INSIDE A dingy room near the busy highway connecting Sohna in Haryana to Alwar in Rajasthan, a wooden table is littered with used syringes and needles. Here’s where “Dr” Rafiq Ahmed has cemented his status over the last 40 years as the “Bengali doctor” for several villages in the area. As patients wait, Ahmed checks the blood pressure of a woman and scribbles on a yellowing pad. “I wrote her a liver medicine,” he says.
In a nutshell, this scene illustrates the change that the Pradhan Mantri Jan Arogya Yojana (PMJAY), the largest government health insurance scheme in the world, can bring in districts like Mewat, which was declared as India’s most backward by the Niti Aayog this year.
Rolled out by Prime Minister Narendra Modi Sunday, PMJAY provides an annual cover of Rs 5 lakh to eligible beneficiaries in the form of reimbursements for bed charges, and drugs and diagnostics two days before, during, and 15 days after hospitalisation. This, officials and doctors in Mewat say, could go a long way in eliminating the scourge of “quacks” like Ahmed.
“I see 30-40 patients every day. The civil hospital is a busy place, so they sometimes send patients to me for injections, vaccinations, etc. I don’t have any degree but I don’t charge any extra money. I only ask for Rs 50-70 to meet the cost of medicines or injections. Sometimes, I prescribe medicines, too,” says Ahmed, while refusing to be photographed.
Officials say the danger of turning to unregistered practitioners like Ahmed is that if the illness escalates, there’s nothing much doctors at the district hospital can do except refer these patients to “bigger centres” in Nalhar, or facilities in Delhi and Jaipur. The 100-bed Al Afia district hospital and the 500-bed SHKM in Nalhar are the only two government facilities that are part of the rollout in Mewat.
But one of the biggest advantages of PMJAY, officials say, is that it allows national portability, which means a resident of Mewat is entitled to free hospitalisation at an empanelled hospital anywhere in the country.
Express Series Part II | What govt needs to bridge: Swank 500-bed hospital, crumbling 1-room health centre
It’s not so simple for residents across the district, through. Government doctors at local health centres say that given the lack of facilities and specialists, the first port of call for many remain such “quacks”. Besides, they say, the scheme will not reimburse medical expenses for drugs and diagnostics unless the patient is hospitalised.
“I have been here for 13 years and I have never seen a specialist. In the entire district, outside of government centres, there are less than 15 MBBS doctors,” says Dr Krishan Kumar, senior medical officer at the community health centre in Ferozepur Jhirka. There are also cases like that of Genduri village, where the local health centre has been converted into living quarters for a security guard after doctors refused to stay there because of the presence of a cremation ghat nearby.
Yet, for patients like Sehwan, 3, in Mewat’s Sakras village, PMJAY represents hope and relief.
Sehwan’s left eye had to be removed when he was two because of a malignant tumour. “Every 21 days, we have to travel to Alwar for his treatment, spending Rs 4,000-4,500 each trip. One-and-a-half years ago, when the surgery was done, it cost us Rs 30,000-40,000. Since then, we have been going to Alwar every three weeks. Sehwan’s father is a driver, and there are 10 people in the family. It is very difficult,” says Mohammed Sahebuddin, Sehwan’s grandfather.
In a series of ground reports on how PMJAY will impact healthcare in India’s most backward district, The Indian Express found that 4.58 lakh people or around 57,370 families out of a total population of 11 lakh, who were identified from the Socio Economic Caste Census (SECC) 2011, are eligible for PMJAY in Mewat.
But the challenges here in rolling out the scheme, The Indian Express found, were many: The gaps in the government system, from a 500-bed facility to a health centre operating out of a temporary dilapidated building, and the stringent empanelment norms that has left out all private facilities from the scheme.
“We go to the Bengali doctor or the local pharmacy for medicines. There is a long queue at the local health centre and even longer ones at the civil hospital. Anyway, all they do is refer us to a bigger place,” says Ganga Sahay, in Bhadas village.
Sahay’s daughter-in-law Anju Bala is the village sarpanch who, like her counterparts, were mandated with verifying the list of beneficiaries who will get a “gold card” that entitles them to reimbursement under PMJAY.
But Sahay admits that he is still not fully aware of the scheme’s benefits. With awareness yet to filter down, the Ayushman Bharat kiosk at Al Afia Hospital has received just about 1,000 queries about the scheme over the last month. This also explains some of the “teething issues” at the kiosk.
“As gold cards are being generated, there are problems in verifying the ID documents. Of the 1,000 queries since August 16, just 275 cases could be verified… of those, 75 got rejected because the document or the biometric available did not match,” says one of the liaison staff at the kiosk.
“In many cases, the ID document is the old ration card where numbers are written by hand. Also, the system often comes up with records of different families in different districts for the same document. We have also been told not to forward any case where Aadhaar is not available. The system is not accepting any other ID card,” he says.
“We have been informally told to accept only those with Aadhaar and whose biometrics match,” says Dr Renu Sharma, the district nodal officer for PMJAY.
According to the Health Ministry and the National Health Agency, which implements the scheme, any official ID document can be used to verify beneficiaries. And Haryana State Health Agency CEO Dr Saket Kumar denies that any instruction has been issued to restrict verification to Aadhaar. “This should not be the case. There is no such issue,” says Kumar.
For families of patients like Sehwan, meanwhile, there’s more that can be done. “A health cover is very good. But apart from treatment expenses, I spend a lot of money on conveyance, food, etc. If this pays for that, too, it will be a godsend,” says Sahebuddin.