How PM-JAY Empowers Women With Choice
From policy makers to field workers and beneficiaries, women tell us about the successes and challenges of the Maternal and Child Health packages of PM-JAY
The Pradhan Mantri Jan Arogya Yojna (PM-JAY) aims to provide financial protection against catastrophic health expenditure for secondary and tertiary care through over 1300 healthcare packages. Within these are around 59 packages and 77 procedures that provide a cover for Obstetrics and Gynecology care complementing the other health interventions towards better health outcomes for mothers and children. While the Janani Sukarsha Yojna (JSY—a safe motherhood intervention under the National Health Mission with the objective of reducing maternal and neonatal mortality by promoting institutional delivery among pregnant women) entitles all women to free care and a cash incentive for institutional delivery, PM-JAY compliments JSY, by adding another layer of care for the beneficiaries. It provides women with high risk pregnancies the choice to seek treatment in a public or private facility.
No scheme of this scale is devoid of challenges. There are challenges related to enrollment and awareness on the entitlements, getting pregnant women early in the PM-JAY system, referrals to private facilities, service availability, quality and value that continue to be areas that implementers and policymakers continue to untangle.
Below is an account of women of the scheme—from policy makers to those ensuring last mile delivery of PM-JAY, about the successes, challenges, high points and somber moments working on PM-JAY.
At the Frontlines
Versha Maurya, an ASHA worker from Laulai, Chinhat block, has been actively involved in creating awareness for PM-JAY and enrolling beneficiaries into the scheme in her village. Most of those entitled for PM-JAY have been enrolled and Versha continues to follow up on beneficiaries who may have been left out because of lack of identification documents. One of her many tasks is to ensure complete antenatal care, institutional delivery and postnatal care for pregnant women in her village, for which she assists women to the Community Health Centre in Chinhat. After being oriented with the guidelines of PM-JAY, she is now aware that beneficiaries also have the choice of opting for care in private hospitals in high risk pregnancy cases, which may require a cesarean delivery and also for neonatal care. “Every month we have 2 to 3 deliveries in our village. If any of the pregnant women are also a PM-JAY beneficiary and have been alerted of complications, I inform them of their entitlements to seek care at an empaneled private facility without spending money if they want,” says Versha.
Dr Smriti Mishra, joined the PM-JAY implementation team of Azamgarh in 2018, as the District Program Coordinator. She is a qualified dentist and has worked for the community all her life. Her role in leading the implementation in Azamgarh includes ensuring 10.56 lakh PM-JAY beneficiaries get access to healthcare. For which she coordinates with hospitals, organizes enrollment camps, and liaises with the district functionaires. “PM-JAY cover for obstetric and gynecology care has come as a boon for women. While our district hospitals continue to provide care, in my district there are 17 private hospitals, and 10 have opted for obstetric and gynecology specialty and we need to increase that so that women have more choices. I am working on this so we can improve the network and ease of access for the beneficiaries,” says Smriti who believes the scheme empowers vulnerable women with choice.
In Purahati village of Ambari, 34-year-old Anjana Jaswal* (name changed) delivered a baby boy in January this year. Her two older daughters aged 13 and 9 years were delivered in the government district hospital. “In my third pregnancy during the antenatal check up I was told there is a complication and may need a surgical delivery. My village ASHA informed me that as a PM-JAY beneficiary, I am eligible for care from private hospitals empaneled under the scheme. I was happy and my son was born in a private hospital. I did not have to pay anything and was provided nutritional supplements at the time of discharge,” she says, expressing a deep satisfaction with the care provided to her.
Drivers from the State
Nitu Singh is Manager, Operations, at State Agency for Comprehensive Health and Integrated Services (SACHIS), Lucknow, the implementing body of PM-JAY in Uttar Pradesh. She tells us that one of the issues that comes up with maternal and child care packages and is now being actively addressed, is that of enrolling a new member (daughter in law) in a PM-JAY beneficiary family. Currently, a marriage certificate is necessary for enrolment into the scheme for newly married women. “We have suggested to the National Health Authority to ease enrolment via Aadhar card or ration card. Singh is also hopeful that with the release of the government order to incentivise ASHAs for their role in helping beneficiaries avail the scheme, PM-JAY uptake will see an improvement especially among women.
Manisha Tripathi, who leads the work for ACCESS Health in Uttar Pradesh, says the government’s decision to include nearly 1.5 lakh ASHAs into the PM-JAY will bring more women under the insurance cover. At the field level, ASHAs are connected to the community and play a huge role in mobilizing and creating awareness among pregnant women. “Maternal and child health care in rural areas begins with the public sector. Strengthening the public sector in informing beneficiaries about the choice of care is necessary to help the beneficiary make an informed choice,” she says. “Continuum of care is the vision of Ayushman Bharat reforms for which there is a need for more coordination and setting up referral pathways so the beneficiary can truly exercise her choice,” says Tripathi whose team provides technical support to SACHIS.
Policy planners
Dr. Lily Singh, Director General, Family Welfare Division of Uttar Pradesh has been vocal about the need for ensuring early identification of PMJ-AY beneficiaries to ensure they get the entitled care—a big part of which is the choice of care at a public or private hospital. “We are working on strengthening First Referral Units and conducting a review of PM-JAY fund utilization to understand if they are being optimally utilized to improve the quality of service for the beneficiary,” says Dr Lily Singh. Building better coordination between ASHAs and the Arogya Mitra will also make an impact on scheme uptake, she believes.
Her department has been actively involved in finding ways to simplify the process of inclusion of new members- married women daughters-in-law into PM-JAY of an entitled family, and tackle other common errors in documentation that lead to rejection.
“The aim is to identify PM-JAY beneficiaries among women at public and private facilities, so that these mothers can get the cashless and quality care they are entitled to. Greater convergence between SACHIS and the Department of Family Welfare will ensure that beneficiaries get timely intervention and help,” she says.
Mrs Sangeeta Singh, CEO, SACHIS has been at the helm of the scheme implementation for the last three years. She is happy that from the total hospital admissions, women accounted for nearly 45 percent (4.9 lakh). This includes care for oncology (6.19 percent out of total female utilization) and ophthalmology (18 percent). For Obstetric and Gynecology care 10 percent women availed services. “We still live in times where women’s health is not a priority, but it is encouraging that PM-JAY has provided a mechanism for families to prioritize care for women’s health needs, which tells us that we are in the right direction,” says the dynamic CEO.
Specifically on Obstetric and Gynecology care, 38 percent utilization is for institutional deliveries and both public and private have provided services equally.
However, we need to expand services especially in aspirational districts where the private participation is low and negligible. For me, making the choice possible for the women is of utmost priority so that when government facilities fall short private care comes in. “For this we are working on making the scheme more attractive by revising the pricing of delivering care, this will give an additional incentive to provide care to a greater number of women,” says Mrs Singh.