India took a giant leap on 23rd September 2018 providing its poor and marginalized population accessible and affordable health care with the launch of Pradhan Mantri Jan Arogya Yojana (PMJAY). Over a span of 4 months the success of the health insurance scheme is evident from the 14,12,624 beneficiaries admitted, 14,754 number of empanelled hospitals, 2,22,77,890 e-cards issued as of 4th March 2019. Ayushman Bharat, world’s largest government-funded healthcare program, is taking healthcare protection to new aspirational levels.
With high out of pocket expenditure, low financial protection, low health insurance coverage amongst both rural and urban population and expensive tertiary care, PMJAY is a move in the right direction. The scheme intends to overcome catastrophic health expenditure and provide equitable healthcare for the poor and vulnerable groups with the component of ‘Affordability’ by assuring 5 lakh health insurance per family.
Researching its implementation process, we witnessed a beautiful convergence of social roles and responsibilities, where every stakeholder is personally attached to the cause and putting in his or her best. Especially, the ground level functionaries including, ASHA workers, Ayushman Mitras, Nurses, Pharmacist, Common Service Centers (Lok Mitra Kendra) have been instrumental in expanding the coverage and awareness. Several inspiring stories underscore the invaluable role they play in the success of the scheme.
Reminiscing my visit to Khatauli village, district Pauri Garhwal, Uttarakhand, I met Deveshwari Devi, a 75 year old woman living alone but looked after by her nephew, Ashish Negi. Ashish told us how when she fell sick last month, an ASHA worker, stood by the entire process. In his words, ‘my world would have collapsed if I could be of no assistance to my aunt’. ASHA worker, Urmila, proactively made her Ayushman card and got her admitted in a premium hospital. Now Deveshwari Devi has undergone a heart surgery with two stents costing approx. Rs. 70-80,000/-. She is recovering fast with no financial backlog on her nephew. Urmila today has helped at least 10 other families in her village by informing them about PMJAY. In another inspiring case, we met a couple of Ayushman Mitras from a private hospital in Ghaziabad who had to conduct 14 Medical Camps in the surrounding areas for spreading awareness and issuing gold cards among the beneficiaries. The Ayushman Mitras brought the scheme to the rural and semi-rural areas.
Travelling the harsh terrain of the hilly states of Himachal Pradesh and Uttarakhand, we witnessed how Lok Mitra Kendras acted as a connecting link for the people hailing from remote locations.
Ayushman Mitras are the first point of contact for the people travelling from remote locations or from the adjoining states to avail the healthcare facilities in the public hospitals and empanelled private hospitals. They acted not only as a contact person to the people but also caregivers during and post completion of the medical procedure. These service-oriented and self-driven individuals understood the struggle that a patient had to go through, solved their queries with utmost dedication. The beneficiaries, in turn, developed a sense of comfort and trust in these self-motivated Ayushman Mitras.
To illustrate this with an interesting and self-explanatory story, Premu’s story from a hospital in Uttarakhand is an insightful case in point-
A farmer by profession, Premu fends for a family of twenty. When his wife Pano Devi was diagnosed with blood cancer, last year, the moment was both emotional stress and a fear of the impending financial catastrophe. It was not in his capacity to afford the chemotherapy treatment which amounted to lakhs. Ayushman Mitra at the hospital could emotionally connect with the crisis Premu was going through and took upon himself to assist him at every step. The Mitra acted as a channel between the doctor and Premu, conveyed all his queries, advised him to buy medicines from the Jan Aushadhi Kendra under the PMJAY card and other such operational needs. In Premu’s words ‘I felt comfort in knowing that I could go forward with my wife’s treatment without worrying about the financial difficulties’. He further expressed the willingness to inform everyone in his village and surrounding areas about the scheme. The assistance that Ayushman Mitras had given them at the time of need was invaluable.
The insight from the above stories is evidence that the ground functionaries play a crucial role in the success of the scheme. Their self-motivation, dedication and proactive attitude have added that essential element that makes PMJAY a social mission and a means of transformation in the society. Ayushman Mitras, especially, are the foot soldiers and carry a lot of responsibility for successful implementation of the scheme and how it reaches the common man. In the scheme of things they should rather be perceived as decisive in its on-ground success and policy initiatives must be taken with them under focus.