New Delhi: The Government of India through its various ministries such as the Ministry of Health and Family Welfare (MoHFW), Ministry of AYUSH (Ayurveda, Yoga, Naturopathy, Unani, Siddha, Sowa-Rigpa and Homoeopathy), Department of Pharmaceuticals, Ministry of Chemicals and Fertilizers and others, has been running a number of healthcare schemes and programmes aimed at all segments of the population. These schemes and programmes, according to the government aim to make healthcare affordable and accessible to all, in line with Sustainable Development Goal (SDG) 3 – ‘Good Health and Well-Being’ for all. Along with this, these schemes and programmes are measures intended to decrease the out-of-pocket expenses of the people on health. According to the National Sample Survey Organisation (NSSO), 2016, in rural areas in India, about 67.8 per cent of households report income or savings as a major source of finance for meeting expenses related to hospitalisation. The figure is higher in urban India, with 74.9 per cent of the households majorly relying on income or savings for such expenses.
NDTV spoke with experts to know what are the nationwide schemes that people should know about and can take advantage from.
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Here are some of the major healthcare schemes of the Central Government to improve public health in the country:
Ayushman Bharat Yojana (ABY)
Launched in September 2018, the Ayushman Bharat Yojna aims to provide healthcare (through Health and Wellness Centres) and health insurance facility (through Pradhan Mantri Jan Arogya Yojana) to the poor, at all healthcare levels—primary, secondary and tertiary.
The ABY has two sub-missions:
Establishment of Health and Wellness Centres (HWCs): These centres are aimed at improving access to affordable and quality healthcare services at the primary level. These centres provide Comprehensive Primary Health Care (CPHC), covering both maternal and child health services and non-communicable diseases, including free essential drugs and diagnostic services.
Pradhan Mantri Jan Arogya Yojana (PM-JAY): It provides financial protection to the poor for availing healthcare services at the secondary and tertiary levels. Citizens with Ayushman Bharat card are entitled for cashless treatment of up to Rs. 5 lakh in all government and those private hospitals that are empanelled under the scheme. These hospitals cannot deny treatment to Ayushman Bharat card holders and all pre-existing diseases are covered under it. The scheme covers 3 days of pre-hospitalisation and 15 days of post-hospitalisation, including diagnostic care and expenses on medicines.
The eligibility criteria is based on the Socio-Economic Caste Census (SECC), 2011. This means that if the family is listed in the SECC database, it is eligible under this scheme. But, since the SECC happened in 2011, there are many families that might be eligible now but could not be included in that census. Such families in rural areas can be identified if they fall into at least one of the six deprivation criteria:
• only one room with kucha walls and kucha roof
• no adult member between ages 16 to 59
• households with no adult male member between ages 16 to 59
• disabled member and no able-bodied adult member
• SC/ST households
• landless households deriving a major part of their income from manual casual labour
In Urban areas, 11 occupational categories of workers are eligible for the scheme:
• Domestic worker
• Street vendor/cobbler/hawker /other service provider working on streets
• Construction worker/ plumber/ mason/ labour/painter/ welder/security guard/coolie and other head-load worker,
• Sweeper/sanitation worker/mali
• Home-based worker/artisan/handicrafts worker/ Tailor
• Transport worker/ driver/ conductor/ helper to drivers and conductors/ cart puller/ rickshaw puller
• Shop worker/ assistant/ peon in small establishment/ helper/delivery assistant / attendant/ waiter
• Electrician/mechanic/assembler/repair worker
An applicant must provide their Aadhar Card, address proof, bank details and other relevant documents at the time of registration. According to the National Health Authority, over 17.8 crore Ayushman Bharat cards have been issued so far, since the launch of the scheme. According to the MoHFW, the treatment packages are comprehensive, covering treatment for over 20 specialities that include super speciality care like oncology, neurosurgery and cardio-thoracic and cardiovascular surgery. The PMJAY also covers COVID-19. According to NHA, the treatment and testing of COVID-19 will be done for free of cost at any of the private hospitals empanelled for the scheme.
The Union Government’s allocation for 2022-23 towards the Pradhan Mantri Jan Argya Yojna stands at Rs. 6,412 crore, increase of 0.2 per cent compared to last years’s budget of Rs. 6,400 crore. However, the revised estimate for 2021-22 is at Rs. 3,199 crore. More than 50 per cent decrease in the revised budget highlights that there is the need to further drive the adoption of the AB-PMJAY across the country, said Dr Yogesh Jain who runs a community hospital in rural Bilaspur, Chhattisgarh and is a member of Jan Swasthya Abhiyan, a people’s movements working for health rights.
While talking about the benefits of Ayushman Bharat, Dr Jain said that during hospitalisation, the beneficiaries will not be required to pay any charges or the hospitalisation expenses. He added that the benefit also include pre- and post-hospitalisation expenses. 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, he said.
However, Dr Jain said that the Ayushman Bharat is yet to reach its full potential. He said,
The goal has to be universal health coverage and equitable access to healthcare and the COVID-19 pandemic should be a wake-up call, an alarm bell. Health being a state subject, states’ ownership and commitment are critical for the success of the programme. Also, the government must remember that any insurance scheme can be an add on but not a replacement to universal access to health. For that, there has to be adequate public health infrastructure and the services offered under Ayushman Bharat should be available at more hospitals. More and more private hospitals must be empaneled under the scheme so that people can got to their nearest hospital and are not forced to go from hospital to hospital to search for the services they need. Issuing health cards alone will not be helpful.
He also highlighted the need for a regular monitoring and assessment of the scheme as there are challenges of deceitful billing as well along with low adoption of the scheme. He said that currently, there is no clarity on the monitoring and assessment mechanism for the scheme.
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Pradhan Mantri Bhartiya Janaushadhi Pariyojana (PMBJP)
This scheme aims to reduce the average healthcare expense of people by providing quality generic medicines at affordable prices and anyone, irrespective of their economic status, can take advantage of this scheme. Launched by the Department of Pharmaceuticals, Ministry of Chemicals and Fertilizers in November 2008, this scheme currently provides 1,451 drugs and 240 surgical instruments at subsidised rates at the PMBJP stores. It also sells products like protein bars, protein powders and other food supplements at lower rates. This service provided by the Central Government can be accessed using a mobile App as well called ‘Janaushadhi Sugam’.
Under the Scheme, medicines are procured from World Health Organization – Good Manufacturing Practices (WHO-GMP) certified suppliers for ensuring the quality of the products. Each batch of drug is tested at laboratories accredited by ‘National Accreditation Board for Testing and Calibration Laboratories’ (NABL). Only after passing the quality tests, the medicines are dispatched to PMBJP Kendras. Medicines available under PMBJP are priced 50-90 per cent less than the branded prices.
As per the Annual Report 2020-21 of the Department of Pharmaceuticals, the PMBJP scheme has been approved for continuation with the financial outlay of Rs. 490 crore for the period from 2020-2021 to 2024-20-25. The target is to open 10,500 PMBJP stores across the country by March 2025 from the current 8,355 stores. However, no state-wise targets have been fixed under the scheme. It has also been decided to expand the product basket of PMBJP up to 2,000 medicines and 300 surgical items by March 2025.
In the pandemic year 2020-21, the actual spending on PMBJP was raised to Rs. 65 crore from Rs. 35.51 crore in the year 2019-20. In the second pandemic year 2021-22, the Revised Estimate on PMBJP was Rs. 68.5 crore which was further increased to Rs. 72.5 crore in the budget 2022-23. Chhaya Pachauli, Expert, Jan Swasthya Abhiyan stressed that the spending under this scheme needs to be increased manifold. She said,
This is a very important scheme for many people in the country. While the scheme has reached almost every district, in many districts there is only one such shop. I aim should be to take this scheme to every block at least. The scheme needs to be made accessible to more and more people.
A Parliamentary Standing Committee, reviewed the PMBJP and presented its report to the Lok Sabha on March 17, 2021. It said that presently close to 1,800 to 2,000 people are purchasing medicines from a single Janaushadhi store in a month but there is no information regarding the average population covered by an outlet under the scheme.
Ms Pachauli said that in order to make medicines more affordable, the government’s public sector undertaking should be tasked with the manufacturing of the medicines which is still primarily done by the private companies in India. As per the report of the Parliamentary Standing Committee on the availability of medicines and medical device during the COVID-19 pandemic, dated March 21, 2022, despite the need of the country, none of the Pharma Public Sector Undertakings (PSUs) under the Department of Pharmaceuticals were granted voluntary license to manufacture Remdesivir and other COVID essential drugs for public health supply.
Programmes To Fight Against The COVID-19 Pandemic
The Government of India has been providing free testing and treatment for COVID-19 at government testing centres and hospitals. Under the nationwide vaccination drive against COVID-19, all citizens irrespective of their income status are entitled to free immunisation. To get the free vaccination, one can register on the Co-WIN (Covid Vaccine Intelligence Work) portal and pre-book a vaccination appointment. While talking about the government’s efforts towards fighting the pandemic, Partha Mukhopadhyay Senior Fellow at the Centre for Policy Research said,
We are fortunate to have elders who have got vaccinated because they care for the young and also because they hold a belief, that has been built over many years, that government is not malevolent. We are also enjoying protection earned at the cost of possibly millions of lives in the last two years. But, one needs to keep the genomic surveillance in high gear and testing of people admitted to hospital for any reason should continue.
The Central Government also provides insurance to the healthcare workers fighting COVID-19. However, there has been a decrease in the amount allocated Pradhan Mantri Garib Kalyan Package announced in October 2021. The package was allocated Rs. 226 crore, a decrease of 72 per cent from Rs. 813 crore that was allocated in budget 2021-22.
COVID-related interventions have not received additional allocation in 2022-23. The government also has a COVID19 Emergency Response and Health System Preparedness programme but in the budget 2022-23, there is no mention of it. According to Jan Swasthya Abhiya’s health experts, it seems like the government is assuming that there is now no need to make provisions for care related to the COVID pandemic, even though cases continue to be reported across the country. Ms Pachauli said,
Public resources may fall short in achieving the goal of vaccinating all against COVID19, particularly if future vaccination needs and boosted doses are taken into account. It seems that now the Government’s policy would be that the private sector hereafter will be the main source of Covid vaccines.
According to the researchers at the Centre for Budget Governance and Accountability (CBGA), there is a possibility that the revised esmates of 2022-23 might include these heads, as the need arises.
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In view of the COVID-19 pandemic, the Ministry of Health and Family Welfare (MoHFW) launched eSanjeevani OPD free teleconsultation system for people to get medical consultation from the safety of home. Any person with a laptop or a desktop computer with camera-mic-speaker or tablet/mobile phone with video calling facility and a mobile phone to receive one time passwords can avail the facility by registering on the eSanjeevaniOPD website. After logging in and filling patient information, the user will be added in queue of patients in the virtual consultation room. Once the ‘call now’ button is enabled for the user, they can press it and finally, the doctor can be consulted on video call and eprescription is given. The eprescription can be downloaded to get medicines from nearby medical shops.
The eOPD timings are different in all states and Union Territories which one can check from the official website. In Delhi, the eSanjeevaniOPDs take place from Monday to Saturday: 9:00 AM to 1:00 PM and 2:00 PM to 7:00 PM.
National AIDS Control Programme (NACP)
NACP was launched in 1992 to combat an epidemic of HIV-AIDS and also to ensure proper treatment, caregiving and a dignified life to HIV patients. The services provided under NACP includes prevention interventions among the high risk groups such as sex workers, injecting drug users and others, HIV (Human Immunodeficiency Virus) counselling and testing services, prevention of parent to child transmissions, free Antiretroviral Treatment (ART) through ART centres, Laboratory services for CD4 testing and other investigations, Paediatric ART for children, Early infant diagnosis for HIV exposed children and infants below 18 months. ART centres are present in all government hospitals.
In 2022-23 budget, the programme was allotted Rs. 2,622.75 crore, an increase of almost 11.61 per cent from Rs. 2,349.73 crore the revised allocation for the year 2021-22. According to the National AIDS Control Organisation, India has a prevalence of adult HIV of 0.22 per cent. The Union Health Ministry reported last month that because of the effort under the programme, the annual new HIV infections in India has declined by 48 per cent against the global average of 31 per cent and annual AIDS-related deaths have declined by 82 per cent against the global average of 42 per cent of patients from 2010. The government aims to reach out to eight crore people annually with prevention, detection and treatment services.
National Mental Health Programme
The Government of India launched the National Mental Health Programme (NMHP) in 1982 with an aim to address the mental illnesses in the country. The primary objective is to reduce distress, disability, and premature mortality related to mental illness and to enhance recovery from mental illness by ensuring the availability of and accessibility to mental health care for all. Treatment of Mentally ill, rehabilitation and prevention and promotion of positive mental health are the three main components of the National Mental Health Programme.
The NMHP has received an allocation of Rs 40 crores, which continues to be the same since 2019-20. This amounts to spending only Rs 0.30 per person per year. Dr Harish Shetty, Psychiatrist, Mumbai said that the country is currently facing a mental health epidemic. He said that there is a need for a nationwide study of the prevalence of mental health illnesses among people in India. He added that the capacity building of health care workers on mental health issues facing patients and the healthcare community itself is going on at a very slow pace and needs to be accelerated.
A focussed assessment to the new needs has to be carried out across all districts. We need to do know the profile of mental disorders in every district. An audit of the National Mental Health Programme is also needed. More people died of Suicide than TB and we have massive TB prevention programs. But we lack campaigns and programmes for mental health. The NMHP should reach out and spread like a movement, said Dr Shettry.
In the Budget 2022-23, the Central Government announced the ‘National tele-mental health programme’ including 23 tele-mental health centres of excellence with National Institute of Mental Health and Neurosciences (NIMHANS) being the nodal centre and IIT Bangalore being the technical support. Dr Shetty said that it is a welcoming step for better access to mental health counselling.
According to the experts from Centre for Budget Governance and Accountability, there is an urgent need to augment additional funding and devise national agenda around preventative health, testing and screening as these are key to reducing the overall mental disease burden in India.
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NDTV – Dettol have been working towards a clean and healthy India since 2014 via the Banega Swachh India initiative, which is helmed by Campaign Ambassador Amitabh Bachchan. The campaign aims to highlight the inter-dependency of humans and the environment, and of humans on one another with the focus on One Health, One Planet, One Future – Leaving No One Behind. It stresses on the need to take care of, and consider, everyone’s health in India – especially vulnerable communities – the LGBTQ population, indigenous people, India’s different tribes, ethnic and linguistic minorities, people with disabilities, migrants, geographically remote populations, gender and sexual minorities. In wake of the current COVID-19 pandemic, the need for WASH (Water, Sanitation and Hygiene) is reaffirmed as handwashing is one of the ways to prevent Coronavirus infection and other diseases. The campaign will continue to raise awareness on the same along with focussing on the importance of nutrition and healthcare for women and children, fight malnutrition, mental wellbeing, self care, science and health, adolescent health & gender awareness. Along with the health of people, the campaign has realised the need to also take care of the health of the eco-system. Our environment is fragile due to human activity, which is not only over-exploiting available resources, but also generating immense pollution as a result of using and extracting those resources. The imbalance has also led to immense biodiversity loss that has caused one of the biggest threats to human survival – climate change. It has now been described as a “code red for humanity.” The campaign will continue to cover issues like air pollution, waste management, plastic ban, manual scavenging and sanitation workers and menstrual hygiene. Banega Swasth India will also be taking forward the dream of Swasth Bharat, the campaign feels that only a Swachh or clean India where toilets are used and open defecation free (ODF) status achieved as part of the Swachh Bharat Abhiyan launched by Prime Minister Narendra Modi in 2014, can eradicate diseases like diahorrea and the country can become a Swasth or healthy India.