Tuesday, March 23, 2010
Delivery of services through Panchayats
There is resistance of people to pay Rs. 30.00 to get a RSBY card for a family of five, as they feel it would be another waste of their money, mainly to benefit others (TPAs, Insurance Companies, Registered Hospitals, etc).
It is observed, whenever individuals or organizations or government or public sector employees claim medical reimbursement, invariably hospitals inflate the rates and charge high fees, saying, after all the reimbursement is from other agencies and why the patient should bother. There is no fixed service fees. Invariably patients are admitted and many unwanted high cost tests / scans are under take to fleece to the maximum.
It is time, there is a cap on the limit of money a hospital can take subject to rendering genuine service. This where the catch is. Who is to judge what is a genuine service?
Instead of a card for a family, RSBY should be integrated with UID Smart card for every citizen from birth to death and proper tracking needs to be included. Every citizen should get uniform good service. It should not be, you name the person, I shall tell you the type of treatment we extend.
One example that of Cancer Institute, Chennai, a non-profit, mainly charity organization. Here the Doctors are de-linked from the Administration. There is only 2 categories - payment and free categories. If the monthly earnings of an individual or family is above rs. 1,000, then it is payment. Else it is totally free. The payment is same, irrespective of if the patient is rich or poor. The treatment is also the same, irrespective of if you are rich or poor. There has been no instance of visible corruption or favoritism in treatment.
In many villages, the Village Nurse would give importance, only if the family is politically connected or is rich enough to influence the community leaders. The health registers and stock of medicines are not updated even for years and there is no system of checking!!
Invariably, the PRIs are steeped in corruption. The only way we can make people get truly benefited is to de-link the service providers and service seekers. Introduce Multi Purpose Biometric Smart Card cum Bank Debit Card based transaction mandatory and track all transactions for transparency and accountability. Eliminate the cancer of corruption, through a major surgery, if we want the benefits to genuinely reach the poorest of the poor. No cosmetic change can improve the systems.
This may sound extremely negative; but unfortunately that is the fact of the matter. Unfortunately, most Service Providers including NGOs prefer to fish in troubled waters and keep the water agitated and deny the common man their rightful dues, so that they can survive! That is how the rich are getting richer and the poor are getting poorer and the gap is widening day by day. Apparently some benefits are shown to reach the poor. But at what cost to the nation is not seen,as electoral aims have come to play a major role and are seen to be more important than citizen welfare in a democracy!!
The above was in response to a post in UNDP Solutions Exchange - Decentralization Community discussions (firstname.lastname@example.org) as follows:
"We are currently engaged in providing civil society partnerships to state governments in the Rashtriya Swasthya Bima Yojana (RSBY) scheme (www.rsby.in) launched in April 2009. It is a smart-card based health insurance system.
There are numerous cases where Below Poverty Line (BPL) families have been financially wiped out because of a health related catastrophe, such as an accident, a problem pregnancy, or any other severe medical condition. While universal access to healthcare is the responsibility of the government and is the desired scenario, in the absence of the same, affordable health insurance for all assumes even greater importance. Health insurance is one way of providing protection to poor households against the risk of health spending leading to perpetual poverty. The objective of the scheme is to protect BPL households from major health-shocks that involve hospitalization. RSBY is currently the most inclusive and comprehensive national health insurance scheme, especially for a section of society for whom quality healthcare forever seemed out of reach. At a one-time enrolment fee of merely Rs 30/-, the scheme provides coverage to five members of the family, up to an annual total coverage of Rs 30,000. The scheme covers most serious illnesses and procedures that require hospitalization.
The scheme is currently running in 22 states and some states are entering its second phase. However, given the vastness of the country and the levels of literacy in the country, the utilization of the scheme has not been as much as desired. Even if enrollment is satisfactory, beneficiary utilization is not necessarily optimal. In a population with relatively low literacy and poor understanding of healthcare processes, the beneficiaries lack the support and guidance to utilize the benefits of this unique scheme to their maximum advantage.
It is also important to note that many of the components coming under the broad premise of primary health care like family welfare, health and sanitation, women and child development, social welfare, including welfare of the handicapped and mentally retarded etc and poverty alleviation programmes are subjects transferred to rural local governments as per the Eleventh Schedule of Article 243 G of 73rd Amendment to the Constitution of India, though the actual situation might vary from State to State.
Members may also note that the Union Budget 2010-2011 has announced that the Rashtriya Swasthya Bima Yojana (RSBY) benefits would be extended to all such Mahatma Gandhi NREGA beneficiaries who have worked for more than 15 days during the preceding financial year. This is also important as Panchayats play a major role in the implementation of NREGS.
In this context, we request inputs from members on the following:
· What are the special institutions, systems, etc which are needed at the village and block levels to increase utilization of such RSBY by BPL population?
· Could you share experiences in awareness generation and increased utilization of RSBY or similar schemes among the identified population by PRIs?
· Is there a need for building any specific capacity/capability in the PRIs for improving utilization of RSBY among the BPL population and other NREGS beneficiaries with the aid of PRIs? Recommended and/or proven strategies for the same would be invaluable".