Editorial 1: Dignity and the city
Context:
- India’s urban population is about 35 per cent. By 2050, it is projected to be around 60 per cent. Cities are spaces of opportunity and well-being, but not everyone can flourish equally.
- Women are constrained by fear, violence and exclusion. Urban planning and management often do not address women’s economic and social realities or foster their “right to the city”.
Ensuring the freedom and safety to women in the city
- In a 2021 ORF study across 140 Indian cities, 52 per cent of women highlighted that they turned down opportunities for education and employment due to lack of safety
- Due to rise in violence and exclusion, women feel lack of sense of freedom or autonomy. One of the key reasons is the lack of gender-responsive urban planning, design and governance
- When cities are designed for able-bodied, heterosexual men, many realities are not reflected — including those of women, children and older persons.
- There are two key factors that prevent women from equitable access to the city —
- violence and fear, and
- the unequal burden of care work.
Framing the urban polices while considering the safety and autonomy of women
- Lack of safety affects women’s sense of well-being. While women’s safety is on the agenda of many, solutions are predominantly posited with a technocratic approach — more CCTV cameras, policing or emergency apps.
- Safety though linked to inclusion and equity, cannot be subsumed under a security perspective alone. It is only when these linkages are translated into urban policies that we will find meaningful and sustainable solutions.
“women’s” issue is an urban issue of equity and inclusion.
- First, we need to accept that this is not a “women’s” issue but an urban issue of equity and inclusion.
- Change is needed in many arenas including physical and social infrastructure, safe spaces, services such as transport and response to gender-based violence.
- The public domain needs to be made more gender friendly and inclusive of all people of diverse ages, socio-economic statuses, genders, abilities and ethnicities.
- Further, the unequal burden of care shapes women’s everyday reality in the city. Care work is central to any society and economy, but is invisible.
- A 2021 Oxfam report showed that Indian women and girls put in 3.26 billion hours of unpaid care work daily. We need to imagine our cities differently to foreground the work of care in policy and planning.
- Childcare, healthcare, housing, play, parks, leisure spaces should be designed for the participation of a wider section of city residents, especially the most vulnerable and excluded groups.
- Therefore, Privileging care offers an opportunity to transform our cities into places of well-being, not just production and consumption.
Conclusion:
- It requires a holistic approach to people’s social and economic realities. Diverse voices must inform policies. As famous urbanist Jane Jacobs, “cities have the capability of providing something for everybody, only because, and only when, they are created by everybody”
- Therefore, the journey towards equity, inclusion and safety will require us to be innovative and bold. Our cities must be measured by the dignity afforded to every person in the city.
Editorial 2: Five years of Caring
Context:
- India took a giant leap toward ensuring access to quality healthcare services by launching the flagship health protection scheme, Ayushman Bharat Pradhan Mantri Jan Arogya Yojana (AB-PMJAY) in September 2018.
- The scheme has taken the country closer to Sustainable Development Goal 3.8, which envisions universal health coverage.
About Ayushman Bharat Pradhan Mantri Jan Arogya Yojana (AB-PMJAY):
- The scheme provides a health cover of Rs 5 lakh per family per year for secondary and tertiary care hospitalisation to more than 12 crore families (bottom 40 per cent of the population)
- Beneficiaries are selected on the basis of select deprivation, and occupational criteria, in rural and urban areas respectively, as per SECC database of 2011.
- AB-PMJAY offers a unique feature of portability to its beneficiaries which allows eligible beneficiaries to avail healthcare services (as per defined packages) in any empaneled hospital across the country.
Significance of the schemes:
- About 15.5 crore families are covered under AB-PMJAY and states’ schemes are being implemented in convergence with it. This amounts to potential coverage for half of India’s population
- The scheme’s success nudged the states/UTs (who are accountable for ensuring effective public health as it is a state subject) to extend it to more beneficiaries.
- It reduces out-of-pocket expenditure (OOPE), and efficient utilisation of the government budget.
- The Ayushman Card is like a pre-paid card worth Rs 5 lakh, which can be used to avail free treatment at more than 27,000 empanelled hospitals. So far, more than 24 crore Ayushman Cards have been created
- Every hospital is mandated to have dedicated Pradhan Mantri Arogya Mitras (PMAMs) who guide the beneficiaries.
- The scheme caters to the poor and underprivileged sections of society. Its design ensures that the difficulties of people from this section in accessing healthcare services should be mitigated.
- Feature of AB-PMJAY is interstate portability. This means a patient registered in one state is entitled to receive care in any other state that has an AB-PMJAY programme. This has proved helpful to migrants, especially in emergencies
- NHA has deployed a public dashboard where the scheme’s implementation, on a day-to-day basis, can be tracked. Details of people who have availed treatment under the scheme are also published without compromising their privacy.
- The scheme has tried to bridge the shortfall between healthcare providers and service-takers.
Steps need to be taken for better participation of private sector
- The success of the scheme can also be attributed to different stakeholders, especially service providers.
- To elicit the participation of private service providers, health benefit packages (HBPs) covering all in-patient treatment have been revised five times in the last five years
- Private sector hospitals which have avoided joining the scheme have no justifiable reason to stay out now. Efforts are being made to settle the claims within a defined standard of 15 days.
- A few states like Uttarakhand have brought down the claims settlement time to less than seven days. Efforts are being made to reward hospitals with a trustworthy record with an upfront payment of 50 per cent of the claim amount immediately after submission of claims, without adjudication.
Steps taken to check financial fraud and deliverance of qualitative health facilities under the scheme:
- The implementation of a scheme of this size requires real-time monitoring and constant efforts to plug all loopholes.
- The National Anti-Fraud Unit (NAFU) designs, implements and oversees anti-fraud initiatives. There are Anti-Fraud Units at the state level as well.
- As a first step towards checking abuse, Aadhaar-based authentication for card creation and registration for treatment has been mandated.
- The NHA has been using Artificial Intelligence (AI) and Machine Learning (ML) technologies to detect suspicious transactions/potential frauds.
- The NHA’s call centre makes calls to every beneficiary who has availed treatment within 48 hrs of discharge to verify the quantity and quality of the treatment. Another call is made after 15 days to know about the prognosis.
Conclusion:
- AB-PMJAY guarantees cashless secondary and tertiary inpatient care for almost all health conditions to its beneficiaries.
- This ambitious scheme has extraordinary potential to protect people from serious health hazards and safeguard families against financial shocks due to healthcare expenditure.