Ministry of Health and Family Welfare | Indian Polity for UPSC CSE PDF Download

Pradhan Mantri Swasthya Suraksha Yojana

The Pradhan Mantri Swasthya Suraksha Yojana (PMSSY) was initiated in 2003 by the Union Ministry of Health and Family Welfare. The chief objective of the scheme is to correct the regional imbalances in the availability of affordable and reliable tertiary healthcare services in the country. It also aims at boosting the facilities for quality medical education in India.

There are two components under PMSSY. They are:

• Setting up institutions like the All India Institute of Medical Science (AIIMS).
  - Under the scheme, totally 22 AIIMS have been announced (six are functional).
  - Each of the new AIIMS would have state-of-the-art modular operation theatres and diagnostics facilities; 750 beds at least; 15 – 20 speciality departments; 100 MBBS seats; 60 B.Sc. Nursing seats.
  - The new institutes would have a focus on PG education and research.
• Upgrade of government medical colleges or institutes
  - Addition of 8 – 10 speciality departments; 150 – 250 beds and around 15 new seats for PG.

The government passed the AIIMS Act in order to create AIIMS institutions. According to the Act, all AIIMS institutions are institutions of national importance and they would function as autonomous bodies under the Health Ministry.
As per the Act, the objectives of establishing the new AIIMS are mentioned below.

• Developing teaching patterns in UG and PG medical education so as to demonstrate high standards of medical education in all institutes in India.
• Bringing together in one place educational facilities of the highest order for training personnel in all important branches of health activity.
• Attaining self-sufficiency in PG medical education.

For other government schemes related to the health sector, check the table below:

Pradhan Mantri Swasthya Suraksha Yojana Concerns

In 2018, the Comptroller and Auditor General of India (CAG) submitted a report on the performance of the PMSSY. Some of the concerns flagged in the report are discussed below.

• Even though the scheme was announced in 2003, no operational guidelines had been formulated for it since its inception. Hence, several decisions were taken in an ad hoc manner. Additionally, there was an increase in costs and delays in the implementation.
  - The report recommended that guidelines be formulated for the same. Also, that evaluation studies should be taken up for status check and in the identification of weaknesses in planning & implementation.
• The report said that a significant portion of the funds allocated to the scheme was not utilised due to: (1) Delays in getting approvals; (2) Slow pace of equipment procurement; (3) Posts not being filled; (4) Pending utilisation certificates. The CAG noted that there was no mechanism in place for monitoring actual expenditure which led to accumulation of unspent funds.
  - The report recommended that the Ministry should ensure that contracts were adhered to in the completion of works. Additionally, accountability should be fixed in case of additional expenditure without adequate justification for the same.
• There were delays in execution of work by as much as five years due to poor contract management and inadequate monitoring. There were also other deficiencies in the work such as (1) Improper estimation of scope and quantities; (2) Delay in procurement and installation of equipment; (3) Contractors being paid extra.
  - The CAG recommended that better monitoring of projects should be undertaken to speed up the completion of the pending work.
• The report said that there was an acute shortage of faculty and non-faculty posts in the AIIMS which led to restricted functioning of several departments. It also led to the dependence on outsourced employees who were hired on a contractual basis. Further, delays in filling up sanctioned posts were attributed to delay in finalising recruitment rules, court cases and non-availability of eligible candidates.
  - The report suggested the Ministry to take up several steps to fill up the vacant posts in the institutes.
• The report said that the committees constituted at national, state, and institute levels to review the project implementation were non-functional.
  - The CAG recommended effective monitoring by the committees for the synchronisation of activities related to the completion of works and procurement of equipment.

Ayushman Bharat Pradhan Mantri Jan Arogya Yojana (AB PM-JAY)

Ayushman Bharat Programme

The Ayushman Bharat programme was launched in 2018 to address health issues at all levels – primary, secondary, and tertiary. It has two components:
- Pradhan Mantri Jan Arogya Yojana (PM-JAY), earlier known as the National Health Protection Scheme (NHPS)
- Health and Wellness Centres (HWCs)
Ayushman Bharat is an integrated approach comprising health insurance and primary, secondary and tertiary healthcare. The HWCs are aimed at improving access to cheap and quality healthcare services at the primary level. PM-JAY will cover the financial protection for availing healthcare services at the secondary and tertiary levels.

Ayushman Bharat is the largest government-funded healthcare programme in the world with over 50 crore beneficiaries. It has been dubbed ‘Modicare’.

Need for Ayushman Bharat

• The 71st round of the National Sample Survey Office (NSSO) revealed many grim numbers about the country’s healthcare system.
  - About 86% of rural households and 82% of urban households do not have access to healthcare insurance.
  - Over 17% of the country’s population spend a minimum of 1/10th of their household budgets on availing health services.
  - Unexpected and serious healthcare problems often lead families to debt.
  - Over 19% and over 24% of the urban and rural households respectively meet their healthcare financial needs through borrowings.
• To address these grave concerns, the government, under the National Health Policy 2017, launched the Ayushman Bharat programme along with its two sub-missions, PMJAY and HWCs.

UPSC aspirants can also get the List of Government Schemes in India at the linked article, and read in detail about the benefits of the various programmes and campaigns launched by the Government.

[Question: 891544]

Pradhan Mantri Jan Arogya Yojana (PM-JAY)

PMJAY is one of India’s most ambitious health sector schemes.

• It was launched as the National Health Protection Mission and renamed later.
• It is the largest government-funded health insurance scheme in the world.
• The scheme offers eligible families an insurance cover of Rs. 5 lakh per annum per family.
• This amount is intended to cover all secondary and most tertiary care expenditures incurred.
• There is no cap on family size and age under the scheme, to ensure that nobody is left behind.
• The cover will include pre and post-hospitalization expenses. It will also cover all pre-existing conditions.
  - 3 days of pre-hospitalization and 15 days of post-hospitalization like medicines and diagnostics are covered.
• Components of treatment covered under the scheme:
  - Medical examination, consultation, and treatment
  - Medical consumables and medicines
  - Intensive and non-intensive care services
  - Medical implant services
  - Lab and diagnostic investigations
  - Complications arising out of treatment
  - Accommodation benefits and food services
• The beneficiary will also receive a defined transport allowance per hospital.
• The beneficiaries can take cashless treatment from any empanelled hospital anywhere in the country. This includes both public and private hospitals. By default, all government hospitals in the states that are implementing the scheme will be empanelled.

PM-JAY Eligibility Criteria
PM-JAY is an entitlement-based scheme. The eligible families are fixed based on the deprivation criterion in the Socio-Economic Caste Census (SECC) database.
The detailed categories in both urban and rural areas are given below:

• Families with only 1 room with kutcha roof and walls.
• Families with no adult members between the ages of 16 and 59.
• Households headed by females with no male adult members between the ages of 16 and 59.
• Families with disabled members and no adult able-bodied members.
• SC/ST households.
• Landless households that derive a major chunk of their income from manual casual labour.
• Rural area families with anyone of the following:
  - Households with no shelter
  - Destitutes
  - Living on alms
  - Manual scavenging
  - Primitive tribal groups
  - Legally released bonded labourer
• In the urban areas, 11 occupational categories are eligible for the scheme:
  - Beggar/Ragpicker/Domestic worker
  - Street vendor/hawker/cobbler/Other service provider working on the streets
  - Construction worker/Plumber/Mason/Labourer
  - Painter/Welder/Security guard
  - Coolie and other head-load worker
  - Sweeper/sanitation worker
  - Mali/home-based worker
  - Artisan/handicrafts worker/Tailor
  - Transport worker/driver/conductor/helper to driver and conductor/Cart puller/rikshaw puller
  - Shop worker/assistant/Peon in small establishment/Helper/delivery assistant/Attendant/waiter
  - Electrician/Mechanic/assembler/repair worker/Washerman/Chowkidar
• According to the data in the SECC 2011, certain beneficiaries are excluded. They include households with a motorized vehicle, fishing boat, that pay income tax/professional tax, with a refrigerator, landline phone, an earning member who earns more than Rs.10000 per month, owns land above a certain limit, government servants, etc.

PM-JAY Benefits
PM-JAY is a visionary scheme that aims at the fulfilment of the concept of Universal Health Coverage (UHC). It offers many benefits, which are discussed below.

• It will reduce medical expenditure for many families, which is currently, mostly out-of-the-pocket expense. Eligible families can avail of quality medical services without getting into debt.
• The insurance cover provided by this scheme includes items that are generally excluded from standard medi-claims (for example, pre-existing conditions, internal congenital diseases, and mental health conditions).
• The scheme requires hospitals to maintain a certain minimum standard.
• Insurers and third-party administrators will have access to the large new market that opens up because of the scheme.
• The scheme has the potential to initiate wide reforms in India’s healthcare system.
• After one year of the scheme’s beginning, beneficiary families are said to have saved over Rs.13000 crores.
• Over 60% of the treatments have been done by private hospitals. The private sector has played an active role in this scheme and they have also benefitted from it. In many tier II and III cities, private hospitals have observed increased footfall. 
• Economically weaker sections of society can have access to quality healthcare services without financial hardships.
• The scheme has also resulted in the creation of more jobs. In 2018, it generated more than 50000 jobs. This number is expected to increase as the government is planning to build 1.5 lakh HWCs by 2022.
  - 90% of the jobs are in the health sector and the remaining in allied sectors like insurance.
• The scheme is supported by a robust IT framework.
  - IT supports beneficiary identification, maintaining treatment records, processes claims, addresses grievances, etc.
  - There is fraud detection, prevention, and control system at both the central and state levels, which is critical for preventing fraud.

PM-JAY Criticisms
There are certain criticisms and challenges in the implementation of PM-JAY. They are briefly described below.

• There has been a criticism that while the allocation of funds for PM-JAY has increased exponentially, the fund for the National Rural Health Mission (NRHM) has gone up only by 2%. So, the scheme has been eating into the funds for NRHM.
• Under this scheme, the private sector has been given a large role in offering primary health care to the people. This has been protested by many people in various states, as regulation of the private sector is marginal.
• There is a shortfall of healthcare professionals and personnel needed to implement a vast scheme as this.
• There is also a problem of infrastructure as many primary healthcare centres run without even the basic facilities such as electricity, regular water supply, etc.
• The scheme excludes those economically weaker sections that fall under the organized sector and have no access to health insurance.

[Question: 891545]

Health and Wellness Centres (HWCs)

HWCs are being created by converting the existing primary health centres and subcentres. They provide comprehensive primary health care (CPHC) including a child and maternal health services, non-communicable diseases, and also diagnostic services, and free essential drugs.
Services offered by HWCs:

• Care in pregnancy and child-birth.
• Neonatal and infant health care services.
• Childhood and adolescent health care services.
• Family planning, Contraceptive services and other Reproductive Health Care services.
• Management of Common Communicable Diseases and Outpatient care for acute simple illnesses and minor ailments.
• Screening, Prevention, Control and Management of Non-Communicable diseases.
• Care for Common ophthalmic and ENT problems.
• Basic Oral health care.
• Elderly and Palliative health care services.
• Emergency Medical services.
• Screening and Basic management of Mental health ailments.

HWCs are important because they offer CPHC that is critical to enhancing health outcomes. Primary healthcare plays a vital role in preventing many disease conditions. Providing CPHC decreases morbidity and mortality at a lower cost and greatly reduces the requirement for secondary and tertiary care.

National Digital Health Mission

Prime Minister Narendra Modi launched the National Digital Health Mission on 15th August 2020. The mission aims to create an integrated healthcare system linking practitioners with the patients digitally by giving them access to real-time health records. This will promote prompt and structured healthcare across the country.
How will it be helpful from the UPSC Exam perspective?

• Questions that can be asked in Prelims
  - National Digital Health Mission launched under which ministry?
  - Year of launch
  - Components of National Digital Health Mission
  - Aims of the mission
• Questions that can be asked in Main
  - Government initiatives towards improving the country’s healthcare infrastructure.
  - Critical analysis of the National Digital Health Mission
  - Essay on digitalizing healthcare

Important Facts about the National Digital Health Mission

Learn about all important government schemes that are important for most of the competitive examinations including the IAS Exam.

Similar Articles which an IAS Aspirant should read to holistically approach the topic,  National Digital Health Mission:

Background of National Digital Health Mission

• National Health Policy 2017 envisions:
  - Highest level of health and wellbeing for all at all ages
  - Preventive and promotive health care orientation in all development policies
  - Universal healthcare access
• MoH&FM set up a committee under J. Satyanarayana to develop an implementation framework for the National Health Stack
• The Satyanarayana committee recommended drafting a National Digital Health Blueprint to lay down the building blocks and action plan for a digital health mission.
• National Digital Mission Blueprint recommended the establishment of an entity called National Digital Health Mission to provide for a digital healthcare ecosystem for healthcare services across the country.

National Health Authority that is the apex authority to implement the National Digital Health Mission is also the implementing authority of Ayushman Bharat.

Objectives of National Digital Health Mission

• Establishment of Digital Health Systems
  - Core digital health data managed by these systems
  - To manage the Infrastructure requirements for seamless exchange of services.
• Creation of Registries
  - It will have all credible data of clinical establishments, healthcare professionals, health workers, drugs, and pharmacies
• Enforcement of adoption of open standards by all national digital health stakeholders
• Establishment of Standardized personal health records
  - It will take inspiration from international standards
  - Based on an individual’s informed consent, the records can be easily shared between individuals and healthcare professionals, and services providers.
• Enterprise-class health application systems
  - The aim will be to achieve health-related Sustainable Development Goals (SDGs).
• Adoption of cooperative federalism while coordinating with states and union territories.
• Promotion of private players’ participation along with the public health authorities
• Making healthcare services portable nationally.
• Promotion of Clinical Decision Support (CDS) Systems by healthcare professionals.
• Digitally manage:
  - Identifying people, doctors, and health facilities,
  - Facilitating electronic signatures
  - Ensuring non-repudiable contracts
  - Making paperless payments
  - Securely storing digital records, and
  - Contacting people

The National Digital Health Mission is set to be built alongside the existing public digital infrastructure like PM Jan-Dhan Yojana.

Components of National Digital Health Mission

There are four components:

• National Health Electronic Registries
• A Federated Personal Health Records (PHR) Framework – It will fight twin challenges of:
  - Access to healthcare reports/data by the patients and the healthcare provider for treatment
  - Making the data available for medical research
• A National Health Analytics Platform
• Other Horizontal Components like:
  - Unique Digital Health ID,
  - Health Data Dictionaries
  - Supply Chain Management for Drugs,
  - Payment gateways

Salient Features of National Digital Health Mission

• The institutional framework of the mission runs at different levels starting from the apex level, followed by the board of directors, CEO, and operations.
• It is an IT-enabled healthcare infrastructure system
• Health ID – It will be a repository of all health-related information. Every participating stakeholder including healthcare providers and Indian citizens will be part of this health ID system on a voluntary basis. A unique health ID will be created by every citizen interested to access the benefits of this mission.
• Health data consent managers will be linked with unique health IDs of the patients; who will aid the seamless exchange of the health records between the patient and the doctors.
• The healthcare services will be provided through a mobile app or through an official website.
• Digi Doctor – He/she will be the one who will be responsible for providing healthcare services across the country. An interested healthcare professional can act as a digital doctor to provide prescriptions to patients sitting in a different location altogether. He/she will be assigned free digital signatures which can be used to prescribe medicines.

What are the expected outcomes of NDHM?

As per the MoH&FW; the effective and efficient implementation of the mission can bring the following outcomes:

• Citizens can access their health records within 5 clicks.
• Unlike going for diagnostic tests multiple times with each visit to doctors, through this mission a citizen will have to undergo a diagnostic test only once and can follow up treatments from different healthcare providers.
• All healthcare services are provided at a single point.
• Continuum of care is assured at primary, secondary, and tertiary care.

Challenges to the National Digital Health Mission

• Data misuse – It is a challenge to secure the health data of the citizens along with other personal information to avoid a breach of the right to privacy.
• Leakages from health repositories – Technological advancement and high security to avoid any leakage of the data.
• Profiteering
• Foreign surveillance

Conclusion
The National Digital Health Mission (NDHM) encompasses:

• Health and Well-being for all
• Health and Well-being at all ages
• Universal Health Coverage
• Quality of Care
• Accountability for Performance
• Efficiency and Effectiveness in the delivery of services
• Creation of a holistic and comprehensive health eco-system

Way Forward with National Digital Health Mission

• The NDHM still does not recognize ‘Health’ as a justiciable right. There should be a push draft at making health a right, as prescribed in the draft National Health Policy, 2015.
• One of the biggest concerns is regarding data security and privacy of patients. It must be ensured that the health records of the patients remain entirely confidential and secure.
• In addition, the failure of a similar National Health Service (NHS) in the United Kingdom must be learnt lessons from and the technical and implementation-related deficiencies must be proactively addressed prior to launching the mission on a pan India scale.
• The standardisation of NDHM architecture across the country will need to find ways to accommodate state-specific rules. It also needs to be in sync with government schemes like Ayushman Bharat Yojana and other IT-enabled schemes like Reproductive Child Health Care and NIKSHAY etc.

Pradhan Mantri Swasthya Suraksha Yojana (PMSSY)

The Pradhan Mantri Swasthya Suraksha Yojana (PMSSY) was initiated in 2003 by the Union Ministry of Health and Family Welfare. The chief objective of the scheme is to correct the regional imbalances in the availability of affordable and reliable tertiary healthcare services in the country. It also aims at boosting the facilities for quality medical education in India.
There are two components under PMSSY. They are:

• Setting up institutions like the All India Institute of Medical Science (AIIMS).
  - Under the scheme, totally 22 AIIMS have been announced (six are functional).
  - Each of the new AIIMS would have state-of-the-art modular operation theatres and diagnostics facilities; 750 beds at least; 15 – 20 speciality departments; 100 MBBS seats; 60 B.Sc. Nursing seats.
  - The new institutes would have a focus on PG education and research.
• Upgrade of government medical colleges or institutes
  - Addition of 8 – 10 speciality departments; 150 – 250 beds and around 15 new seats for PG.

The government passed the AIIMS Act in order to create AIIMS institutions. According to the Act, all AIIMS institutions are institutions of national importance and they would function as autonomous bodies under the Health Ministry.
As per the Act, the objectives of establishing the new AIIMS are mentioned below.

• Developing teaching patterns in UG and PG medical education so as to demonstrate high standards of medical education in all institutes in India.
• Bringing together in one place educational facilities of the highest order for training personnel in all important branches of health activity.
• Attaining self-sufficiency in PG medical education.

For other government schemes related to the health sector, check the table below:

Pradhan Mantri Swasthya Suraksha Yojana Concerns

In 2018, the Comptroller and Auditor General of India (CAG) submitted a report on the performance of the PMSSY. Some of the concerns flagged in the report are discussed below.

• Even though the scheme was announced in 2003, no operational guidelines had been formulated for it since its inception. Hence, several decisions were taken in an ad hoc manner. Additionally, there was an increase in costs and delays in the implementation.
  - The report recommended that guidelines be formulated for the same. Also, that evaluation studies should be taken up for status check and in the identification of weaknesses in planning & implementation.
• The report said that a significant portion of the funds allocated to the scheme was not utilised due to: (1) Delays in getting approvals; (2) Slow pace of equipment procurement; (3) Posts not being filled; (4) Pending utilisation certificates. The CAG noted that there was no mechanism in place for monitoring actual expenditure which led to accumulation of unspent funds.
  - The report recommended that the Ministry should ensure that contracts were adhered to in the completion of works. Additionally, accountability should be fixed in case of additional expenditure without adequate justification for the same.
• There were delays in execution of work by as much as five years due to poor contract management and inadequate monitoring. There were also other deficiencies in the work such as (1) Improper estimation of scope and quantities; (2) Delay in procurement and installation of equipment; (3) Contractors being paid extra.
  - The CAG recommended that better monitoring of projects should be undertaken to speed up the completion of the pending work.
• The report said that there was an acute shortage of faculty and non-faculty posts in the AIIMS which led to restricted functioning of several departments. It also led to the dependence on outsourced employees who were hired on a contractual basis. Further, delays in filling up sanctioned posts were attributed to delay in finalising recruitment rules, court cases and non-availability of eligible candidates.
  - The report suggested the Ministry to take up several steps to fill up the vacant posts in the institutes.
• The report said that the committees constituted at national, state, and institute levels to review the project implementation were non-functional.
  - The CAG recommended effective monitoring by the committees for the synchronisation of activities related to the completion of works and procurement of equipment.