SKOCH conducted field studies and survey to gauge the grassroots level impact of Ayushman Bharat scheme. Domain experts visited empanelled private and government hospitals across the country. Some of the compelling stories from the grassroots are presented as Case Studies

Jamuna was sick for six months and was not getting any treatment. Her condition deteriorated and someone in the village told her husband that he can go to hospital with Ration Card and ask for Ayushman Bharat benefit. The family came to Guwahati from Kamrup on 24 July 2019 and she was registered as a beneficiary and admitted in emergency care. Her husband is a driver and earns about Rs 8,000 per month. He had given up, but broke down saying that she may survive because of the medical help being given to her, which was impossible to get. The family incurred Rs 2,700 additional expense on medicines, which is reimbursed.

Fifty-four-year-old Hira is a widow and was hospitalised suffering pain for over six months. She was taking local medication. Her son is a driver and earns about Rs 7,000 a month. She got the card about 8-months ago but was not sure what to do with this, till such time as the local doctor told her to avail free treatment at a big hospital. Ayushman Bharat Card was given to her by ASHA worker. The procedure was successfully carried out and she was discharged on 5 August 2019. Commercial cost of the procedure is estimated at around Rs 35,000.

Dilip met with road accident few years ago and received multiple fractures in his right shoulder. He recovered slowly but shoulder became weak. He recently met with another accident and shoulder got dislocated. Meghalaya has no medical facility to fix this. The family came to Guwahati and bone grafting was done. If it was done privately, the expense would have been around Rs 100,000. His wife is a homemaker and has two sons studying at local school. He was on bed for 15-days and there were no earnings for the family in between. But family was relieved that there was no medical expense and the operation was successful.

Promila, 38, works as housemaid. She earns Rs 2,000 per month. She suffered pain for about three months before the family decided to go to doctor. They did not consult a doctor because they had no money. They were told by ASHA worker to go to hospital and avail free treatment under Ayushman Bharat. The family had no assets and was planning to borrow from the local moneylender. She was operated upon successfully and recovered well. She was kept in ICU for a day and then transferred to the recovery room.

Makibur, 29, works at a local hotel. The card was made for the family about 9-months ago. This is the second instance that the family has availed the benefit. First, it was his mother who was treated for gall stones. Makibur was having dull pain for a fortnight on right side of his abdomen, which when became severe, was admitted on 26 July 2019. At a meagre earning of Rs 8,000 per month, he was not in a position to afford the procedure cost of more than Rs 30,000. Under Ayushman Bharat, the procedure was carried out successfully and soon enough he went back to work.

For a long time, forty-seven year old Jinnat, was feeling pain in her abdomen and was given pain killers by the local doctor. Because there are no ultrasound facilities nearby her village, no USG could be performed to ascertain the cause of pain. She was told by one of his neighbours, who received treatment under Ayushman Bharat, to visit the nearby government hospital. She was immediately admitted and stabilised. She is widow and her son is the only earning member, who works as a driver and earns about Rs 6,000 a month.

Johan, 47, is a casual labour in a tea estate in upper Assam and earns Rs 3,200 a month.  With such meagre earning he could never think of getting any treatment. So, he continued to bear the pain for over a year. It was quite difficult for him as he is the only earning member and had no money to access medical facilities in a big hospital. A government team visited the tea estate and made Ayushmaan Card for all the workers. This kindled a ray of hope for Johan that his miseries will come to an end. He was diagnosed with kidney stones and was operated upon.

Arabinda, 63, was complaining of difficulty in swallowing for which he went to a local health centre. Doctors gave initial treatment and referred him to the Guwahati Medical College Hospital (GMCH). He was further referred to GMC Cancer Institute. He was at the hospital for over a month and underwent treatment for cancer. At one time he became so critical that he had to be admitted in ICU. He is undergone surgery and received chemotherapy radiation. With a meagre earning of Rs 300 a day working as mason, it was impossible for the family to imagine to receive any such treatment.

This is the second time, sixty-nine-year-old Bhandeswari is admitted to the hospital. During the first instance she was operated upon and was given radiation therapy. That instance had the approval of Rs 50,000. During the current hospitalisation, she underwent chemotherapy and completed 25-sessions. She stayed at hospital for five months to complete full course of treatment and recover.  The commercial cost of this treatment is estimated to be around Rs 3 lakh.

With an earning of Rs 250 a day, Azizul, 48, could never imagine to be treated. He had almost given up and was suffering tremendously. Since this disease pre-existed the making of Ayushmaan Card, the family had to sell their agriculture land at Rs 1.5 lakh to support his treatment. There was a new ray of hope with the making of the card as a result of which Hak now lives. He was admitted for treatment in July 2019 and discharged post recovery.

Niru, 37, was admitted at Guwahati Neuro Research Centre (GNRC), Kamrup-Rural, Guwahati with cerebral hemorrhage. Husband works as a casual labour in a stone query and earns about Rs 1,500 a month. Many days in a month, during rains the query does not operate, so there is no earning for the family, which owns no land either. When Niru fell unconscious, with the help of ASHA, she was taken to hospital by a government ambulance on 27 July 2019. She recovered in the hospital and soon discharged.

Raj Kumar, 46, works as a peon in Gurugram. About seven months ago, he had severe stomachache. Local doctor treated him, which gave him temporary relief. But this did not last long and the pain reoccurred. As a result, he had to abstain from work and was sacked. He could not afford the treatment like USG and other procedures prescribed by the doctor. He was then advised that he can get this treatment under Ayushman Bharat scheme and he visited Alfaa Hospital. He was diagnosed with stones in kidney and was operated upon accordingly. His months-long suffering came to an end.

Twenty-four-year-old Komal is a student doing LLM from a college in Dehradun. Last week she came to her village and fell sick. Her condition deteriorated and she was admitted in hospital. The family was already enrolled in Ayushman Bharat and all treatment was carried out without any expense to the family. She recalled a similar instance couple of years ago, when due to some illness she was hospitalised and incurred an expense of Rs 23,000.

Surjit Singh had been facing problem in urine discharge for nearly 5-years. A farmer by profession, fifty-two-year-old Surjit took medicine from a local doctor. Recently, he received a letter from the government saying that his entire family is covered under Ayushman Bharat scheme and that all kinds of treatment at a hospital will be free of charge. He visited Alfaa Hospital a few months ago and was admitted. However, the problem reoccurred recently and was admitted once again to undergo surgery to permanently get rid of the ailment.

Jaibir, 23, was admitted to the hospital with the complaints of vomiting, loose motion and stomachache due to food poisoning. He got admitted to the hospital along with his younger sister, who also suffered from food poisoning. His mother taking care of her both the kids in the hospital looked very disturbed, but heaved a sigh of relief that the entire treatment is covered under Ayushman Bharat and that she does not have to bear the expenses.

On 2 August 2019, Bharath Kumar, 22, was admitted with severe abdominal pain. This had happened in the past as well, when he took local medication and was temporarily relieved. Investigations revealed that it was a case of kidney stones, which was causing pain. The surgery was performed the very next day. He was not even aware of the benefits under Ayushman Bharat till such time he was assisted by Ayushman Mitra.

Lingappa is 72 years and has been suffering with multiple ailments and has been on medication supported by his family. Given his physical weakness, he fell and suffered multiple fractures in his leg and went to neighbourhood doctor. When pain increased, he was brought to the KC General Hospital. It was a bad case by then but due to immediate medical attention and the surgery that was performed, his leg was saved. The old man was completely unaware of the Ayushman Bharat and did not believe that the treatment was done free of charge.

Jeevan was 10-years old when he started feeling abdominal pain. Since, the family did not have enough means to get the treatment done at a big hospital, it continued to visit nearby dispensary. Two years passed in-between! Recently, the family received Ayushman Bharat card and its hope to help Jeevan rid of his problem was rekindled. On 1 August 2019, he was admitted in hospital and surgery was performed. The patient was relieved as much as the family.

In a not so common case of appendicitis at the age of five, Kunal Gowda was admitted in the middle of the night in emergency at KC General Hospital. Since he was in severe pain and had to be operated upon urgently, the hospital called the specialist and the operation was performed within next two hours. Kunal’s life is saved. The hospital did not ask the family to deposit any advance, rather informed them that under Ayushman Bharat the treatment would be free of charge.

Nine month old Sheria was born with congenital heart disease. Her father is a washerman and earns about Rs 10,000 a month and is the only earning member. It was practically impossible for him to get her treated at any hospital and was only praying to God for help. When the Ayushman Card was made for him, he was told that this entitles him to get treatment for her daughter. Without wasting any time, he approached Sri Jayadeva Institute of Cardiovascular Science & Research, admitted his daughter, who was operated upon subsequently.

Fifty six year old resident of Tumkur, Geetha suffered multiple heart related complications in the past and went through surgeries. In 1998, she went through a major heart surgery as a result of which she had to quit working as a teacher. Her mother retired from the government and gets pension of Rs 9,000 per month. Recently, Geetha suffered a stroke and went through Mitral Valve Repair surgery. The procedure cost was Rs 130,000. The family had learnt about Ayushman Bharat through newspaper and TV commercials and made their card.

Thirteen month old Pavan Kumar was not able to sit properly and maintain her posture. The infant was treated for calcium deficiency for three months, but in vain. The body at places started becoming blue all of a sudden followed by which they rushed to the hospital and consulted paediatrician. They were referred to Narayana Institute of Cardiac Science and the baby was admitted and diagnosed with TAPVC. She went through a cardiac procedure and was recovering when we met her.

Bindhu, 43, has two children and works as a domestic help. She is the earning member and makes about Rs 15,000 per month. Her husband is visually handicapped who stays at home. She experienced pain in her stomach and consulted gynaecologist at a local dispensary. She was advised to go to a bigger hospital in town but due to lack of means, she did not do so. When the Ayushman Bharat card was made for her, learning the benefits of the scheme, she immediately approached the hospital. She got all the treatment at par with any other hospital and like an equal citizen. The hysterectomy was performed successfully on 3 August 2019.

Vishnu, 18, is at stage 5 on dialysis post-kidney transplant failure. His mother had donated a kidney to him about 9-years ago, but the procedure was unsuccessful. Ever since he is going through three dialysis each week. Few months ago, his father who is an auto-rickshaw driver, earning 500 a day, received a call from a donor. He had to refuse as the family had no money to afford the investigations and procedure. The cost of dialysis became unaffordable for the family until the Ayushman Bharat card was given to them. The boy’s health has improved and the family now awaits a donor.

Suffering with third stage cancer, mason Anil Kumar, 40, was admitted in ICU, Regional Cancer Centre, Thiruvananthapuram with little hope for recovery. With medical attention and care given to him over his month-long stay in the hospital, he has gone through several sessions of chemotherapy. He soon started showing signs of improvement. With a meagre earning of Rs 700 a day, Anil could never imagine to avail medical facilities at a speciality hospital like this one.

When in 2018, Kala, now 48, first suffered pain in her abdomen, she completely ignored it, assuming she is gastric. It became repetitive and she consulted doctor in nearby town and was treated, which gave her relief. But in absence of proper diagnosis, she did not receive appropriate treatment. Affording this was also a task for her as she earned about Rs 500 a day working as a casual domestic help. She has two children and husband works as a casual labour and earns Rs 200 a day. Recently, Ayushman Bharat card was made for her. Using this card, she came to the government hospital and was operated upon, which brought her relief.

Regional Institute of Ophthalmology is a super-speciality hospital, which is affordable only by the upper strata. Rebekka, 67, is one of those fortunate ones from small village in Killam District to have received multiple treatments at this hospital, which saved her vision. Looking after a family of eight, working as a domestic help with no regular income, slowly losing her vision was a big worry for her. She was admitted on 25 July 2019 and was discharged on 5 August 2019. She still visits hospital aided by her sons for post-operative consultations.

Thankapdan, 74, is a carpenter by profession and lives with his elder son who works with him as an assistant. Vellanad is a small village with minimal medical facilities. The nearest health centre is a few kilometres away in another village. Together, father and son duo earn about Rs 600 a day. He was suffering with cataract for a long time but could not save enough to go through treatment. There was a camp organised in the village whereby all families were given Ayushman Bharat card and were told how to benefit from this. Thankapdan’s son took him to the hospital, where he was treated for cataract.

Shaiju, 34, met with an accident in July 2019. He suffered cut on his right knee, which was stitched at a local dispensary. Soon, the wound was infected and he had to visit the hospital to consult a specialist. He was prescribed medication and was told to return after a week. Until now he was paying money from his pocket as he was not aware of Ayushman Bharat. During next visit, he enrolled himself and received the treatment at no cost till the time his wound healed.

Sixty eight years old Vidhyanandhan has been unemployed for a long time. He is supported by his family for his daily needs. His son works as a plumber and earns about Rs 500 a day. Even a minor fever, pushed the family further deeper into poverty. When Vidhyanandhan fell sick recently, the family was broke as son had no work for days. He went to hospital asking for help. The Ayushman Mitra there helped him with registration and asked him to bring his father to hospital for treatment. Vidhyanandhan was admitted and was diagnosed with urinary infection that made him run high fever for days.