The Implementation of RSBY in Chhattisgarh, India: A study of the Durg district

Authors

  • S Nandi Public Health Resource Network (PHRN)
  • M Nundy Public Health Resource Network (PHRN)
  • V Prasad Public Health Resource Network (PHRN)
  • K Kanungo Jamia Hamdard University
  • H Khan Jamia Hamdard University
  • S Haripriya Public Health Resource Network (PHRN)
  • T Mishra Public Health Resource Network (PHRN)
  • S Garg Public Health Resource Network (PHRN)

DOI:

https://doi.org/10.5195/hcs.2012.61

Keywords:

Rashtriya Swasthya Bima Yojana (RSBY), Insurance, Chhattisgarh, Out-of-Pocket Expenditure

Abstract

The Rashtriya Swasthya Bima Yojana (RSBY) scheme is a health insurance model currently being implemented by the Indian government. It is a model, however, still in nascent state, subject to tensions and value testing. Very few studies have hitherto assessed the scheme’s implementation and whether the stated objectives of the government initiative are being fulfilled. This short study undertaken in the Durg district of Chhattisgarh reveals that RSBY fails to cover the population living Below the Poverty Line (BPL). Likewise there is discrepancy in the consistency of information and knowledge regarding the scheme among the beneficiaries who are themselves continuing to incur high out-of-pocket expenses.

There are thus severe issues in transparency and accountability within the RSBY scheme. Unless the public health delivery system is strengthened and the private sector regulated and indeed monitored, the scheme will not yield the desired results, and the cost of healthcare will further escalate for the poor. In the absence of regulated health services there needs to be more debate, and indeed greater research, on the implementation and the design of RSBY.

 

Author Biographies

S Nandi, Public Health Resource Network (PHRN)

Sulakshana Nandi is the State Convener of the Public Health Resource Network (PHRN) in Chhattisgarh. She holds a Masters degree in Social Work and is currently pursuing MPH through distance learning from the University of Western Cape, South Africa.

She has been involved with the Public Health Resource Network (PHRN) from its inception stage and has been part of the team that has contributed to writing of its modules for training on district health management and planning. She is involved in capacity building, trainings and research activities in the state and outside. She is a Resource person for areas like BCC, ASHA, Gender, community mobilization, women’s health, Tribal health, and district planning.

Ms. Nandi has written two papers documenting Mitanin’s struggles to reform PDS and to fight state sponsored ‘deforestation’ and one on addressing women’s concerns in NRHM and presented them in the International Women and Health Meeting (IWHM) and its India consultations. Her article on “Health Action by Mitanins’ was published in the Medico Friends Circle bulletin in 2004.

  • Research and Publications:

Co-edited: Tribal Health module (PHRN)

Co authored:

-        Reducing Child Malnutrition: Thailand Experience (1977-86): A Review of International Literature

-        Assessment of the Mitanin Referral system in Chhattisgarh

-        Study to analyse implementation of Rashtriya Swasthya Bima Yojana in Chhattisgarh– Presented at EPHP, Bangalore (organized by IPH and University of Antwerp).

M Nundy, Public Health Resource Network (PHRN)

Dr. Nundy has a Post graduate degree in Social Work and has completed her Ph. D. in Public Health from the Centre of Social Medicine and Community Health, Jawaharlal Nehru University in 2010.

As Senior Programme Coordinator (2009 to present)with the Public Health Resource Network (PHRN), Dr. Nundy Co-ordinates research and evaluation studies of PHRN and capacity building initiatives on District Health Planning under National Rural Health Mission in PHRN active states. Dr Nundy is a Resource person for IGNOU-PHRN Post Graduate Diploma in District Health Management (PGDDHM) and the Community Health Fellowship programme of PHRN.

  • Research experience

-        Worked as a Technical Consultant for the National Commission on Macroeconomics and Health set up by the Ministry of Health and Family Welfare and WHO, India from May 2004 to April 2005.

-        Project Associate with the School Health Project component of University School Resource Network – Jawaharlal Nehru University (USRN – JNU) from June to December 2009

-        Consultant on a pilot project “Modes of Service Delivery, Collective Action and Societal Regulation: Making Public Services Responsive to the Poor in Brazil, India and Mexico” for IDS, Sussex

  • Publication / Papers/Reports

-        Prasad, V. and M. Nundy (2011 forthcoming), “A Health Programme for Homeless Children in Residential Care: A Handbook for Programme Managers”, PHRN.

-        PHRN (2010), Issues in Urban Health – Co-editor and Contributor to the module

-        PHRN-MSSRF-TN-FORCES (2010), Towards Universalisation of Maternity Entitlements: An Exploratory Case Study of Dr.  Muthulakshmi Maternity Assistance Scheme. (co-authored)

-        Deshpande, M., Rama. V. Baru and M. Nundy (2010), Understanding Children’s Health Needs and Programme Responsiveness, Working Paper Series 3, Vol. 1, USRN, New Delhi.

-        Baru, R.V. and M. Nundy (2009), “Health PPPs in India: Stepping Stones for Improving Women’s Reproductive Health Care?” in Timmermann, Martina and Kruesmann, Monika (ed.) Public Private Partnerships within the Ethical Framework of the UN Global Compact: The Example of the “Women`s Health Initiative for Improving Women`s and Girls´ Health in India”, UNU Press, Tokyo.

-        Baru, R.V. and M. Nundy (2008), “Blurring of Boundaries: Public-Private Partnerships in Health Services in India” in Economic and Political Weekly, Vol. 43, No.4, pp. 62-71. Larger version of this paper was presented at the RC 19 of International Sociological Association on Social Policy in a Globalising World: Developing a North-South Dialogue, University of Florence, Italy, September 6-8th 2007 and RC 37 of International Political Science Association on Comparative Health Policies in Developing Welfare Societies, University of Delhi.

-        Nundy, M. (2007), Health Sector in Delhi, Background Paper for project project “Modes of Service Delivery, Collective Action and Societal Regulation: Making Public Services Responsive to the Poor in Brazil, India and Mexico”, IDS, Sussex

-        Nundy, M. and R. V. Baru (2006), “Approaches to Health Financing: A Review of Country Experiences” in the Journal of Health and Development, Vol. 2, No. 3 and 4.

-        Three Background Papers for National Commission on Macroeconomics and Health (NCMH), GOI (2005). ‘Primary Health Care in India: Review of Policy, Plan and Committee Reports’; ‘The ‘Not-for-Profit’ sector in Medical Care’ and co-authored ‘Delivery of Health Services in the Private Sector’.

V Prasad, Public Health Resource Network (PHRN)

Dr. Vandana Prasad is the National Convener of Public Health Resource Network (PHRN). She is a Paediatrician (Royal College of Physicians, London, UK) who has been working on public health and child nutrition since 1994. She is currently in the process of completing her Masters in Public Health (2009 – 2011) through Distance Learning, from School of Public Health, University of Western Cape, South Africa. She provides national leadership to the Public Health Resource Network.

Dr. Prasad is a national level trainer for Capacity Building in District Health Management and Planning, which is a joint collaboration of PHRN, National Health Systems Resource Center, and NRHM. Her area of expertise is women and child health issues for which she has been a trainer for more than fifteen years.

 

  • Recent Research
  1. Towards Universalisation of Maternity Entitlements: An Exploratory Case Study of the Dr. Muthulakshmi Maternity Assistance Scheme in Tamil Nadu (2010). New Delhi: PHRN-MSSRF-TN FORCES
  2. Prasad, V., Soibam, H. & Jacob, S. (2010).  Food Security of the Homeless in Delhi: A Study of the Nutritional Status and Dietary Intakes of Adult Homeless Persons in New Delhi. New Delhi: PHRN-CES
  3. Research on ‘Child Care Practices in Four Underprivileged Urban Locations in Delhi’; a collaboration with Mobile Creches and Plan International (2004)
  4. ‘Feasability study on ECCD interventions in India’ for Bernard van Leer Foundation, The Netherlands, 2005

 

  • Recent Publications:
  1. Sengupta, A. and Prasad, V. (2011). Towards a Truly Universal Indian Health System. The Lancet.  377 (9761) :
  2. Prasad, V. (2009). Ch-3 Elementary education and the health of children. In Kumar, A & Singh, AP (eds) Elementary Education in India: Issues and Challenges. New Delhi: Uppal Publishing House
  3. Kalita A., Zaidi S., Prasad V., & Raman V.R. "Empowering health personnel for decentralized health planning in India: The Public Health Resource Network". Human Resources for Health 2009, 7:57
  4. ‘Strategies For Children Under Six – A Framework For The 11th plan’ – Economic and Political Weekly, Dec- Jan 2008
  5. Should India Use Commercially Produced Ready To Use Therapeutic Foods (RUTF) For Severe Acute Malnutrition (SAM), Vandana Prasad, Radha Holla, Arun Gupta, Vol 4, No 1 (2009), Journal of Social Medicine, www.socialmedicine.info
  6. Part author and co editor of Books 1 – 18 of the PHRN learning course on ‘Public Health Management’ course as stated above.
  7. Contributor to the FOCUS (Focus on Children Under Six) Report, Citizen’s Initiative for Children Under Six Citizens’. (2006). FOCUS, New Delhi : Secretariat of the Right to Food Campaign.

K Kanungo, Jamia Hamdard University

Kanica Kanungo has a BSc (in Biotechnology) from Holkar Science College, Indore (M.P.) and is currently in the final year of MBA (Health Management) from Jamia Hamdard, New Delhi. She participated in the RSBY research project as part of her internship.

H Khan, Jamia Hamdard University

Md. Hashim Khan has completed B Pharma from Pt. Ravi Shankar Shukla University Raipur, (C.G.). He has worked briefly on health issues in Bastar district of Chhattisgarh and is currently pursuing MBA (Health Management) from Jamia Hamdard, New Delhi. She participated in the RSBY research project as part of his internship.

S Haripriya, Public Health Resource Network (PHRN)

Soibam Haripriya has completed her MPhil in Sociology from University of Delhi, 2010. She has been involved with Public Health Resource Network (PHRN) since its inception and has been a Senior Programme Coordinator in PHRN. She is currently pursuing her PhD. She has been closely associated with human rights issues and has written widely on gender and issues in Manipur. She has many publications to her credit.

  • Respect to foster unity in cultural mosaic”(on Sacred Groves of Manipur and cultural taboos and biophilia protecting it – Co-author)- The telegraph 27 July 2007
  • “Usual Suspects” (on deep-rooted class prejudices leading to tendency to suspect the domestic help-Co-author)-Tehelka Web special 6 June 2008
  • “Domestic Workers: Suspects and Victims” Co-author- Indian Current 09-15 June 2008.
  • “Dying Children’s Indigenous Games”- Co-author- The Sangai Express -5 May 2009
  • “Staging Stories Of History: Remembering M. Biramangol”- (profile of a theatre personality- Co-author)- The Sangai Express 5 November 2009
  • “Of Memories, Melancholy and the Milieu”, Imphal Free Press 11 July 2010
  • “When Periphery becomes the Centre”, Morung Express -24 July 2010
  • “Centering the Periphery while falling off the Map”, The Sangai Express -25 July 2010

T Mishra, Public Health Resource Network (PHRN)

Tarang Mishra holds a Post Graduate Diploma in Health Management from IIHMR Jaipur and has worked in the capacity of Programme Coordinator with Public Health Resource Network Chhattisgarh team. Prior to joining PHRN she was working with the Government of Gujarat as a District Programme Manager under NRHM, based in Ahmedabad.  She is currently a consultant in the health sector.

S Garg, Public Health Resource Network (PHRN)

Mr. Garg holds Post Graduate Diploma in Rural Management from Institute of Rural Management Anand (1994-96) and is a Bachelor of Engineering (Mechanical) from Thapar Institute of Engineering and Technology, Punjab (1990-94). His experiences of working in the states of Chhattisgarh, MP and Orissa are as follows:

Mr. Garg is the Senior Programme Coordinator (Community Initiatives) in State Health Resource Centre, Chhattisgarh which is a technical advisory to the Government of Chhattisgarh (ongoing). He heads the Community Initiatives cell at SHRC, which includes initiatives like the Mitanin (Community Health Worker) Programme, Decentralised planning, Community Monitoring and Nutrition Fellowships.

Since the last four years, he is Advisor to Commissioners of Supreme Court (WP 196/2001) also known as the Right to Food case. In this, his role is to monitor the implementation of honourable Supreme Court’s Orders on food programmes in state of Chhattisgarh and liason with the State Governemnt for pro-poor policy change.

Publications:

Authored

- Grassroot Mobilisation for Children’s Nutrition Rights. Economic and Political Weekly, 2006.

-        Chapter on Malnutrition in Tribal Areas in Tribal Health module (PHRN, module 15)

Co-authored-

-        Strategies for Children under Six. Economic and Political Weekly, 2007

-        Reducing Child Malnutrition: Thailand Experience (1977-86): A Review of International Literature

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Published

2012-03-27

Issue

Vol. 2 No. 1 (2012): Health System Dynamics and Barriers

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