Swachh Bharat Abhiyan, is a nation-wide campaign that aims to clean up the streets, roads and infrastructure of India's cities, towns, urban and rural areas. The objectives of Swachh Bharat include Construction of individual, cluster and community toilets, elimination of open defecation, and 100% collection, scientific processing and disposal of waste. The mission aims to achieve an "open-defecation free" (ODF) India by 2 October 2019, the 150th birth anniversary of Mahatma Gandhi. The mission will also contribute to India reaching “Sustainable Development Goal 6”, established by the UN in 2015.

The campaign was officially launched on 2 October 2014 at Rajghat, New Delhi by Prime Minister Narendra Modi and is India's largest cleanliness drive to date with three million government employees and students from all parts of India participating in 4,043 cities, towns, and rural areas.

The mission has two thrusts: Swachh Bharat Abhiyan (Rural), which operates under the Ministry of Drinking Water and Sanitation; and Swachh Bharat Abhiyan (Urban), which operates under the Ministry of Housing and Urban Affairs.

As part of the campaign, the government has constructed 11 million toilets till date. As per an independent survey released by Quality Council of India in August 2017, overall national rural household access to toilet coverage increased to 62.5% and usage of toilets to 91.3%, with Haryana topping the national ranking with 99% of households in rural areas covered and usage of toilets of 100%. World Health Organization (WHO) has in its report stated that at least 180,000 diarrheal deaths were averted in rural India since the launch of the Swachh Bharat Mission. The mission is however lagging behind in its objective of 100% collection, scientific processing and disposal of waste and supply of clean drinking water in the rural areas and interior parts of the Country.

A ban on manufacture and use of single use plastic bags once implemented may help but a permanent solution to a clean India can come about only by cleaning up of the corruption in the local bodies right from the Corporator to the Sanitary inspectors who demand huge amounts as bribes for disposal of collected garbage from the contractors. Banning tobacco products, closing down polluting industries which flush their effluents into the rivers and waterways and stricter laws and penalties against littering, spitting and defecating in public places are other permanent solutions the Government should consider to make the Swach Bharat Yojana a success.

AYUSHMAN BHARAT YOJNA

Ayushman Bharat Yojana is a centrally sponsored scheme launched in 2018, under the Ministry of Health & Family Welfare, Govt of India. The scheme aims at making interventions in primary, secondary and tertiary care systems, covering both preventive and promotive health, to address healthcare holistically .It is an umbrella of two major health initiatives namely, Health and Wellness centres and National Health Protection Scheme (NHPS).

NHPS is formed by subsuming multiple schemes including Rastriya Swasth Bima Yojna, Senior citizen health Insurance Scheme (SCHIS), Central Government Health Scheme (CGHS), Employees' State Insurance Scheme (ESIS) etc. The National Health Policy, 2017 has envisioned Health and Wellness Centres as the foundation of India’s health system which the scheme aims to establish.

Ayushman Bharat - National Health Protection Scheme(NHPS)

Ayushman Bharat-National Health Protection Scheme, will cover over 10 crore (one hundred million) poor and vulnerable families (approximately 50 crore (five hundred million) beneficiaries) providing coverage up to 5 lakh rupees ($7,100) per family per year for secondary and tertiary care hospitalization.

Benefits of the scheme are portable across the country and a beneficiary covered under the scheme will be allowed to take cashless benefits from any public or private empaneled hospitals across the country.

It will be an entitlement based scheme with entitlement decided on the basis of deprivation criteria in the SECC database. It will target about 10.74 crore poor, deprived rural families and identified occupational category of urban workers' families as per the latest Socio-Economic Caste Census (SECC) data covering both rural and urban.

One of the core principles of Ayushman Bharat - National Health Protection Mission is to provide co-operative federalism and flexibility to states.

For giving policy directions and fostering coordination between Centre and States, it is proposed to set up Ayushman Bharat National Health Protection Mission Council (AB-NHPMC) at apex level Chaired by Union Health and Family Welfare Minister. States would need to have State Health Agency (SHA) to implement the scheme. Covering almost all secondary and many tertiary hospitalizations (except a negative list).

Wellness centres

Rs 1200 crore ($170 million) allocated for 1.5 lakh health and wellness centers, Under this 1.5 lakh centers will be setup to provide comprehensive health care, including for non-communicable diseases and maternal and child health services, apart from free essential drugs and diagnostic services. The government will upgrade existing Public Health Centres to Wellness Centres. The welfare scheme has been rolled out on August 15, 2018. Further, Contribution of private sector through CSR and philanthropic institutions in adopting these centres is also envisaged. The list of Services to be provided at Health & Wellness Centre include:-

Pregnancy care and maternal health services,Neonatal and infant health services, Child health, Chronic communicable diseases, Non-communicable diseases, Management of mental illness, Dental care and Geriatric care emergency medicine.

Progress and shortcomings

26 states and union territories have accepted the scheme except for states of Delhi, Odisha, West Bengal and Telangana. More than a lakh people had taken benefit of the scheme till October 2018. By 26th November more than 825,000 e-cards had been generated and there was a push to recruit more private hospitals to the scheme. According to the annual report, 46.5 lakh hospital treatments were given under the scheme. Out of these, 24.7 lakh patients were treated by private hospitals in the last one year and the rest by public ones. As many as 8,571 government hospitals and 9,665 private hospitals had been empanelled in one year.

Among the 32 states and union territories which are part of the scheme, Rajasthan had the maximum number of hospitalizations. As many as 122 hospitalizations per lakh population took place in a year there. It was followed by Chhattisgarh and Kerala, with 114 and 98 hospitalizations per lakh population in their respective states. Tamil Nadu, Haryana and Andhra Pradesh paid the highest per cent of claims to the insurance companies under the scheme.

The scheme however suffers from the following short comings :-

Quality control

Low volumes of certified hospitals are currently empanelled under the scheme and out of 18,019 empanelled hospitals, only 603 were quality accredited or certified. The revised rates of various treatments that were being offered to the private sector, were unviable for it to operate.

Widespread misuse of the scheme by unscrupulous private hospitals through submission of fake medical bills. Under the Scheme, surgeries have been claimed to be performed on persons who had been discharged long ago and dialysis has been shown as performed at hospitals not having kidney transplant facility. There are at least 697 fake cases in Uttarakhand State alone, where fines of Rs one crore has been imposed on hospitals for frauds under the Scheme.

The Government has moved fast and imposed heavy fines on the hospitals involved in these frauds and steps were being taken to only empanel hospitals under the scheme which have been accredited by the National Accreditation Board for Hospital (NABH) which certifies that hospitals are providing a certain quality of care according to the standards prescribed by it.

The Government needs to monitor the scheme closely and see that it is implemented strictly and is freed from corruption, fraud, malpractices and exploitation for it to succeed like the Swachh Bharat scheme.

If both the Swachh Bharat Abhiyan and Ayushman Bharat Yojna are implemented successfully, it may not be long before India can take its place as one of the Healthiest Countries in the World.

S.G.B.Rao, LSW Lifescienceworld
www.lswlifescienceworld.com