Health Policies and Programmes

Presented by,

Ms. Priya S Dev

Research Scholar
Department of Social Work
Bharathidasan University
Khajamalai Campus,Trichy.
Ayushman Bharat Yojana.

• Ayushman Bharat Pradhan Mantri Jan Arogya Yojana (abb. AB PM-JAY, translation: Prime Minister's, People's
Health Scheme; also referred to as Ayushman Bharat National Health Protection Scheme abb. NHPS) is a national
public health insurance fund of the Government of India that aims to provide free access to health insurance
coverage for low income earners in the country. Roughly, the bottom 50% of the country qualifies for this scheme.
People using the program access their own primary care services from a family doctor. When anyone needs
additional care, then PM-JAY provides free secondary health care for those needing specialist treatment and tertiary
health care for those requiring hospitalization.

• Urban Primary Health Centre Ayushman Bharat Bidipeth Nagpur

• The programme is part of the Indian government's National Health Policy and is means-tested. It was launched in
September 2018 by the Ministry of Health and Family Welfare. That ministry later established the National Health
Authority as an organization to administer the program. It is a centrally sponsored scheme and is jointly funded by
both the union government and the states. By offering services to 50 crore (500 million) people it is the world's
largest government sponsored healthcare program. The program is a means-tested as its users are people with low
income in India.
Features of PM-JAY

• Providing health coverage for 10 crores households or 50 crores Indians; providing a

cover of ₹5 lakh (US$6,600) per family per year for medical treatment in empaneled
hospitals, both public and private; offering cashless payment and paperless
recordkeeping through the hospital or doctor's office;using criteria from the Socio
Economic and Caste Census 2011 to determine eligibility for benefits;no restriction on
family size, age or gender; all previous medical conditions are covered under the
scheme; it covers 3 days of pre-hospitalisation and 15 days of post-hospitalisation,
including diagnostic care and expenses on medicines; the scheme is portable and a
beneficiary can avail medical treatment at any PM-JAY empanelled hospital outside their
state and anywhere in the country;providing access to free COVID-19 testing
Implimentation

• Participation by states and union territories

• India's 28 states and 8 union territories each make their own choice about whether to participate in Ayushman Bharat [Link]
February 2018 when the program was announced 20 states committed to join. In September 2018 shortly after launch some states
and territories declined to participate in the program. Maharashtra and Tamil Nadu initially declined to join because they each had
their own state healthcare [Link] programs, Mahatma Jyotiba Phule Jan Arogya Yojana and the programme for Tamil
Nadu, were already functioning well. These states later both joined Ayushman Bharat Yojana with special exceptions to make it part
of their existing infrastructure. In a similar way, Kerala, despite having its own health program agreed to begin using Ayushman
Bharat Yogana from November 2019. West Bengal initially joined the program but then opted out in favor of establishing their own
regional health [Link] did the same. By January 2020 Odisha had not joined the [Link] March 2020 Delhi
announced that it would join the program.

• Participation by local people

• In May 2020 Prime Minister Narendra Modi said in his radio show Mann Ki Baat that the Ayushman Bharat scheme had recently
benefited more than one crore people. By May 2020, the scheme had provided more than 1 crore treatments with a value of
₹13,412 crore. The number of public and private hospitals empanelled nationwide stands at 24,[Link] Ayushman Bharat Yojana
programme announced a special collaboration with the Employees' State Insurance programme in November 2019. From June
2020, the program had entered a pilot to cover 120,000 workers with that insurance at 15 hospitals.
Challenges

• When Ayushman Bharat Yojana began there were questions of how to reconcile its plans with other existing health
development recommendations, such as from NITI Aayog. A major challenge of implementing a national health care
scheme would be starting with infrastructure in need of development to be part of a modern national [Link]
Ayushman Bharat Yojana seeks to provide excellent healthcare, India still has some basic healthcare challenges
including relatively few doctors, more cases of infectious disease, and a national budget with a comparatively low
central government investment in health care. Some of the problems lay outside the Health Ministry such as urban
development or [Link] many government hospitals have joined the program, many private corporate
hospitals have not. The private hospitals report that they would be unable to offer their special services at the
government low price, even with a government subsidy.

• There has been misuse of the Ayushman Bharat scheme by private hospitals through submission of fake medical
bills. Under the Scheme, surgeries have been claimed to be performed on persons who had been discharged long ago
and dialysis has been shown as performed at hospitals not having kidney transplant facility. There are at least 697
fake cases in Uttarakhand State alone, where fine of ₹1 crore (US$130,000) has been imposed on hospitals for
frauds under the [Link] analysis of high-value claims under PMJAY has revealed that a relatively small
number of districts and hospitals account for a high number of these, and some hint of an anti-women bias, with
male patients getting more coverage. Despite all efforts to curb foul-play, the risk of unscrupulous private entities
profiteering from gaming the system is clearly present in AB-PMJAY
 Pradhan Mantri Swasthya Suraksha Yojana (PMSSY)

• Pradhan Mantri Swasthya Suraksha Yojana (PMSSY) is a government

scheme under the Ministry of Health and Family Welfare.
• Government schemes are important for the UPSC exam as many
questions are asked about them in the exam, especially in the UPSC
Prelims.
• In this article, you can read all about the Pradhan Mantri Swasthya
Suraksha Yojana for UPSC and other government exams.
 Pradhan Mantri Swasthya Suraksha Yojana

• The Pradhan Mantri Swasthya Suraksha Yojana (PMSSY) was initiated in 2003 by the Union
Ministry of Health and Family Welfare. The chief objective of the scheme is to correct the regional
imbalances in the availability of affordable and reliable tertiary healthcare services in the country. It
also aims at boosting the facilities for quality medical education in India.
• There are two components under PMSSY. They are:
• Setting up institutions like the All India Institute of Medical Science (AIIMS).
• Under the scheme, totally 22 AIIMS have been announced (six are functional).
• Each of the new AIIMS would have state-of-the-art modular operation theatres and diagnostics
facilities; 750 beds at least; 15 – 20 speciality departments; 100 MBBS seats; 60 [Link]. Nursing seats.
• The new institutes would have a focus on PG education and research.
• Upgrade of government medical colleges or institutes
• Addition of 8 – 10 speciality departments; 150 – 250 beds and around 15 new seats for PG.
• The government passed the AIIMS Act in order to create AIIMS institutions. According to the Act,
all AIIMS institutions are institutions of national importance and they would function as autonomous
bodies under the Health Ministry.
LaQshya' programme (Labour Room Quality
Improvement Initiative)
• Background:
• The percentage of institutional births in India has doubled from 38.7% to 78.9% in the decade 2015-16,
according to the National Family Health Survey (NFHS-4).However, this increase in coverage has not
translated in commensurate reduction of maternal and newborn mortality and stillbirths. One of the major
factors being inadequacies in the quality of care provided in health [Link] current figures of maternal
mortality ratio of 130 and neonatal mortality rate of 24 suggest that though there has been tremendous
improvement in maternal newborn healthcare indicators, there still exists a vast scope to achieve the targets set
for our country.
• It is estimated that approximately 46% maternal deaths, over 40% stillbirths and 25% of under-5 deaths take
place on the day of the delivery. Half of the maternal death each year can be prevented if we provide higher
quality health [Link] of care is increasingly recognized as a critical aspect of the unfinished maternal and
newborn health agenda, mainly with respect to care around labour and delivery and in the immediate postnatal
period.
• In this respect, Ministry of Health and Family Welfare has launched program ‘LaQshya’- quality improvement
initiative in labour room & maternity OT, aimed at improving quality of care for mothers and newborn during
intrapartum and immediate post-partum period.
 Overview of LaQshya

• Ministry of Health & Family Welfare, Government of India launched an ambitious program LaQshyaon
11th December 2017 with following objectives:
• Reduce maternal and newborn morbidity and mortality
• Improve quality of care during delivery and immediate post-partum period
• Enhance satisfaction of beneficiaries, positive birthing experience and provide Respectful Maternity Care
(RMC) to all pregnant women attending public health facilities.
• Target Beneficiaries:
• LaQshya program will benefit every pregnant woman and newborn delivering in public health institutions.
Program will improve quality of care for pregnant women in labour room, maternity Operation Theatre and
Obstetrics Intensive Care Units (ICUs) & High Dependency Units (HDUs).
• Following facilities are being taken under LaQshya initiative on priority:
• All Government Medical College hospitals.
• All District Hospitals & equivalent healthy facilities.
• All designated FRUs and high case load CHCs with over 100 deliveries/60 (per month) in hills and desert
areas.
 Key Features:

• LaQshya program envisagesto improve quality of care in labour room and maternity
OT.
• Under the initiative, multi-pronged strategy has been adopted such as improving
Infrastructure upgradation, ensuring availability of essential equipment, providing
adequate Human Resources, capacity building of health care workers and improving
quality processes in labour room.
• Implementation of ‘fast-track’ interventions (NQAS assessment, Trainings,
Mentoring, Reviews etc.)
• Capacity-building of healthcare workers by skill-based training like Dakshta &
improving quality processes in the labour room.
• To strengthen critical care in Obstetrics, dedicated Obstetric ICUs at Medical College
Hospital level and Obstetric HDUs at District Hospital are operationalized under
LaQshya program.
Strategies

• Reorganizing/aligning LabourRoom & Maternity Operation Theatre layout as per

Standard Guidelines issued by the Ministry of Health & Family Welfare,
Government of India.
• Ensuring all Government Medical College Hospitals, District Hospitals have
dedicated obstetric HDUs and Obstetric ICU as per GoI MOHFW Guidelines, for
managing complicated pregnancies that require life-saving critical care.
• Ensuring strict adherence to clinical protocols for management and stabilization of
the complications before referral to higher centers.
• Continued mentoring and hand holding support to improvise skills.
• Regular MDSR, C-section audit and Referral audits & linkage among lower level
facilities.
• Collating best quality practices across States which can be replicated by other
States.
National Health Mission.
• The National Health Mission (NHM) encompasses its two Sub-Missions, the
National Rural Health Mission (NRHM) and the newly launched 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. The NHM
envisages achievement of universal access to equitable, affordable & quality
health care services that are accountable and responsive to people's needs.
Goals
• Outcomes for NHM in the 12th Plan are synonymous with those of the 11th Plan and are part of
the overall vision. Specific goals for the states will be based on existing levels, capacity, and
context. State specific innovations would be encouraged. Process and outcome indicators will be
developed to reflect equity, quality, efficiency, and responsiveness. Targets for communicable and
non-communicable diseases will be set at state level based on local epidemiological patterns and
taking into account the financing available for each of these conditions.

• The endeavor would be to ensure the achievement of indicators in Box 1 as follows :

 Reduce MMR to 1/1000 live births

 Reduce IMR to 25/1000 live births
 Reduce TFR to 2.1
Prevention and reduction of anaemia in women aged 15–49 years
Prevent and reduce mortality & morbidity from communicable, non-
communicable; injuries and emerging diseases
Reduce household out-of-pocket expenditure on total health care expenditure
Reduce annual incidence and mortality from Tuberculosis by half
Reduce the prevalence of Leprosy to <1/10000 population and incidence to zero
in all districts
Annual Malaria Incidence to be <1/1000
Less than 1 percent microfilaria prevalence in all districts
Kala-azar Elimination by 2015, <1 case per 10000 population in all blocks
Ayushman Bharat Digital Mission (ADHM)

• Prime Minister launched the Ayushman Bharat Digital Mission (ABDM) via video
conferencing on 27th September 2021, in the presence of Shri Mansukh Mandaviya,
Union Minister of Health and Family Welfare and Dr Bharati Pravin Pawar, Minister of
State for Health and Family Welfare, among other dignitaries.

• Ayushman Bharat Digital Mission will connect the digital health solutions of hospitals
across the country with each other. The Mission will not only make the processes of
hospitals simplified but also will increase ease of living. The Digital Ecosystem will also
enable a host of other facilities like Digital Consultation, Consent of patients in letting
medical practitioners access their records, etc. With the implementation of this scheme,
old medical records cannot get lost as every record will be stored digitally.
Details of Ayushman Bharat Health Infrastructure Mission
• The ‘Pradhan Mantri Ayushman Bharat Health Infrastructure Mission’ aims to strengthen the critical healthcare infrastructure of the
country at several levels (e.g., villages or blocks) over the next five years. The scheme aims to boost citizen’s access to the public
health infrastructure by building facilities for primary and critical care in urban and rural areas of the country.
• Through the mission, the government aims to address three areas in the public health sector in India. The three areas are as follows:
• Augment health facilities for treatment
• The mission aims to offer high-class testing network for effective diagnosis and monitoring of diseases. In line with this, the
government aims to set up ‘Integrated Public Health Labs’ across 730 districts and Block Public Health Units across 3,000 blocks in
the country. In addition, the government plans to establish 5 regional centres for disease control, 20 metropolitan units and 15
biosafety level (BSL) labs to further strengthen the testing network.
• Establish integrated public health labs for diagnosis of diseases
• The government aims to support health & wellness centres in the country to ensure effective and timely treatment. The mission
covers 11,024 urban and 17,788 rural health & wellness centres. These centres will have facilities for early detection of diseases and
offer free medical consultations, tests and medicines. In addition, the government also plans to set up 35,000 new critical care beds
across 600 districts in the country to offer effective care to the seriously ill patients.
• Expand existing research institutions that study pandemics
• The mission aims to build capabilities to conduct comprehensive research studies on the pandemic. In line with this, the
government aims to strengthen the existing 80 viral diagnostic and research labs in the country. At a state level, the government
plans to set up 15 new biosafety laboratories. At the national level, the government plans to establish one National Institute for One
Health and four National Institutes of Virology.
Impact of the Ayushman Bharat Health Infrastructure Mission

• The PM Ayushman Bharat Health Infrastructure Mission is expected to help

achieve holistic healthcare in India. Measures under the scheme are a step towards
addressing critical areas of public health through multinodal and multidimensional
interventions in the healthcare system. Establishment of the health & wellness
centres is expected to strengthen the country’s capacity to detect & diagnose new
infections. Planned health labs are also expected to result in the availability of
adequately trained professionals who can work on research and diagnosis in new
pathogens. This would also help India reduce dependency on foreign laboratories
and partners for research in novel pathogens and biological threats. This scheme
also aligns with India’s ‘Atmanirbhar Bharat’ (self-reliant India) initiative.