Ayushman Bharat: Making The Dream A Reality
– By R Shankar, President – HEAL Foundation, Former Health Editor – MSN.com and New Indian Express
Prime Minister Narendra Modi has been often emphasising in Parliament and elsewhere that Ayushman Bharat is the need of the hour. He has also revealed that, cutting across party lines, MPs have been writing to him seeking help on behalf of the poor for medical treatment. Over 10 lakh people have so far benefitted from Ayushman Bharat.
One major point that he said was that he was willing to look into shortcomings, if any, in Ayushman Bharat, but asked the Opposition not to write off the entire scheme. “The need of the hour is to strengthen Ayushman Bharat. We want our poor to get the best quality and affordable medical treatment,” PM Modi had said.
Yes, the PM is right. Ayushman Bharat is the need of the hour. But the need of the hour for some tweaking of Ayushman Bharat has now come. The Centre and the Health Ministry should redouble its focus on states that have fallen far below in healthcare standards. This should come on the basis of the latest Niti Aayog report.
Based on various health parameters, the report has indicated that there are six states that have lagged behind — UP, Bihar, Odisha, MP, Uttarakhand, and Rajasthan. All these states saw a decline in overall performance scores with the exception of Rajasthan, which improved by 6.3 points. Among the eight empowered action group states, only three — Rajasthan, Jharkhand and Chhattisgarh—showed improvement in overall performance during the period.
The Centre must now focus more on these states, especially the chronic ones of Bihar and Uttar Pradesh.
The recent tragedy in Bihar in which over 150 children below 10 years and belonging to families living below the poverty line died due to Acute Encephalitis Syndrome (AES) should come as an eye-opener against the backdrop of Ayushman Bharat.
The Bihar tragedy could have been prevented through more effort in strengthening public health centres and hospitals in endemic poverty-stricken areas – something that was underscored in Ayushman Bharat..
For example, there are serious questions on the medical infrastructure available in Muzaffarpur where most of the recent deaths of kids took place due to AES. At the government-run Sri Krishna Medical College and Hospital in Muzaffarpur, three kids were forced to share a bed; some were made to lie on the floor.
And what made matters worse was the acute shortage of doctors, unavailability of key medicines, and lack of nursing staff and beds. The hospital lacked facilities and funds to tackle the AES crisis.
This is not the first time that children have succumbed to AES. Between 2000 and 2010, over 1,000 children succumbed to the infection in Muzaffarpur district alone. This year too, the deaths have been from the same district.
That begs the question as to why the government did not step in to prevent deaths this year.
The National Health Protection Scheme (NHPS) announced in the 2018 Union Budget and the Aysuhman Bharat scheme are excellent thought-through plans. NHPS was designed for over 10 crore poor and vulnerable families who constitute the burgeoning base of the pyramid it terms of population. NHPS is part of Universal Health Protection Scheme to keep India’s population healthy by strengthening the Public Healthcare Centres.
A major component of Ayushman Bharat is to reboot the rural health centres towards preventive healthcare. If this had taken place, Bihar tragedy could have been avoided. Over 1.5 lakh PHCs were to be recalibrated as wellness centres to bring healthcare system closer to the homes of people. These centres were to provide comprehensive health care and provide free essential drugs and diagnostic services.
It is only when all these components work in tandem will Ayushman Bharat be truly successful.
In fact, the Niti Aayog report states that the decline in the overall score of five empowered action group states — Bihar, UP, Uttarakhand, MP and Odisha — is attributed to drop of performance in several indicators.
In the case of Bihar, reasons for the deterioration include performance related to quality accreditation of public health facilities and time taken for National Health Mission fund transfer.
Speaking on the dire health situation in Bihar in Parliament on June 26, the Prime Minister had said that the alarmingly high death toll of children due to AES is “unfortunate and a matter of shame for us. We have to take this seriously”.
The PM’s words should be the starting point for either a few changes in Ayushman Bharat or the need to better implementation. India’s vision for health sector for the years ahead is indeed big and ambitious thinking. But implementation is the biggest challenge. Modi government is never short on ideas, but implementation has sometimes been its Achilles Heel.