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How Ayushman Bharat can boost Health for all

Given that Union Budget 2019 is just a few weeks away, there is considerable buzz around which sectors are likely to receive a real boost in terms of increased allocation of funds. Strengthening healthcare infrastructure and ensuring healthcare
for all had featured prominently in the BJP manifesto that was released ahead of the Lok Sabha elections this year. Therefore, one can expect that Budget 2019 will boost healthcare initiatives such as Ayushman Bharat and pave the way to strengthen the country’s healthcare infrastructure.

While delivering the interim Budget speech in Lok Sabha, the then Finance Minister Piyush Goyal had stated that about 10 lakh people have availed free treatment under the Pradhan Mantri Jan Arogya Yojana (PMJAY), also called as ‘Ayushman Bharat’.

Ayushman Bharat benefits poor and low-income families

This would have cost the affected people around three thousand crore rupees but under the scheme, they received the benefit of free treatment, which reached them on time. Further, the PMJAY had been given an allocation of Rs 6,400 crore in the interim budget.

Historically, in India, the state is endowed with the primary responsibility of managing healthcare. The chasm between rural and urban indicators of health have always been a worrying concern, as social inequalities play out due to multiple issues that are known to prevail, particularly in rural areas such as female foeticide and maternal deaths.

Healthcare challenges like maternal deaths require urgent steps

In this regard, Tamil Nadu presents an exemplary case study in tackling maternal deaths, an issue that continues to pose disturbing concerns across the country.

From a healthcare perspective, the state took several measures that ensured a significant decline in its maternal mortality rate through an increase in institutional deliveries and deliveries assisted by a skilled birth attendant.

Other measures include improved infrastructure of sub-centres for antenatal care clinics, deliveries, immunization and deployment of more community level staff. The initiative was further strengthened when the state government in 2004 issues a direction to the effect that all maternal deaths should be audited.

Political will had also played a pivotal role in Tamil Nadu’s success story in bringing down maternal mortality rates. For pregnant women belonging to low-income families, the Dr. Muthulakshmi Reddy Memorial Maternity Assistance scheme provided a cash assistance of one thousand rupees spanning six months. This 1989 scheme is credited with having benefited more than 441,095 women.

Another noteworthy instance pertains to Vellore Hospital’s Christian Medical College, which rolled out an innovative birth-companion initiative in 2002. With limited hospital staff and increasing number of childbirths, the need of the hour was to ensure that a pregnant woman is in the company of birth companions, usually her relatives, to provide emotional support and assistance. All doctors and nurses in government hospitals were sensitised on the issue and a government order was issued in 2004.

In 2005, with funding from the World Bank, the Tamil Nadu Health Systems project is credited with having developed a highly successful PPP initiative that provided emergency transportation service across many districts with ambulances and other minor expenses borne by NGOs. The performance of these NGOs were subjected to monitoring committees to ensure their optimum performance.

At a state-level, we have examined a mere tip of the ice berg. Bigger healthcare issues and challenges loom large and these vary from state to state.

Prime Minister Narendra Modi’s Ayushman Bharat provides annual health cover of five lakh rupees to more than 100 million families and is further expected to benefit over 500 million individuals belonging to low-income families.

One of the core strengths of the Ayushman Bharat scheme is to boost co-operative federalism and offer flexibility to states.

Higher allocation of funds in Budget 2019 towards Ayushman Bharat can pave the way for far reaching changes in the context of healthcare benefits that reach the poorest of the poor, which can gradually evolve to systemically address some pain points in its implementation phase as well.

As Piyush Goyal had stated, “By 2030, we will work towards a comprehensive wellness healthcare system for all.” Budget 2019 can mark the beginning of the ‘Health for all’ journey.


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