1. Ayushman Bharat Scheme
By- Dr. Shalli

2. Introduction
Healthcare in India is largely underpenetrated- 1.25% of the GDP on health & underperforming public healthcare system
Nearly 55–60 million Indians are pushed into poverty every year because they are unfortunately compelled to shell out half of their annual household expenditure to meet medical needs.

3. Ayushmaan Bharat Scheme- Introduction
“Ayushman Bharat - National Health Protection Scheme” which will cover over 10 crore poor and vulnerable families (approximately 50 crore beneficiaries) providing coverage upto 5 lakh rupees per family per year for secondary and tertiary care hospitalization.
Prime Minister Narendra Modi launch programmes of Ayushman Bharat National Health Protection Mission in Chhattisgarh on Ambedkar Jayanti 14/5/2018)
AB-NHPM will subsume the on-going centrally sponsored schemes - RashtriyaSwasthyaBimaYojana (RSBY) and the Senior Citizen Health Insurance Scheme (SCHIS)

4. Launch of AYUSHMAN BHARAT
14th April 2018-Honorable Prime Minister launched the first Health and Wellness Centre at Jangla, Bijapur, Chattissgarh

5. Objectives National health protection scheme:
Focus on general wellness of the poor people. Providing the medical benefit to the poor people of the nation. The govt. will share the steps regarding enrollment of the scheme
Health and wellness centers:
Establishing health and wellness center at the nearest distance so that the patients need not travel a long distance and can avail medical facilities within the shortest time span
Along with these health scheme, 24 medical colleges and Govt. hospitals will be established across the nation. Each state will have at least one Govt. medical college under the new India 2018

6. AYUSHMAN BHARAT – Rationale CONTINUUM OF CARE – CPHC & PMRSSM
TERTIARY
PMRSSM
SECONDARY
Referral
Preventive, Promotive, Curative,, Rehabilitive & Palliative Care
PRIMARY
Unmet need: NCDs/other Chronic Diseases
NCDs account for 62% mortality; 55% Premature, 62% OOPE of Total Health Expenditure
NSSO data (71st Round. 2014) shows 11.5% and about 4% in rural and urban areas respectively sought any form of Outpatient care - at or below the CHC (secondary health centres) (except for Childbirth).
Presently the Sub centre and Primary Health centre- currently provide preventive care mostly related to maternal and child health,
The need for primary health care is met by unqualified practitioners. particularly in the high focus states,
There is a huge unmet need for early detection and management of Non-communicable diseases and other chronic conditions. NCDs currently account for 62% mortality of which 55% is premature mortality.
Studies show that losses associated with physical NCDs is expected to be about $3.55 trillion by 2030
Existing services: RMNCHA
CONTINUUM OF CARE – CPHC & PMRSSM

7. National Health Protection Scheme

8. Salient Features
Ayushman Bharat - National Health Protection Mission will have a defined benefit cover of Rs. 5 lakh per family per year.
Benefits of the scheme are portable across the country and a beneficiary covered under the scheme will be allowed to take cashless benefits from any public/private empanelled hospitals across the country.
Ayushman Bharat - National Health Protection Mission will be an entitlement based scheme with entitlement decided on the basis of deprivation criteria in the SECC database.

9. Salient Features The different categories in rural area include
families having only one room with kucha walls and kucha roof;
families having no adult member between age 16 to 59;
female headed households with no adult male member between age 16 to 59;
disabled member and no able bodied adult member in the family;
SC/ST households; and landless households deriving major part of their income from manual casual labour,
Also, automatically included families in rural areas having any one of the following: households without shelter, destitute, living on alms, manual scavenger families, primitive tribal groups, legally released bonded labour.
For urban areas, 11 defined occupational categories are entitled under the scheme.

10. Salient features
One of the core principles of Ayushman Bharat - National Health Protection Mission is to co-operative federalism and flexibility to states.
To control costs, the payments for treatment will be done on package rate (to be defined by the Government in advance) basis.
For giving policy directions and fostering coordination between Centre and States, it is proposed to set up Ayushman Bharat National Health Protection Mission Council (AB-NHPMC) at apex level Chaired by Union Health and Family Welfare Minister.

11. Salient features
States would need to have State Health Agency (SHA) to implement the scheme.
To ensure that the funds reach SHA on time, the transfer of funds from Central Government through Ayushman Bharat - National Health Protection Mission to State Health Agencies may be done through an escrow account directly.
In partnership with NITI Aayog, a robust, modular, scalable and interoperable IT platform will be made operational which will entail a paperless, cashless transaction.

12. Health and wellness Centres

13. Organization of Comprehensive Primary Health Care
Family/Household and Community Level
Health and Wellness Centres
First Referral Level
Comprehensive Primary Health Care : Preventive, Promotive, Curative, Palliative, and Rehabilitative and delivered close to where people live.
Sub centres/PHC/UPHC strengthened as HWC
Take fromog
General medical Consultation (at PHC/UPHC);
Specialist consultation and First level of hospitalization at CHC/SDH/DH

14. CPHC - ESSENTIAL PACKAGE OF SERVICES
Care in Pregnancy and Child-birth.
Neonatal and Infant Health Care Services
Childhood and Adolescent Health Care Services.
Family Planning, Contraceptive Services and other Reproductive Health Care Services
Management of Communicable Diseases: National Health Programmes
General Out-patient Care for Acute Simple Illnesses and Minor Ailments
Screening, Prevention, Control and Management of Non- communicable Diseases
Care for Common Ophthalmic and ENT Problems
Basic Oral Health Care
Elderly and Palliative Health Care Services
Emergency Medical Services including Burns and Trauma
Screening and Basic Management of Mental Health Ailments

15. Quality of Care Key principles - Provision of Patient Centred Care
Enable Patient Amenities at HWC
Adhere to standard treatment guidelines and clinical protocols for care provision
Achieve Indian Public Health Standards with regards to HR, infrastructure, equipment, service delivery and supplies
National Quality Assurance Standards for HWCs will be developed
Patient satisfaction to be captured through IT systems

16. Robust IT System – to meet diverse needs of different stake holders
Patient centric –
Unique Individual ID
Individual health record
Family health folder-SECC data/mapping PMRSSM
Facilitates continuum of care through alerts
Facilitates access to patient care information
Service Providers -
Enables continuity of care across levels
Generates workplans/serves as job aids
Facilitates use of platforms like MOOC and ECHO
Facilitates follow up and compliance to treatment
Decision Support System for service providers at various levels
Programme Managers-
Dashboard for monitoring at different levels
Provide monitoring reports to assess performance for payments
Overarching system – integration of all existing IT systems Eg- RCH portal/ NIKSHAY/ IDSP/ HMIS/ PMRSSPM

17. Health promotion Community mobilization and Intersectoral Convergence
“Health in All” Approaches – NHP 2017 Recommendations -
Swachh Bharat Abhiyan
Balanced, healthy diets and regular exercises
Addressing tobacco, alcohol and substance abuse
Yatri Suraksha – preventing deaths due to rail and road traffic accidents
Nirbhaya Nari –action against gender violence
Reduced stress and improved safety in the work place
Reducing indoor and outdoor air pollution
States to develop strategies and institutional mechanisms in each of the seven areas, to create “Swasth Nagrik Abhiyan” –a social movement for health.

18. Health Promotion by Ayushman Ambassadors
Age appropriate, skill-oriented, theme based, graded curriculum for the teachers (primary, middle and high school)
2 teachers in every school as “Health and Wellness Ambassadors”, trained to transact health promotion/disease prevention through interesting activities for one hour every week
20 hour sessions delivered through weekly interactive classroom-based activities
All Tuesday -Health and Wellness Day in the schools
Students will act as Health and Wellness Messengers in the society.
Regular reinforcement of messages/themes through IEC/BCC activities such as interactive activities/posters/class room/Assembly discussion

19. Infrastructure Branding / Colour code Citizen Charter Space for –
Examination room with adequate privacy and Telehealth
Diagnostics and medicine dispensation
Wellness room
Waiting area
IEC
Labour room at delivery points
Alternate prototype designs will be provided
5. Display boards –
Contact Details of Primary Care Team and referral centres
Jurisdiction of Gram Panchayat/ Urban Local body representatives

20. Major impact
AB-NHPM will have major impact on reduction of Out Of Pocket (OOP) expenditure on ground of:
i) Increased benefit cover to nearly 40% of the population, (the poorest& the vulnerable
ii) Covering almost all secondary and many tertiary hospitalizations. (except a negative list)
iii) Coverage of 5 lakh for each family, (no restriction of family size)
   This will lead to 
increased access to quality health and medication.
the unmet needs of the population which remained hidden due to lack of financial resources will be catered to, 
timely treatments, improvements in health outcomes,
patient satisfaction,
improvement in productivity and efficiency,
job creation thus leading to improvement in quality of life.

21. Expenditure involved
The expenditure incurred in premium payment will be shared between Central and State Governments in specified ratio as per Ministry of Finance guidelines in vogue.
The total expenditure will depend on actual market determined premium paid in States/ UTs where AB-NHPM will be implemented through insurance companies.
In States/ UTs where the scheme will be implemented in Trust/ Society mode, the central share of funds will be provided based on actual expenditure or premium ceiling (whichever is lower) in the pre-determined ratio.

22. Summary