Determined to benefit people beyond demographic locations, caste and creed, Rajasthan is aiming to take healthcare to the last-mile benefitting even the most marginalised sections of society. From Bhamashah Swasthaya Bima Yojana (BSBY) to Daughters of India campaign, the State is set to leave an indelible mark in healthcare delivery, observe Mukul Kumar Mishra and Kartik Sharma of Elets News Network (ENN).
A cursory glance at the wide array of initiatives undertaken by the Government of Rajasthan, showcases the government is making concerted efforts to cater people with comprehensive healthcare services.
With Narendra Modi government at the Centre focusing its efforts to make healthcare delivery accessible and affordable with schemes like Ayushman Bharat, launched recently on September 23, the Rajasthan Government has already launched initiatives to align itself with such an endeavour.
It may be noted that the Ayushman Bharat is arguably world’s largest medical insurance scheme having a provision of Rs 5 lakh per family insurance coverage to poor and vulnerable people.
The Rajasthan Government is undertaking a number of initiatives to enable people with better patient care. It has not only set an example with the announcement of many healthcare schemes but also ensured their proper implementation.
Bhamashah Swasthaya Bima Yojana (BSBY), which benefits around one crore families, is one of the most successful healthcare insurance programmes in Rajasthan.
Under the scheme, the insurer gets Rs 30,000 for general illness and Rs three lakh for critical illness.
A section of experts believes the State’s BSBY scheme can provide blueprint for effective implementation of Ayushman Bharat, the Centre’s flagship healthcare insurance scheme. This proves how the State has made tangible progress in making medical facilities easily accessible and affordable to people at large.
The Rajasthan Government has implemented various schemes to bring down the Infant Mortality Rate (IMR) and Maternal Mortality Ratio (MMR), providing universal access to public health services, prevention and control of communicable and non- communicable diseases etc.
Kushal Mangal Karyakram was launched for the management of high-risk pregnancies improving maternal health. Rajasthan is the first State to establish Special Newborn Care Units (SNCUs) at all district hospitals. It aims to provide curative services to neonates.
The State Government has been applauded for initiatives i.e care of the newborns, protection of girls through the “daughters are precious” campaign, promotion of breastfeeding through ‘Aanchal’ mother’s milk bank and arrangements for neonatal and mothers’ health care in the district hospitals.
Through Public-Private-Partnership (PPP) mode, the State Government has tried to improve healthcare infrastructure in rural areas. Primary Health Centres (PHCs) have been handed over to private players for better management.
The State is torchbearer in terms of technology and innovations that have been harnessed to benefit people. The Government recently launched innovative software named ‘Nidaan’ for presumptive diagnosis and monitoring of seasonal and non-communicable diseases as well as the trends of ailments found in specific areas. The software is found to be helpful in formulation of specific action plans for control of diseases.
With the aim to screen newborns for hearing loss, a device called ‘SOHAM’ has been launched. This device would help doctors to detect and treat infants having hearing impairment. Another mobile app based ECG device, ATOM, was also launched to screen patients at primary healthcare level.
Telemedicine centers have been established across the State to provide patients best medical facilities in their nearby areas. The goal for establishing telemedicine network is to provide accessibility of medical practitioners to the remotest regions through state-of-the art technologies with optimal economical outcomes.
eInitiatives include Integrated System for Monitoring of PCPNDT Act (IMPACT) Software, ASHA Soft, e-Aushadhi, Pregnancy, Child Tracking & Health Services Management System (PCTS), e-Shubhalaxmi Yojna and eUpkaran Software.
The State government’s healthcare interventions to augment overall healthcare delivery enabling people to get better medical facilities in terms of quality, accessibility and affordability are:
Mothers Milk Bank
Rajasthan is the first State in the country to introduce community mother milk banking project. The bank collects excess breast milk from lactating mothers and provides it to infants deprived of it. The bank is very helpful for those mothers who are unable to feed infants due to clinical reasons, or those who are orphaned or abandoned.
Recently the State established its 18th center at Sirohi district hospital. With this, the Anchal/Divya Mother Milk Bank project in the State has now become the largest Human Milk Bank network in Asia, leaving China behind which has 17 Human Milk Banks.
The districts having this facility include Beawar (Ajmer), Alwar, Banswara, Baran, Barmer, Bhilwara, Bharatpur, Bundi, Chittorgarh, Churu, Dholpur, Jalore and Karauli. The State Government has banned the use of dairy and formula milk in hospitals where the milk banking units have been established.
As per the latest data (From Sept 2016 to March, 2018), over 23,839 lactating mothers have donated their milk to the Aanchal facility which in turn benefited about 14,808 infants and helping them improve their nutrition levels. Total 50.44 lakh ml milk was donated during this period.
Kushal Mangal Karyakram (KMK)
With an aim to bring down maternal mortality ratio (MMR) in the State, the Government launched Kushal Mangal Karyakram (KMK) in 2015.
It is the scheme where high-risk pregnancies are identified. These are such pregnancies which turn into mortality and add up to maternal mortality ratio. Under the programme, the Government provides facility of planned conception, HRP (Humanitarian response plan) tracking, follow up, planned institutional deliveries and post partum care. On every Friday, the health department observes State Motherhood Day. Camps are organised at identified Community Health Centers (CHCs) every month.
Government gynaecologists provide antenatal care (ANC) services at these centers. Since October 2015, a total of 7,741 camps have been organised. 2.10 lakh beneficiaries & 23,927 high risk pregnancies have been identified till March-18. Prasuti Niyojan Diwas is being observed every fourth Thursday of every month. Camps are organised to check birth preparedness, counseling for nutrition/ institutional delivery/ danger signs/ referral system (8th & 9th month of pregnancy).
Janani Shishu Suraksha Yojana (JSSY)
Launched in 2011, the scheme entitles all pregnant women free deliveries including caesarian section with zero out of pocket expenses, accessing public health institutions. As the neonate mortality contributes approximately 75 percent of IMR(Infant mortality rate), therefore this group of children are provided free of cost facility for investigations, treatment, medicines and any referral facility from home to facility and back home facility.
Janani Suraksha Yojana(JSY)
Under the scheme, the State Government pays special care to expecting mothers. A specific amount is paid to pregnant woman if she delivers her child in a government facility. In rural areas, the amount is Rs 1,400 while in an urban area it is Rs 1,000.
The Government launched Chirrau project, with the motive to reduce neonatal mortalities across the State. It aims at curbing infant deaths and promotes superior pre/post pregnancy maternal care at hospitals across the State. The scheme is successfully running in eight districts i.e Udaipur, Dholpur, Sawai Madhopur, Barmer, Sirohi, Karauli, Jalore and Rajsamand.
These districts have Sick Newborn Care Units (SNCUs), Newborn Stabilization Units (NBSUs) and Newborn Care Corners (NBCCs) which help to boost existing healthcare services for pregnant women, fetus and newborns at these centers to prevent birth complications.
• It strengthens SNCU points and establish strong NBSU linkage
• Strengthens C-section points
• Improve LR & newborn care practices at high delivery points
• Improve HRP identification & timely delivery planning
• Line-listed tracking of neo-natal deaths
• Improving accountability and reviews
Rashtriya Bal Swasthya Karyakaram (RBSK)
To protect the overall child health, the State Government initiated the scheme under which all children of Anganwadi Centres (0-6 yrs) and school going children up to 18 years are being screened for four Ds- Defects at birth, Diseases, Deficiencies, Developmental delays and Disabilities (30 identified illnesses) through dedicated Mobile Health Team. If a child is screened with any identified 30 diseases, he is being given free referral and follow-up, and surgical treatment, if required. Health of all school students and in Aganwadis is screened by AYUSH doctors based on 30 health parameters and if any child is found having health related problems, they are referred to the next higher-level facility.
‘Daughters are precious’ campaign
Daughters, like sons, too bring an invaluable bundle of joy to any couple’s married life. They are priceless and an embodiment of love, care, kindness and sacrifices. As a symbol of good luck, they boost the sense of responsibility to any couple’s life from the day she comes into existence. Any parent would vouch for the same. Today, there is no field left where a girl hasn’t left her indelible mark while bringing a wave of love, laughter and pride.
With the motive to encourage girl child, the Rajasthan Government launched ‘Daughters are Precious Campaign’ in 2016. The aim was to ensure survival of girl child, as the State had one of the lowest girl child sex ratio in the country due to female foeticide. Since 2016, the State Government has brought out many schemes to encourage save girl child.
Mukhyamantri Shubhlaxmi Yojana
To address the declining sex ratio in the State, the Government launched this scheme on 1 April, 2013 in the State. It aims to promote girl child birth and to reduce maternal mortality ratio. Under this scheme, an incentive of Rs 2,100 is given to mother on delivery at Government and private accredited health institutions other than JSY incentive. Amount of Rs 2,100 is given after the child turns one and on complete immunisation of the girl child. Rupees 3,100 is given after five years of age at the time of admission in school. Thus, a woman can get monitory benefit of Rs 7,300 for her girl child.
Mukhyamantri Rajshree Yojana
It is a special programme to encourage and empower girl child. It aims to secure girls’ future through different sum of amount at different intervals of time. With the motive to reduce infant mortality rate of girl child across the State, the Rajasthan Government started this scheme on 1 June, 2016. It aims to make parents of the girl child financially strong so that they wouldn’t face financial constrain in educating their daughters to excel in different walks of life.
• A total amount of Rs 50,000 is paid under the programme.
• First installment at birth — Rs 2,500
• Second installment (After completion of one year) — Rs 2,500
• Third Installment at the time of admission in first class in Government school — Rs 4,000, fourth installment on admission in sixth class — Rs 5,000, fifth installment on admission in 10th class — Rs 11,000
• Sixth installment on passing 12th class — Rs 25,000
Online JSY and Shubhlaxmi Payment System (OJAS)
It is an online platform which facilitates the users to capture beneficiary wise details of payment for Janani Suraksha Yojana (JSY) scheme and Shubhlaxmi Yojna, after due eligibility at CHC & above government health institutions. It ensures timely and seamless online payment for JSY and Shubhlaxmi beneficiaries. Started in August 2015, the online platform covers all public health institutions including CHCs and Sub Centers (SCs).
More than 4,000 JSY cases, 1,800 RSY & 700-800 SLY 2nd cases per day
Online Sanction issued for Payment transfer – 1 August 15 to March 2018
• JSY – Rs 321.33 crore for 22.62 lakh cases
• RSY – Rs 213.36 crore for 10.13 crore cases
• SLY – Rs 113.40 crore for 5.38 crore cases
Integrated Ambulance Project
In a bid to strengthen the emergency referral transport services, the Rajasthan Government incorporated ‘108’ toll free ambulance yojana in September 2008, which is a free emergency response services. Another helpline toll free ‘104’ medical advice service was launched in January, 2012. It is a medical helpline which provides advice, counseling, information directory services and many more health related information.
Off late, the Government has integrated these emergency numbers. Now callers don’t need to call on separate number to avail services. Medical advice is being provided through same call center.
Telemedicine Services Project
The Government has made available telemedicine services at different type of health institutions (District Hospital – 30/ Sub Division Hospital – 17/ Satellite Hospital – 4/ Community Health Centre – 49) across the State. The main objectives of the project are to cross geographical barriers to provide specialist healthcare services to people staying in rural & remote areas.
As an enabler, technology has driven healthcare industry to reach extramile. The Rajasthan Government has also harnessed its potential to benefit people at large. IT is a promising tool in healthcare that can provide new ways to healthcare providers to collect, store, retrieve and transfer information electronically. The Government has taken a slew of measures on this front.
Integrated System for Monitoring of PCPNDT Ac t (IMPA CT) Software
The web based Software IMPACT was launched on October 1, 2012. It provides online surveillance system of government for prevention of sex determination to save girl child.
Launched in December 2014, the online platform facilitates the health department, to capture beneficiary wise details of services given by ASHA to the community. The online system enables the online payment (27 types performance incentives) of ASHA to their bank accounts. It generates various kind of reports to monitor the progress of the programme. Till date, Rs 318 crore (Rs 90.75 crore in 2017-18) have been paid to ASHA workers.
It is a web-based application which deals with the management of stock of various drugs, sutures and surgical items required by different district drug warehouses of Rajasthan. e-Aushadhi helps in ascertaining the needs of various district drug warehouses such that all the required materials, drugs are constantly available to be supplied to the user district drug warehouses without delay.
Pregnancy, Child Tracking & Health Services Management System (PCTS)
It is a online software used as an effective planning and management tool by Medical, Health & Family Welfare department, Government of Rajasthan. The system maintains online data of government health institutions in the State. This software helps in tracking of pregnant women for better health surveillance; it is a useful tool for improving institutional delivery. It also helps in tracking BPL and JSY cases.
eUpkaran software was launched with the vision to streamline things on the front of equipment and diagnostics facility as it was found that . It is a comprehensive software solution to improve the inventory management & maintenance services of equipments in hospitals across the Rajasthan. The key objectives are effective inventory management, promotion of rational usage of equipments and ascertaining new demand of equipments and instruments, etc.
With above schemes and initiatives, the Rajasthan Government has tried to create an ideal healthcare delivery model to cater people of every stratum with best medical facilities. The Government is making tangible progress in terms of IMR (Infant mortality rate) and MMR (Maternal mortality rate) which has been a big roadblock jeopardizing healthcare accessibility and affordability till now.