The largest public health scheme in the world- National Health Protection Mission (Ayushman Bharat) has been launched formally from Ranchi on 23 September 2018. The scheme guarantees a health cover of Rupees 5 lakh per annum per family to 10 crore families across the country and include more than 1,000 treatment packages. Despite of laudable intentions and aim to achieve universal health coverage in India, ‘Ayushman Bharat’ is facing number of challenges in terms of inadequacy of funds, lack of health infrastructure, resistance to participate from some of the states and so on.

Challenges for Implementation –

The public health system has inherent defect of inadequacy of health infrastructure e, especially at Primary Health Care level. Despite of announcement by Finance Minister of establishment of 1.5 lakh Health and Wellness Care centres all over India, a meagre 80,000 Rupees allocation per PHC would be grossly insufficient to dream a transformation in public health scenario in India. As ‘Ayushman Bharat’ scheme primarily supports secondary and tertiary healthcare services, it is unlikely to help fix the broken public health system in the country. Most primary healthcare centres in our country suffer from perennial shortage of doctors and even district hospitals are without specialists. Apart from inadequacy of health infrastructure, the lack of funds for ‘Ayushman Bharat’ is the biggest challenge in front of implementing agencies. ‘Ayushman Bharat’ plans for sharing of expenditure on the scheme between the Center and the states in a ratio of 60:40. Though the MoUs have been signed by the majority of the states, still five states in India (Delhi, Kerala, Odisha, Punjab, Telangana) are hesitant in joining the ‘Ayushman Bharat’. These states have opted out of the scheme.

Challenges for ‘Ayushman Bharat’ in Maharashtra –

‘Ayushman Bharat’ is going to be implemented in 80 Government Hospitals in Maharashtra and not a single private Hospital has been empanelled for the same in the first phase of its implementation. The Government of Maharashtra has taken a decision to implement Maharashtra’s own ‘Mahatma Phule Jan Aarogya Yojana (MPJAY)’ alongwith this national level ‘Ayushman Bharat’ scheme in all the districts of Maharashtra. It is interesting to note that MPJAY caters for upto Rupees 1.5 lakh expenditure on health per family per year vis a vis upto Rupees 5 lakh expenditure for eligible families under ‘Ayushman Bharat’. The Government of Maharashtra has not clarified about methodology of reimbursement of health expenditure to the empanelled hospitals as upto Rupees 1.5 lakh expenditure for the eligible families would be adjusted from Health Insurance Companies responsible for implementation of MPJAY and the modality for remaining amount has not been yet decided by the state Government. Another contrasting feature is about the extent of coverage of illness as MPJAY covers 971 ailments whereas ‘Ayushman Bharat’ scheme covers 1349 ailments. At this stage,Government of Maharashtra has not clarified anything about reimbursement of health expenditure on 390 ailments which are not the part of PMJAY, but have been included in ‘Ayushman Bharat’ scheme. The eligible beneficiaries under ‘Ayushman Bharat’ scheme in Maharashtra are estimated at approximately 83.72 lakh people only whereas PMJAY covers under 2.2 crore population in Maharashtra. The disappointing feature of the ‘Ayushman Bharat scheme in Maharashtra is about non inclusion of families of farmers who have committed suicides in 14 of the districts in Maharashtra. The overall assessment of impact of upcoming ‘Ayushman Bharat’ scheme in Maharashtra is not very encouraging due to various grey areas in its implementation and the ongoing scheme PMJAY is comparatively found to be better as compared to the proposed national level ‘Ayushman Bharat’ scheme.

‘Ayushman Bharat’ scheme has the potential to turn as game changer for ailing public health scenario in India, provided the implementation hitches of the scheme are removed and with the involvement of private sector, it is properly implemented. It is not the grand announcement of the scheme which matters but the sound implementation of the scheme with focus on measurable outcomes is the criterion to judge the success of this scheme.

(The author of this article ,Lt Col (Dr) Satish Dhage, is an ex Deputy Assistant Director Health in Army and has also been qualified for IPS (Indian Police Services) through IPS LCE 2012. Presently, he is Director, MGM Institute of Competitive Exams Aurangabad. For any queries or feedback, he can be contacted on email id : drsatishdhage@gmail.com)