Bhubaneswar: Year 2025 has clocked in.                                                                       

For the year to turn hale and healthy for the denizens of Odisha, it holds out a big challenge for the Mohan Charan Maji led BJP government in rolling out the ambitious health insurance programme of PM Narendra Modi govt – Pradhan Mantri Jan Arogya Yojana (PMJAY) or Ayushman Bharat Yojana (ABY) – in the State.

As per the Odisha Health Minister Mukesh Mahaling, the state government is all set to implement the scheme by 31st March 2025. The Minister added that with the roll out of the Central govt’s PMJAY in Odisha, the denizens here can avail treatment in more hospital/health centres.

The Ayushman Bharat roll out in Odisha will see beneficiaries availing treatment from 27000 hospitals vis-à-vis from 927 hospitals currently.

The State government in its 2024-25 budget has earmarked Rs 3500 crore for the successful implementation of the scheme in the State..

And the Odisha health department expects the coverage under the scheme extending up to a whopping 3.5 cr people.

AB-PMJAY

The scheme of Modi govt is a health assurance scheme that provides health cover of Rs. 5 lakh per family per year for secondary and tertiary care hospitalization.

STATUS

As per the Union Health Ministry data, as on date, a total of over 36.335 cr AB-PMJAY cards generated, when the target is 55cr. The scheme is currently implemented in 33 of 37 states and UTs.

Here are top 10 states in card generation.

• Uttar Pradesh – over 5.17 cr
• Madhya Pradesh – over 4.20cr
• Bihar – over 3.65cr
• Maharashtra – over 2.91 cr
• Gujarat – over 2.66cr
• Chhattisgarh – over 2.32 cr
• Rajasthan – over 2.18 cr
• Karnataka – over 1.78cr
• Assam – over 1.72cr
• Andhra Pradesh – over 1.56cr

The above top-10 states in AB-PMJAY card generation shows Chhattisgarh with a population of over 3.06cr has generated cards for nearly 76% of its population, thereby, gaining big from the scheme, as the number of hospitalizations availed stood at a massive of over 45.22 lakh. The tribal state figured 7^th among the top-10 states with high hospitalizations availed. Tamil Nadu tops the chart.

The above data shows implementation of the scheme has been poor in Bihar.

CHALLENGES BEFORE ODISHA GOVT

As seen from the above data, big and poor states like Bihar, Haryana, UP and MP fare poor in card generation and hospitalization. 

Why the states fared poorly have been outlined by an IIT Madras study conducted in 3 states viz Bihar, Haryana, Tamil Nadu, which was mandated by National Health Authority (NHA). The reasons it outlined are given below, which remain challenges before the Odisha govt as it is readying to roll out the AB-PMJAY scheme.

• The reach and penetration of information regarding PMJAY was still very low in Bihar and Haryana.
• Reason for low reach: inadequate human resources with requisite skill sets to implement the scheme at the State level.
• Insufficient information
• Long waiting time at kiosk for completion of identification process
• Low hospitalistion may also be attributed to poor knowledge of beneficiaries on grievance cell.

CAG SHOWS WAY FORWARD FOR ODISHA

The scheme seems faltering on many grounds in many states, as the IIT- Madras and CAG report revealed.

Since Odisha is going the roll out the scheme from March, here is the list of CAG recommendations the State may follow to have seamless delivery of PMJAY services to eligible citizens in the State.

• IEC cell need to formed, recommends CAG.
• CAG has asked all states to prepare IEC plan
• Spending on IEC activities need to be benchmarked at 25% of allotted budget. 
• CAG identified duplication of PMJAY cards in Tamil Nadu and many other states, State need to adhere to protocol to avoid duplication..
• States have to put a suitable mechanism for identifying State-wise beneficiaries under the Scheme, to weed out ineligible beneficiaries in a time-bound manner.
• The registration process needs to be strengthened to avoid delay in registration beyond the prescribed time.
•  Validation checks should be in place so as to avoid invalid entries and increase the accuracy and reliability of the data.
• State Health Authority (SHA) need to set up a designated IEC cell to promote awareness about the scheme and maximize reach, impact and awareness amongst targeted beneficiaries.
• There is a strong need to invest in public hospitals to improve and upgrade the quality of the existing health facilities in accordance with prescribed criteria.
• District Implementing Units (DIU) are need to be formed in every District with adequate manpower and infrastructure for smooth functioning of Scheme
• Monitor Empanelled Health Centres through physical inspections and necessary audits.
• SHA should have a mechanism to monitor and curb instances involving out of pocket expenditure by the beneficiaries.