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Lessons from the past


A recently released performance audit by the Comptroller and Auditor General (CAG) of India of the Pradhan Mantri Swasthya Suraksha Yojana (PMSSY) has many learnings for Ayushman Bharat-Pradhan Mantri Jan Arogya Yojana (AB-PMJAY).

Unfortunately, irregularities pointed out in a 2013 CAG report of the PMSSY have been repeated in the 2018 report as well, which means that there was no corrective action. The current performance audit covering from 2003-04 to 2016-17, found that the six new AIIMS had a cost overrun of INR 2,928 crores, and a time overrun of about four to five years in various packages. A shortage of faculty posts in different AIIMS, ranging from 55 per cent to 83 per cent, combined with a shortage of non-faculty posts (from 77 per cent to 97 per cent) meant that six to 14 speciality, super-speciality and other departments of 42 departments in these new AIIMS remained non-functional. The six new AIIMS were holding an unutilised balance of funds of INR 1,267.41 crore while INR 393.53 crores for civil works and INR 437.28 crores for procurement of equipment lay unspent with the executing agencies.

For patients, the intended beneficiaries of this scheme, the lack of faculty and non functional equipment etc meant shortages of beds ranging between 43 per cent and 84 per cent. Thus the CAG report points out that almost 15 years after PMSSY was announced and a significant spend on the institutions, these institutions had failed to deliver as per the original plan.

With the first phase of AB-PMJAY set to roll out on September 25 in 12 states and two union territories, the latest CAG report is a harsh reality check. As of early September, a total of 29 states and UTs have signed the MoU and have started work on the implementation of the AB-PMJAY, so a nation-wide consensus is slowing by surely building up. Will Prime Minister Modi’s personal supervision of this scheme, often referred to as Modicare, ensure that the implementation is glitch free? More importantly, even as no one doubts the need for such a scheme, does it have the checks and balances to detect frauds, leakages, false beneficiaries, etc? Thus, AB-PMJAY needs to be measured against each finding of the CAG report on the PMSSY so that any gaps are plugged as early as possible, ideally before the launch of the scheme.

Firstly, has adequate planning gone into AB-PMJAY? In the case of the PMSSY, it was a case of the old adage, haste makes waste. A preliminary feasibility assessment in March 2006 grossly under assessed several factors. Four crucial years were lost getting revised assessments and fresh approvals. The capital cost for the six new AIIMS for Phase-I escalated by 145 per cent in these four years, from INR 1,992 crores in March 2006 (estimated capital cost for each new AIIMS being INR 332 crores) to INR 4,920 crores in March 2010 (at the rate of INR 820 crores per new AIIMS).

The CAG report also points out that as the Ministry of Health & Family Welfare had not formulated any operational guidelines for PMSSY, implementation was guided by instructions issued from time to time resulting in several ad hoc decisions. Many critics are saying the same of AB-PMJAY, linking its launch this year to the general elections next year. Of course, this is being vigorously countered. Anti-fraud guidelines and a Data Privacy and Information Security Policy were launched recently. JP Nadda, Union Minister for Health and Family Welfare has stated that the information security system has more than 94 controls set at various levels for secure handling of sensitive personal data. He has already reportedly cracked down on fake websites masquerading as the AB-PMJAY.

Secondly, funding does not guarantee success. The 2018 CAG report points out that while PMSSY was adequately funded, managing and monitoring were the weakest links. The CAG report specifically pulls up the national, state and institute level monitoring committees which were formed to review project implementation, saying that they remained ineffective. This is where the technology backbone of the Ayushman Bharat-PMJAY will hopefully play a vital role in tracking and monitoring the implementation of the scheme.

India desperately needs a health safety net and AB-PMJAY is definitely a step in that direction. While PM Modi’s government has launched many initiatives in the past four years, the Indian electorate will judge them on this one scheme. Will the PM’s vision translate into reality for the
targeted 10 crore households?

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