The Universal Health Coverage Numbers Game

Some years ago, during a sojourn in Sitapur, we began discussing Rashtriya Swasthya Bima Yojana (RSBY), the National Health Insurance Scheme which provides 'cashless care' for hospitalisation at 'empanelled' private hospitals. The RSBY coverage limit is Rs. 30,000 per year for a family of five. I was already involved in the research of government-supported insurance schemes in Karnataka, and knew that while they gave poor families 'access' to private hospitals (there are denials as well), the devil was in the out-of-pocket expenditure that followed.

Here the tale was different:
"हमने उनको भगा दिया", "किन को ?”  "अरे, कार्ड छापने वालों को!"
which roughly translates to: “We chased them away”, “Who?”, “The card printers!”

Every year, the RSBY card has to be re-issued, so Third Party Administrators (TPAs) go to these villages to enrol people in the scheme at a cost of Rs. 30. But my friends in SKMS (Sangtin Kisan Mazdoor Sangathan) were fed up of getting a useless card - “We go to Sitapur city with this card to all the private hospitals, but no one gives us free treatment”. So they refused to get enrolled and asked the TPA to leave. One year, the District Collector got involved – he went to some villages and requested the villagers to cooperate! But as far as I know, some are still holdouts.

Addressing health inequities through community-led advocacy in Bangalore – experiences, successes and challenges

For some reason, I have not written much about my work in Bangalore. Maybe because it was 'paid' work and I spent so much time writing reports, updates etc. in the style that the organization and funders required. Well, now that the project has wound up, here goes... Below is a paper I submitted for the Medico Friends Circle (MFC) annual meet in February - I modified it slightly for this post. It is a long write-up (almost 2500 words) and a bit technical. But I think there are interesting stories in there...