ABSTRACT

‘Ayushman Bharat’ programme is India’s most definitive step so far towards promotive, preventive, curative, palliative and rehabilitative aspects of Universal Health Coverage. Adopting continuum of care approach, Ayushman Bharat is being implemented through two interrelated components, viz., Health and Wellness Centres to provide primary care and PMJAY for providing financial protection for accessing hospitalization care at the secondary and tertiary levels. PMJAY is world’s largest Government funded health protection scheme covering about 50 crore beneficiaries. Nowhere in the world this kind of work has been implemented on such a large scale. Consolidation and stabilizing the implementation of scheme is an enormous task. The AB-PMJAY is being currently implemented across 32 States/ UTs. A well-defined Complaint and Public Grievance Redressal Mechanism, has been put in place through which complaints/ grievances are registered, acknowledged, escalated for relevant action, resolved and monitored. PMJAY has created a robust IT system for implementation of the scheme. Monitoring and Evaluation is key for successful implementation and ensuring the intended results of such a large scheme like AB-PMJAY. At the Central level, these UHC dimensions (coverage, benefits and financial protection) are being continuously kept on track on periodic basis through the following functional domains: Beneficiary management, Transaction management, Provider management and Support function management (comprising functions such as capacity development, grievances, frauds and abuse, call centre, etc.). A strong real-time online MIS is set up at the national level to review Key Performance Indicators and achievement of results with respect to the targets defined under the domains. For a program of scale, magnitude and complexity as that of PMJAY, it is critical to put in a place strong anti-fraud mechanism not only from financial perspective but also to safeguard people’s health from unethical and malpractices. National Health Authority is cognizant of the issue and has taken number of steps to safeguard the program from the inception.

For full text of this article, Contact Mr. Jitender Sharma at jitender.sharma@jaipuria.ac.in

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