45

• Name of Scheme in the State: Ayushman Bharat Pradhan Mantri Jan Arogya Yojana

(AB PM-JAY) and Mukhiya Mantri Jan Arogya Abhiyan (MMJAA)

• Name of the State Health Agency: State Agency for Comprehensive Health and Integrated

Services (SACHIS)

• Mode of Implementation: Trust

• Date of Roll-Out of Scheme: 23/09/2018

• Families with E-Cards: 3793360

• Empanelled Hospitals: 2657

UTTARPRADESHSTATE HIGHLIGHTS

PREFERENTIAL TREATMENT OF AB PM-JAY BENEFICIARIES IN GOVERNMENT HOSPITALS

Thematic area/division: Treatment of Beneficiaries

Separate registration counter and separate ward has been earmarked for AB PM-JAY beneficiaries to encourage

preferential treatment of AB PM-JAY beneficiaries in government hospitals.

In order to increase uptake of scheme benefits and to encourage beneficiary footfall in government hospitals, the Government of Uttar Pradesh has issued government orders to encourage preferential treatment of AB PM-JAY beneficiaries in government hospitals:

i. Separate registration counters in government hospitals reserved for AB PM-JAY beneficiaries with specific signage to demarcate them from regular counters. Separate stamps to signify scheme beneficiaries’ casefiles/lab reports to differentiate them from non-AB PM-JAY patients.

ii. Separate wards for AB PM-JAY beneficiaries in lieu of the above initiative to instil a sense of importance and entitlement in scheme beneficiaries, with the aim of increasing beneficiary footfall in such EHCPs.

iv. Prioritisation of radiological and laboratory investigations for AB PM-JAY beneficiaries.

46

PREFERENTIAL TREATMENT OF AB PM-JAY BENEFICIARIES IN GOVERNMENT HOSPITALS

Thematic area/division: Treatment of Beneficiaries

Separate registration counter and separate ward has been earmarked for AB PM-JAY beneficiaries to encourage

preferential treatment of AB PM-JAY beneficiaries in government hospitals.

In order to increase uptake of scheme benefits and to encourage beneficiary footfall in government hospitals, the Government of Uttar Pradesh has issued government orders to encourage preferential treatment of AB PM-JAY beneficiaries in government hospitals:

i. Separate registration counters in government hospitals reserved for AB PM-JAY beneficiaries with specific signage to demarcate them from regular counters. Separate stamps to signify scheme beneficiaries’ casefiles/lab reports to differentiate them from non-AB PM-JAY patients.

ii. Separate wards for AB PM-JAY beneficiaries in lieu of the above initiative to instil a sense of importance and entitlement in scheme beneficiaries, with the aim of increasing beneficiary footfall in such EHCPs.

iv. Prioritisation of radiological and laboratory investigations for AB PM-JAY beneficiaries.

SPECIAL CALL CENTRE FOR BENEFICIARY FEEDBACK

Thematic area/division: Grievance Redressal

A dedicated call centre has been established to provide beneficiaries with scheme-related information and solve queries

regarding scheme entitlement. The call centre also regularly collects beneficiary feedback on various fronts such as griev-

ance resolution, treatment confirmation, general beneficiary feedback and anti-fraud activities.

For active communication with beneficiaries and follow-up for special requests to ensure provision of AB

PM-JAY services to beneficiaries, the Uttar Pradesh State Health Agency has empanelled a call centre to

carry out regular telecommunication activities for AB PM-JAY in the State. In addition to engaging with bene-

ficiaries regarding scheme-related FAQs and queries regarding scheme entitlement, the call centre is also

tasked with collecting beneficiary feedback on various fronts such as grievance resolution, treatment confir-

mation, general beneficiary feedback and anti-fraud activities. Various other channels which include but are

not limited to social media, letters and communication, etc., are also used for beneficiary communication and

feedback.

INSTITUTIONAL SETTING/EMPOWERING COMMITTEES

Thematic area/division: Institutional Setup

A specialised committee has been constituted to provide guidance and opinion on various aspects of AB PM-JAY including

medical advice during claim adjudication, expert medical opinion for anti-fraud activities and special requests for unspeci-

fied packages.

UP-SHA has empanelled a third-party committee consisting of specialist and super-specialist doctors from

Institutes of National Eminence. This specialized committee provides guidance and opinion on various

aspects of AB PM-JAY in addition to medical advice during claim adjudication. Their services have now been

extended to seeking expert medical opinion for anti-fraud activities (specialist desk audits) and special

requests (Unspecified Packages). The inclusion of this group as a Medical Advisory Body in addition to the

existing Medical Committee at the State is a great value addition to the institutional setting at the SHA in

terms of cost-saving and expert clinical advice for unspecified package rates, claim disposal, and anti-fraud

activities.

MULTIDIMENSIONAL AWARENESS CAMPAIGNS

Thematic area/division: IEC

The SHA conducted several innovative IEC activities such as hospital flowchart, ASHA tutorial video, radio jingle, booklets,

etc., to spread awareness and reach out to various stakeholders.

Several IEC activities have been undertaken by the State for spreading awareness to both beneficiaries and

other stakeholders. These include the following:

i. Hospital flowchart: It is an essential tool for understanding the operational aspects of the scheme in the

hospital ecosystem. This diagram has been used not only in orientation of workflow to various

47

stakeholders but has aided the same stakeholders (mostly medical colleges and other government

institutions) in organising and customising scheme operations to suit their own institutional workflows.

ii. ASHA Tutorial Video: Created to orient ASHA workers about various scheme aspects that they may

then use to inform potential beneficiaries about the scheme, its benefits and other implementation details.

The videos and subsequent trainings were introduced so as to indoctrinate a feeling of owner

ship within ASHA workers towards the scheme.

iii. Radio Jingle aired on 100.7 Hz All India FM Radio in the month of June 2020 which was conceptualised,

created, edited, and given voiceovers by the State Team.

iv. Celebration video of 1-year of journey AB PM-JAY in Uttar Pradesh conceptualised, created and

edited by the State Team (uploaded on SACHIS website).

v. Creation and distribution of the following material for IEC/documentation purposes:

a. Booklets containing Important Scheme Aspects and FAQs – distributed to public representatives

(such as vidhayaks, etc.), heads of various public departments, and district authorities (DM,

Collectorate, etc.)

48

stakeholders but has aided the same stakeholders (mostly medical colleges and other government

institutions) in organising and customising scheme operations to suit their own institutional workflows.

ii. ASHA Tutorial Video: Created to orient ASHA workers about various scheme aspects that they may

then use to inform potential beneficiaries about the scheme, its benefits and other implementation details.

The videos and subsequent trainings were introduced so as to indoctrinate a feeling of owner

ship within ASHA workers towards the scheme.

iii. Radio Jingle aired on 100.7 Hz All India FM Radio in the month of June 2020 which was conceptualised,

created, edited, and given voiceovers by the State Team.

iv. Celebration video of 1-year of journey AB PM-JAY in Uttar Pradesh conceptualised, created and

edited by the State Team (uploaded on SACHIS website).

v. Creation and distribution of the following material for IEC/documentation purposes:

a. Booklets containing Important Scheme Aspects and FAQs – distributed to public representatives

(such as vidhayaks, etc.), heads of various public departments, and district authorities (DM,

Collectorate, etc.)

b. Hospital Booklets were developed containing a list of all healthcare providers (government and

private) empanelled under the scheme. 37 Hospital Booklets were distributed to each district for

information and communication to respective stakeholders.

c. Hospital Checklists were developed and sent to all 75 districts (with appropriate funding) for

distribution to every ASHA worker in the district. The checklists contained information regarding all

EHCPs with details of their specialties and their districts. In backward and aspirational districts, checklists

containing information of Hospitals in neighbouring districts were also sent.

d. Bimonthly official SHA Newsletter has been conceptualised, created and edited by the State Team and is

being distributed to authorities in all 75 district authorities (DM/SDM/CMOs) and CEOs of all other SHAs.

WEBINARS WITH STAKEHOLDERS TO RESUME HEALTH SERVICES

Thematic area/division: COVID-19

The state conducted webinars with healthcare providers

and district level officers to facilitate resumption of

services amidst the COVID-19 pandemic situation. The

State also acknowledged and appreciated EHCPs for

ensuring continuous services despite COVID-19

pandemic.

In order to resume services in the COVID-19

pandemic situation, the State has conducted

webinars with various stakeholders such as

private EHCPs, district authorities and government

EHCPs. The State also awarded Certificates of

Appreciation to those EHCPs that

continued/resumed their services and continued

providing treatment to AB PM-JAY beneficiaries

despite the COVID-19 situation.