- 1. A National Health Stack should be created. There is need for development of an integrated system for healthcare across the country.
- 2. Ayushman Bharat has largely addressed the demand side issues. Supply side is yet to respond. There is need to build a large number of hospitals to address the demand.
- 3. Ayushman Bharat could work as an umbrella organisation for delivery of the integrated health services across the country. This would make financing, monitoring and delivery of services inclusive, smoother and efficient.
- 4. There is need to revamp and develop outcome-based statistical system. Technology can play a critical role in this endeavour.
- 5. Evidence based policy making is critical for making an impact at the grassroots. The success or failure of the scheme should not be judged by the input but by the outcome. This will happen only if there is reliable outcome-based data.
- 6. Market principles in welfare scheme. Introduce competition, accountability and innovation in welfare schemes. These terms are normally associated with the market economy. But they are now equally relevant for the implementation of welfare schemes.
- 7. There is a need to develop a robust independent evaluation mechanism for effective and regular evaluation of welfare schemes.
- 8. For-profit private hospitals can play a big role in creating the required healthcare infrastructure. Conducive environment needs to be created to attract private investments in the sector, especially in the rural India.
- 9. Social welfare schemes in other areas like education, sanitation, poverty eradication and livelihood creation should also be integrated in respect to their focus area-wise.
Prime Minister Narendra Modi has secured voter trust through his agenda of welfare programmes. Among the programmes that stand out in the overall welfare bouquet are: First, Ayushman Bharat that has improved capacity utilisation of healthcare infrastructure through better monitoring. Combining insurance and technology, the scheme has revolutionised delivery of free and quality healthcare services. 40 lakh poor Indians have availed free insurance benefits in less than a year, without having to do any paperwork. Secondly, Swachh Bharat is changing behaviour towards cleanliness and hygiene. India is now an ‘open defecation-free’ country, as declared by Prime Minister on the occasion of the 150th birth anniversary of Mahatma Gandhi. It’s only a matter of time when this achievement will lead to improvements in health outcomes. And thirdly, PMGSY, DDU-GKY and other rural schemes for low-cost housing, electricity connections, cooking gas connections, no-frills bank accounts and MUDRA loans and others for skilling, physical and financial rural infrastructure will unleash entrepreneurial energies in the villages and unlock the economic potential there, reducing the India-Bharat divide.
Have key welfare schemes like MGNREGA, PMJAY, Ayushman Bharat, NFSA, been a success? If yes how can they be digitised in the next steps of strengthening? What is the truth of rural distress and is the government holding on to inconvenient data?
Amarjeet Sinha, Secretary, Rural Development, who has played key role in designing Sarva Siksha Abhiyan (SSA) to National Rural Health Mission (NRHM), argued that the socio-economic census of 2015 was key to addressing deep seated challenges in rural areas that required a complete transformation. It identified deprived households that needed special attention for delivery of key schemes from housing, toilets, electricity to gas cylinders, he added. Citing the recently released 76th round NSSO 2018 data on housing he claimed that 76.6 per cent houses in rural areas have been built so far in pukka category, which are not just brick and mortar houses, but have electricity, toilet, insurance support among others. Batting for an evidence based approach, he underlined that decentralisation does not mean you give governance the go by. It rather means that there has to be good governance and programmes that need to be subjected to scrutiny.
There is significant visible transformation in India’s comprehensive primary as well as secondary and tertiary healthcare. He claimed that the government has so far completed some 25,000 health and welfare centres in its target of building 150,000. It is assured that free diagnostic services in hub and spoke model, free drugs, yoga promotion, telemedicine are in the pipeline. “We have heard of problems in PMJAY but not of frauds or schemes. It is a federal scheme, a national endeavour that works along with states and has demonstrated that public and private sectors can work together,” said Vinod K Paul, Member, Niti Aayog.
An emerging area of concern has been the row around delayed release or holding back of key data by NSSO in the past few months on range of subjects including jobs and unemployment. It is largely accepted that many a times what is claimed by government or authorities is not the situation on the ground and there is need for third party independent assessments.
There is interesting tension evolving in policymaking with paucity of credible data and critical thinking at one level and at another large amount of data that is being made available on a fairly regular basis, which may also include junk data. “Challenge in a technological world is in being able to determine what are relevant and critical kinds of data needed for what kinds of policy making decisions,” said Yamini Aiyar, CEO and President, CPR adding that technology has helped leap-frog some critical gaps in delivery. However, there is need to exercise caution against perverse incentives creeping into systems very effectively using the shield of data used as administrative decision-making. She asked as to why is the state system so broken that it needs infusions of such high degree of scrutiny . “Too much of scrutiny at the wrong level can lead to too much of centralisation and under-performance of the system,” said Aiyar while accepting the need for a robust independent evaluation data mechanism.
Dhiraj Nayyar, Director for Economics and Policy for Vedanta Ltd and formerly with NITI Aayog felt that the existing statistical systems were designed in 1950s or 60s but the entire economic structure now has changed and become more complex. However, he argued that it is not right to say that the government is fudging or doctoring data. “I don’t believe the government doctors data. Government can say growth is 8 per cent, but if it is 3 per cent, people will feel the pinch. If you doctor data, it will not give you desired political outcomes. It is in the interest of government to get the data right,” insisted Nayyar. He further said that the government is now adopting market principles of competition, accountability and innovation on welfare schemes. And while a lot of junk data does come in, it can be immediately driven out. “PM Modi is conscious that welfare must reach the last person. Overall revamp of statistical system and third party verification needs to done. But you cannot doctor reality,” stressed Nayyar.
N R Bhanumurthy, a macroeconomist and professor with NIPFP disagreed that there is a rural distress today. He said that rural transformation today is visible through the substantial amounts being spent by centre and state governments. “Ten years ago we were only talking about outlays, now we are talking about outcomes. That itself shows that there is a huge transformation in the way statistical system has grown over a period of time,” he said. He also cited Samagra in Madhya Pradesh as an example where welfare programmes are being integrated to ensure there is no duplication of beneficiaries.
However, differing with Bhanumurthy, Yamini Aiyar said that there is rural distress today and the problem cannot be solved unless large sections of people are taken off-farms by first investing in agricultural productivity.
Making suggestions for the future, Dhiraj Nayyar underlined that there cannot be a trade-off between growth and welfare or growth and environment. Growth is the best welfare, he said adding that the government works well in mission mode and so something like right of clean drinking water as part of holistic approach to welfare economics will be a government priority he hoped. He also suggested that some projects and health schemes need to converge through efficient use of modern technologies for better reach and quality delivery of welfare schemes and services.
Issues regarding women restraining themselves from health check-ups and thus being out of the benefits of Ayushman Bharat is also being noticed recently. They need to be enthused to avail the welfare benefits. “Data shows that accessing secondary and tertiary schemes is specially skewed towards men,” accepted Paul. He also said that there is a vibrant opportunity for women to engage through primary healthcare. The government is pushing for ‘Jan Andolan’ to deal with societal issues and ensure participation of community such as for anaemia or breast cancer screenings.