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Still a distant dream

Friday, June 06, 2014

The RGJAY scheme to provide low-cost medical facilities to the poor sections of society has largely failed in the Naxal-affected districts of Bhandara, Chandrapur, Gondiya, Gadchiroli and Nandurbar, discovers Vishnudas Sheshrao

Treatment becomes a far-fetched and almost unattainable dream for the people falling under the government's Rajiv Gandhi Jeevandayee Arogya Yojana (RGJAY) scheme when even the registration for treatment happens to be an impossibly tedious process.

The state government's ambitious online health scheme, set up to deliver medical care to deprived classes, is not working out. The reasons are simple:
Several districts do not have high band frequency Internet Irregular supply of electricity Six months after the scheme was launched, registration in the Naxal-affected districts of Bhandara, Gondiya, Chandrapur, Gadchiroli and Nandurbar has not yet touched the 1,000 mark. However, there are many patients who would make for eligible beneficiaries, who are struggling with life-threatening health problems, but are undergoing and paying for their medical treatment at private hospitals.

Only 582 patients have been registered till May end as beneficiaries from Nandurbar district. However, in the adjoining Dhule district, 7,680 patients were registered and authorised and cleared for free surgeries.

Similarly, Bhandara district has registered only 788 patients while the neighbouring Nagpur registered 3,073 in the same time span. Gondiya has registered 551 patients, Chandrapur 951 patients and Gadchiroli 642 patients till the end of May. In other districts though, the number of patients registered under this scheme has run into many thousands.

Padmakar Valvi (Minister of Sports and Youth Welfare) said “The registration is going in Nandurbar district, however, the number may be low as compare to other districts. In my opinion, other small surgeries should be added in RGJAY so it will be more helpful for poor people.”

One of the main reasons for low registration in these district is the difficulty of reaching out to people living in remote areas. The district co-ordinator admitted that the scheme is yet to reach scores of villages.

Months after the health scheme started, several districts did not have computers, Internet connection and electricity supply. When they got the computers and Internet connectivity, they did not get decent places to set up RGJAY centres. Consequently, registration for RGJAY could not work out. The scheme is thus struggling in these districts.

Local authorities, as well as senior officers in the state, were not eager to implement the health scheme in these districts. Every district has one district co-ordinator for RGJAY as per the list published on the official website. However, in Naxal affected regions, one co-ordinator has to handle two districts.

Local authorities demanded that these districts should have two co-ordinators per district as virtual and physical communication is very difficult here. People are illiterate and they cannot read pamphlets informing them about the scheme.

In border areas, gypsy communities do not understand Marathi, Hindi or English. They have got their own dialect. It takes considerable time to convince them to come in for medical treatments.

A Chief Civil Surgeon attached to these hospitals said, “The patient first has to be diagnosed for one of the 971 diseases covered by the RGJAY. However, our problems is that we don't have diagnostic facilities here.”

He added, “The patients have to go to Nagpur to get diagnostic tests done. If he is found positive in the tests, then the patient has fulfilled just one of the conditions mentioned in the long list which includes at least half a dozen documents. Under normal circumstances, no one is ready to go for it. Consequently, registration is very low.”

Jitendra Pande (43), who works with unaided private schools in Gondiya, was diagnosed with a heart problem last year. Since November 2013, he has regularly been going to the district office of RGJAY at the district head quarters. Every time, he has been given some medicine and told that his surgery will be done soon.

When contacted, Pande, on Thursday evening was admitted in a private hospital as the intensity of his pain was unbearable. He said, “Every time they give me free medicine and a promise of surgery. I have completed my documentation and am waiting for the surgery. After a long wait, now I have come to a private hospital.”

Chaya Patel, a resident of Nandurbar district, is one of the very few fortunate patients who was been operated under the RGJAY. She was being operated on Thursday in a private hospital, the bill for which will be paid by an insurance company on behalf of RGJAY.

Chaya's husband said, “It was not that easy as you think. Last year, we four brothers got divided. Consequently, my name was deleted from the ration card. Initially, they told me that my wife cannot be a beneficiary for free medical scheme.”

He added, “I made several rounds to the tehsil office to get a new card with old notes and entry dates. Finally, it worked out.”

Some private hospitals are performing small surgeries as their package is lucrative and it has low risk. However, there is hardly any private hospital carrying out complex heart surgeries.

170 students will have to wait for another year
Students between the age group of 6 and 13 are finding it difficult to register under this scheme as their names are not updated on ration cards.

Earlier these students were treated under some other scheme. Headmasters of schools used to refer students with health problems to the district civic hospital where they were treated free of cost. However, now students are also covered under RGJAY for which they have to submit a long list of documents.

An estimated 170 students are deprived of free medical treatment in these five districts simply because their name is not on the ration cards and their age is above six years. According to officials, they have to wait till the next fiscal year for free medication.

Copied Andhra Pradesh scheme but not its success
The Maharashtra government had initiated this scheme along the lines of that of the Andhra Pradesh government after watching the rising popularity of the then AP Chief Minister Y.S. Rajasekhara Reddy who had started a unique scheme – Aarogyasri – to provide free medication to poor people who cannot afford costly surgeries.

The state government had started the RGJAY in November 2013, strategically just six months before the general Parliamentary elections and one year before the state assembly elections, with an aim to gain mileage from the economically backward classes having income below Rs.1 lakh per year.

In Andhra Pradesh, this scheme was trouble-free with a total health cover of Rs.2 lakh per family covering 938 medical surgeries and treatments. Against this, in Maharashtra, the health cover was reduced to Rs.1.5 lakh and the number of diseases covered are 971.

No Naxal threat
The fear of Naxal violence is a presumed reason behind the low registration rate. However, no Naxal violence has been reported as far as doctors and para-medical staff are concerned. A district co-ordinator, who does not wish to be named, said, “When we ask civic hospital staffers for transportation of patients, they are reluctant. Though there is no casualty of doctors so far, the mines on roads do not distinguish between an ambulance and a police jeep.

Medical treatments performed
District          Pre-auth      Treated
Bhandara       788              717
Gondiya          551              492
Chandrapur   951              865
Gadchiroli      642              619
Nandurbar     582              534


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