“Dialogue, Data, and Partnerships”: Towards Universal Health Coverage in Uttar Pradesh

Sangeeta Singh, Chief Executive Officer, State Agency for Comprehensive Health and Integrated Services (SACHIS) has steered the Ayushman Bharat Pradhan Mantri Jan Arogya Yojana (AB-PM-JAY) in the largest state of India.

Priyamvada Kowshik, Journalist Health & Wellness, in conversation with Sangeeta Singh to understand the challenges and opportunities that lie ahead for Uttar Pradesh.

When you look back at the last three years of PM-JAY in the state, what have been the big lessons for you?

Two of the last three years of implementation of PM-JAY have been a relentless struggle for the entire country as we fought the pandemic. A big lesson learnt was that we evolved to be responsive. The year taught us how to manage crisis situations, improvise, and keep the scheme running efficiently. We were able to ensure continuity of service to beneficiaries. Communication and regular contact with stakeholders to a large extent has been a crucial factor in surmounting this. Dialogue has also helped us find and address the hurdles in beneficiaries availing services.

What do you think has been the biggest challenge in implementing PM-JAY?

One of the big challenges has been accurate beneficiary data. The scheme uses the Socio-Economic Caste Census (SECC 2011) data. There are two issues, one is that this excluded a lot of people from the marginalized population from the state, which we have over three years included through the state insurance scheme. The State’s policy decision to include families of Antyodaya Ration Card holders (a scheme that provides subsidized food to poor families) has expanded the base. The second issue is that SECC data is not comprehensive, which has affected the identification of the beneficiary. Unlike other states that had some form of state-managed insurance scheme running for its most vulnerable population, and could build on the existing data, we did not have a scheme before PM-JAY. Naturally, data that is running and cross-verified is richer. However, use of Antyodaya datasets has shown encouraging results as the data is verified and there has been visible growth in scheme enrolment and utilization since then.

A big learning for a scheme of this magnitude is that we should look closely at the data we have and ensure the dataset includes the categories we want to address. Incorporating the right kind of data and having the right attitude, that is a learning.

What are some of the initiatives to increase hospital participation? And what is the role of public hospitals?

Increasing the participation of public hospitals is very important, almost 40 percent of the hospitals are public facilities. We are conducting gap analysis of scheme utilization in public hospitals to understand some of the challenges. Based on this we will develop a targeted outreach with the public facilities. The Department of Health & Family Welfare is ramping up the infrastructure in public hospitals and filling in specialist positions which will have a positive impact on utilization and quality of care. NHA has also recommended incentive plans to increase public sector participation. When public hospitals start earning from the treatment provided under the PM-JAY, the scheme will benefit the people of the state. We are confident that in the coming year the public hospital participation will increase in the state.

What has been the role of the media in information dissemination, and do you look at media as partners too?

Yes. Engaging the press and partnering with the local media and channels impacts scheme utilization. The media workshop conducted a few months ago by our technical partners and Center for Advocacy Research (CFAR) was useful in clearing concepts and the finer aspects of PM-JAY for members of the media. We now know how to move forward and engage the press, partner with local newspapers and channels. When stories of beneficiaries are featured in the local media, it makes a positive impact, people are curious to know more and avail the scheme.

 What do you think are the priorities for you in 2022?

As we grow and add finer nuances to the systems and processes we have built, it is important to realize that growth comes from alignment with the right partners and building better interdepartmental coordination, as we have done last year. To strengthen these into mutually meaningful partnerships is one of the key agenda for 2022. All government schemes want the best for the beneficiary, so it makes sense to join hands.

Our partnership with Project Samuday, a CSR initiative of HCL Technologies in Hardoi district has been a step in the right direction. Our partnership objectives are mutually beneficial—they have been helping us with generating awareness, making Ayushman cards, educating the beneficiaries about PM-JAY and improving access to secondary and tertiary healthcare through the scheme in the district of Hardoi. This partnership has been a good learning experience and has also shown good results. This year we will be building a Partners Forum and bringing newer partners.