National Health Insurance Scheme could be game changer for poor but needs community ownership

Feb. 19, 2013 - PRLog -- New Delhi, February 19, 2013: With a promise of access to cashless hospitalization for over thousand aliments for people living below poverty line and unorganized sector workers, Rashtriya Swasthaya Bima Yojana (RSBY) can be a game changer, said Mr. Anil Swarup, Director General for Labour Welfare said here today.

Mr. Swarup who is credited as the architect of the ambitious health insurance scheme was addressing a gathering of civil society organizations from across seven states.

“Enrolment in the scheme cannot be the only concern as the utilization of the provisions by poorest communities for whom the scheme exists is equally important. For RSBY to be truly successful, we need to make the communities aware about its benefits,” Mr. Swarup said.

The sharing was event attended by over 150 participants who are part of the civil society organizations network that Poorest Areas Civil Society (PACS) works with for implementation and utilization of insurance schemes.

“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 organizations,” Sam Sharpe, Head, DFID India.

“There is a need for counting the positive contribution of the scheme alongside the challenges, as the provisions can truly benefit some of the poorest and socially communities,” Belinda Bennet, Head of Region South Asia, Christian Aid UK.

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

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 Memorandum of Understanding (MoUs) with state agencies in these states.

“In terms of convergence of constituencies, the socially excluded communities who make the profile of beneficiaries for the scheme are also key focus of PACS programme’s work,” he adds.

Poor and access to health

India’s health system faces the ongoing challenge of responding to the needs of the most disadvantaged members of Indian society. Despite progress in improving access to health care, inequalities by socioeconomic status, geography and gender continue to persist. This is compounded by high out-of-pocket expenditures, with the rising financial burden of health care falling overwhelming on private households, which account for more than three-quarter of health spending in India. Health expenditures are responsible for more than half of Indian households falling into poverty; the impact of this has been increasing pushing around 39 million Indians into poverty each year.  

Out-of-pocket expenditure on health, as a proportion of household expenditure, has increased over time, in both rural and urban areas. Expenditures on both inpatient and outpatient health care are consistently higher in private facilities as compared to public facilities; and the expense of non-communicable diseases exceeds that of communicable diseases. Notably, the proportion of expenditures spent on health has increased more for the poorest households.

Challenges with RSBY

There exists a massive shortfall between the registered beneficiaries and actual hospitalization. The latest figures on the ministry website show that there are 34,096,044 active smart cards that are registered, while numbers of hospitalization claims are at 4,823,080.  

While provision of smartcard and digitization 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 a long-term planning through the entire life cycle of the scheme covering enrolment, post enrolment and long-term utilization aspects.

Most of the civil society organizations 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.    

Why and how PACS works on RSBY

The Poorest Areas Civil Society (PACS) works with CSOs for equal and discrimination-free access to social security schemes and entitlements for the poor and socially excluded groups. Spread across seven poorest states, the programme engages on livelihood, health, nutrition and other entitlement schemes as a strategy to bridge 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 organizations to engage actively in the implementation and monitoring of RSBY scheme. PACS believes that community engagement and ownership would lead not only increased access but also strengthen the accountability mechanism inbuilt in the scheme.

The distinct strength that PACS and its partners bring onboard is of a strong linkage with grassroots leadership. With 83 civil society partners working on access to health, RSBY is placed very strongly in PACS programme’s mandate.

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 Memorandum of Understanding (MoUs) with state agencies in these states.

In terms of convergence of constituencies, the socially excluded communities who make the profile of beneficiaries for the scheme are also key focus of PACS programme’s work. This further strengths the vision of our collaboration for its implementation. The Government and State Nodal Agencies (SNAs) have been instrumental in not only recognizing the need for a civil society engagement, but also are proactively bringing ideas and strategies to the fore through this partnership.

In terms of direct outreach we work directly in 50 districts across the five states. We have conducted training on a community-focused approach for all these partners and have developed a range of communications and training approach.