A substantial number of Indians are outside social safety nets, and lack healthcare access. The public healthcare system, crucial for ensuring access, is further fortified by the Ayushman Bharat Health and Wellness Centers (AB-HWC) scheme. Launched in 2018, this initiative is the Centre’s flagship programme aimed at achieving universal healthcare access.

The AB-HWC aims to provide equitable access to comprehensive healthcare services for all. A market-based provision can limit access to users according to their ability to pay. The AB-HWC, aligning with universal healthcare tenets, rectifies market failures and affirms healthcare as a fundamental human right.

The AB-HWC initiatives aim at ensuring comprehensive primary care through a network of health and wellness centres. Currently, over 1.61 lakh AB-HWCs are operational. With approximately 213 crore footfalls, it demonstrates enhanced access to comprehensive healthcare. Several States have surpassed 100 per cent of their targets in terms of functional AB-HWCs.

The AB-HWC helps in eliminating unqualified practitioners as accessibility to trained medical professionals improves. The number of doctors at rural Primary Health Centres (PHCs) and Community Health Centres (CHCs) increased between 2018 and 2022 whereas doctors in service at rural PHCs rose to 30,640.

Training of medical staff (85 per cent) under the scheme resulted in a substantial increase in screening for non-communicable diseases (NCDs). Besides, teleconsultations initiated under the scheme reached 17 crore.

Out-of-pocket expenditure

The economically vulnerable face substantial barriers in accessing healthcare due to high out-of-pocket expenditures. As per the NSSO survey, non-hospitalized treatment at rural public health facilities costs ₹325. The AB-HWC scheme addresses this challenge by providing free drugs, diagnostics, and immunization services.

As per National Health Account Estimates, government health expenditure (GHE) rose from 28.6 per cent in 2013-14 to 41.4 per cent, while out-of-pocket expenditure declined from 64.2 per cent to 47.1 per cent. The continued awareness programmes with over 80 lakh wellness sessions conducted at AB-HWC accompanied by screening go a long way in aiding preventive care, including tuberculosis and diet and nutrition, indirectly reducing out-of-pocket expenditure. The efforts of (sub-health centres) SHC-HWC in fostering mental health awareness are instrumental in empowering the population to de-stigmatise mental health.

The expanded AB-HWC ensures comprehensive care in pregnancy and childbirth, promoting and facilitating institutional delivery, identifying high-risk pregnancies, and providing follow-up. Women constitute 54 per cent of total footfalls, indicating enhanced care for women and children under the scheme. Moreover, about 93 per cent of immunisation services are offered through public provision. The lack of reliable information and complete awareness from private healthcare providers robs women of their agency in childbirth decisions. The AB-HWC facilities and awareness, including complete information on deliveries as a public provision, ensure agency of women over their bodies and delivery decisions.

Ayushman Bharat is part of a broader vision for achieving universal health coverage. Since health outcomes are influenced by various factors, it is essential that public provision, such as AB-HWC is assessed from the provisions ensured in the scheme and not from health outcomes.

As the AB-HWC achieves its target, upgrading existing SHC-HWCs and expanding additional SHC-HWCs to meet IPHS standards becomes imperative. A comprehensive national health expenditure policy under cooperative federalism is indispensable to achieve the universal healthcare envisaged under the Ayushman Bharat scheme. States achieving targets under the AB-HWC scheme should be incentivised with additional grants from the Centre.

The writer teaches economics at IIT,Kharagpur. Views expressed are personal

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