A pilot of Ayushman Bharat struggles with enrolment numbers as Haryana is yet to locate beneficiaries. Modi’s pet project will be launched Sunday.
Palwal, Karnal: On Sunday, 23 September, 33 states and union territories will join the Narendra Modi government’s ambitious healthcare scheme, the Pradhan Mantri Jan Arogya Yojana (PMJAY), touted as the largest insurance scheme in the world.
But a pilot of the project, popularly known as Ayushman Bharat, currently underway in Haryana has brought to the fore a major teething problem — enrolment.
In over a month, Haryana has enrolled less than 1 per cent of its total beneficiaries.
The two states and one union territory that have not joined Ayushman Bharat are Odisha, Telangana and Delhi.
The state had launched the pilot project in 22 district hospitals, one Employees’ State Insurance (ESI) medical facility and one medical college on 15 August.
The medical institutions were to cater to 73.5 lakh beneficiaries in the state, identified through a “deprivation criteria” based on the Socio Economic Caste Census (SECC), 2011.
Also read: Modi’s Ayushman Bharat is the jadi booti you mix with your vote and drink
As of Wednesday, however, Haryana had enrolled and distributed the Ayushman Bharat ‘gold cards’ to just 5,000 beneficiaries — a mere .068 per cent of the total beneficiaries in the state. The gold card, a piece of paper containing the Ayushman Bharat identification number, authenticates a beneficiary.
“We have identified 5,000 beneficiaries since the start of the pilot programme on 15 August,” said Dr. Ravi Vimal, deputy CEO of the Haryana State Health Agency that is the implementing authority for Ayushman Bharat in the state.
‘Unable to locate beneficiaries’
State functionaries say the major problem has been in locating the beneficiaries.
Haryana had tasked its ASHA workers to find the beneficiaries and bring them to the selected hospitals where the ‘gold cards’ are issued.
“We have visited every nook and corner of the district. On an average, we were able to find just 5 to 6 beneficiaries or households on a daily basis,” said Saroj, an ASHA worker in Palwal district.
“More than half of the people are not known to even the neighbourhood; some have died, some have left the village and some are missing,” said Saroj, who is based out of Hari Nagar village in the district.
Saroj added that the lists contains incomplete information on the same family. “We have visited several families where the names of two brothers and their families find mention, whereas the remaining family are not on the list of beneficiaries.”
Locating the beneficiaries, it appears, is a recurring problem across the country.
The Modi government had identified 55 crore beneficiaries to provide an annual health cover of Rs 5 lakh per family per year but is yet to locate 3.25 crore of them. The majority — of almost 2 crore beneficiaries — are yet to be traced in Uttar Pradesh and Bihar.
“It’s not an easy task and it is an on-going process. Many of these missing beneficiaries are likely to be migrants who have left the state in search of work,” said Indu Bhushan, CEO of Ayushman Bharat. “We are creating awareness about the scheme so that they start coming forward for the registration and benefits”.
Experts believe that 100 per cent coverage to all targeted beneficiaries is next to impossible.
“The 2011 SECC data is obsolete because of migration patterns, which is why the government is unable to trace those it wants to cover in the scheme. This pattern is more prominent in urban areas because of the presence of migrant labour,” economist Pronab Sen, the country’s first chief statistician, told ThePrint.
“Extensive coverage of the scheme, which government is trying to ensure, is not at all possible without a more recent census”.
Waiting for the launch
For the past month, Bimla Kumari, 50, of Hari Nagar, a village in Palwal, has been unable to digest food. She said she has bouts of unbearable stomach pain that last an hour. Kumari, however, hasn’t seen a doctor yet, relying on home-made churans and pills.
“I will go to see the doctor once my name appears on the list of beneficiaries for (Ayushman Bharat) scheme,” she said.
Bimla typifies another issue with the scheme — that of certain family members making the cut while others do not. Bimla and her husband, Naresh Kumar, in his 60s, are not on the list, but his brothers and their families have received their ‘gold cards’, despite all of them living in the same house.
Dr Vimal, the CEO of the Haryana Health Agency, however, said patients such as Bimla will have their names added under the government’s additional data collection drive (ADCD).
“Under the ADCD, if any of the family members’ name is mentioned in the master data called ‘beneficiary identification software’, the other family members will also be added to the software once they establish their relationship through ration card, marriage certificate, Aadhar card or any other ID proof,” Vimal said.
Hospitals in Palwal and neighbouring Karnal, though, said they are sending back people hoping to receive treatment under the scheme.
“We are sending back almost 25 per cent of the patients who come to check their enrolment numbers every day. Of the 10 patients we get, we have to send back 2-3 as we fail to find their names in the list of beneficiaries,” said Dr. Jagdish Dureja, medical superintendent and nodal officer, Kalpana Chawla Hospital, Karnal.
The two districts also have poor enrolment numbers. Of the 2.9 lakh beneficiaries in Palwal, only 197 had received their ‘gold cards’ as of Wednesday. In Karnal, of the approximate 5.75 lakh beneficiaries, only 151 cards had been issued till Wednesday.
Dr Pradeep Sharma, the chief medical officer at the Civil Hospital, Palwal, said the numbers would improve in the coming days.
“On a daily basis, the district is generating 10-15 ‘golden cards’. We have started seeing the rush at the counters as people are getting aware about the scheme,” Sharma said.
Also read: Ayushman Bharat explained: The scheme, the beneficiaries, the inspiration
For primary healthcare, funds yet to be received
So far, Haryana has also had trouble launching its primary healthcare efforts under the Ayushman Bharat.
For first-stage treatment, Haryana, like the rest of the country, was to upgrade its existing smaller health centres to health and wellness centres (HWCs), which were to have more doctors and better facilities for disease screening and diagnosis.
Under the scheme, 400 such HWCs are to come up in Haryana, 24 of which were to begin operations from 25 August. So far, none have been converted into full-fledged wellness centres.
While community health doctors and nurses have been selected and sent on training to specifically handle the HWCs, there are no computers and software to identify the beneficiaries. The government is also yet to appoint other staff, such as sweepers, in several clinics.
“We are upgrading the clinic and the work is still in the progress. A lab technician has been deployed but for only three days of the week,” said Dr Abhay, dental surgeon, who is heading the HWC, Karnal.
“We are also waiting for digital connectivity and computers that would help us keep digital records of patients”.
Of the five HWCs set to be established in Karnal district, not even one has been fully functional in the pilot phase.
In Palwal, of 14 sub-centres manned by multipurpose health workers, seven are in the process of being upgraded into HWCs.
“We have received the funds for only seven centres till now,” an official involved in the upgradation said. “The state has to provide additional manpower such as a pharmacist, para-medical staff, laboratory technician, class-IV workers but we are waiting for the deputations.”