Ayushman Bharat PM-JAY: Transforming India’s healthcare story
Author: Dr R S Sharma
New Delhi: The National Health Policy (NHP) of 2017 had listed among its foremost objectives, the achievement of Universal Health Coverage. Achieving a significant reduction in out of pocket expenditure due to health care costs was one of another key objective. Ayushman Bharat Pradhan Mantri – Jan Arogya Yojana (AB PM-JAY) was conceived out of this vision to move towards a more holistic approach to healthcare service delivery.
Ayushman Bharat PM-JAY was not the nation’s first tryst with healthcare insurance. Due credit must be given to predecessor schemes such as Rashtriya Swasthya Bima Yojana (RSBY), state schemes like Aarogyasri in Andhra Pradesh, Jeevandayee Yojana in Maharashtra. However, in terms of scope and scale, AB PM-JAY simply dwarfed all existing healthcare insurance interventions. It is for the first time that we now have a health insurance scheme with a pan-India presence being implemented almost everywhere in the country.
As of 01st April 2022, Ayushman Bharat PM-JAY in alliance with State health schemes covers a beneficiary base of more than 14 Crore families (70 Crore individuals). Almost 18 Crore individuals have been identified under the scheme and provided with an Ayushman card! AB PM-JAY has facilitated almost 3.28 Crore hospitalizations providing treatment worth over Rs. 37,600 Crores. All this has been achieved in a little over 3.5 years and amidst the greatest global pandemic in recent times.
As I reflect on the trajectory of Ayushman Bharat PM-JAY, the scheme’s success is mounted on the vision of the Hon’ble Prime Minister and the versatile policy framework conceptualized by the Cabinet. This policy framework crystallized the guiding principles behind Ayushman Bharat PM-JAY which are as follows:
Comprehensive healthcare benefits
AB PM-JAY was launched with 1,393 treatment packages covering treatment for various medical specialties like oncology, neurosurgery, cardiovascular surgery etc up to Rs. 5 Lakhs per beneficiary family. This was subsequently increased to 1,670 treatment packages. The benefits package under AB PM-JAY was comprehensive covering pre and post hospitalisation expenses. Additionally, all pre-existing conditions were covered from day one of the policy period. The portability feature empowered beneficiaries from the remotest villages to seek treatment at the most advanced healthcare facilities.
Converged and integrated within the healthcare ecosystem
Under AB PM-JAY considerable flexibility was provided to the States and Union Territories (UTs) in choosing their mode of implementation, beneficiary database and creating the network of hospitals. Further, NHA diligently pursued convergence with the existing State based schemes. Currently, AB PM-JAY is implemented in alliance with more than 25 State-specific health schemes. Additionally, District Implementation Units were set up in over 600 districts across the country to ensure the administrative reach of AB PM-JAY to the beneficiary’s doorstep.
Ensuring equity in access to healthcare services
Renewed impetus has been given to extending the scheme benefits to the marginalized sections of society covered under the Socio-Economic Caste Census database. Likewise, AB PM-JAY has adopted an enlightened approach towards ensuring gender-specific equity. The erstwhile RSBY scheme had mandated a limit of adding up to 5 family members. Unfortunately, this led to the exclusion of female members of the household, especially the girl child. However, under AB PM-JAY, this capping was done away with. Women account for approximately 50 per cent of Ayushman cards generated using NHA IT platform and 47 per cent of authorized hospital admissions.
Robust, scalable, and interoperable technology platforms
One of the problems that afflicted in the past was fragmented IT systems for the schemes like Ayushman Bharat PM-JAY. Therefore, under AB PM-JAY, a highly versatile technology platform was developed to aid in beneficiary identification, transaction management and hospital empanelment. This award-winning IT platform is now active across 26 States and UTs. As a result, SHAs and NHA have gained granular insights into the scheme to aid in evidence-based policymaking and necessary course correction, where required.
Public and private partnership
Under Ayushman Bharat PM-JAY both public and private hospitals have been empanelled for providing healthcare services to the scheme beneficiaries. The participation of the private sector has increased avenues for the scheme’s beneficiaries to seek treatment and concurrently reduced the burden on tertiary care facilities in the public sector. Under AB PM-JAY, it was ensured that public hospitals would be equally reimbursed for their services and at the same rates as that of private hospitals. This has also supported public sector hospitals to create a pool of untied funds that could be sustainably invested in infrastructure and human resources. The complementary role of the public and private sector hospitals has been vital in ensuring that the scheme implementation proceeded seamlessly.
Aapke Dwar Ayushman
One of the key activities that I green-lighted upon assuming charge of NHA was the “Aapke Dwar Ayushman”. Under Aapke Dwar Ayushman, a grassroots network of frontline healthcare workers, Gram Panchayat officials and village-based digital entrepreneurs were used to undertake door-to-door mobilization of beneficiaries across communities. Special night camps were set up for daily wagers. These efforts translated into the creation of more than 4.7 crore Ayushman cards since January 2021, an increase of 55% in the Ayushman cards generated by NHA IT system. NHA is launching Aapke Dwar Ayushman with renewed vigour. This time we are focusing on States such as Assam, Bihar, Gujarat and Uttar Pradesh.
Aside from this, I would also like to take this opportunity to give credit to the entire Ayushman Bharat PM-JAY ecosystem consisting of NHA, SHAs, DIUs, Implementation support agencies, Pradhan Mantri Arogya Mitras, frontline healthcare workers, Ayushman card creators from partner agencies such as CSC / UTIITSL for their tireless support in making AB PM-JAY such a grand success. However, going forward much more needs to be done to help the scheme realize its full potential. /PIB/
(The writer is Chief Executive Officer, National Health Authority)
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NEP-2020 aspires for inclusive excellence in school education
Rajeev Ranjan Roy
The New Education Policy-2020 (NEP-2020), unveiled recently, aims at achieving excellence in school learning by imparting quality, affordable and inclusive education to all, with an extra emphasis on those children coming from socially and educationally disadvantaged groups of the society. It is a futuristic endeavour towards building Ek Bharat, Shrestha Bharat. The previous education policies largely focussed on the issues of access and equity in giving school education, while the NEP-2020 commits to laying the foundation of a vibrant Bharat where no one is devoid of a kind of school education, which helps every student become an asset for the nation in a true sense. The unfinished agenda of the National Policy on Education 1986, which was modified in 1992, has been effectively dealt with in the NEP-2020 along with the vision behind the Right to the Free and Compulsory Education Act, 2009, which “laid down legal underpinnings for achieving universal elementary education.”
Given the undisputed role of education in nation building, the NEP-2020 rightly lays the stress on standardization and accreditation of school infrastructure and teachers as well, since education with accountability, transparency and affordability is the need of the hour, and hence the need to “empower schools, teachers with trust, enabling them to strive for excellence and perform at their very best, while ensuring the integrity of the system through the enforcement of complete transparency and full public disclosure of all finances, procedures and outcomes.” Since private sector is significantly present in the field of school education, the idea to promote ‘not-for-profit’ entities is a unique feature of NEP-2020, which at the same time intends to promote private philanthropic efforts for quality education, thereby affirming the public-good nature of education, while protecting parents and communities from arbitrary increase in tuition fees.
An equally important area, which has got due attention in the NEP-2020 is the need for efficient resourcing and effective governance through school complexes and clusters, a significant initiative in view of the fact that nearly 28 per cent of India’s public primary schools and 14.8 per cent of upper primary schools have less than 30 students. The average number of students per grade in the elementary schooling system – Grades 1 to 8 – is about 14, with a notable proportion having below six students during 2016-17, the year which also had 1,08,017 single-teacher schools, and majority of them – 85,743 – being primary schools taking care of Grades 1-5 children. It was, therefore, a pressing need to evolve a mechanism for establishing a grouping structure, say, school complexes, consisting of one secondary school together with all other schools, which lead to greater resource efficiency and more effective functioning, coordination, leadership, governance, and management of schools in the cluster. This will not only ensure optimum utilisation of resources, but will also foster the sense of oneness and togetherness among the school children, who are the future of the nation.
What further makes the New Education Policy-2020 uniquely special is its pledge for equitable and inclusive education for all, one of the great dreams of our founding fathers. Education, as the NEP-2020 rightly envisions, is “the single greatest tool for achieving social justice and quality.” Inclusive and equitable education, indeed an essential goal in its own right, is also critical to achieving a social order where every citizen has “the opportunity to dream, thrive, and contribute to the nation.” Quality, affordable and ethical education to all is the first move to break multiple social and economic barriers, which sow the seeds of exclusion, discrimination and exploitation against our own people on different parochial considerations.
Needless to say efforts were made in the past as well to bridge the educational chasm between socially and educationally disadvantaged groups (SEDGs) and the children of top social strata, but the desired results remained elusive. SEDGs account for the country’s overwhelming population, but their children’s share in quality school educational institutions has been minimal over the years. Early childhood care and education (ECCE) needs to be handled more comprehensively. According to the Unified-District Information System for Education (U-DISE) 2016-17 data, about 19.6 per cent of students belonged to Scheduled Castes (SCs) at the primary level, but this fraction fell to 17.3 per cent at the higher secondary level. These enrollment drop-outs were more severe for ST students (10.6 per cent to 6.8 per cent), and differently-abled children (1.1 per cent to 0.25 per cent), with even greater declines for female students within each of these categories. Thus, there is no scope for any complacency on the part of the government. A series of interventions including better facilities, more and more hostels, scholarships and other enabling support have been provisioned in the NEP-2020 so that the idea of ‘learning for all’ is realised in a more comprehensive manner.
Teachers are not only an integral part of an education system, but the most important stakeholder in the entire gamut of things. Their quality and ability to teach school students, when they are in their formative age, become something of paramount importance. From their recruitment to training, every precaution needs to be taken to ensure that school education is not rendered to a mere formality, but becomes a game changer. The New Education Policy-2020 comes with a basket full of tools and parameters to ensure holistic training and upgradation of teachers and their teaching skills in a sustainable manner. From continuous professional development (CPD) to career management and progression (CMP), the NEP-2020 vouches for a set of common guidelines – National Professional Standards for Teachers (NPST), which will be put in place by the National Council for Teacher Education (NCTE) in its restructured new form as the Professional Standard Setting Body (PSSB) under the General Education Council. This exercise will be carried out in consultation with National Council Educational Research and Training (NCERT), SCERTs, teachers from across levels and regions.
The teacher education will also undergo a sea-change. By 2030, the minimum degree qualification for teaching will be a 4-year integrated B.Ed. that teaches a range of knowledge content. Today B.Ed. teaching is most poorly regulated in our country ever since the standalone B.Ed. colleges were allowed to be opened up in the private sector. It is high time to take B.Ed. teaching more than seriously. The NEP-2020 stipulates that by 2021, a new and comprehensive National Curriculum Framework for Teacher Education (NCFTE-2021) will be formulated by the NCTE. NCFTE, which will also factor in the requirements of teacher education curricula for vocational education, will be revised once every 5-10 years.
In conclusion, the NEP-2020 visualizes to impart a school education which lays the foundation of a self-reliant India and also to help our country emerge as a knowledge hub. From the foundation of learning to foundational literacy and numeracy to checking drop outs and ensuring universal access to education for all and at all levels to the restructuring of school curriculum, India is in for a metamorphosis in the field of school education, recognizing, identifying and fostering the unique capabilities of each student. Tools such as multi disciplinarity, emphasis on conceptual understanding, creativity and critical thinking, ethics and human and constitutional values, full equity and inclusion, and light but tight regulatory framework are bound to do wonders. Education is a public service, a rare pursuit in nation building, which should be holistic and inclusive and must make one take pride in India and its rich, diverse, ancient and modern culture and knowledge systems and tradition. The NEP-2020 aspires so, indeed!
( The writer is a senior journalist and author. The views expressed are strictly personal.)
NEP-2020 aspires for inclusive excellence in school education
Rajeev Ranjan Roy
The New Education Policy-2020 (NEP-2020), unveiled recently, aims at achieving excellence in school learning by imparting quality, affordable and inclusive education to all, with an extra emphasis on those children coming from socially and educationally disadvantaged groups of the society. It is a futuristic endeavour towards building Ek Bharat, Shrestha Bharat. The previous education policies largely focussed on the issues of access and equity in giving school education, while the NEP-2020 commits to laying the foundation of a vibrant Bharat where no one is devoid of a kind of school education, which helps every student become an asset for the nation in a true sense. The unfinished agenda of the National Policy on Education 1986, which was modified in 1992, has been effectively dealt with in the NEP-2020 along with the vision behind the Right to the Free and Compulsory Education Act, 2009, which “laid down legal underpinnings for achieving universal elementary education.”
Given the undisputed role of education in nation building, the NEP-2020 rightly lays the stress on standardization and accreditation of school infrastructure and teachers as well, since education with accountability, transparency and affordability is the need of the hour, and hence the need to “empower schools, teachers with trust, enabling them to strive for excellence and perform at their very best, while ensuring the integrity of the system through the enforcement of complete transparency and full public disclosure of all finances, procedures and outcomes.” Since private sector is significantly present in the field of school education, the idea to promote ‘not-for-profit’ entities is a unique feature of NEP-2020, which at the same time intends to promote private philanthropic efforts for quality education, thereby affirming the public-good nature of education, while protecting parents and communities from arbitrary increase in tuition fees.
An equally important area, which has got due attention in the NEP-2020 is the need for efficient resourcing and effective governance through school complexes and clusters, a significant initiative in view of the fact that nearly 28 per cent of India’s public primary schools and 14.8 per cent of upper primary schools have less than 30 students. The average number of students per grade in the elementary schooling system – Grades 1 to 8 – is about 14, with a notable proportion having below six students during 2016-17, the year which also had 1,08,017 single-teacher schools, and majority of them – 85,743 – being primary schools taking care of Grades 1-5 children. It was, therefore, a pressing need to evolve a mechanism for establishing a grouping structure, say, school complexes, consisting of one secondary school together with all other schools, which lead to greater resource efficiency and more effective functioning, coordination, leadership, governance, and management of schools in the cluster. This will not only ensure optimum utilisation of resources, but will also foster the sense of oneness and togetherness among the school children, who are the future of the nation.
What further makes the New Education Policy-2020 uniquely special is its pledge for equitable and inclusive education for all, one of the great dreams of our founding fathers. Education, as the NEP-2020 rightly envisions, is “the single greatest tool for achieving social justice and quality.” Inclusive and equitable education, indeed an essential goal in its own right, is also critical to achieving a social order where every citizen has “the opportunity to dream, thrive, and contribute to the nation.” Quality, affordable and ethical education to all is the first move to break multiple social and economic barriers, which sow the seeds of exclusion, discrimination and exploitation against our own people on different parochial considerations.
Needless to say efforts were made in the past as well to bridge the educational chasm between socially and educationally disadvantaged groups (SEDGs) and the children of top social strata, but the desired results remained elusive. SEDGs account for the country’s overwhelming population, but their children’s share in quality school educational institutions has been minimal over the years. Early childhood care and education (ECCE) needs to be handled more comprehensively. According to the Unified-District Information System for Education (U-DISE) 2016-17 data, about 19.6 per cent of students belonged to Scheduled Castes (SCs) at the primary level, but this fraction fell to 17.3 per cent at the higher secondary level. These enrollment drop-outs were more severe for ST students (10.6 per cent to 6.8 per cent), and differently-abled children (1.1 per cent to 0.25 per cent), with even greater declines for female students within each of these categories. Thus, there is no scope for any complacency on the part of the government. A series of interventions including better facilities, more and more hostels, scholarships and other enabling support have been provisioned in the NEP-2020 so that the idea of ‘learning for all’ is realised in a more comprehensive manner.
Teachers are not only an integral part of an education system, but the most important stakeholder in the entire gamut of things. Their quality and ability to teach school students, when they are in their formative age, become something of paramount importance. From their recruitment to training, every precaution needs to be taken to ensure that school education is not rendered to a mere formality, but becomes a game changer. The New Education Policy-2020 comes with a basket full of tools and parameters to ensure holistic training and upgradation of teachers and their teaching skills in a sustainable manner. From continuous professional development (CPD) to career management and progression (CMP), the NEP-2020 vouches for a set of common guidelines – National Professional Standards for Teachers (NPST), which will be put in place by the National Council for Teacher Education (NCTE) in its restructured new form as the Professional Standard Setting Body (PSSB) under the General Education Council. This exercise will be carried out in consultation with National Council Educational Research and Training (NCERT), SCERTs, teachers from across levels and regions.
The teacher education will also undergo a sea-change. By 2030, the minimum degree qualification for teaching will be a 4-year integrated B.Ed. that teaches a range of knowledge content. Today B.Ed. teaching is most poorly regulated in our country ever since the standalone B.Ed. colleges were allowed to be opened up in the private sector. It is high time to take B.Ed. teaching more than seriously. The NEP-2020 stipulates that by 2021, a new and comprehensive National Curriculum Framework for Teacher Education (NCFTE-2021) will be formulated by the NCTE. NCFTE, which will also factor in the requirements of teacher education curricula for vocational education, will be revised once every 5-10 years.
In conclusion, the NEP-2020 visualizes to impart a school education which lays the foundation of a self-reliant India and also to help our country emerge as a knowledge hub. From the foundation of learning to foundational literacy and numeracy to checking drop outs and ensuring universal access to education for all and at all levels to the restructuring of school curriculum, India is in for a metamorphosis in the field of school education, recognizing, identifying and fostering the unique capabilities of each student. Tools such as multi disciplinarity, emphasis on conceptual understanding, creativity and critical thinking, ethics and human and constitutional values, full equity and inclusion, and light but tight regulatory framework are bound to do wonders. Education is a public service, a rare pursuit in nation building, which should be holistic and inclusive and must make one take pride in India and its rich, diverse, ancient and modern culture and knowledge systems and tradition. The NEP-2020 aspires so, indeed!
( The writer is a senior journalist and author. The views expressed are strictly personal.)
