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Mind the gap

Aarti Dhar
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While the government is extending the ambit of the Rashtriya Swasthya Bima Yojana, a huge gap exists on the delivery end

Rag pickers:The scheme has been extended for these workers as well.Photo: Ishaan Raghunandan
Rag pickers:The scheme has been extended for these workers as well.Photo: Ishaan Raghunandan

When Union Finance Minister P. Chidambaram announced extension of the Rashtriya Swasthya Bima Yojana (RSBY) — a health insurance scheme for below poverty line (BPL) families — to several other categories in his Budget speech in February, it brought a smile on the faces of the new beneficiaries.

As of now, the scheme covers 34 million BPL families and is proposed to be extended to other categories such as rickshaw, auto-rickshaw and taxi drivers, sanitation workers, rag pickers and mine workers. With a promise of access to cashless hospitalisation for over thousand aliments, the RSBY has often been described as a potential game changer in the public health sector.

However, an event organised in the Capital recently where over 150 participants shared their experiences regarding the actual implementation of the scheme, revealed a far from fairy tale story.

There exists a huge gap between the registered beneficiaries and actual hospitalisation. The latest figures on the Union Health Ministry website show that there are 34,096,044 active smart cards that are registered, while the number of hospitalisation claims is a mere 4,823,080.

While the provision of smart card and digitisation provides for a seamless and convenient option, the ground reality of limited awareness and understanding amongst the communities and gaps in coordination and implementation among the different stakeholders present formidable challenges for the scheme.

In this context, the success of RSBY depends largely on long-term planning through the entire life cycle of the scheme covering enrolment, post enrolment and long-term utilisation, the participants said.

Most of the civil society organisations have limited understanding of the scheme and are evolving strategies for increasing the stake of socially excluded groups – especially in terms of safeguarding their interests in the public-private partnership model of RSBY.

Poorest Areas Civil Society (PACS) that organised the event works with civil society organisations for equal and discrimination-free access to social security schemes and entitlements for the poor and socially excluded groups. Spread across seven of the poorest States, the programme engages on livelihood, health, nutrition and other entitlement schemes as a strategy to bridge the gap between schemes and poorest communities.

PACS works on RSBY through a twin-pronged strategy: making demand/supply channels more effective for greater benefit to the poor and creation of space for the community organisations to engage actively in the implementation and monitoring of RSBY scheme.

“Health costs are one of the key reasons that push and trap socially excluded communities in a state of poverty. This makes the potential of RSBY truly phenomenal and that is what needs to be harnessed by involving community based organisations,” Sam Sharpe, Head, DFID India.

Highlighting that community uptake is critical for the scheme to be successful, Rajan Khosla, director, PACS Programme, said that RSBY needs ownership by the poor people.

The PACS programme has been actively engaging with the implementation of RSBY in five of the seven States it works in. These are Uttar Pradesh, Bihar, Jharkhand, West Bengal and Odisha. It has signed Memorandums of Understanding (MoUs) with government agencies in these States.

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