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Fact check : Is Amartya Sen's claim about the Ayushman Bharat neglecting primary health care true?

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Summary

Amartya Sen’s argument that Ayushman Bharat neglects the primary health care is not true. Health and Wellness Centres (HWCs) under Ayushman Bharat focuses on Primary Health care by covering both maternal and child health services. 

According to several reports, Amartya Sen’s who is a very highly acclaimed economist and Noble laureate spoke against the Ayushman Bharat scheme and how it is failing to acknowledge the primary healthcare. He had apparently said that rather than giving money to people, the government should focus on health and education in a way that would render to the capabilities of people. He had specifically mentioned that both the BJP and UPA government had failed in providing primary healthcare as reported by Indian Express. According to him, the Ayushman Bharat scheme aims at the wrong side of the population. He also claimed that the government rather than focusing on helping people with funds to cure diseases can facilitate for primary healthcare more such as immunity-boosting supplements for children and infants in the primary level. “What India needed was a radical change of primary healthcare,” he said as reported by The Telegraph. He was speaking at a panel discussion organised by publisher Orient BlackSwan during the launch of a book ‘A Quantum Leap in the Wrong Direction?’

However looking into the Ayushman Bharat scheme, his opinionated claims can be proven false or he could have been misunderstood. Either way, it can be proven that the Ayushman Bharat scheme does not only focus on Secondary and Tertiary levels but also on Primary levels. Firstly, it is important to understand the functioning of the scheme. It can be seen that this scheme is divided into two,

  1. Establishment of Health and Wellness Centres (HWCs)
  2. Pradhan Mantri Jan Arogya Yojana (PM-JAY)

According to the National Health Portal website of the HWC portal, the motive of the HWCs is to “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”. It is important to note that the government in February 2018 had announced the establishment of 1,50,000 HWCs from existing Sub Centres and Primary Health Care Centres. Given below are all the motives and key elements of the scheme. Reading through it thoroughly can make us clearly understand that primary health care is very much part of the scheme. 

Furthermore, secondary and tertiary health care is also part of the scheme under the PM-JAY. According to the official website, “ PM-JAY will cover medical and hospitalization expenses for almost all secondary care and most of the tertiary care procedures”. This shows that while HWCs look after primary health care, PM-JAY focuses on Secondary and Tertiary care.

However, the confusion and false rumours regarding the scheme supporting only secondary and tertiary health care could have arisen from more media portrayal and people’s familiarity with PM-JAY. Another reason could be because of the fact that this scheme is a very recent initiative and only minimal amount from the health budget is allocated for primary care. It still has a long way to go in successful implication. But the claim that this governmental scheme does not focus on primary health care is false because both aspects of the scheme were put into action together. The proof for this can be seen on the Press Information Bureau website. Click here to see the implementation statistics for PM-JAY and HWCs.

If Amartya Sen had claimed that the governmental scheme focuses only on secondary and tertiary health care, then that is false. However, if he had claimed that secondary and tertiary care are more successfully implemented than the primary care, that can be considered true.

Ayushman Bharat targetted repeatedly

In an article published in ‘The Wire’ titled Ayushman Bharat Trivialises India’s Quest for Universal Health Care, the author Jean Drèze accused Prime Minister Modi of deception. He writes,

The budget allocation for PMJAY in 2018-19 is just Rs 2,000 crore. That is not much more than the previous year’s budget allocation of Rs 1,000 crore for Rashtriya Swasthya Bima Yojana, PMJAY’s predecessor, which is now being subsumed under PMJAY. In other words, there is virtually no new money this year for PMJAY.

The author has said that even though the budget has been doubled(100% increase), there is no new money for PMJAY. Doubling the budget is nothing? That's strange logic.

The author further writes:

According to recent media reports, NITI Aayog experts anticipate the annual PMJAY budget to rise to Rs 10,000 crore or so in the next few years, or something in that range. But Rs 10,000 crore (more than five times the current PMJAY budget) is still chickenfeed for the purpose of providing health insurance to 10 crore families. It comes to Rs 1,000 per family, or Rs 200 per person. For the whole year.

That's a very strange understanding of Insurance. The author has claimed that the government has allocated just Rs 200 per person for the whole year. This calculation will be true only if all 10 crores family (or 50 crores people) will fall sick in the same year to claim the insurance. Now, what is the chance that all 50 crore members of 10 crores family will fall sick in the same year? If this happens then the entire insurance industry will crumble.

It is surprising that The Wire has published such a dubious article.

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