In rural areas, frontline workers i.e., the ASHAs (Accredited Social Health Activists) facilitate contact with the public health sector. These act as community-based mobilizers that receive performance-linked incentives for service access and utilisation by their catchment population (usually, a village of 1,000 population) (NHSRC, 2019). The Anganwadi Workers from the Women and Child Development Department of the Government of India serve as the other community-based village-level frontline workers that help with maternal child health nutrition and immunization services, and in community mobilization.

The Auxiliary Nurse Midwife (ANM) at the sub-centre serves as the first contact with the formal public health sector (MoHFW, n.d.-b). Even though referral linkage exists between the facilities at the different tiers, care seekers in India most commonly use ‘walk-in’ services. In-patient admissions happen through out-patient and emergency departments. Many health services in rural India are also accessed through the non-formal practitioners, whose services are unregulated, with concerns regarding the quality of care offered (unsafe injection practices, multi-pharmacy, steroid, and antibiotic abuse, etc.) (Gautam et al., 2014). Frequently, these local practitioners serve as the first point of contact for health care seekers and cover up for the unavailability of formal providers. They also refer patients to formal health facilities for care, but often with delay and complications.

In urban areas, for critical cases, people frequently choose to seek care in the private sector. The perception of better care quality, convenience, staff availability, and system responsiveness are some of the reasons for people preferring the private sector over the public health sector (Barik and Thorat, 2015). However, care in the private sector is costlier than the public sector. Drugs and services in the latter are usually subsidised.

Schemes like the Employee State Insurance Corporation, the Central Government of Health Services, Corporate Empanelment Schemes, and Ayushman Bharat serve as the other major routes of health access to public and private health care providers for individuals and families (Table 2.4).

The most recently (2018) launched an insurance scheme under Ayushman Bharat known as the Ayushman Bharat Pradhan Mantri Jan Arogya Yojana (PM-JAY), which is a government funded health insurance scheme offering socioeconomically disadvantaged families a benefit cover of Rs 5 lakh per year for hospitalizations (National Health Authority, 2022b). With PMJAY, several neurological diseases that require secondary and tertiary care are also covered such as meningitis, epilepsy and stroke, and care can be accessed in both public and private facilities (Paul, 2019). In addition, in September 2021, the Ayushman Bharat Digital Mission (ABDM) was introduced, with the aim of improving digital health infrastructure and bridging current gaps within the country (National Health Authority, 2022a). ABDM will be able to facilitate access of patients to their own health records, allow patients to share their health records with health care providers, provide the ability to access health services via tele-consultations etc. (National Health Authority, 2022a).

Table 2.4 Schemes related to health care

Name of the scheme	Details	Nature of health issues	Coverage	Source
Ayushman Bharat	Two components, which are: Establishment of Health and Wellness Centres AB-Pradhan Mantri Jan Arogya Yojana (PM-JAY) –PM-JAY	AB-PMJAY provides financial protection to the socioeconomically disadvantaged. It will offer a benefit cover of Rs. 500,000 per family per year (on a family floater basis).	Launched in 2018. Over 2,89,23,388, hospital admissions have been covered as of 28th February 2022 (National Health Authority, 2022b).	National Health Portal of India (2019)
Employees’ State Insurance Scheme	Employees of factories and other establishment’s where 10 or more persons are employed.	Cover incidences of sickness, employment injury related death and provides medical care to insured persons and their families.	Benefits about 2.13 crore insured persons/ family units.	National Portal of India (2020)
Central Government Health Scheme	For Central Government employees.	The medical facilities are provided through Wellness Centres (previously referred to as CGHS Dispensaries) / polyclinics.	Approximately 35 lakh beneficiaries are covered by CGHS in 71 cities all over India.	MoHFW (2020a)

 

References:

Barik, D., & Thorat, A. (2015). Issues of unequal access to public health in India. Frontiers in public health, 3, 245.

Gautham, M., Shyamprasad, K. M., Singh, R., Zachariah, A., Singh, R., & Bloom, G. (2014). Informal rural healthcare providers in North and South India. Health policy and planning, 29(suppl_1), i20-i29. https://doi.org/10.1093/heapol/czt050

Ministry of Health and Family Welfare. (n.d.-b). Rural Health Statistics 2019-2020. Statistics Division, Ministry of Health and Family Welfare. Government of India.

Ministry of Health and Family Welfare. (2020a). Central Government Health Scheme.

National Health Authority (2022a). Ayushman Bharat-Digital Mission. Government of India. Available from: https://abdm.gov.in/

National Health Authority (2022b). Ayushman Bharat-Pradhan Mantri Jan Arogya. Government of India.

National Health Portal (2019). Ayushman Bharat Yojana. Government of India. Available from: https://www.nhp.gov.in/ayushman-bharat-yojana_pg

National Health Systems Resource Centre (2019). Update on ASHA Programme: July 2019. Ministry of Health and Family Welfare. Available from: https://nhsrcindia.org/sites/default/files/2021-06/ASHA%20Update%20July%202019.pdf

National Portal of India (2020). Employee State Insurance Scheme. Government of India. Available from: https://www.india.gov.in/spotlight/employees-state-insurance-scheme#tab=tab-1

Paul, V. (2019). Ayushman Bharat Pradhan Mantri Jan Arogya Yojana (AB PMJAY): Hope for Millions and Exciting New Prospects for Neuro-Healthcare. Neurology India, 67(5), 1186. https://doi.org/10.4103/0028-3886.271284