Implementation and execution of the Ayushman Bharat

Scheme in private and government hospitals.

SUBMITTED Assigned by Prof. Jabir Ali
BY Vaibhav Mendhe
Mansi Singh
HAHM22049
HAHM22023
Baisakhi Murmu HAHM22022
Nidhi Sharma HAHM22034
Divyansh HAHM22010
Ritik Raj HAHM22008
Mohit Gidwani HAHM22006
Abstract
 PMJAY is the world’s largest Government funded health
protection scheme covering about 50 crore beneficiaries.
 Monitoring and Evaluation are key for successful
implementation and ensuring the intended results of
such a large scheme like AB-PMJAY.
 ‘Ayushman Bharat programme is India’s most definitive
step so far towards promotive, preventive, curative,
palliative and rehabilitative aspects of Universal Health
Coverage.
Introduction

The Ayushman Bharat initiative is India's most significant move yet toward promoting health and wellness. Health
and wellness centres (HWCs) provide primary care, and the Pradhan Mantri Jan Arogya Yojana (PMJAY) offers
financial security for accessing medical care at higher levels.

The Ayushman Bharat program will provide comprehensive health care to 50 crore people, including treatment for
noncommunicable diseases and mother and child health care. The program will establish 1.5 lacks Health and
Wellness Centres (HWCs), which will provide coverage for hospitalisation for secondary and tertiary care at the
cost of Rs. 5 lacks per household per year.

The programme can be implemented by insurance companies, directly by trusts or societies, or in a hybrid
manner, that is, partially through insurance and partially through trusts. There are no restrictions on the size of
eligible families, ensuring that all members, especially girls' children and senior citizens, are covered. In other
words, a beneficiary from one state may receive care at any hospital accredited by the nation’s government.
Key Characteristics

 The current budget proposal plans to convert 1.5 lakh sub-health centres and primary health centres
into Health and Wellness Centres (HWCs).
 Everyone living in the service area is allowed to use the free services provided by HWCs.
 In addition to primary health care (MCH), HWCs will provide a broader range of services, such as
noncommunicable disease (NCD) care, palliative care, and rehabilitative care. HWCs will also
offer a platform for teleconsultation.
Key Features
•Through a network of licensed healthcare providers, health coverage of up to Rs. 5,00,000 per
family per year is available for secondary and tertiary care hospitalization.

•Up to 15 days of hospitalization and 3 days of pre-hospitalization are provided.

•There is no cap on family size, age, or gender; all pre-existing conditions are covered.

Protection under PMJAY

About 40% of the population will receive the vital secondary and tertiary hospitalisation
treatment through PMJAY. This equates to roughly 10.74 crore families in absolute terms.
.
 The Framework of MEDICAL PACKAGES
The Health and Wellness Centres within Ayushman Bharat aim at the following:

I. Enhanced Service in the following packages at operational AB-HWCs :

i. Care for mothers and young children

ii. Services relating to family planning, prescription drugs, and other reproductive health issues

iii. Screening, detecting, treating and managing chronic and non-communicable diseases like TB and hepatitis.

II. Enlarged Secondary healthcare Health and Wellness Centres list of medicines and diagnostics to make more
medicines available

III. Wellness goals

iv. Integrating Yoga into the healthcare delivery system

v. Engaging with the Ministry of AYUSH at the Provincial and District levels to achieve the following:

 Group of local Yoga Instructors at the Health and wellness Level.

 A pool of local yoga instructors at the HWC level .

 Institutional Arrangement for the implementation of the scheme:-
I. In pursuance of the decision of the Cabinet, National Health Agency was registered as a
Society under the Societies Registration Act, 1860 on 11.05.2018 to manage the AB-
PMJAY scheme.
II. National Health Authority (NHA) in the form of an attached office of Ministry of
Health &Family Welfare with full functional autonomy, consequent upon the Cabinet
decision
III. State Health Agency (SHA) is the nodal agency responsible for implementation of
PMJAY in the state headed by CEO.
IV. In addition to the state level posts, a District Implementation Unit (DIU) is also setup
to support the implementation in every district included under the scheme
FINANCIAL MECHANISM OF THE SCHEME

 AB-PMJAY is fully funded by the Government, and the cost is shared between the
Central and State Governments.
 The ratio of contribution towards premium between Centre and State is 60:40 in all
States except North Eastern States & 3 Himalayan States where the ratio is 90:10
with an upper limit for the Centre.
 To ensure that the funds reach SHA on time, the transfer of funds from the Central
Government through NHA to state health agencies.
 NHA to State Health Agencies may be done through an escrow account directly.
 Budget allocation and beneficiaries under Scheme Ayushman
Bharat:
 Total of Rs. 2400 Crore was allocated during the financial year 2018-19, out of which Rs.
1965 crore was released to the states/UTs during the year. Also the project has been
allotted Rs. 6400 crores in funding for the fiscal year 2021–2022.
 Approximately 1.05 million hospital admissions totaling approximately Rs. 11,862 crores,
have been permitted under AB-PMJAY from March 1, 2020, to July 19, 2021.
 Approximately 23,000 hospitals have been appointed under AB-PMJAY as of July 20,
2021, by various State/UT Governments.

 the Indian government has committed to establishing 1,50,000 Health and Wellness
Centres (AB-HWCs) by modernizing Sub Health Centres (SHCs) and rural and urban
Primary Health Centres (PHCs).

 As on 20th July 2021, 77,406 AB-HWCs are operational across the country
More than 52 % J&K population enrolled
under AB PM-JAY SEHAT scheme
 the Indian government has committed to establishing
1,50,000 Health and Wellness Centres (AB-HWCs) by
modernising Sub Health Centres (SHCs) and rural and
urban Primary Health Centres (PHCs).

 As on 20th July 2021, 77,406 AB-HWCs are

operational across the country

  More than 52 percent people have enrolled themselves

under Ayushman Bharat Pradhan Mantri Jan Arogya
Yojana (AB PM-JAY) SEHAT Scheme in Jammu and
Kashmir till January 01, 2022
 In the Kashmir division, Shopian district has registered
the highest number of beneficiaries and in the whole
J&K, Rajouri tops the list.
 SWOT Analysis of the AB-PMJAY
Strength
i. Coverage of the plan
ii. A committed institutional framework
Opportunities
i. Expanding the program's reach and
coverage
ii. Enhancing the infrastructure and quality
of the public health sector
Weakness
i. Orissa, West Bengal, Telangana, and
Delhi did not participate.
ii. Private healthcare providers should have
participated to their fullest potential
Threats
i. Various state-level capacities for the
management of the scheme.
ii. Keeping up with the rural side response
(especially in the rural areas).
MECHANISMS FOR MONITORING TO ENSURE SUCCESSFUL
IMPLEMENTATION OF THE PLAN

Centres for Health & Wellness under Ayushman Bharat - Among their other
responsibilities, they monitor the implementation of national health programs at hospitals and other
healthcare facilities that may fall under their administrative purview. Local bodies are expected to
play a significant part in successfully administrating NHM schemes and programs, including AB-
HWCs, under NHM. Village Health Sanitation & Nutrition Committee (VHSNC) is established at
the village level.
Pradhan Mantri, Ayushman Bharat Arogya Yojana, Jan - The National Anti-Fraud Unit
(NAFU) was established with the main duty of preventing, detecting, and deterring fraud and abuse
under PMJAY in order to achieve this goal. The many dashboards created using business
intelligence technologies aid in identifying the gaps and provide a summary of the progress. The
National Health Authority is aware of the problem and has already taken several measures to
protect the program.
 CONCLUSION

 Through the following functional disciplines, Beneficiary operation, sale operation,

Provider operation, and Support function operation (comprising functions similar to
capacity development, grievances, frauds and abuse, call centres, etc.
 The PMJAY program is India's most significant stride in promoting, preventing,
curing, palliative, and rehabilitative components of universal health coverage thus
far.
 Complaints and public grievances are filed, recognised, escalated for appropriate
action, handled, and monitored via a well-defined complaint and public grievance
redressal mechanism.
Thank You