7 PM | More equal care: Gender gap in Healthcare services| 12th December 2019

Context:Ayushman Bharat Scheme and Gender gap in healthcare services.

Global gender gap report:

  • It is published annually by the world economic forum since 2006 as a framework for capturing the magnitude of gender-based disparities and tracking their progress over time.
  • Global gender gap index is a part of this which measures gender equality across four pillars– they are economic opportunity, political empowerment, educational attainment and health and survival.
  • India ranks 108 in the overall index and 147th out of 149 in the sub-index of ‘health and survival’.

Women in India and healthcare services:

  • According to the National Family Health Survey (4th round), the main reasons women do not seek healthcare services are because:
  • these services are unaffordable,
  • these are not easily available and
  • there aren’t enough women healthcare providers.
  • Faced with limited resources, families, in general, prioritise the healthcare, nutrition and other needs of men at the cost of women.
  • Some cultural factors, such as the reluctance of women in some regions to consult male doctors, also constrain their access to healthcare services.

Ayushman Bharat:

  • Ayushman Bharat, a flagship scheme of Goverment of India was launched as recommended by the National Health Policy 2017, to achieve the vision of Universal Health Coverage (UHC).
  • This initiative has been designed on the lines as to meet SDG and its underlining commitment, which is “leave no one behind”.
  • Ayushman Bharat is an attempt to move from sectoral and segmented approach of health service delivery to a comprehensive need-based health care service.
  • Aim of Ayushman Bharat: The aim is to undertake path breaking interventions to holistically address health (covering prevention, promotion and ambulatory care), at primary, secondary and tertiary level.
  • The scheme adopts a continuum of care approach, comprising of two inter-related components:
    • Health and Wellness Centres (HWCs)
    • Pradhan Mantri Jan Arogya Yojana (PM-JAY)

Health and Wellness Centres (HWCs):

  • The Government of India in 2018 announced the creation of 1,50,000 Health and Wellness Centres (HWCs) by transforming existing Sub Centres and Primary Health Centres. 
  • Functions:
  • These centres would deliver Comprehensive Primary Health Care (CPHC) bringing healthcare closer to the homes of people covering both maternal and child health services and non-communicable diseases, including free essential drugs and diagnostic services.
  • Health and Wellness Centers, are envisaged to deliver an expanded range of services to address the primary health care needs of the entire population in their area, expanding access, universality and equity close to the community.
  • The emphasis of health promotion and prevention is designed to bring focus on keeping people healthy by engaging and empowering individuals and communities to choose healthy behaviours and make changes that reduce the risk of developing chronic diseases and morbidities.

Pradhan Mantri Jan Arogya Yojana (PM-JAY):

  • The second component under Ayushman Bharat is PM-JAY, which aims at providing health insurance cover of Rs. 5 lakhs per family per year for secondary and tertiary care hospitalization to over 10.74 crores poor and vulnerable families (approximately 50 crore beneficiaries).
  • There is no cap on the family size under the scheme.
  • This scheme was earlier known as National Health Protection Scheme (NHPS) before it was rechristened to PM-JAY.
  • PM-JAY has been rolled out for the bottom 40% of poor and vulnerable population.
  • The households included are based on the deprivation and occupational criteria of Socio-Economic Caste Census 2011 (SECC 2011) for rural and urban areas respectively.
  • The scheme subsumed then existing Rashtriya Swasthya Bima Yojana (RSBY), launched in 2008.
  • PM-JAY is completely funded by the Government, and cost of implementation is shared between Central and State Governments.

Features of Ayushman Bharat Scheme in favour of Women:

  • Cashless services through PM-JAY are helping to narrow the gender gap in availing healthcare.
  • In earlier schemes like the Rashtriya Swasthya Bima Yojana families with no adult male members is one of the deprivation criteria for identifying target beneficiaries. PM-JAY’s design will help a large number of women. 
  • There is no cap on the size of families. A cap of five beneficiaries from a family in earlier schemes worked against women. It was observed that large families preferred that their male members be beneficiaries.
  • Benefits of the scheme are portable across the country i.e. a beneficiary can visit any empanelled public or private hospital for cashless treatment.
  • The packages include a large number of health conditions that exclusively, or primarily, affect women. Of the 1,393 health benefit packages under PM-JAY, 116 are women centric, 64 are for only men while 1,213 are common to both.

Findings of the analysis of initial PM-JAY data:

  • The initial data for utilisation of services under PM-JAY shows that the use of services is more or less evenly balanced among men and women. Of all hospital admission requests, 52 per cent were for men and 48 per cent were for women.
  • Use by women patients is higher in 10 specialties — OPD diagnostics, radiation oncology, follow-ups, palliative care, burns management, ophthalmology, pediatric cancer, PHC and surgical oncology. However, in others like pediatric surgery, general medicine, urology and cardiology utilisation by male patients is higher.
  • There are variations across states as well. For example, at the national level, 66 per cent of all treatment in orthopedics were received by men. However, in Kerala, the proportion is 53 per cent while it is much greater in UP and Maharashtra at 70 per cent.
  • Among the three major specialty services provided by PM-JAY, “oncology, cardiology and nephrology”,  a majority of the users of oncology services are women. However, there are large gender gaps in the use of cardiology and nephrology-related services.

The overall message from the analysis of initial PM-JAY data is that the scheme seems to be on the right track, even though more effort is needed to achieve total gender parity. 

Way Forward:

  • Monitoring the service utilization pattern: Timely monitoring the disaggregated service utilisation data will help sensitise implementing agencies and district authorities about possible gender gaps.
  • IEC Campaign: Gender Gaps can be addressed by more informed and gender-sensitive planning, including targeted IEC (information, education and communication) campaigns.
  • Awareness campaign:Women might need to be informed about their eligibility for the scheme so that they can get their e-cards made and seek treatment in time. 
  • Women Healthcare providers: Tele-consultations with women healthcare providers might be required in case there are cultural barriers in consulting with male doctors.

PMJAY has a strong potential to empower women to take decisions on their health and wipe out the gender gap in use of health services. The scheme will be successful only when it can ensure that women and girls receive their due in the use of healthcare services.


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