from home to institution, between facilities in case of a referral and drop back home is provided), Rashtriya Bal Swasthya Karyakram (RSSK) (which provides newborn and child health screening and early interventions services free of cost for primary defects, diseases, deficiencies and developmental delays to improve the quality of survival), Pradhan Mantri Surakshit Matritva Abhiyan (PMSMA) to improve coverage of ANC and improved identification and tracking of high risk pregnancies and Mission Indradhanush (MI) and Intensified Mission Indradhanush (IMI) in improving immunisation coverage.

Various interventions that are implemented for better healthcare in SC/ST areas and beneficiaries are as follows;

• The population norms for setting up Health Facilities in tribal areas are relaxed. Against the population norms of 5,000, 30,000, and 1,20,000 for setting up of Sub Centre, PHC and CHC respectively, in tribal and desert areas its 3,000, 20,000 and 80,000.
• Relaxed norms for Mobile Medical Units (MMUs).
• All tribal majority districts whose composite health index is below the State average have been identified as High Priority Districts (HPDs) and these districts receive more resources per capita under the National Health Mission (NHM) as compared to the rest of the districts in a State.
• Implementation of Free Drugs and Free Diagnostics Service Initiatives.
• SC/ST households are covered under Ayushman Bharat, Pradhan Mantri Jan Arogya Yojana (AB-PMJAY) for health coverage up to Rs 5 Lakh per family per year as per Socio Economic Caste Census (SECC).

29-Jul-2022: Steps taken for improving maternal and child health in the country

Under National Health Mission (NHM), technical and financial support to the States is given as per the proposals submitted by the States/UTs in the form of Programme Implementation Plans (PIPs) based on the requirements, including maternal and child health and state specific innovations, and the approvals are accorded as Record of Proceedings (RoP) to States/UTs.

Further, one of the components of the 12-packages to deliver Comprehensive Primary Healthcare under Ayushman Bharat – Health & Wellness Centres (AB-HWC) scheme is “Care in pregnancy and childbirth” and includes:

• Early diagnosis and registration of pregnancy and issuing of ID number and Mother and Child protection card
• Ensuring four antenatal care checks of high risk pregnancies including screening of Hypertension, Gestational Diabetes, Anaemia, HIV, Hepatitis b, Thyroid Profile for hype- or hyper- thyroidism, syphilis, etc.
• Referral and follow up of the high risk pregnancy cases.
• Counselling regarding care during pregnancy including information about nutritional requirements
• Facilitating institutional delivery and supporting birth planning

The Government has formulated several schemes/ programmes for facilitating check-ups and screening of pregnant women, which are as follows:

• Surakshit Matritva Aashwasan (SUMAN) provides assured, dignified, respectful and quality healthcare at no cost and zero tolerance for denial of services for every woman and newborn visiting public health facilities to end all preventable maternal and newborn deaths.
• Pradhan Mantri Surakshit Matritva Abhiyan (PMSMA) provides pregnant women a fixed day, free of cost assured and quality antenatal check up by a Specialist/Medical Officer on the 9th day of every month.
• Monthly Village Health, Sanitation and Nutrition Day (VHSND) is an outreach activity at Anganwadi centers for provision of maternal and child care including nutrition in convergence with the ICDS.
• MCP Card and Safe Motherhood Booklet are distributed to the pregnant women for educating them on diet, rest, danger signs of pregnancy, benefit schemes and institutional deliveries.
• Reproductive and child health (RCH) portal is a name-based web-enabled tracking system for pregnant women and new born so as to ensure seamless provision of complete services to them including antenatal care, institutional delivery and post-natal care.
• Outreach camps are provisioned for improving the reach of health care services especially in tribal and hard to reach areas. This platform is used to increase the awareness for the Maternal & Child health services, community mobilization as well as to track high risk pregnancies.

16-Apr-2022: Dr. Mansukh Mandaviya virtually chairs the 4th Anniversary celebrations of Ayushman Bharat Health and Wellness Centres; over 1 lakh AB-HWCs join virtually

Union Health Minister, Dr. Mansukh Mandaviya chaired the 4th Anniversary celebrations of Ayushman Bharat -Health and Wellness Centres (AB-HWCs) through a video conference (VC) today with more than 1 lakh AB-HWCs, State Health ministers, senior Officials of all the States and UTs, healthcare workers from various hospitals and development partners.

Accentuating the healthcare services being provided through the digital platform of tele-consultation, the Union Health Minister noted that “Health is an important issue in the development sector. Under the visionary leadership of Hon'ble Prime Minister, we have moved away from “token solution to total solution” in the healthcare sector and teleconsultation services are an example of this. E-Sanjeevani is providing affordable and accessible health care as envisioned by the Prime Minister. People in many states have been quick to recognise the benefits of e-Sanjeevani and this has led to an encouraging trend of widespread rapid adoption of this digital modality of seeking health services. Patients consult with doctors and specialists on a daily basis using this innovative digital medium to seek health services. Today, some HWCs are also providing screening services for some serious diseases like Oral Cancer, Breast Cancer and Cervical Cancer. This helps the country not only in early detection but also in providing early treatment to the patient. Healthy Citizens can only make a Healthy Society and Healthy Society builds a Healthy Nation. AB-HWCs are a stepping stone towards this vision".

"Teleconsultation Services are very crucial for people in remote areas and are helpful in making healthcare services accessible for all. States/UTs should mobilize all stakeholders in providing services at the spokes and efficiently connecting them with the hubs", he further added. The Union Health Minister advised States/UTs to promptly and proactively spread awareness regarding AB-HWCs health melas which will be organized under Azadi Ka Amrit Mahotsav (AKAM) from 18th-22nd April in addition to the Yoga sessions to be organized on 17th April at all HWCs on this occasion so that citizens can actively participate in these health melas and become aware of the HWCs services being provided in their regions. He also advised states to extensively do screening for TB, Cervical Cancer, Diabetes and Oral Cancer during this Health Mela. He also encouraged and called on everyone to actively participate in this Health Mela.

The Union Health Minister also released four booklets – Quarterly report on AB-HWCs, Guidelines on Human resources for health, Public Health Management Cadre’ Guidance for implementation and Indian Public Health Standards Guidelines.

Expressing her happiness on the fact that today more than 1,17,440 HWCs are actively providing expanded health services across the country, which has minimised the distance of a person from a health centre to 30 min, the Union Minister of state, Dr. Bharati Pravin Pawar said, "Today it is a matter of great pride for us that following the path shown by our Hon'ble Prime Minister Shri Narendra Modi ji, today all the necessary health services are being provided to the countrymen near their homes easily without any financial burden. Be it pregnant mothers, newborn babies, our teens, teenagers or respected elders, all are availing the benefits of health services at the Health & Wellness Centre. Not only this, the health and wellness center infrastructure has also been designed keeping in view the needs of the Divyaangs so that the Specially abled patients can also access the primary health services. These health centers are ensuring delivery of health facilities in the health interest of the community and fulfilling the commitments of National Health Policy 2017.”

Member NITI Aayog, Dr. VK Paul appreciated the game-changing step of teleconsultation services in creating a nirogi India. He emphasized that Primary health centres are the most important component of the health system of our country as they cater to the local population and are embedded as the first point of contact for health services in their minds. He said that the focus of the health sector has now moved from the previous paradigm of catering only to a few like for mothers, child, WASH services to full comprehensive health coverage now for all.

Union Health Secretary Shri Rajesh Bhushan informed participants that the Government of India is committed to the establishment of 1,50,000Ayushman Bharat- Health and Wellness Centres (AB-HWCs) by Dec 2022. He said that we have already made 1,17,400 AB-HWCs functional in the country and more than 1 lakh have registered successfully on e-Sanjeevani HWCs portal too. Reiterating the National Health policy’s idea to achieve Universal health coverage, he said that it is being proactively taken up by the government and these HWCs will help in bolstering our efforts in achieving the same. These HWCs provide free testing, diagnostic services etc so the citizens can get quality care at their local HWCs itself. Apart from these services, HWCs are also running other health programs and schemes so that along with health, the idea of wellness and wellbeing is also spread among the citizens. He thanked the states/UTs for their untiring efforts and providing the leadership in their respective states.

About AB-HWCs and 4th Anniversary Celebrations:

Translating the intent of the National Health Policy 2017 to achieve Universal Health Coverage into budgetary commitment, the Government of India announced the establishment of 1,50,000 Ayushman Bharat- Health and Wellness Centres (AB-HWCs) in February 2018.

Existing Sub-Health Centres and Primary Health Centres in rural and urban areas are being transformed to deliver comprehensive primary health care, to all citizens, free of cost, closer to homes. AB-HWCs are a major shift from selective to comprehensive primary health care inclusive of promotive, preventive, curative, rehabilitative and palliative care; from disease-centred to wellness centred; and whole-of-society approach, institutionalizing intersectoral coordination in alignment with the emergent international ‘Health in All’ approach as a complement to ’Health for All’.

Yoga sessions at AB-HWC - 17th April 2022

On the second day, i.e.  On 17th April 2022, Yoga sessions are to be organized in all the AB-HWCs under ‘Azadi Ka Amrit Mahotsav’  to highlight the integration of health and wellness in service provision at AB-HWCs.

Block Health Melas- 18th April 2022 to 22nd April 2022

From 18th April 2022, Block Health Melas at AB-HWCs in at least one block in each district of the State/UT will be inaugurated across the country. Each Block Health Mela would be for one day and each block in the State/UT is to be covered.

Dr Sunil Kumar, DGHS, Dr. Manohar Agnani, Additional Secretary, Shri Vikas Sheel, AS & MD, Shri Vishal Chauhan, Joint Secretary, Dr Harmeet Singh, Joint Secretary, Dr. Ashok Babu, Joint Secretary and other senior officials of the Ministry and the States/UTs were present in the meeting.

20-May-2020: Prime Minister interacts with the One Croreth Beneficiary of Ayushman Bharat

Prime Minister Narendra Modi today expressed his happiness as the number of the beneficiaries under the Ayushman Bharat has crossed one crore.

In a series of tweets, the Prime Minister said it would make every Indian proud that the number has crossed 1 crore.

He said, “In less than two years, this initiative has had a positive impact on so many lives. I congratulate all the beneficiaries and their families. I also pray for their good health.”

Shri Modi said he appreciates the efforts of  doctors, nurses, healthcare workers and all others associated with Ayushman Bharat.

Prime Minister said, “Their efforts have made it the largest healthcare programme in the world. This initiative has won the trust of several Indians, especially the poor and downtrodden.”

Explaining the advantages under Ayushman Bharat, the Prime Minister one of the biggest benefits is portability.

In his tweet Shri Modi said, “Beneficiaries can get top quality and affordable medical care not only where they registered but also in other parts of India. This helps those who work away from home or registered at a place where they don’t belong.”

Prime Minister said he is unable to interact with the Ayushman Bharat beneficiaries owing to the current situation. However he interacted on telephone with Pooja Thapa from Meghalaya who is the 1 Croreth beneficiary of the Ayushman Bharat.

3-Mar-2020: Distribution of Ayushman Bharat Cards

Services at Ayushman Bharat- Health & Wellness Centres (AB-HWCs) are free and universal to all individuals residing in the service area.

Ayushman Bharat - Pradhan Mantri Jan Arogya Yojana (AB-PMJAY) is an entitlement-based scheme for providing health cover up to Rs. 5 lakh per family per annum to around 10.74 crore poor and vulnerable families. No registration or enrolment of entitled beneficiaries is required for availing the benefits under AB-PMJAY.

However, in order to create awareness and facilitate easy availing of benefits, paper-based e-cards are being issued to the beneficiaries, after verifying their identity. The identification of beneficiaries is a continuous process and the responsibility of issuing AB-PMJAY e-cards lies with the States/UTs.

In Madhya Pradesh, around 83.92 lakh beneficiary families are entitled for benefits under AB-PMJAY and as on 02.03.2020, 1,40,63,887 individual beneficiaries have been verified under the scheme.  State has been advised to issue e-cards to eligible beneficiaries in a mission mode.

12-Feb-2020: Curriculum for School Health Ambassador Initiative under Ayushman Bharat

Union Minister of Human Resource Development Shri Ramesh Pokhriyal “Nishank”, Union Minister of Health & Family Welfare, Dr. Harsh Vardhan jointly released curriculum for School Health Ambassador Initiative under Ayushman Bharat in New Delhi today. MoS, Ministry of Health & Family Welfare Shri Ashwini Kumar Choubey also graced the occasion.

Speaking on the occasion Shri Pokhriyal said that the goal of ed­ucation is not only to increase the knowledge, but also to inculcate be­havior which promotes consciousness about good health. He said that the teachers are the best mentors for the children and now they will also act as “Health and Wellness Ambassadors” and will disseminate various key information by organising culturally sensitive activity based sessions for one hour per week for 24 weeks in a year to promote joyful learning. The first phase of implementation will be in all the public upper primary, secondary and senior secondary schools of aspirational districts. Subsequently, remaining districts will be taken up in the second year.

Shri Pokhriyal informed that the School Health Programme (SHP) under Ayushman Bharat was launched on April 14, 2018 by the Prime Minister, Shri Narendra Modi in Bijapur, Chhattisgarh. This is a joint collaborative programme of the Ministry of Health and Family Welfare and the Ministry of Human Resource & Development, Department of School Education & Literacy. The initiative targets both Education and Health implementers and is envisaged to facilitate an integrated approach to health programming and more effective learning at the school level. Ministry of Human Resource & Development and Ministry of Health and Family Welfare (MoHFW) along with NCERT has developed curriculum framework and training material for training of nodal teachers, in line with Sustainable Development Goals (SDG- 3).

The Minister hoped that this initiative will help students to show good academic performance of the students as well keep them healthy and enhance skills/counter issues which they may come across throughout their life.

Dr. Harsh Vardhan stated that the efforts put in by National Council of Educational Research and Training (NCERT) for developing 24-hour curriculum, training materials for training of nodal teachers, facilitators guide were developed in consultation with MoHFW. Growing up healthy, emotional wellbeing and mental health, interpersonal relationships, values and responsible citizenship, gender equality, nutrition, health and sanitation, promotion of healthy lifestyles, prevention and management of substance misuse, reproductive health and HIV prevention, safety and security against violence and injuries, and promotion of safe use of internet, media and social media are the 11 identified themes.

In this new initiative, health promotion and prevention activities program has been added in addition to ongoing health screening program through Rashtriya Bal Swasthya Karyakram (RBSK) teams and provision of services (IFA, Albendazole and sanitary napkins). While health screening and provision of services are ongoing activities, the newly added health promotion and prevention component will be implemented by two teachers identified in every school as “Health and Wellness Ambassador”. These ambassadors will be supported by class monitors as “Health and Wellness Messengers”, Dr. Harsh Vardhan elaborated.

Dr Harsh Vardhan also stated that a National Resource Group (NRG) of 40 members has already been constituted by NCERT who have sound training skills and experience in Adolescent Health. The NRG will train the State Resource Group which will comprise of 2 persons each from SCERT, SIHFW and DIET from each selected district at the 5 Regional Institute of Education (RIE) at Shillong, Mysore, Bhopal, Bhubaneshwar and Ajmer.

Ms. Preeti Sudan, Secretary, Health & Family Welfare; Dr. Rajiv Garg, DGHS; Shri H Senapathy, Director NCERT; along with officials of Ministry of Health & Family Welfare, Ministry of Human Resource Development and representatives from the developmental partners such as Jhepeigo, UNFPA, USAID, UNICEF and WHO were also present during the inauguration ceremony.

11-Feb-2020: Medical Facilities provided under Ayushman Bharat Yojana

Services at Ayushman Bharat- Health & Wellness Centres (AB-HWCs) are free and universal to all individuals residing in the service area. AB-HWCs would provide service delivery of a package of preventive, promotive, curative and rehabilitative services delivered close to communities to overcome the challenge of dual burden of disease. The expanded range of services would include services related to Non-Communicable diseases (NCDs), Mental health, ENT, Ophthalmology, Oral health, Geriatric and palliative health care and Trauma care, in addition to the existing services of RCH and communicable diseases. Further Free Diagnostics and Drugs Services have been expanded to make more medicines/ diagnostics available at these AB-HWCs.

Ayushman Bharat – Pradhan Mantri Jan Arogya Yojana (AB-PMJAY) provides health cover up to Rs. 5 lakh per family per annum for secondary and tertiary hospitalization care through a set of 1393 defined packages, including one (1) unspecified surgical package, across 24 specialties. The details of specialties covered under AB-PMJAY are at Annexure.

The Health cover under AB-PMJAY includes all the expenses incurred for hospitalization of beneficiaries and it includes the following components:

• Medical examination, treatment, and consultation
• Pre-hospitalization
• Medicine and medical consumables
• Non-intensive and intensive care services
• Diagnostic and laboratory investigations
• Medical implant services (where necessary)
• Accommodation benefits
• Food services
• Complications arising during treatment
• Post-hospitalization follow-up care up to 15 days

As on 06.02.2020, over 81.25 lakh cases of hospital admission amounting to Rs. 11,355.63 crore have been registered across 32 States/UTs under AB-PMJAY.

1-Oct-2019: PM addresses Arogya Manthan marking one year of Ayushman Bharat

Prime Minister Shri Narendra Modi launched a new mobile application for the Ayushman Bharat, the world’s largest health insurance scheme aimed at securing the health of over 10.70 Crore Poor families in the country.  The Prime Minister was presiding over the over the valedictory function of Arogya Manthan at New Delhi. 

He interacted with select beneficiaries of Ayushman Bharat Pradhan Mantri - Jan Arogya Yojana PM-JAY. He visited the exhibition on PM-JAY which showcased the journey of the scheme over the past one year. He also launched the ‘Ayushman Bharat Start-Up Grand Challenge’ and released a commemorative stamp on the occasion.

Speaking on the occasion, the PM said, the first year of Ayushman Bharat has been about resolution, dedication and mutual learning. We are running the world's largest health care scheme successfully in India due to our determination. Access to medical facilities should be easily available to every poor and every citizen in the country.  There is a sense of dedication behind this success and this dedication belongs to every state and union territory of the country.

It is a great achievement to awaken hope among the lakhs of poor people of the country to recover from the disease. In the last one year, if any one person's land, house, jewelry or any other items are saved from mortgage or sale for medical treatment, then this is a huge success of Ayushman Bharat. In the last one year about 50,000 poor could avail the benefit under PMJAY outside their district and state where they could get better facilities.

Ayushman Bharat is one of the revolutionary steps of New India and not just because it is playing an important role in saving the life of an ordinary person, but it is also a symbol of the dedication and strength of 130 crore people of the country.

Ayushman Bharat is a collective solution for the whole of India as well as a holistic solution for a healthy India. This is an extension of the government's thinking under which we are working in totality instead of thinking in pieces to deal with India's problems and challenges. Ayushman Bharat ensures better treatment to patients in any part of the country.

Arogya Manthan is a two-day event organized by the National Health Authority, to mark the completion of one year of Ayushman Bharat PM-JAY. The purpose of the Arogya Manthan is to provide a platform to meet for all the important stakeholders of PM-JAY to meet and discuss the challenges faced in the implementation of the scheme in the past year and to forge new understanding and pathways to improving implementation.

---

23-Sep-2018: Prime Minister launched the health assurance scheme: Ayushman Bharat - Pradhan Mantri Jan Arogya Yojana - at Ranchi, Jharkhand

The Prime Minister launched the health assurance scheme: Ayushman Bharat - Pradhan Mantri Jan Arogya Yojana - at Ranchi, Jharkhand. He also unveiled plaques to lay the Foundation Stone for medical colleges at Chaibasa and Koderma. He also inaugurated 10 Health and Wellness Centres.

Speaking on the occasion, the Prime Minister said that this launch has been done with a vision to provide the poorest of the poor, and the underprivileged sections of society, with better healthcare and treatment. He said this scheme, which envisions health assurance of 5 lakh rupees per family per year, will benefit over 50 crore people, and is the world's biggest health assurance scheme. He said the number of beneficiaries of this scheme is roughly equal to the population of the European Union, or the population of America, Canada and Mexico, taken together.

He said the first part of Ayushman Bharat - the health and wellness centres, was launched on Babasaheb Ambedkar's birth anniversary, and the second part - the health assurance scheme, is being launched two days before Deendayal Upadhyay's birth anniversary.

Explaining how comprehensive the PMJAY is, the Prime Minister said it would cover 1300 illnesses, including serious illnesses such as cancer and heart disease. He said private hospitals too would be part of this scheme.

The Prime Minister said that the amount of 5 lakhs would cover all investigations, medicine, pre-hospitalization expenses etc. He said it would also cover pre-existing illnesses. He said that people can learn more about the scheme by dialing 14555, or through their Common Service Centre.

The Prime Minister said that for the States that are a part of PMJAY, people can get the benefit of the scheme in whichever of these States they go to. He said more than 13,000 hospitals across the country have joined the scheme so far.

The Prime Minister also spoke of the 10 health and wellness centres inaugurated today. He said the number of such centres across the country has reached 2300. He said the aim is to have 1.5 lakh such centres in India within four years.

The Prime Minister said that the Union Government is working with a holistic approach to improve the health sector in the country. He said the focus is on both "Affordable Healthcare" and "Preventive Healthcare."

The Prime Minister expressed confidence that through the efforts of all those involved with PMJAY, and the dedication of the doctors, nurses, healthcare providers, ASHAs, ANMs etc., the scheme would become a success.

14-Jun-2018: 20 States sign MoU for implementing Ayushman Bharat – National Health Protection Mission (AB-NHPM)

Shri J P Nadda, Union Minister of Health and Family Welfare exchanged the Memorandum of Understanding with the State Health Ministers of 20 States marking their commitment towards the launch of the Ayushman Bharat – National Health Protection Mission (AB-NHPM) at a Health Ministers conclave.

The success of the scheme hinges upon the active participation of the States. States need to own the scheme while Centre will design the policy framework with all possible flexibility and support. Exchanging of Memorandum of Understanding is an important step in formalizing the partnership between Centre and States.

Shri J P Nadda further stated that AB-NHPM will protect around 50 crore people (from about 10 crore families). It will be cashless and paperless access to services upto Rs. 5 lakhs per year will be available for the beneficiary families at the point of service in both public and private empanelled hospitals across India. He further said that the beneficiaries under the scheme can avail services anywhere in India and it is expected to bring a visible relief to the target families by mitigating the financial risk arising out of catastrophic health episodes.

AB-NHPM will protect the people and at the same time Health and Wellness Centres (HWCs) will deliver comprehensive primary health care. The H&WC would provide preventive, promotive, and curative care for non-communicable diseases, dental, mental, geriatric care, palliative care, etc. He further stated that the Government has initiated universal screening of common NCDs such as diabetes, hypertension and common cancers along with Tuberculosis and Leprosy, which will eventually help in reducing the disease burden of the country.

Ayushman Bharat - National Health Protection Mission (AB-NHPM) will have major impact on reduction of Out Of Pocket (OOP) expenditure. The scheme will give cashless benefits in any public or private hospital across the country, ensuring accessible and equitable quality health care to the marginalized and vulnerable sections.

NHPM is a move towards comprehensive model of health services delivery, from a sectoral, fragmented and segmented approach. It is a big step to improve secondary and tertiary hospitalization and healthcare facilities.

The Health Ministers and Secretaries were appreciative of the support and inclusive approach extended by the Ministry of Health and Family Welfare and National Health Agency for Ayushman Bharat – National Health Mission (AB-NHPM) with substantial engagement of all the stakeholders while firming up all the aspects of the Mission like operational guidelines, model tender document for selection of insurance companies and implementation support agencies for trusts, etc.

20 states have so far signed MoU and its likely to be 25 States by the end of this month. During the conclave, model tender documents, final operational guidelines for AB-NHPM were released which are focused on beneficiary centric delivery of services while ensuring there is no compromise on the quality of healthcare services and preventing frauds. The participants were appreciative of the inclusive approach taken by National Health Agency during consultations and workshops.

A web portal for initiating the empanelment of hospitals under the mission was also launched. This marks the commencement of the implementation of AB-NHPM and takes the Mission closer to launch. Training / Demo of empanelment software will be conducted in next two weeks and States can operationalize empanelment of hospitals by 1st of July.

21-Mar-2018: Cabinet approves Ayushman Bharat – National Health Protection Mission

The Union Cabinet has approved the launch of a new Centrally Sponsored Ayushman Bharat -National Health Protection Mission (AB-NHPM) having central sector component under Ayushman Bharat Mission anchored in the MoHFW. The scheme has the benefit cover of Rs. 5 lakh per family per year. The target beneficiaries of the proposed scheme will be more than 10 crore families belonging to poor and vulnerable population based on SECC database. AB-NHPM will subsume the on-going centrally sponsored schemes -Rashtriya Swasthya Bima Yojana (RSBY) and the Senior Citizen Health Insurance Scheme (SCHIS),

Salient Features: AB-NHPM will have a defined benefit cover of Rs. 5 lakh per family per year. This cover will take care of almost all secondary care and most of tertiary care procedures. To ensure that nobody is left out (especially women, children and elderly) there will be no cap on family size and age in the scheme. The benefit cover will also include pre and post-hospitalization expenses. All pre-existing conditions will be covered from day one of the policy. A defined transport allowance per hospitalization will also be paid to the beneficiary.

Benefits of the scheme are portable across the country and a beneficiary covered under the scheme will be allowed to take cashless benefits from any public/private empanelled hospitals across the country.

AB-NHPM will be an entitlement based scheme with entitlement decided on the basis of deprivation criteria in the SECC database, The different categories in rural area include families having only one room with kuccha walls and kuccha roof; families having no adult member between age 16 to 59; female headed households with no adult male member between age 16 to 59; disabled member and no able bodied adult member in the family; SC/ST households; and landless households deriving major part of their income from manual casual labour, Also, automatically included families in rural areas having any one of the following: households without shelter, destitute, living on alms, manual scavenger families, primitive tribal groups, legally released bonded labour. For urban areas, 11 defined occupational categories are entitled under the scheme.

The beneficiaries can avail benefits in both public and empanelled private facilities. All public hospitals in the States implementing AB-NHPM, will be deemed empanelled for the Scheme. Hospitals belonging to Employee State Insurance Corporation (ESIC) may also be empanelled based on the bed occupancy ratio parameter. As for private hospitals, they will be empanelled online based on defined criteria.

To control costs, the payments for treatment will be done on package rate (to be defined by the Government in advance) basis. The package rates will include all the costs associated with treatment. For beneficiaries, it will be a cashless, paper less transaction. Keeping in view the State specific requirements, States/ UTs will have the flexibility to modify these rates within a limited bandwidth.

One of the core principles of AB-NHPM is to co-operative federalism and flexibility to states. There is provision to partner the States through co-alliance. This will ensure appropriate integration with the existing health insurance/ protection schemes of various Central Ministries/Departments and State Governments (at their own cost), State Governments will be allowed to expand AB-NHPM both horizontally and vertically. States will be free to choose the modalities for implementation. They can implement through insurance company or directly through Trust/ Society or a mixed model.

For giving policy directions and fostering coordination between Centre and States, it is proposed to set up Ayushman Bharat National Health Protection Mission Council (AB-NHPMC) at apex level Chaired by Union Health and Family Welfare Minister. It is proposed to have an Ayushman Bharat National Health Protection Mission Governing Board (AB-NHPMGB) which will be jointly chaired by Secretary (HFW) and Member (Health), NITI Aayog with Financial Advisor, MoHFW, Additional Secretary & Mission Director, Ayushman Bharat National Health Protection Mission, MoHFW (AB-NHPM) and Joint Secretary (AB-NHPM), MoHFW as members. CEO, Ayushman Bharat - National Health Protection Mission will be the Member Secretary, State Secretaries of Health Department may also be members as per the requirement. It is proposed to establish an Ayushman Bharat - National Health Protection Mission Agency (AB-NHPMA) to manage the AB-NHPM at the operational level in the form of a Society. AB-NHPMA will be headed by a full time CEO of the level of Secretary/ Additional Secretary to the Government of India.

States would need to have State Health Agency (SHA) to implement the scheme States will have the option to use an existing Trust / Society / Not for Profit Company/ State Nodal Agency or set up a new Trust / Society / Not for Profit Company/ State Health Agency to implement the scheme and act as SHA. At the district level also, a structure for implementation of the scheme will need to be set up.

To ensure that the funds reach SHA on time, the transfer of funds from Central Government through AB-NHPMA to State Health Agencies may be done through an escrow account directly. The State has to contribute its matching share of grants within defined time frame.

In partnership with NITI Aayog, a robust, modular, scalable and interoperable IT platform will be made operational which will entail a paperless, cashless transaction. This will also help in prevention / detection of any potential misuse / fraud / abuse cases. This will be backed by a well-defined Grievance Redressal Mechanism. In addition, pre-Authorisation of treatments with moral hazards (Potential of misuse) will be made mandatory.

In order to ensure that the scheme reaches the intended beneficiaries and other stakeholders, a comprehensive media and outreach strategy will be developed, which will, inter alia, include print media, electronic media, social media platforms, traditional media, IEC materials and outdoor activities.

Implementation Strategy: At the national level to manage, an Ayushman Bharat National Health Protection Mission Agency (AB-NHPMA) would be put in place. States/ UTs would be advised to implement the scheme by a dedicated entity called State Health Agency (SHA). They can either use an existing Trust/ Society/ Not for Profit Company/ State Nodal Agency (SNA) or set up a new entity to implement the scheme. States/ UTs can decide to implement the scheme through an insurance company or directly through the Trust/ Society or use an integrated model.

Major Impact: In-patient hospitalization expenditure in India has increased nearly 300% during last ten years. (NSSO 2015). More than 80% of the expenditure are met by out of pocket (OOP). Rural households primarily depended on their 'household income / savings' (68%) and on 'borrowings' (25%), the urban households relied much more on their 'income / saving' (75%) for financing expenditure on hospitalizations, and on '(18%) borrowings. (NSSO 2015). Out of pocket (OOP) expenditure in India is over 60% which leads to nearly 6 million families getting into poverty due to catastrophic health expenditures. AB-NHPM will have major impact on reduction of Out Of Pocket (OOP) expenditure on ground of:

1. Increased benefit cover to nearly 40% of the population, (the poorest & the vulnerable)
2. Covering almost all secondary and many tertiary hospitalizations. (except a negative list)
3. Coverage of 5 lakh for each family(no restriction of family size) 

This will lead to increased access to quality health and medication. In addition, the unmet needs of the population which remained hidden due to lack of financial resources will be catered to. This will lead to timely treatments, improvements in health outcomes, patient satisfaction, improvement in productivity and efficiency, job creation thus leading to improvement in quality of life.

Expenditure involved: The expenditure incurred in premium payment will be shared between Central and State Governments in specified ratio as per Ministry of Finance guidelines in vogue. The total expenditure will depend on actual market determined premium paid in States/ UTs where AB-NHPM will be implemented through insurance companies. In States/ UTs where the scheme will be implemented in Trust/ Society mode, the central share of funds will be provided based on actual expenditure or premium ceiling (whichever is lower) in the pre-determined ratio.

Number of Beneficiaries: AB-NHPM will target about 10.74 crore 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. 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.

States/Districts covered: AB-NHPM will be rolled out across all States/UTs in all districts with an objective to cover all the targeted beneficiaries.

Background: RSBY was launched in the year 2008 by the Ministry of Labour and Employment and provides cashless health insurance scheme with benefit coverage of Rs. 30.000/- per annum on a family floater basis [for 5 members], for Below Poverty Line (BPL) families, and 11 other defined categories of unorganised workers. To integrate RSBY into the health system and make it a part of the comprehensive health care vision of Government of India, RSBY was transferred to the Ministry of Health and Family Welfare (MoHFW) w.e.f. 01.04.2015. During 2016-2017, 3.63 crore families were covered under RSBY in 278 districts of the country and they could avail medical treatment across the network of 8,697 empanelled hospitals. The NHPS comes in the backdrop of the fact that various Central Ministries and State/UT Governments have launched health insurance/ protection schemes for their own defined set of beneficiaries. There is a critical need to converge these schemes, so as to achieve improved efficiency, reach and coverage.

1-Feb-2018: Ayushman Bharat for a new India -2022

The Government has announced two major initiatives in health sector, as part of Ayushman Bharat programme to address health holistically, in primary, secondary and tertiary care systems, covering both prevention and health promotion.

The initiatives are as follows:-

1. Health and Wellness Centre:- The National Health Policy, 2017 has envisioned Health and Wellness Centres as the foundation of India’s health system. Under this 1.5 lakh centres will bring health care system closer to the homes of people. These centres will provide comprehensive health care, including for non-communicable diseases and maternal and child health services.  These centres will also provide free essential drugs and diagnostic services. The Budget has allocated Rs.1200 crore for this flagship programme. Contribution of private sector through CSR and philanthropic institutions in adopting these centres is also envisaged.
2. National Health Protection Scheme:- The second flagship programme under Ayushman Bharat is National Health Protection Scheme, which will cover over 10 crore poor and vulnerable families (approximately 50 crore beneficiaries) providing coverage upto 5 lakh rupees per family per year for secondary and tertiary care hospitalization.  This will be the world’s largest government funded health care programme. Adequate funds will be provided for smooth implementation of this programme.

These two health sector initiatives under Ayushman Bharat Programme will build a New India 2022 and ensure enhanced productivity, wellbeing and avert wage loss and impoverishment. These Schemes will also generate lakhs of jobs, particularly for women.

In order to further enhance accessibility of quality medical education and health care, 24 new Government Medical Colleges and Hospitals will be set up, by up-grading existing district hospitals in the country. This would ensure that there is at least 1 Medical College for every 3 Parliamentary Constituencies and at least 1 Government Medical College in each State of the country.