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Bihar falling behind on Ayushman Bharat

Healthcare workforce piece.
Patients wait to be seen at a medical clinic in Bihar. Reports indicate that the state is falling behind on the Government’s flagship health insurance scheme Ayushman Bharat.

Is the state of Bihar falling behind on the Centre’s flagship health insurance scheme, Ayushman Bharat? It can be argued that this is the case based on recent reports, which indicate the overwhelming majority of families eligible for the scheme have yet to avail benefits under it. 

As reported in The Economic Times, the Government of India has yet to release a single grant to the state despite having released Rs 1,699 crore to states and union territories in conjunction with the scheme during the past fiscal year. Underperformance on the scheme has been pinpointed as the reason why this is the case. 

Thus far, Bihar has issued a mere 4.4 million cards to beneficiaries across 2.2 million families, despite being home to approximately eleven million eligible families. This suggests that around eighty percent of those eligible to receive benefits under Ayushman Bharat in Bihar are missing out. Approximately 156,000 hospital admissions have been reported under the scheme. 

In November last year, Bihar and Uttar Pradesh were named the worst performers on Ayushman Bharat. Both states recorded fewer hospital admissions and fewer claims under the scheme despite the large size of their respective eligible beneficiary populations. In comparison with Kerala, a state with just 4.1 million potential beneficiary families who reported Rs 366 crore worth of claims, Bihar reported just Rs 104 crore despite its potential beneficiary family population numbering at almost eleven million. 

Prime Minister Narendra Modi has previously called out the Bihar state government for its performance on the scheme. Last year, Modi expressed displeasure with the implementation of Ayushman Bharat in Bihar, as well as in Arunachal Pradesh, Goa, Nagaland, and Sikkim. 

Issues related to Ayushman Bharat in the state include low awareness among prospective beneficiaries. Awareness rates in Bihar stood at less than twenty percent, while in Tamil Nadu awareness was eighty percent. Bihar has also been called out for non-spending of funds. As reported by Health Issues India in July of last year, Bihar had spent less than one-third of the Rs 88.5 crore allocated to it by the Centre for implementing Ayushman Bharat. 

An opinion piece published in The Print in June last year identifies reasons why Bihar is struggling and underperforming on Ayushman Bharat. Insufficient healthcare and administrative infrastructure to enable beneficiaries to avail benefits and to handle logistical issues are among the reasons given. A relative dearth of monetary resources to handle their share of funding for the scheme (Ayushman Bharat costs are borne in a sixty-forty ratio between the Centre and the state governments) again complicates the implementation of the scheme. Multiple commentators have castigated the state government under Chief Minister Nitish Kumar for his administration’s performance on healthcare.

South Gandhi Maidan, Patna, Bihar, India, 23rd January 2014. Shri Nitish Kumar, Chief Minister of Bihar attends the 115th birth anniversary of Netaji Subhas Chandra Bose today, Thursday foggy morning. Netaji Subhas Chandra Bose is a great freedom fighter for India. The Chief Minister arrived at 0953 AM and completed the flowering ceremony at the feet of marble statue of Netaji Subhas Chandra Bose in the entrance of a park often less visited. Meanwhile, the All India Forward Bloc (AIFB) on Saturday condemned the "negative attitude" of the Congress-led United Progressive Alliance (UPA) in not observing Netaji Subhash Chandra Bose's birth anniversary as 'Desh Prem Divas' . After receiving the Guard of Honor from Bihar Armed Police the Chief Minster left the place in a white Ambassador with registration number BR 1AB 0007. © Rupa Ghosh/ live News.
Bihar Chief Minister Nitish Kumar, whose government has been criticised in some quarters for its poor performance on a number of key socioeconomic indicators – including health. Image credit: RUPA GHOSH / 123rf

 Inputs from individuals cited in The National Herald are far from favourable. “[The] health minister himself has admitted that his ministry has no expertise in carrying out such schemes,” commented Sanjay Yadav, a leader in the Rashtriya Janata Dal (RJD). “‪It shows the apathy and lack of seriousness on part of the NDA [National Democratic Alliance] government. The dysfunctional and broken healthcare system in Bihar is a glaring example of how Nitish Kumar led NDA government failed [the] people of Bihar.” 

Similarly, a whistleblower cited in The National Herald criticised the state government under Kumar

“They cannot blame others for the poor performance of the state as BJP-JDU government has been at the helm for several years. They cannot escape the responsibility,” said a whistleblower and an expert who was involved in the formulation of the policies for Ayushman Bharat.”

Health Issues India, in the wake of last year’s tragedy in Bihar’s Muzaffarpur district which witnessed the deaths of scores of children, reported on how Bihar’s healthcare infrastructure “was in the ICU.” Health Issues India also noted the poor performance of Bihar on allocation of healthcare funds for Ayushman Bharat

“While Ayushman Bharat is by no means a panacea for strengthening public health infrastructure, the funds allocated to Bihar provided some opportunity to fortify the frontline of its public health system through the creation of HWCs and enable beneficiaries to avail treatment and services. Had funds been properly spent, timely diagnoses could have been made in a number of the encephalitis cases, potentially averting a number of the deaths.”

The latest reports about Bihar and Ayushman Bharat are no more promising. State health minister Mangal Pandey acknowledges the situation, explaining “we had no experience of running a scheme of such scale, unlike some other states. It took time to set up the infrastructure and get medical human resources, and hence we are behind some other states.” However, Pandey has said “we are speeding up the implementation” and claims twenty lakh e-cards have been issued to beneficiaries in the past three months. 

For Ayushman Bharat to be a success, in Bihar and in states of similar economic development and socioeconomic profiles, the issues flagged must be resolved. In a time when healthcare accessibility remains a major issue for a substantial swathe of the Indian population, that this is imperative in a state where indicators are so low goes without saying.

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