Ayushman Bharat Mission:  Achievements & Challenges

The Indian government and the World Bank announced two $500 million supplementary loans on March 9th, 2023 to support and expand the nation's public healthcare system. The World Bank will contribute $1 billion to India's flagship Pradhan Mantri-Ayushman Bharat Health Infrastructure Program (PM-ABHIM).

According to a World Bank statement, the $500 million Public Health Systems for Pandemic Preparedness Program (PHSPP) would help the government prepare India's monitoring system to diagnose and report epidemics of potential worldwide significance, assure a prompt response, and avoid pathogen emergence.

The other initiative, the Enhanced Health Service Delivery Program (EHSDP), will promote the government's efforts to reinforce service delivery through a revamped primary health care model, including improved household access to basic medical services, stronger links between each household and its primary care institution through routine household visits, and risk evaluation of non-communicable illnesses.

Here is an overview of the Indian government’s flagship public healthcare programme.

Key components

Ayushman Bharat, launched in 2018 is a major reorganisation of how beneficiaries obtain healthcare at the primary, secondary, and tertiary care levels.

It entails a movement towards promotive, preventative, curative, palliative, and rehabilitative components through primary access to Health and Wellness Centers (HWCs).

The scheme has two key components:

1. Establish Health and Wellness Centers (HWCs): The initiative sought to create 1,50,000 Health and Wellness Centers (HWCs) to provide comprehensive healthcare services to residents closer to their homes.
2. Pradhan Mantri Jan Arogya Yojna (PM-JAY): The initiative sought to provide secondary and tertiary care services to society's most destitute members. The strategy sought to provide medical coverage of Rs. 5 lakh per family per year for secondary and tertiary care hospitalisation to more than 10.74 crore poor and vulnerable households, representing the bottom 40% of India's population.

On April 18th, 2018, the first HWC was inaugurated in Bijapur, Chhattisgarh. Almost 17,000 HWCs were operationalized in the first year, exceeding the target of 15,000 set for FY 2018-19.

Achievement

• The target of opening 1.5 lakh HWCs was achieved in 2022 and according to the information available on the National Health Portal a total of 1,59,009 HWCs are currently functional.
• In March 2021, the National Health Authority (NHA), the apex government entity that oversees the Ayushman Bharat scheme, announced that it would collaborate with UTI Infrastructure Technology and Services Limited (UTIITSL) to provide free PVC Ayushman Bharat cards to PM-JAY recipients in 11 states and union territories.
• To scale up COVID-19 vaccination capacity in India, 10,000 private hospitals were empanelled under Ayushman Bharat PM-JAY, over 600 hospitals under the Central Government Health Plan (CGHS), and other private hospitals under the State Government Health Insurance Scheme in February 2021.

Doctor-to-Population Radio remains a challenge

Despite the fact that Ayushman Bharat has made great advances in improving healthcare in India, the country continues to confront issues regarding the doctor-to-population ratio. The healthcare system remains stressed, with only one doctor for every 1,457 people.

The WHO Global Strategy on 'Human Resource for Health: Workforce 2030' calculated in 2016 that nations needed around 44.5 physicians, nurses, and caregivers per 10,000 population to achieve the median objective of the Sustainable Development Goals key indicators.

On July 26 2022, Dr. Bharati Pravin Pawar, Union Minister of State for Health and Family Welfare told the Rajya Sabha that there isn't a shortage of physicians in the nation. “As of June 2022, there were 13,08,009 allopathic doctors registered with the State Medical Councils and the National Medical Commission (NMC). Considering 80% availability of registered allopathic physicians and 5.65 lakh AYUSH doctors, the country's doctor-population ratio is 1:834, which is higher than the WHO guideline of 1:1000."

Variables such as a disproportionate representation of the health personnel among states, rural-urban, and public-private sectors, as well as the lack of a live register for practicing doctors, showed how the figures presented in Parliament may not represent the entire picture.

According to a WHO study from 2021, India remained well behind the 44.5:10,000 ratio till 2018, and was only slightly higher than the 2006 norm of 22.8 healthcare professionals per 10,000 people.

Moreover, traditional medicine practitioners, according to specialists, are typically excluded from this universal formula.

According to Dr. KR Antony, a former UNICEF health and nutrition specialist, "the WHO formula is "globally relevant for comparative evaluation," and hence "AYUSH doctors cannot be treated at par with MBBS doctors in the overall figure" in India. He said that focusing on a broad national ratio without considering nuance and disaggregated data is deceptive.

Finally, the Ayushman Bharat programme has emerged as a transformative project aiming at giving universal healthcare to millions of Indians. The system has increased access to healthcare while also reducing the burden of hefty hospital bills on families by providing free therapy and financial protection to the weakest segments of society.

Yet, Ayushman Bharat is an important step towards providing fair and accessible healthcare for all Indians, and its success demonstrates the strength of government-led healthcare endeavors.