On April 7, the World Health Day, Prime Minister Narendra Modi reasserted that the government is working tirelessly to augment India’s health infrastructure with a focus on ensuring good quality and affordable healthcare to its citizens. Health is an essential part of the Sustainable Development Goals (SDGs) and ‘Universal Health Coverage’ by 2030 was one of the targets that various countries set for themselves while adopting the SDGs in 2015. It reads, “Achieve universal health coverage, including financial risk protection, access to quality essential healthcare services, and access to safe, effective, quality, and affordable essential medicines and vaccines for all.”
India has adopted a holistic approach towards healthcare to realise the mantra from Indian scriptures that says: May All be Happy; May All be Free from Illness. Ever since Prime Minister Modi took an oath of office in 2014, healthcare has been on the top of his government’s agenda.
The result is a comprehensive Ayushman Bharat National Health Mission which is by far the most serious attempt by any government to move from a selective approach to healthcare to delivering a comprehensive range of services spanning preventive, promotive, curative, rehabilitative and palliative care. This programme now has four major components that stand out as examples of excellence in the planning and implementation of healthcare systems anywhere in the world. Together these will accelerate the country’s progress towards achieving the goals of the National Health Policy laid down in 2017 and the targets of the Sustainable Development Goal – 3 by 2030.
Ayushman Bharat Jan Arogya Yojana SEHAT (AB-PMJAY SEHAT)
AB-PMJAY SEHAT is the world’s largest health insurance scheme fully financed by the Government, launched with the aim of covering 10 crore households or nearly 50 crore Indians at the bottom of the income distribution. Holders of Ayushman Bharat Golden Card, given under this scheme, get free treatment up to Rs. 5 lakhs for about 1,670 procedures in more than 23,000 Government and empanelled private hospitals across India. This includes offering cashless payment and paperless recordkeeping through the hospital or doctor’s office. There is no restriction on family size, age or gender. All previous medical conditions are covered under the scheme. AB PM-JAY 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 his state or anywhere in the country.
Sharing the progress made by this ‘pathbreaking scheme’, PM Modi stated that under the Ayushman Bharat Jan Arogya Yojana, more than 3.2 crore people got free treatment, over 18 crore Ayushman cards were issued and 14 crores of families became its beneficiaries. The latest data suggests that AB PMJAY and state health schemes cover 70 crores of the population currently. The National Health Authority has recently approved a proposal to expand this health insurance cover to another 40 crore Indians who are not covered by any government or private insurance till now. There are plans to extend the scheme to cover even gig workers earning between Rs. 15,000 and Rs. 25,000 per month and other such groups.
AB PM-JAY achieved yet another milestone in April 2022. The Samba district of Jammu division in the Union Territory of Jammu and Kashmir became the first district in India to cover 100% of households under the scheme.
AB PM-JAY has been transformational from a sociological and economic point of view. A CMIE study shows that in districts that fall in the bottom 10 percent of the income distribution which belongs to States that did not implement the Ayushman Bharat scheme, there is a 20 percent plus increase in out-of-pocket expenditure on health. On the other hand, a recent working paper by Prasanna L Tantri of the Indian School of Business shows that apart from other benefits, the implementation of the Ayushman Bharat program was associated with a 21 per cent decline in out-of-pocket health expenditure and an 8 per cent reduction in the tendency to borrow emergency loans for health purposes among poor households in the first two years of implementation of the scheme. Tantri’s study credibly shows the effectiveness of the program implementation and its benefits in reaching out to the economically deprived sections of society.
Ayushman Bharat – Health and Wellness Centres (AB-HWC)
Among the many laudable initiatives of the AB program, one was the commissioning of 1.5 lakh primary health facilities named Ayushman Bharat – Health and Wellness Centres by 2022 in a phased manner. On the World Health Day, PM Modi informed that as many as 1.17 lakh Ayushman Bharat – Health and Wellness Centres were operational and 1.03 crore wellness sessions had already been organised. AB-HCWs deliver a range of comprehensive healthcare services Ever since Prime Minister Modi took an oath of office in 2014, healthcare has been on the top of his government’s agenda. The result is a comprehensive Ayushman Bharat National Health Mission like maternal and child health, services to address communicable and non-communicable diseases, and services for the elderly and palliative care. AB-HWCs provide free essential medicines and diagnostic services, tele-consultation, and health promotion including wellness activities like Yoga as well. It is a matter of pride for the country that the central government has provided more than 2.48 crore tele-consultation services to common citizens through these centres across India in the last four years.
On the occasion of the fourth-anniversary celebration of ABHWCs, health minister Mansukh Mandaviya said, “E-Sanjeevani is providing affordable and accessible healthcare to the people across the country. Today, some HWCs are also providing screening services for diseases like oral cancer, breast cancer and cervical cancer. ABHWCs are a stepping stone towards this vision.” Over 18.85 crore citizens had been screened for hypertension and 15.84 crores for diabetes at HWCs till March of 2022. The minister stated that healthy citizens can only make a healthy society and a healthy society builds a healthy nation.
Ayushman Bharat Digital Mission (ABDM)
Ayushman Bharat Digital Mission (ABDM) is the Indian government’s cutting-edge initiative that will redefine India’s future of public health and development. ABDM will ensure that health service providers in the public and private sectors have an aggregated and complete view of the data for providing efficient health services to the citizens.
Dr. R.S. Sharma, CEO of, the National Health Authority (NHA) under whose aegis this program is being implemented calls ABDM a very important step in the global push for Universal Health Coverage (UHC).
Currently, localised and fragmented technology deployment puts citizens at a disadvantage. They can neither access their health records speedily nor store them conveniently. ABDM will bring healthcare stakeholders on a single platform. Therefore, ABDM will prove useful in policy analysis and evidence-based interventions. It will help in making the digital health infrastructure of the country more robust, secure and inclusive.
Under ABDM, the countrymen will get a digital Health ID and have all their health records all in one place, empowering the doctors to access the full medical history of their patients, of course with their consent. NHA developed the “ABDM Health Records App” that facilitates this and the patient has full control over his data.
All the doctors, nurses, and paramedics of India will be registered under the ‘Healthcare Professionals Registry’; while all the hospitals, clinics, labs, medicine shops, etc. will be registered under the ‘Health Facility Registry’.
ABDM will make it easier for the poor and marginalised to find a doctor from anywhere in the country who knows and understands their language and is experienced in the best treatment for their disease.
Ayushman Bharat Health Infrastructure Mission (AB-HIM)
The PM Ayushman Bharat Health Infrastructure Mission is one of the largest schemes for strengthening healthcare infrastructure across India with an outlay of around ₹64,180 crores spread over six years. Launching it on October 25, 2021, PM Modi stated that Ayushman Bharat Health Infrastructure Mission will create an entire ecosystem for services, from treatment to critical research in every corner of the country. It will fill critical gaps in the public health infrastructure, especially in critical care facilities and primary care in both urban and rural areas.
Under the scheme, the government will provide support for infrastructure development to 17,788 rural Ayushman Bharat Health and Wellness Centres (AB-HWC) in 7 high-focus states and 3 North-Eastern states, and 11,044 such centers spread across urban India. Similarly, there shall be support for 3383 Block Public Health Units (BPHU) in 11 high-focus states.
Besides the above, Critical Care Hospital Blocks will be made available in districts having more than 5 lakh population, while the remaining districts will be covered through referral services.
The scheme will help people access a full range of diagnostic services through Integrated Public Health Laboratories to be set up in all districts of the country. Ayushman Bharat Health Infrastructure Mission will help develop the capacities of health systems and institutions at primary, secondary, and tertiary levels. It will help prepare healthcare systems for responding effectively to the current and future pandemics, and disasters.
Ayushman Bharat has the potential to bring an enormous positive change in addressing the affordability of medical procedures as also in the development of medical infrastructure. As expected, Ayushman Bharat is on the path to improving human capital by increasing access to curative and preventive healthcare. This remarkable scheme’s massive impact will surely be seen in the long run.
Revolutionising Health Insurance
Ayushman Bharat PM-JAY is not the nation’s first tryst with healthcare insurance. Due credit must be given to predecessor schemes such as Rashtriya Swasthya Bima Yojana (RSBY) and state schemes such as Aarogyasri in Andhra Pradesh and Jeevandayee Yojana in Maharashtra. However, in terms of scope and scale, AB PM-JAY has dwarfed all existing healthcare insurance interventions. For the first time, we have a health insurance scheme with a pan-India presence.
As of April 1, AB PM-JAY, in alliance with state health schemes, covers a beneficiary base of more than 700 million individuals. AB PM-JAY has facilitated almost 32.8 million 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.
There are six guiding principles behind Ayushman Bharat PM-JAY.
1. Comprehensive healthcare benefits
AB PM-JAY was launched with 1,393 treatment packages covering treatment for various medical specialties such as oncology, neurosurgery, cardiovascular surgery, etc. with costs up to Rs. 5 Lakh per beneficiary family. This was subsequently increased to 1,670 treatment packages.
2. Convergence and integration 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 creation of the network of hospitals. Further, NHA diligently pursued convergence with the existing state-based schemes. Currently, AB PM-JAY is being implemented in alliance with more than 25 state-specific health schemes. Additionally, District Implementation Units have been set up in over 600 districts across the country to ensure the administrative reach of AB PM-JAY to the beneficiary’s doorstep.
3. Ensuring equity in access to healthcare services
Renewed impetus has been given to extending the scheme benefits to the marginalized sections covered under the Socio-Economic Caste Census database. AB PMJAY adopted an enlightened approach toward ensuring gender-specific equity. The erstwhile RSBY scheme mandated a limit of five family members, which led to the exclusion of female members, especially the girl child. However, under AB PM-JAY, this capping was done away with. Women account for approximately 50% of Ayushman cards generated using the NHA IT platform and 47% of authorized hospital admissions.
4. Robust, scalable, and interoperable technology platforms
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 active across 26 States and UTs. As a result, State Health Agencies (SHAs) and NHA have gained granular insights into the scheme to aid in evidence-based policymaking and course correction, where required.
5. Public and private partnerships
Under AB PM-JAY both public and private hospitals have been empanelled for providing healthcare services. 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 reimbursed equally 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 happens seamlessly.
6. Aapke Dwar Ayushman, or the frontline grassroots mobilisation system
Under the Aapke Dwar Ayushman initiative, a grassroots network of frontline healthcare workers, panchayat officials, and village-based digital entrepreneurs was used to undertake door-to-door mobilisation of beneficiaries across communities. Special night camps were set up for daily wagers. These efforts translated into more than 47 million Ayushman cards being generated since January 2021, an increase of 55%. NHA is launching Aapke Dwar Ayushman with renewed vigor. This time NHA is focusing on States such as Assam, Bihar, Gujarat, and Uttar Pradesh.
