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AYUSHMAN BHARAT – NATIONAL HEALTH PROTECTION MISSION

What is Ayushman Bharat Scheme?

1. The Government announced two major initiatives in health sector, as part of Ayushman Bharat programme.
   1. Health and Wellness Centre
   2. National Health Protection Scheme
2. Aimed at making path breaking interventions to address healthcare problems holistically, in primary, secondary and tertiary care systems.
3. Covers both prevention and promotion of health.

Need for Ayushman Bharat

1. India is in a state of health transition.
2. Infectious diseases such as tuberculosis, malaria, dengue, H1N1 pandemic influenza and antimicrobial resistance are a threat.
3. Also the country is facing the emerging problem of chronic non-communicable diseases such as cardiovascular diseases, diabetes, cancer which are now the leading cause of mortality.
4. New factors are emerging that threatens the country’s health security like ageing population, climate change, globalization, urbanization and changing lifestyles.
5. We lag behind in addressing healthcare delivery across the length and breadth of the country.
6. We have one of the highest levels of out-of-pocket spending on health.
7. Average cost of treatment in private hospitals is 4 times higher than that of public. This pushes many people below poverty line.
8. Funding for healthcare has been a major concern.
9. Several states have implemented or supplemented their own health protection schemes. Ayushman Bharat programme builds on these schemes.
10. Failure of Rashtriya Swasthya Bima Yojana (RSBY).

RSBY

1. Poor families get an annual coverage of Rs. 30,000.
2. It was world’s largest publicly-funded health insurance (PFHI) scheme.
3. RSBY will be subsumed under National Health Protection Scheme.
4. Similarly, Senior Citizen Health Insurance Scheme (SCHIS) will also be subsumed under NHPS.

Why RSBY failed?

1. Failed to cover a large number of targeted families.
2. Prevalent discrimination against disadvantaged groups.
3. Lack of mandate on insurance companies to achieve higher enrolment rates.
4. Absence of oversight by government agencies.
5. RSBY resulted in higher out-of-pocket expenditures.
6. This caused the failure of the scheme despite its holistic health care coverage.

Health and Wellness Centre

1. Health and Wellness Centres will be the foundation of country’s health system.
2. 1.5 lakh centres will bring health care system closer to the homes of people.
3. Will provide comprehensive health care, including for non-communicable diseases and maternal and child health services.
4. Will also provide free essential drugs and diagnostic services.
5. Also provide mental health services, vaccinations against selected communicable diseases, and screening for hypertension, diabetes, and some cancers.
6. Allocation of Rs. 1200 crore for this flagship programme.
7. Contribution of private sector through CSR and philanthropic institutions in adopting these centres is also envisaged.

National Health Protection Scheme

1. National Health Protection Scheme will cover over 10 crore poor and vulnerable families or around 50 crore people.
2. Will provide coverage upto 5 lakh rupees per family per year for secondary and tertiary care hospitalization.
3. Identification of eligible families through the socio-economic caste census (SECC) data.
4. World’s largest government funded health care programme.
5. National Health Agency will govern the implementing mechanism.
6. Adequate funds will be provided for smooth implementation of this programme.
7. Cost of packages will be decided by National Health Agency.

Significance of Ayushman Bharat

1. Move towards the goal of universal health coverage
2. Creating Swasth Bharat.
3. Accessible healthcare at secondary and tertiary level institutions for the bottom 40% of the population.
4. High involvement of states as the states are the custodians and the implementers of the scheme.
5. Ensures enhanced productivity, well being and avert wage loss and impoverishment.
6. Generation of lakhs of jobs, particularly for women.
7. Like Jan Dhan scheme did for financial inclusion, Ayushman Bharat will create huge awareness of health insurance
8. A higher life expectancy.
9. The country will meet its social development goals.
10. With respect to infrastructure and trained medical professionals, tertiary healthcare faces a big challenge. This problem is more acute in rural areas. AB will address this challenge.
11. Will improve access to healthcare and bridge the demand-supply gap.

Challenges for Ayushman Bharat

1. Inadequate funding.
2. Proper and transparent implementation on such a large scale.
3. Limited and uneven distribution of human resources at various levels of health services.
4. Presently, a lack of capacity to respond to huge demand for beds. This will take some time.
5. Private players faced various hurdles in earlier schemes like RSBY.
6. There was opaque procedure for empanelment and cost fixating mechanisms.
7. Huge delays in reimbursement to private hospitals was also a challenge in RSBY.
8. At the same time, the pricing mechanism of private players needs to be checked.
9. Politics of parties will hinder the participation of states.

Way Forward

1. Categorise hospitals into Entry level, Progressive level and Accreditation level. This will help in standardisation in clinical practices.
2. Use of technology and digitisation for accessible and affordable patient care to the last mile of the country.
3. Need for proper medical claims system and fraud control mechanisms.
4. Effective collaboration between centre, states and industry.
5. States should have some flexibility as costs could vary in tier 1 cities and tier 2 cities.
6. Proper monitoring and governance of operational and implementation aspect of AB.
7. Timely resolution of complaints.

Practice Questions

1. Discuss the features of Ayushman Bharat programme and examine how Ayushman Bharat is different from Rashtriya Swasthya Bima Yojana.
2. Critically examine the significances of and challenges in the implementation of Ayushman Bharat Programme.

Why in news?

The court admitted a petition to drop adultery as a criminal offence from the statute book

Section 497 of the IPC

Section 497 of the IPC mandates that “Whoever has sexual intercourse with a person who is and whom he knows or has reason to believe to be the wife of another man, without the consent or connivance of that man, such sexual intercourse not amounting the offence of rape, is guilty of the offence of adultery and shall be punished.

Application of Section 497 (example)

1. X (Male) and Y (Female) have been married for nine years. They both are professionals and lead a seemingly happy life. In the 5th year of their marriage, Y falls in love with her colleague Z (Male). X finds out about this affair and collects evidence of this. When he has enough evidence, he files a case of adultery under the relevant IPC provision.
2. In India, under the existing provisions, women cannot be prosecuted for adultery. So in the case mentioned above, Y’s husband can press charges of adultery on Z, who can get jail time of up to 5 years, but the same is not applicable for Y. This could, however, change, with the Supreme Court agreeing to revisit the provision.
3. In this case, both Y and Z are culpable of committing adultery. However, the law does not look at both parties in an adulterous relationship in the same light

What would the court examine?

The court would examine two aspects of the penal provision

1. Why does Section 497 treat the man as the adulterer and the married woman as a victim
2. The offence of adultery ceases the moment it is established that the husband connived or consented to the adulterous act. So, is a married woman the “property” of her husband or a passive object without a mind of her own?

Court’s initial observation

1. SC has noted that in a case of adultery, one person is liable for the offense but the other is absolved and that the concept of gender neutrality, on which criminal law normally proceeds, is absent
2. The court has also noted that once the consent or connivance of the husband is established, there is no offense of adultery at all
3. SC described this as subordination of a woman and something that “creates a dent on the independent identity of a woman”

Past judgments of SC

1. The apex court had earlier on three separate occasions, in 1954, 1985 and 1988, upheld the constitutionality of Section 497
2. In the past, the Supreme Court has emphasized that a married woman is a “victim” and the man is “the author of the crime”
3. It has treated the exemption given to women as a special provision that has the protection of Article 15(3)
4. It has rejected the argument that it is discriminatory by pointing out that neither a man nor a woman can prosecute their disloyal spouses
5. It is only the ‘outsider’ to the matrimonial relationship who can be prosecuted, and that too by the aggrieved husband alone
6. This is made clear in Section 198(2) of the Code of Criminal Procedure, a provision also under challenge

Why section 497 needs to be scrapped?

1.International scenario:

1. Many countries across the world do not treat adultery as an offense any longer
2. In 2012, a United Nations Working Group on laws that discriminate against women wanted countries that treat adultery as a crime, to repeal such laws.
3. UK has abolished adultery laws

2.Violation of Constitutional principles

1. The Constitution confers equal status to a man and a woman
2. It amounts to a violation of a women’s fundamental right against discrimination under Article 15 when the law “assumes a patronising attitude to women.”

3.Not in consonance with changing Social Conditions

Today both women and men move shoulder to shoulder with each other. Also, today Polygamy is not prevalent in Indian society. So, any biasness in the law towards any gender is like not evolving the law with the ever-changing society.

4.Promotes subordination of women

The section encourages the notion of treating wife as a commodity under the subjugation of husband. It harms the individual independent identity of women whose prosecution depends on husband’s consent.

5.Law discriminates against men

When sexual intercourse takes place with the consent of both parties, there is no good reason to exclude the wife and prosecute only her adulterer. Thus, Section burdens man alone for the offence and grants immunity to wife by treating her as a victim according to prevalent social norms.

Conclusion

No marriage or alliance can take away one’s right over one’s own body. Therefore, while the law on adultery as it is today in the IPC is discriminatory on the ground of sex; the very existence of adultery in the criminal statute is violative of the fundamental right to life and to live with dignity. No doubt that the law, as it stands, is inadequate.