ISSN (Print) - 0012-9976 | ISSN (Online) - 2349-8846
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Publicity over Performance

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On 23 September 2018, Ayushman Bharat Yojana (ABY) was launched in India to achieve universal health coverage (UHC) in the country. There was much build-up around it. It was first supposed to be launched by Prime Minister Narendra Modi during the Independence Day celebrations from the Red Fort, then the date was pushed to 25 September, the birth anniversary of Deendayal Upadhyaya, the Rashtriya Swayamsevak Sangh (RSS) thinker and co-founder of the Jan Sangh, which later became the Bharatiya Janata Party (BJP). This later date was then preponed to 23 September, when the Prime Minister launched it from Jharkhand.

Choosing the right launch date, name, and place seems to hold a lot of importance for the Modi government, and may be more important than even the planning or execution of the scheme. This careful consideration of the announcement date and time echoes the care taken in announcing the goods and services tax (GST) in 2017 and the demonetisation of banknotes in 2016. The GST was launched at the stroke of midnight on 30 June 2017, echoing the drama of the announcement of independence during a similar stroke of midnight in August 1947. Demonetisation was similarly unveiled during a live unscheduled television broadcast on the evening of 8 November 2016. While the rest of the world was glued to the television, watching (in horror or jubilation) Donald Trump win an unexpected victory over Hillary Clinton in the United States (US), in India, people watched in similar horror or jubilation (depending on their scale of privilege) as Modi convinced us that demonetisation was a necessary measure to protect the country from black money and terrorist activities. And, now that the obvious loopholes in the logic of demonetisation and the execution of GST are coming to light, we have a new shiny bauble to be dazzled by: “Modicare.”

The Modi government inherited a poorly performing public insurance scheme called the Rashtriya Swasthya Bima Yojana (RSBY) from the previous government. Various studies have found that the RSBY, surprisingly, did not have any significant impact on the out-of-pocket health expenses of the enrolled families (if at all, it increased the spending). The ABY will subsume the RSBY along with the Senior Citizen Health Insurance Scheme (SCHIS), and is expected to be a vast improvement over the previous scheme. It is being repeatedly touted as the “world’s largest state-funded health insurance scheme,” and has also been nicknamed Modicare. Despite the name’s obvious inspiration from Obamacare in the US, there is hardly anything in common between the two except for the end goal of UHC. In fact, unlike Barack Obama, who distances himself from that name, Modi is not shy of it at all (the name Modicare was even referenced by him during his launch speech in Ranchi).

The strange phenomenon of celebrating the success of a programme before it is even underway is something we have come to expect (Modi has already been “nominated” for the Nobel Peace Prize for the ABY). There is a constant sense of jubilation about the “anticipated” success of different initiatives, which is why the careful orchestration of the announcement and publicity of each programme is very important for the Modi government.

Every programme and announcement is given a symbolic or higher meaning in order to play into public sentiment. The GST becomes the new measure for tax freedom, and demonetisation becomes the nationalistic tool to fight counterfeit money. Even the much delayed and much awaited rise in the allowance of front-line health workers is announced as not just a simple change in allowance policy, but as Modi’s early Diwali gift to the accre­dited social health activists (ASHAs) and anganwadi workers of India. The first child born through institutional delivery under the ABY was called the first Ayushman Bharat baby.

The importance (or lack of it) placed by the present government on healthcare is evident in the budgetary allocation of a little over 1% of the gross domestic product (GDP) for healthcare. To put this in context, out of the countries with significant UHC, healthcare spending ranges from a maximum of 9.2% to a minimum of 2.2% of the GDP. Not only does India have one of the lowest healthcare allocations in the world, even these low allocations are being underutilised. In 2017, the Modi government released the National Health Policy (NHP) which assured us that the healthcare allocation will be increased to 2.5% of the GDP by 2025. Just a few months later, the Union Budget 2018–19 was launched, in which the health allocation continued to hover around 1% of the GDP and, in fact, the budget allocation for health was reduced from 2.4%of the central budget in 2017–18 (revised estimate) to 2.1%, hardly an example of walking the talk.

The jarring gaps in the ABY (grossly inadequate budget, infrastructure, and workforce to execute it, not enough emphasis on preventive and out-of-hospital expenses, ridiculously low treatment packages, and so on) have already been pointed out by many. But, what I find surprising is the shocking lack of preparation or thoroughness in the planning of a scheme of this magnitude. This hurry to launch a scheme without first addressing the obvious loose ends, alongside the care taken in creating the drama around the announcement of its launch, does not inspire confidence in the party’s concern for healthcare. Instead, it indicates just another activity to build the aura of the anticipatory success of Modi, to keep the momentum of his public relations management going until the 2019 elections. As Arun Shourie stated in a recent interview, every public programme of this government has become an occasion for image and event management. The fact that this government has spent more than double (₹ 4,343 crore) on its publicity (between May 2014 and May 2018) than what it has allocated this year for what it calls the “world’s largest state-funded health insurance scheme” (₹ 2,000 crore), is telling evidence of where its priorities lie.

Saheli Khastagir

Ghaziabad

Updated On : 2nd Nov, 2018

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