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Sarve Santu Niramaya

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Kartik Sharma, Arpit Gupta and Kusum Kumari of Elets News Network (ENN) explore or try to comprehend how the Rajasthan healthcare space is getting taller by shorter but relevant steps undertaken by the Government of Rajasthan. The policymakers have been mounting all challenges by being constantly devoted to the overall objective of consistent growth and enhancement of healthcare services to ensure easy access and seamless delivery of medical care to all.

“Healthy citizens are the greatest asset any country can have”
– Winston S. Churchill

Undoubtedly, a healthy nation is a wealthy nation, which is realisable only through the strengthening of healthcare space and by bringing out healthcare initiatives for better diagnosis, treatment, prevention and management of not just diseases, illnesses and injuries, but also for the preservation of well-being in people. Moreover, the strengthening of the entire healthcare service delivery is equally important to ensure quality care reaches the neediest of all without any condition attached with the services. In order to make healthcare service delivery seamless and hassle-free, technology can play a vital role, especially mobility and information technology (IT) through the adoption of mobile devices, in providing services at fingertips. With the constant evolution in the mobile technology, healthcare providers are also interestingly experimenting with a range of devices. Never has healthcare come across so exciting and ready for experimentation as it seems to be currently. In the similar vein, Rajasthan has demonstrated leadership in the healthcare space by leveraging technology and constantly striving towards making the system much better by fixing the gaps.
As mentioned in the September issue of eHEALTH magazine, ‘preventive care’ as a concept is now steering the entire healthcare sector. And, undoubtedly, it has also emerged as the core objective of the Government of Rajasthan. Despite being the largest state from the geographical point of view, the Government of Rajasthan aims to reach the remotest corners and empower the poorest to achieve the vision of quality healthcare for all. Accelerating this objective further, the Government of Rajasthan has undertaken a series of e-initiatives, especially under various programmes of the National Health Mission (NHM), and introduced first-ofits kind mobile applications.
Interestingly, some of the mobile applications, such as Kuposhan Watch, introduced by the Government of Rajasthan focus on the recording of data and inspections of officials. It seems the Government is now much more particular about enhancing the system and tools by integrating advanced technologies and other features to provide holistic solutions to the common masses.

      Government of Rajasthan – Major e-Initiatives
  • Kuposhan Watch: For monitoring the real-time status of children with severe acute malnutrition admitted in MTCs and providing assistance for complete healthcare
  • Pregnancy, Child Tracking & Health Services Management System (PCTS): Tracking of information related to newborn deliveries, maternal care, etc.
  • Online JSY and Shubhlaxmi Payment System (OJAS): Facilitates users to capture beneficiary-wise details of payment for JSY and Shubhlaxmi Yojna
  • ASHA-Soft: Ensures effective monitoring of ASHAs, districts and programmes, as well timely delivery of payments
  • Rashtriya Bal Swasthya Karyakram (RBSK): An online platform focusing on improving the overall quality of life of children
  • IMPACT Software: Enables registrations of sonography centres and tracking of activities
  • Integrated Ambulance Service Project (IAP): Dial an Ambulance Service Project for operationalisation of the existing fleet of more than 1,400 ambulances deployed at different parts of the State

Tracking of information related to newborn deliveries, maternal care, etc., has always been a daunting challenge for the policymakers throughout India. In the absence of adequate data and information on the above segments, the policymakers often witness roadblocks in addressing the gaps. The Government of Rajasthan has come out with a Pregnancy, Child Tracking & Health Services Management System (PCTS). Enabled with a dashboard, PCTS allows decision-makers to plan better health policies by going through the data under different categories, such as Total Antenatal Care (ANC) Registered, Total Deliveries, Total Births and Total Children Registered. According to the gaps identified during the process of review, the Government of Rajasthan can revise and design health policies accordingly.
With the coverage of 16,500+ health institutions and all 44,000+ villages, data capturing right from the scratch is now possible through PCTS. Data generated right from the primary healthcare centre (PHC) to hospitals are collated at one place. Moreover, PCTS is integrated with the portal of as Mother & Child Tracking System (MCTS) of Government of India to generate a central database. PCTS is also integrated with the portals of ASHA-Soft for online payment service and Online JSY and Shubhlaxmi Payment System (OJAS) for direct benefit transfer.

Under the scheme, various tertiary care treatment are provided to BSBY beneficiaries at multi-speciality private and government hospitals at free of cost as envisaged by Government at the time of launch of the scheme. In brief, progress under major diseases packages are as follows-

  1. Cardiovascular & Cardiothoracic and Vascular Surgery:
    a.  1,490 claims of Bypass Surgery (coronary artery bypass graft surgery (CABG) amounting Rs 4.37 crore are      booked under the scheme.
    b. Claims of 685 Heart Valve Repair treatment are booked so far amounting Rs 7.23 crore.
    c. Till date 3,133 Angioplasty claims are booked worth of Rs 17.06 crore.
    d. 156 claims of Congenital Heart Disease are also booked under the scheme amounting Rs 1.03 crore.
  2. Cancer: More than 15,689 claims of cancer treatment (chemotherapy, radiotherapy and surgery) are booked so far amounting Rs 19.90 crore.
  3. Brain Surgery: 1,490 claims of brain surgery are booked under the scheme so far and claims amount of Rs 4.37 crore is booked.
  4. Spinal Surgery: 1,123 claims of spinal surgery are booked and cost of such claims is Rs 3.35 crore
  5. Lung Surgery: 105 claims of lung surgery are booked under the scheme which costs around Rs 34.41 lakh.
  6. Plastic Surgery: 330 claims of plastic surgery amounting Rs 1.16 crore are booked under the scheme.

In order to ensure timely delivery of payments to Accredited Social Health Activists (ASHAs), as well as ensure effective monitoring, the Government of Rajasthan came up with the online application ASHA-Soft. Interestingly this system with no capital investment not only allows informed decisionmaking, but also better utilisation of the existing SMS gateway and banker. Undoubtedly, ASHA-Soft has proven to be a boon for ASHAs across Rajasthan, as well has emerged as a reference point for other states for ensuring effective monitoring of ASHAs and the programmes. Recognised and awarded on different platforms, ASHA-Soft has been strengthening the entire system by monitoring the performance of different districts on multiple parameters, such as Total Payments, Monthly Meetings, National Programme, etc., and empowering anganwadi workers by offering opportunities related to higher education, etc.
sarveAnother key e-initiative has been OJAS Software, which facilitates users to capture beneficiary-wise details of payment for JSY and Shubhlaxmi Yojna. Once again, this tool has been playing a key role in monitoring the performance of each delivery, online payments, and timely and transparent payment for beneficiaries and system.
With the growing focus on malnutrition as a medical emergency, especially in an emerging country like India, the government at both state and central levels have been have been working at a breakneck speed to decrease the number of malnutrition cases, particularly in the rural areas. To shoulder this burden equally, the Rajasthan Government recently launched Kuposhan Watch to monitor real-time status of children with severe acute malnutrition admitted in Malnutrition Treatment Centres (MTCs) and assists in providing complete healthcare. Along with the tracking facility, Kuposhan Watch provides access to facilities and officials in the hierarchy for data analysis. Additionally, it has the facility to send automated alerts and voice-based reminders to both parents and caregivers.
With the increased concentration on mother and child care by the Government of Rajasthan, Rashtriya Bal Swasthya Karyakram (RBSK), an online platform focusing on improving the overall quality of life of children, was started in April 2014. In order to ensure equitable child healthcare, the tool enables early detection and treatment. It enables a systematic approach to child health screening and early intervention.
With the intention to regulate sonography centres indulging in abortion or termination of pregnancy, the Government of Rajasthan started IMPACT Software, or Integrated Monitoring System for Pre-Conception, Pre-Natal Diagnostic Technique (PCPNDT) Act, on 1st October 2012, in compliance to the order of the Rajasthan High Court. With more than 1,470 sonography centres registered online and more than 2,000 tracking devices installed, the system allows real-time monitoring and ensures effective implementation of the PCPNDT Act of the state. The system was designed and developed by National Informatics Centre – Rajasthan. Some of the additional features of the system are generation of analytical reports, search tools and provision of feedback. The detailed report enables the policymakers to conduct a demography study and comprehend the gaps. This software has proven to be a progressive step towards reduction of sex-determined activities.
The Government of Rajasthan has initiated Integrated Ambulance Service Project (IAP) as Dial an Ambulance Service Project for operationalisation of the existing fleet of more than 1,400 ambulances deployed at different parts of the State. Presently, 741 equipped 108 Ambulances, 600 Janani Express Vehicles and 200 Base Ambulances are operational in the State, along with a centralised call centre for 108 and toll-free 104 Medical Advice Service. There is an integrated software for the management of 108 Ambulances/104 Janani Express/Base Ambulances/Medical Advice/ Invoice Generation. Global Positioning System (GPS) devices have been installed for the identification of vehicle locations. For this, integrated Geographical Information System (GIS) Mapping of all government health institutions, accredited private hospitals, fire stations, police stations and all ambulances have been done. To provide round-the-clock prehospital emergency transportation care (ambulance) services across the State, integration with SMS gateway and email, and integration with mobile application for reporting of inspection/ vehicle status has been done. There is a control room at Swasthya Bhawan for monitoring and verifications of calls 24/7.
Health insurance in India is a growing segment of India’s economy. The Bhamashah Swasthya Bima Yojana (BSBY) was launched in the state on 13th December, 2015 for around 1 crore eligible families of Rajasthan. The main objective of this scheme is to provide cashless healthcare services to the poor families of Rajasthan, thus, providing social and financial security against illness to these families and reducing out-of-pocket expenditure.
Families identified under the National Food Security Act (2010) and the Rashtriya Swasthya Bima Yojana (RSBY) are eligible for taking treatment at empanelled hospitals under the scheme.
Naveen Jain, Chief Executive Officer, State Health Assurance Agency, Department of Medical, Health & Family Welfare, Government of Rajasthan said, “Our Chief Minister is making colossal efforts to improve the health sector and encourage a healthy, preventive lifestyle. Under her leadership, Rajasthan will be able to turn the aspiration of ‘sarve santu niramaya’ to reality.”
Till date, total 469,765 claims have been enlisted under the BSBY amounting Rs 224.39 crore while total 302,743 claims have been approved by NIAC amounting to Rs 133.79 crores. This is a good claim status, especially in a State like Rajasthan where there is prior existence of other blanket cover health care schemes like Mukhyamantri Nishulk Dawa (MNDY) and Mukhyamantri Nishulk Janch Yojna (MNJY).
In BSBY, participation of private sector is increasing day by day. The number of empanelled private hospitals has shot up by three times since the launch of the scheme (from 167 to 568). Districts like Udaipur, Tonk, Jaipur, Sikar and Sirohi have shown participation of more than 50 per cent of total claim enlisting from the private sector. Various big corporate hospitals like Narayana Hrudayalaya, NIIMS, Mahatma Gandhi University, Geetanjali Medical College & Hospital and Pacific Institute of Medical Sciences are also associated with the scheme.
“We have deputed Swasthya Margdarshak (Health Guides) at every hospital to help patients visiting hospitals and facilitate the complete process of BSBY scheme. Their job is to check the family eligibility card, get the patient admission done and guide the patient at various levels till the treatment is done,” informed Jain.
The Government is steadily moving in the right direction. Recently, a videoconferencing with around 46,000 ASHA sahyoginis was done under the chairmanship of Health Minister. Three rounds of ASHA Samwad were accomplished and ASHAs were thoroughly oriented about the scheme and majorly about their role in reaching out to the community was highlighted. They were also equipped with BSBY kit, including dummy of ration card, Bhamashah Card, pamphlets of private hospitals, frequently asked questions, etc.

      BSBY: In a nutshell
  • Cashless treatment facility in the inpatient department (IPD).
  • Packages offered under the scheme (total 1,715): Maximum number of packages; 1,148 secondary packages, 500 tertiary packages and 67 government-reserved packages.
  • Health insurance cover of Rs 30,000 (for general illnesses) and Rs. 3 lakh (for critical illnesses) per family per year on a floater basis.
  • Health institutions: The scheme is being implemented at empanelled private hospitals and medical college & associated hospitals, district hospitals, sub-divisional hospitals, satellite hospitals and community health centres (CHCs). Presently, 480 Government and 568 private hospitals are providing services under the scheme.
  •  Includes 7-day pre-hospitalisation and 15-day post-hospitalisation expenses.
  • Major stakeholders: The Department of Medical, Health & Family Welfare owns the scheme and the Department of Information Technology (DoIT) and the New India Assurance Co. Ltd. are the key partners.

As it is a huge scheme, an essence of prompt and proper grievance redressal is realised by Government and for this purpose, a system of grievance redressal has been established at district and state level. For the purpose, Grievance Redressal Committees have been established at state and district level under the Chairmanship of CEO of State Health Assurance Agency and District Collectors, respectively. These committees are in place to address the complaints of people, empanelled hospitals, etc. Additionally, a separate call centre is established at Swasthaya Bhawan, State Headquarter, which registers the grievances of the public. As system is also established for getting independent feedback from the beneficiaries so that future improvement may be done accordingly. In the feedback, one fact is revealed that more than 90 per cent of the beneficiaries have been satisfied with the services offered under the scheme. According to them, if there was no such scheme, they would have to either take a loan or mortgage their lands for want of better treatment.
In order to ensure better implementation and in depth monitoring of the scheme Government has planned reviews at the level of seven divisions of Rajasthan, wherein specific divisionrelated issues and problems have been addressed. Required handhold support is also extended to all divisions during these reviews.

From 13th July, 2016, Bhamashah card has become mandatory for getting benefits under the scheme. However, RSBY card is being honoured in the transitory phase till all such RBSY beneficiaries are incorporated in the Bhamashah database

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