RSBY Service Delivery

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Whilst a lot of our work is focussed on increasing awareness and enrolment of households onto the RSBY health insurance scheme, working with empanelled hospitals to improve the delivery of healthcare to RSBY smart card holders is an important part of our work. We are doing this through hospital sensitisation meetings, district and national level consultations, our RSBY helpline and our network of RSBY Mitras.

Problems with service delivery

Rashtriya Swasthya Bima Yojana (RSBY) is a government scheme to provide health insurance to Below Poverty Line (BPL) families. Often these families come from socially excluded groups and, in many cases, RSBY card holders have faced problems in accessing treatment from empanelled hospitals.

Common issues include RSBY card holders being denied treatment, cards being turned down or money being requested for treatment (despite the scheme covering expenses up to 30,000 rupees). These are serious issues, which directly impact on the readiness of community members to use the scheme in future and their faith in government sponsored programmes.

However, hospitals also report various issues that affect their willingness to provide health care services under the scheme. For example, settlements and payments from insurance companies are often slow to come through.

Hospital sensitisation meetings

One way that our civil society organisation (CSO) partners are helping to create a synergy with healthcare providers is through hospital sensitisation meetings. At these meetings the RSBY scheme is explained to hospital staff and they are sensitised about the importance of providing non-discriminatory health care services to socially excluded communities.

So far, 12 district level sensitisation meetings have been carried out in Jharkhand, Uttar Pradesh and Odisha with more than 600 participants from empanelled hospitals.

District-level multi-stakeholder meetings

Where problems are arising between hospitals and insurance companies, CSO partners have arranged multi-stakeholder meetings at which district administration, insurance companies and hospital staff are in attendance.

In Jharkhand, for example, District Review Committees (DRCs) have been initiated to create better and more participatory accountability measures. The DRCs are chaired by a government official from the District Labour and Employment Department, and along with representatives from empanelled hospitals and insurance companies, our CSO partners play a key role in representing the beneficiaries of the scheme, raising issues and concerns from communities regarding RSBY. In April 2013, the Government of Jharkhand institutionalised these meetings. Similar meetings have also been held in Bihar and West Bengal.

As a result of these meetings, many cases of fraud have been raised in front of the administration. For example, actions have been taken against hospitals that have charged extra money to card holders, and against district officials who left out beneficiary families during the enrolment process.

These joint meetings have helped encourage mutual dialogue and are making service providers more responsive and accountable to communities, including those from socially excluded groups. Advocacy and engagement with the government at the district level has also been enhanced through these meetings.

National-level consultation

In February 2013 we organised a national-level consultation on RSBY to share our partner’s regional experiences and challenges of RSBY, and to make recommendations to increase the reach and impact of the programme in the future.

The chief guest at the event was the Honourable Director General for Labour Welfare - Mr Rajeev Sadanandan - and the consultation was also attended by representatives from GIZ (a German development organization involved in RSBY) and state nodal agencies.

The event provided a major platform for civil society and government to come together to discuss the challenges related to RSBY implementation. It was agreed that the best way to increase awareness of RSBY was through local civil society organisations and health staff due to their credibility in the local community.

During the consultation, some policy level recommendations to make RSBY more inclusive were shared with administration. The major recommendations included establishing guidelines and corrective measures to remedy exclusion errors from BPL lists, extending eligibility of the scheme to agricultural workers, and incorporating consumers and civil society organisations in the governance and grievance redressal committees.

RSBY Helpline

In Jharkhand, our mobile-based RSBY helpline is being piloted. One of its aims is to provide a platform for people to submit their grievances in accessing this scheme.

People can ring the helpline number to to log complaints if they encounter problems in accessing healthcare using their RSBY smart cards. The data generated through this grievance system will enable service providers and government authorities to improve RSBY implementation in the state.

RSBY Mitras

Across all of our work on RSBY, our cadre of RSBY Mitras (Friends) are vitally important in helping us to ensure that the voices of communities are heard. These community-based volunteers have been especially trained to work to support communities in accessing RSBY in their villages.

They are equipped with knowledge on how to support communities to log grievances under RSBY. In addition, in Jharkhand, our RSBY Mitras are providing follow-up support for people who register a complaint via our RSBY helpline (see information above).

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