In Uttar Pradesh, a remarkable achievement has been accomplished in the Ayushman Card campaign, with a record-breaking five lakh plus cards being issued in a single day. This accomplishment outshines the previous record of 2.75 lakh cards created in a single day at the end of September. The state has streamlined the process with a mobile app, allowing anyone to easily apply for an Ayushman Card. The campaign, which ends today, has made Uttar Pradesh the frontrunner in Ayushman Card issuance across the country. This initiative aims to provide healthcare benefits to a larger population, and the mobile app simplifies the application process. We speak to  IAS officer Sangeeta Singh, the current  Chief Executive Officer of  State Agency for Comprehensive Health and  Integrated   Services- Ayushman Bharat – Pradhan Mantri Jan Aarogya Yojana of Uttar Pradesh to understand how UP achieved this remarkable feat.  Singh is responsible for implementing the Ayushman Bharat Pradhan Mantri Jan Arogya Yojna in the state.

Excerpt from the interview:

Uttar Pradesh has done a great job issuing PMJAY cards. Can you provide the strategy that has been adopted in making it a huge success?

In the PMJAY project, the role of coordination and management is crucial. Success in this endeavor is attributed to a combination of hard work, teamwork, motivation, and careful strategies. The credit for this success is shared among the dedicated team members who work as a closely-knit family-like unit, constantly inspiring and supporting each other. One key aspect of the project involves strategizing and making cost-effective adjustments as necessary. Additionally, the vision and guidance of our principal secretary are instrumental in achieving our objectives.

Importantly, we focus on identifying the critical needs and priorities of the project. Currently, a significant emphasis lies on producing beneficiary cards efficiently. To reach those individuals who were previously unreached, we collaborated with the National Health Authority to obtain essential data. A recent breakthrough in the National Health Authority’s efforts, which has proven highly successful and is a point of pride for Uttar Pradesh, is the development of self-registration software. This means that anyone with beneficiary data can independently create their card by accessing a specific URL. This approach has gained popularity, especially on social media platforms, where people share their experiences and offer guidance on the process.

The strategy also hinges on community involvement and building trust in the scheme. Community engagement is vital, and we have found that volunteers from villages play a significant role. Young individuals with intermediate or B.A. qualifications, who are knowledgeable about the process and possess some technical skills, can provide assistance and guidance to others in their communities. The involvement of these local volunteers has been a catalyst in increasing awareness and participation among the population. This further reinforces the strategy of community engagement and trust-building.

Another critical aspect is ensuring trust in the healthcare system. It’s essential that the public trusts that the hospitals and healthcare providers will not exploit or overcharge beneficiaries. Therefore, addressing beneficiary grievances promptly is a priority. Timely responses to complaints and technical issues, such as card downloads, admissions, or financial concerns, help build trust and credibility for the scheme.

In conclusion, while hard work is undoubtedly essential, fostering a change in mindset, enhancing community engagement, and building trust in the healthcare system are equally crucial components of our success in the PMJAY project.

Private health centers also have a lot of involvement in this. What kind of programs are you guys doing with them so that they can also be encouraged to participate in this?

This topic is very dear to my heart because we invested significant effort in this project. I am delighted to share that when the scheme was initiated before 2018, a National Health Insurance Scheme was already in operation in Uttar Pradesh for a few years. However, this scheme had encountered issues with hospitals not receiving timely payments from a company that managed it. This resulted in a decrease in hospital interest in participating. Initially, substantial effort was required to onboard hospitals, which involved personal outreach and discussions with various stakeholders to encourage their participation. The primary challenge faced during the initial onboarding of hospitals was their concerns regarding timely payments. They were apprehensive about whether they would receive their payments promptly. Therefore, ensuring timely payments became our responsibility. While there might be delays in some cases, we strive to expedite payments. Our Honorable Chief Minister Yogi Adityanath emphasizes the importance of ensuring timely payments, and we have reduced the turnaround time for payments to 14 to 15 days, which may vary slightly. To address these challenges, we have been hiring more medical auditors and providing continuous training. Additionally, we have expanded our support through the backend on the Go platform.

In the second year, we organized provider workshops in various districts. During these workshops, we engaged with hospitals that had not yet joined the scheme, explaining the advantages of participation and addressing any concerns they had. We highlighted the catchment area of their districts, emphasizing the potential for increased business if they became part of the scheme. We also explained the benefits of being associated with such a substantial healthcare initiative. These workshops were conducted in five districts, with the participation of various stakeholders.

As a result of these efforts, we have successfully onboarded over 3,544 hospitals, of which 1,119 are public hospitals, and more than 2,500 are private hospitals, including large multi-specialty and corporate hospitals. Currently, only a few hospitals remain pending for approval.

We have managed to alleviate the initial apprehensions of hospitals by consistently addressing their concerns about payment rates and the application process. We have worked in collaboration with the National Health Authority and the Ministry of Health and Family Welfare to improve and standardize the rates and packages. Hospitals now have a clear understanding of the packages available and the process for requesting changes or additions.

Our commitment to continuous improvement and problem-solving has resulted in a robust and efficient system. Through ongoing workshops and engagement, we aim to enhance the scheme further, all while maintaining a patient-centric focus. The results of these efforts have been truly gratifying, and we remain dedicated to delivering quality healthcare services to the people of Uttar Pradesh.

 You have set a record of making 5 lakh PMJAY cards in a day. How did you achieve that?

We’ve achieved a remarkable milestone – 545,000 cards to be precise, breaking all records in Uttar Pradesh. It’s a moment of immense satisfaction, as everyone seeks validation. It’s a source of pride that Uttar Pradesh generated 545,000 cards in a single day.

Our top-performing district, Aligarh, created 29,000+ cards, closely followed by Telangana, a whole state in itself, producing 27,000 cards. It’s indeed a time for Uttar Pradesh to celebrate its accomplishments. We’re singing a proud tune in the morning, making a real impact in our country.

Credit for this success goes to the dedicated district magistrates who worked tirelessly. The Chief Medical Officers (CMOs) played a vital role by taking the lead. Our heartfelt appreciation goes to the entire team involved. It’s a significant opportunity, and they seized it with full credit.

This achievement reflects our strategy of reaching out to the people. Two critical components are contributing to our success: accessible data and smoothly functioning software. Cards are being processed in a mere 10 to 15 days, thanks to our strong technical team support. The system is robust and accessible throughout the day, which led to the significant milestone of 545,000 cards by 11 o’clock at night.

The joyful atmosphere spread from here to the Ministry of Health and Family Welfare (MHA), uniting everyone. We celebrated, joked, and interacted in official groups, all sharing in the happiness. It’s an incredibly joyful time for us, and we take pride in achieving these milestones.

Our journey started with 1 lakh, then 2 lakhs, 3 lakhs, 4 lakhs, and now we stand at 3 lakhs plus as of now. Even if we don’t reach 5 lakhs today, we will continue to work and assist others. It’s an all-encompassing strategy where everyone plays a part.

 Recently, the Minister of Health, Shri Mansukh Mandviya has awarded you. Please share a little about this experience.

I forgot to mention how the idea for our recent interventions, reaching out to beneficiaries and hospitals, came about. This concept stems from a strategy that has effectively reached and informed the public. The state of Uttar Pradesh awarded recognition for this strategy. The intervention is known as the “Green Channel.”

The Green Channel is a system involving 26 hospitals, with 12 more set to join. This innovative approach streamlines the flow of funds to hospitals without unnecessary delays. When a claim is raised, the hospital receives 50% of the payment immediately, bypassing the typical claim adjudication process. This method establishes trust in hospitals that have demonstrated good intentions and effective service.

For their commendable performance, these hospitals have received a cash flow award under the Ayushman Bharat scheme. It’s a mutually beneficial approach where hospitals treat patients, and in return, we support them in obtaining consumables, medicines, and enhancing their infrastructure. This strategy aligns with the successful implementation of the scheme.

How has PMJAY helped improve overall health infra and health-seeking behaviour of people in UP?

 I’d like to highlight the heartening progress we’ve observed, especially in women’s health-seeking behavior.

This year, our tagline aligns with Ayushman Bharat’s five-year journey – “Health, Prosperity, and Respect.” Health encompasses not only physical well-being but also prosperity achieved through the significant payouts of Rs 34,000-35,000 crore by Ayushman Bharat. These payouts reduce out-of-pocket expenses, allowing individuals to allocate their saved funds to various other activities. This combination of health and financial stability results in a profound sense of respect. The most remarkable transformation we’ve witnessed is the improved health-seeking behavior of women. This change is empowering because it gives women a voice. The health sector has evolved significantly to cater to their needs, ensuring they receive the attention they deserve. In the past, elderly women with ailments, such as hip fractures, faced significant challenges. Today, thanks to Ayushman Bharat, we see women undergoing total hip and knee replacements, enabling them to actively contribute to their families. They’re no longer forced to struggle for survival, breaking free from dependence on others. This shift has shattered the age-old perception that questioned the investment in women’s health.

Our efforts extend beyond surgical interventions to addressing various health issues, including cancer. We’re paying special attention to basic cancer treatment, focusing on cancer screening, non-communicable diseases (NCDs), and cancer-related training. Our commitment to improving overall health is evident in the incentives provided to strengthen public hospital infrastructure. Although we still have progress to make in terms of cost comparison, we’ve seen hospitals bolster their infrastructure. This not only reduces their liabilities but also enables them to avail benefits. Furthermore, the incentives offered to public hospitals are not exclusive; private hospitals also receive additional incentives for participating. This inclusive approach is driving the overall success of our healthcare initiatives.

While you have made great strides in ensuring a record number of cards are made, how do you ensure that such cards are actually being used by beneficiaries to seek better healthcare?

Currently, we’re witnessing rapid growth in data, particularly in managing small-scale data for the scheme. Initially, when the scheme commenced, we implemented a process of daily pre-authorization. This pre-authorization process allowed individuals to have their claims booked when they approached a healthcare provider. It involved approving and authorizing the treatment, giving the green light for them to proceed. At the scheme’s inception, we started with a relatively smaller data set, around 400 to 500 cases. However, as time passed and the scheme evolved, the data sets expanded significantly. We’re aware that we might still be behind some other states in terms of data volume, and we’re actively working on addressing this gap. Since the scheme’s inception, we’ve facilitated over 25,00,800 treatments, amounting to a payout exceeding Rs 3500 crore. This significant number reflects the tangible impact of the scheme on the lives of people who have received treatments and benefited from it. Regarding PMJDY card-related confusion among the public, our department has taken several steps to mitigate this issue. Our Information, Education, and Communication (IEC) efforts include using jingles, campaigns, and hoardings to raise awareness about the hospitals covered by the scheme. Hoardings have been placed in every district, often in the District Magistrate and Chief Development Officer’s offices, providing information about the affiliated hospitals and the areas where treatment is accessible under the scheme. This multi-pronged approach is aimed at ensuring that people are well-informed about their healthcare options.

How do you ensure that information about PMJAY cards reach people in the remotest parts of the state? What strategies do you employ to achieve this goal?

Our Information, Education, and Communication (IEC) initiatives employ various methods to inform the public. These include jingles, campaigns, and hoardings designed to raise awareness about the hospitals available for treatment under the scheme. We’ve taken proactive steps in every district by investing in hoardings, which are prominently displayed in the District Magistrate’s office or Chief Development Officer’s office. These hoardings provide essential information about the affiliated hospitals and the range of treatments they offer under the scheme.

Additionally, we’ve established a dedicated call center with the contact number 1800 1844 44. This call center serves as a valuable resource for individuals to inquire about their eligibility, seek guidance on selecting the appropriate hospital, or address any card-related issues. It’s a convenient way for people to access information on where to receive care. Furthermore, the list of hospitals participating in the scheme is readily available on our website. To access this information, individuals can simply log in to Ayushman UP.NIC.in, ensuring easy access to details about healthcare facilities. We’ve also utilized community radio, led by Rafi Saheb, to reach out to the public. Through community radio and other small interventions like paper cuttings, we aim to enhance awareness and understanding of the scheme among the community.

Could you please elucidate the significance and influence of the Health Management Information System in bolstering the achievements of the Ayushman Bharat Digital Mission in Uttar Pradesh?

Ayushman Bharat comprises two integral pillars: Pradhan Mantri Jan Arogya Yojana, also known as PMJAY, and Ayushman Bharat Digital Mission (ABDM).

Under PMJAY, individuals have coverage of up to Rs 5 lakh for tertiary care, secondary care, and some primary care treatments, particularly for inpatient care. Simultaneously, through Ayushman Bharat Digital Mission (ABDM), unique IDs are generated for beneficiaries. These IDs are essential for linking their health records with hospitals and creating an environment where a patient’s health card and records are readily accessible online. This will allow doctors to review their previous medical history, enabling them to prepare for systematic treatment, which is a long-term strategy in progress.

Currently, when an Ayushman card is generated, a corresponding ID is also created. However, for those who aren’t Ayushman beneficiaries, which includes the entire population of Uttar Pradesh, a separate Ayushman ID must be generated. We encourage individuals to generate and share their ID numbers for their benefit. This digital record of health history will simplify future medical treatments. Doctors can access and review past prescriptions, current medical records, and make informed decisions on treatment plans. Additionally, hospitals can be seamlessly linked to this digital infrastructure, offering exciting possibilities for improved healthcare services.

Could you please provide some information about the recent inclusion of certain categories of ration card holders in this program?

Presently, approximately 50 lakh families have been added to the program. These families were previously eligible household ration cardholders and had six or more members within their units.

As of today, out of these 50 lakh families, about 40 lakh families have already been incorporated into the scheme. Since the commencement on September 17th, in just 11 days, a substantial progress of 7% has been made. This equates to over 20 lakh individuals having their cards processed during this short span, marking an impressive increase.

It’s worth noting that this isn’t the only category of ration cardholders being included. Another segment involves approximately 11.6664 lakh families, which, when extended to account for individual members, reaches around 22 lakh families.

These families consist of only senior citizens, where all members are 60 years of age or older. This inclusion is significant, as it ensures that elderly citizens, who may not have other means of support, have access to healthcare coverage. This initiative aligns with the government’s commitment to providing health coverage to those receiving old age pensions, extending valuable benefits to this demographic. The data for these families is sourced from the district, and efforts are underway to begin the card issuance process for them.

There has been a significant decline in maternal mortality rate in Uttar Pradesh. So what kind of strategy did you adopt to achieve this?

This intervention is carried out by the Department of Health and Family Welfare. It encompasses several crucial aspects, including sessions for proper immunization, child and family welfare departments, and initiatives like Angan Badi Karyakarta, Poshan Ma, Poshan Saptah, and Poshan Potli.

In particular, there is a significant focus on child nutrition and well-being, where we’re making interventions at a high level. An interesting aspect is the emphasis on the usage of Sajan trees, which are considered beneficial for health. The initiative involves distributing Sajan trees to villages, encouraging their cultivation, and educating the public about their health benefits.

Furthermore, there are subsidies to support the acquisition of cows. These various initiatives from other departments are integrated to work collaboratively with the Health Department.

Additionally, the Ayushman Bharat Pradhan Mantri Jan Arogya Yojana (ABPMJ) plays a significant role. While it doesn’t primarily focus on deliveries, it does cover high-risk deliveries and cesarean deliveries. By including pediatric packages and pediatric surgery packages, the scheme contributes to reducing maternal and child mortality rates.

The collective efforts across these initiatives are aimed at promoting the health of both women and children, ultimately leading to improved overall health outcomes for the community.

Do you have a message for our listeners and readers?

I want to emphasize that the Ayushman Bharat Pradhan Mantri Jan Arogya Yojana is an incredibly ambitious scheme in our country. By participating in this initiative, you not only support yourself and your family but also contribute to the betterment of society, your state, and the entire nation.

The health of our citizens is of paramount importance. A healthy state and a healthy country are the cornerstones of economic progress and infrastructure development. When India aims to position itself on the global stage, it’s through such endeavors that we can truly advance. I’d like to add that even if you aren’t eligible for an Ayushman Card, if you’re a responsible citizen in your village and aspire to make a positive impact, consider working towards the “Ayushman Gram” designation for your village. This is a remarkable opportunity to serve your community.

There’s a user-friendly software available that allows anyone to create health cards for individuals in the village. It’s an inclusive approach. If your village is on the LGBT list, I encourage you to step forward. Detailed instructions and software access are readily available. Videos and further details can be found on the internet, and our website offers comprehensive information.

You can also reach out to senior officials in your district or your DIO team, Asha workers, or Panchayat assistants to gather information. Get involved and saturate your village with Ayushman Cards as much as possible. The more villages that embrace this initiative, the greater the progress we can achieve.

Much like the campaign for Open Defecation Free (ODF) status, the Ayushman Gram initiative started with a declaration. I firmly believe that more and more villages in Uttar Pradesh will declare themselves as Ayushman Grams because our informed and empowered citizens will drive this transformation.

Together, we can work towards ensuring that every citizen benefits from this scheme by leading a healthy and fulfilled life.