The burden of malnutrition and poor health is unacceptably high around the world, including in India. According to the World Health Organization (WHO), access to quality health care is a basic human right. In December 2017, the then Director-General – WHO, reiterated that “Enjoying a high standard of health care is one of the basic human rights without discrimination on the basis of race, religion, political beliefs, economic or social status”; and this is more effective today than ever before. The right to health has been the backbone of WHO’s ownership and authority since its inception.
In order to achieve the Universal Health Coverage targets, the Government of India has implemented a state-of-the-art public health program called ‘Ayushman Bharat’. Based on the recommendations of the National Health Policy, this the system was developed and implemented in the country. It is envisaged that this program will assist India in achieving the Sustainable Development Goals (SDGs); its goal is to “leave no one behind”. Developed with the primary objective of providing a comprehensive needs-based health care system under the Department of Health and Family Welfare, with a budget of approximately Rs. 8,000 crore for the financial year 2021-2022. It aims to fully address the health care process which includes prevention, promotion and patient care at all levels of the lower, upper and lower levels. To – improve the quality, efficiency and effectiveness of health care delivery, attract professional services and resources from various sectors / departments.
Ayushman Bharat has two main components namely:
Health and Wellness Centers (HWCs) and Pradhan Mantri Jan Arogya Yojana (PM-JAY)
As a fundamental human right and healthy people the foundation of a strong nation, India is committed to ensuring the highest quality of health care accessible to all its people through the mandate of the Universal Health Coverage (UHC). This will also assist in meeting the Sustainable Development Goals (SDGs), in particular the SDG-3 (Health and Wellness).
The concept of universal health care (UHC) is not new, it was first proposed by the Bore Committee since 1946 emphasizing that all individuals and communities should have access to the health services they need without economic pressures. The committee recommended the integration of prevention and treatment services at all levels and developed a plan to strengthen primary health care.
At the international level, the Alma-Ata Declaration (1978) has emerged as a major milestone in the field of public health. It had identified primary health care as the key to achieving the goal of ‘Health for All’ by the year 2000AD. Subsequently, the commitments made in the Millennium Declaration (September 2000) led to the development of the Millennium Development Goals (MDSS) which include 8 goals with 21 objectives and a set of estimated health and economic indicators for each target. Although all of these interdependent MDGs have an impact on health; three of MDGs-4, 5 and 6 deal directly with health issues. In 2015, the UN General Assembly unveiled the Sustainable Development Goals (SDGs) – a set of 17 global goals with a target of 169 and a set of 232 indicators to measure progress. Of these, the SDG-3 addresses. direct health while SDG-2, SDG-6 and SDG-5 address health indirectly. The 40th anniversary of the Alma-Ata Declaration (Alma-Ata 40 years: from 1978 – 2018) came at a time when Primary Health Care is once again receiving appropriate attention.
However, the Astana Declaration (2018) shifts from Alma-Ata (primary health care) to Universal Health Coverage (UHC) for assistance. People in India’s rural areas often lack quality medicines at reasonable prices. To provide such a facility, the Department of Pharmaceuticals, Government of India, launched Pradhan Mantri Bhartiya Janaushadhi Pariyojana (PMBJP) (previously known as Jan Aushadhi Scheme) in 2008. Still, the government revised it in 2015 for strengthening its supply after the NDA government came to power.
Pradhan Mantri Bharatiya Janaushadhi Pariyojana (PMBJP) is a campaign launched by the Department of Medicine, Government of India, to provide affordable medicines for most people with special kendra known as Pradhan Mantri Bharatiya Janaushadhi Pariyojana Kendra. Pradhan Mantri Bharatiya Janaushadhi Pariyojana Kendra (PMBJPK) is set to provide generic medicines, which are available at low cost but equal in quality and performance as an expensive brand name. BPPI (Bureau of Pharma Public Sector Undertakings of India) was established under the Department of Medicine, Government. of India, with the support of all CPSUs to coordinate the purchase, supply and marketing of generic medicines by Pradhan Mantri Bharatiya Janaushadhi Pariyojana Kendra.
Governments and communities prioritize, promote and protect the health and well-being of the people, at all levels of society and individuals, through sound health systems; Primary health care and health services must be high quality, safe, complete, integrated, accessible, accessible and affordable to everyone and anywhere, provided with compassion, respect, and dignity by well-trained, competent, motivated, and committed health professionals; Positive and healthy environments where individuals and communities are empowered and engaged in maintaining and improving their health and well-being; Partners and stakeholders to work together to provide effective support to national health policies, strategies and programs.
WHO (2017) has stated that “Investment in health systems could prevent 97 million premature deaths by 2030” According to the World Health Organization (2021), Universal Health Coverage covers a wide range of essential health services – from health improvement to prevention, treatment, rehabilitation, and palliative care throughout life. It aims to reduce morbidity and mortality By helping affordable access to health services, the nation can help break the cycle of illness and poverty, especially among vulnerable groups of people. It is intended to support groups of economically weak and poor people who often need to sell their property, lend and / or compromise their basic necessities in an effort to meet medical expenses related to illness. As a result, such groups of people are often unable to maintain good health and well-being. Therefore, it is recommended that Universal Health Coverage (UHC) should focus more on:
- The proportion of people (between ordinary and marginalized groups) who have access to basic health services (SDG 3.8.1)
- The majority of people who spend most of their household income on health care (SDG 3.8.2)
- Universal Health Coverage – Action Framework
In order to meet the goals of the SDGs, nations around the world are striving to win the UHC by focusing on its three main pillars:
- Service Delivery
- Health Funding
- Dominance
As different nations have their own different health concerns, resources and challenges, they need to develop their own specific framework for action, keeping in mind the following factors:
1. Finance
Expand the financial pool by promoting public-private partnerships and corporations social responsibility Increase integration of domestic resources and regular budget allocations Intervals Improving access to health services, infrastructure, medicine and related services things.
- Provide financial protection to every citizen of the country
- Prepare for an active and wise time bound spending
2. Health Services
- Establish community-based health services.
- Ensuring equity and impartial health service Prioritize health services very important in reducing mortality and illness
- Encourage partnerships between civil society (community) and the public / private sector in order to improve access to essential health services for prevention, rehabilitation and treatment.
- Invest in pre-service medical education and para medical.
- Involve multi-industry partnerships to address health symptoms.
3. Equality
- Identify people at risk to develop and implement health / nutrition programs that fit their needs.
- Expand service delivery to marginalized and vulnerable groups (age, gender, demographics, etc.).
- Ways to increase security including vouchers and conditional transfers which directly or indirectly support good health and well-being.
- Ensuring the fulfillment of basic rights especially for women, children and the elderly.
4. Readiness
- Prepare and continually improve the National disaster preparedness programs especially natural disasters Encourage International adherence Health Regulations See the international framework for monitoring and evaluating policies and programs that are directly or indirectly related to the health sector.
- Improve State and International Cooperation to prepare for and respond to public health emergencies such as epidemics.
5. Dominance
- Establishing forums and processes facilitate dialogue between the various stakeholders (service providers and recipients)
- Ensuring effective and efficient inter-sectoral dialogue.
- Set up transparent monitoring and reporting on UHC progress and make it available to public domains.
- Strengthening national institutions as well organizations by developing skills. Ensuring that all citizens have access data and information of UHC.
The World Health Organization and the World Bank have provided guidelines that can help measure and keep track of progress over time. They provided 16 essential health services (grouped under 4 categories) as indicators of the level and equity of national provision in the country.
Pradhan Mantri Jan Arogya Yojana (AB-PMJAY)
Pradhan Mantri Jan Arogya Yojana (AB-PMJAY) is a Centrally Sponsored Scheme having central sector component under Ayushman Bharat Mission anchored in the Ministry of Health and Family Welfare (MoHFW). It is an umbrella of two major health initiatives, namely Health and wellness Centres and Nationa Health Protection Scheme.
Many countries have been advancing to the UHC; however, the COVID-19 epidemic has had a devastating effect on the ability of health systems to provide uninterrupted health services. Even in countries where health services were traditionally accessible and affordable, governments find it increasingly difficult to respond to the ever-increasing public health needs and rising Annual benefits of Rs. 5 Lakh can be used by any one or more family members to include all members. There is no limit to the size of the family or the age of the family members. In addition, existing diseases are also covered from day one. This means that eligible people suffering from any health condition even before registering under PM-JAY will be able to receive treatment for all those health conditions from the date of registration. Key features of PM-JAY, therefore, include:
- It is the world’s largest health insurance / guaranteed health insurance system that provides cover for Rs. 5 lakhs per family per year for admission to secondary care and tertiary care in all public and private hospitals in India.
- More than 10.74 million poor and vulnerable households (approximately 50 million beneficiaries) are eligible for these benefits. There is no limit on family size, age or gender. PM-JAY provides free access to health care
- Beneficiary services in the service area namely hospitals. Therefore, it is considering helping to reduce the catastrophic cost of treatment that pushes about 6 million Indians into poverty each year.It covers up to 3 days of early hospitalization and 15 days of hospital stay after hospitalization. In diagnosis and treatment. All pre-existing conditions are covered from day one. The benefits of the program are nationwide i.e. the beneficiary can visit any sympathetic public or private hospital in India access to free treatment.
- Services cover approximately 1,393 procedures that cover all medical expenses – including but not limited to drugs, utilities, diagnostic services, doctor fees, room costs, surgeons’ expenses, OT and ICU costs, etc.
- Public hospitals are being reimbursed for health services in parallel with private hospitals.
- PM-JAY has played a major role since its launch – just over three years ago. In December 2021, more than 17.3 crore (17,35,71,234) Ayushman Cards were issued to beneficiaries. The data shows that of these, more than 2.6 crore (2,61,36,725) people have been admitted to hospitals and 8.3 lakh COVID-19 cases have been successfully treated.
Key features of the scheme
Easy access to medical treatment – Each year thousands die in India due to lack of medical care. Most of these individuals were poor and could not afford high medical expenditure. With the implementation of this project, poor people will receive free medical treatment.
Medical insurance amount – Under this scheme, all applicants will be able to attain a medical insurance scheme that amounts to a whopping 5 lakhs. This amount is for one financial year.
Number of beneficiaries – This scheme offers this cashless treatment and medical insurance benefits to as many as 10.74 individuals. Only those people will be able to apply who have their names registered in the SECC-2011 Data list.
Implementation in all areas – The scheme will be implemented in all parts of the nation.
Flexibility of implementation – The central government has highlighted some implementation methods for easy of operations. Each state will be able to choose the implementation mode that suits its needs.
For both villages and cities – People, living in rural areas as well as cities will be able to enroll for this scheme as long as they fulfill other eligibility criteria. 85% and 60% beneficiaries have been identified from villages and urban settlements respectively.
Listed hospitals only – The cashless and paperless treatment will be available only if the patients get admission in empaneled hospitals.
In addition, Ayushman Bharat has assisted in the successful launch of the COVID-19 vaccination campaign; and as a result of this in addition to public hospitals, 10,000 private hospitals have also been included. call to earth. Compared to the global vaccination situation, India’s progress in vaccinating its people has been commendable, especially given the large population. Since its inception, Ayushman Bharat has been striving to achieve his goals of ensuring that dangerous diseases are fully eradicated, reducing catastrophic spending, improved access to health care / services, reducing unmet needs, and transforming different health insurance schemes. in different regions of India. A few notable achievements have been observed in various Indian regions / Union areas such as Jammu & Kashmir, Madhya Pradesh to name a few. Quoting Extraordinary Secretary of Jammu & Kashmir “After two years of successful implementation, the Government of Jammu and Kashmir decided to extend the benefits of AB PM JAY to all people through a 100% government subsidy approach and introduced Universal Health Coverage (AB PM- JAY SEHAT) December 26, 2020. The response has been overwhelming; more than 50 Lakh beneficiaries are registered under this program; of Jammu and Kashmir “.
Data show that despite the current epidemic, over the past five years, there has been little progress in the health sector.costs of health services. The status of Indians and progress to date India’s health policies as well the programs have seen a number of challenges, successes and failures during its 74-year journey. Previous strategies before 1947, were based on a health system inherited from the British. During the post-independence period to the pre-epidemic period, India was making good progress in terms of increasing its health and healthy food resources. COVID-19 assessed the strengths and weaknesses of our healthcare system which include risk identification, risk assessment and risk awareness which are key components of the surveillance system.
Infant mortality rate is an important indicator of national health care and living standards; low infant mortality rate indicates high levels of health care. Comparison of data relating to other important health indicators over a 70-year period (1950-2021) shows that life expectancy at birth is almost double; and that there is a decrease in fertility (by ~ 2.7 fold), birth rate (by >> 2.5 wrapped), infant mortality (by 6.6 folds) and the overall cause of death (by 3.8 folds). Despite the favorable conditions, much remains to be done by our country to improve the health status of our people.
Ayushman Bharat International Health Service As mentioned, Ayushman Bharat has two major divisions namely Health and Wellness Centers (HWCs) and Pradhan Mantri Jan Arogya Yojana (PM-JAY). Both sectors work together to support the prevention, treatment, management and well-being of the general public with special emphasis on vulnerable people and vulnerable groups.
Health and Wellness Centers (HWCs): It is estimated that 1,50,000 Health and Wellness Centers (HWCs) will be built under Ayushman Bharat which will also include the conversion of existing Sub-Centers and Primary Health Centers (PHCs). The main objective of HWCs will be to provide integrated health care (CPHC) close to human settlements / accommodation. These centers will primarily focus on providing maternal and child health services and the delivery of health services for major non-communicable diseases. In addition, these centers will provide essential free medical care and diagnostic services.
It is envisaged that HWCs will improve access, accessibility and equity in terms of public health services. Emphasis will be placed on promoting health and disease prevention through participation and empowering individuals / communities in healthy eating choices and making changes that reduce the risk of chronic infections and other diseases.