A. National Health Authority The Union Cabinet in its meeting held on 21st March 2018 had approved Ayushman Bharat National Health Protection Mission, now renamed as Pradhan Mantri Jan Arogya Yojana (PM-JAY). Based on the approval of the Cabinet, the National Health Agency was set up as a society, under Societies Registration Act 1860, on 23rd May 2018. On 2nd January 2019, the Union Cabinet approved the restructuring of the existing National Health Agency as the National Health Authority (NHA).
Earlier, the National Health Agency functioned as a registered society which has now been dissolved and its status is enhanced to that of an Authority. With the approval of the Cabinet, the National Health Authority has been provided with full autonomy, accountability and mandate to implement PM-JAY through an efficient, effective and transparent decision-making process. The National Health Authority is governed by a Governing Board which is chaired by the Minister of Health and Family Welfare and has 11 members as follows: • Chief Executive Officer, NITI Aayog, ex officio. • Secretary, Department of Expenditure, Ministry of Finance, GoI, ex officio. • Secretary, Department of Health and Family Welfare, Ministry of Health and Family Welfare (MoHFW), GoI, ex officio. • CEO, National Health Authority, Member Secretary. • Two domain experts appointed by the Government of India in the areas of administration, insurance, public and private healthcare providers, economics, public health management. •
Five Principal Secretaries of Health of State Governments, one representing each of the zones viz. North, South, East, West and North Eastern States on a rotational basis. A full-time CEO in the rank of Secretary, appointed by Government of India, oversees the NHA under the guidance of the Governing Board. Organisation structure of NHA The National Health Authority is divided into seven verticals. These cover the operational as well as the support functions for the organisation in implementing PM-JAY. Each vertical in headed by an Executive Director and staffed by personnel skilled and experienced in their specific area of work. These are Finance, Administration, Policy & Knowledge Management, Information Technology, Beneficiary Empowerment, Hospital Networking & Quality Assurance, and State Parliyament.
B. State Health Authority For effective implementation of PM-JAY, State Governments have set up State Health Agencies (SHA) or designated the function to an existing agency, trust, or any other society. The SHA is the nodal agency responsible for implementation of PM-JAY in the State headed by a Chief Executive Officer. The SHA can hire additional staff or Implementing Support Agency (ISA) to perform required tasks for implementation of the scheme. The CEO, SHA is appointed by the State Government and is ex-officio member-secretary of the governing council of the SHA. Along with day-to-day operations of implementation of PM-JAY in the State, the SHA is also responsible for data sharing, verification and validation of family members, IEC, monitoring of the scheme, etc. C. District Implementation Unit In addition to the State-level entity, a District Implementation Unit (DIU) has also been established to support the implementation in every district included under the scheme. This team will be in addition to the team deployed by the insurance company/ISA. The DIU will be chaired by the Deputy Commissioner / District Magistrate / Collector of the District. This Unit will coordinate with the implementing agency (ISA/insurer) and the network hospitals to ensure effective implementation and send review reports periodically. The DIU has to work closely and coordinate with the District Chief Medical Officer and his/her team.
5. FINANCING OF THE SCHEME AND CO-OPERATIVE FEDERALISM PM-JAY is completely funded by the Government and costs are shared between Central and State Governments. The ratio for all States, except North-Eastern States and three Himalayan States and Union Territories with legislature, is 60:40, with the Centre’s share being 60 percent and the State’s, 40 percent. For North-Eastern States and three Himalayan States (viz. Jammu and Kashmir, Himachal Pradesh and Uttarakhand), the ratio is 90:10, with the Centre’s share being 90 percent and the State’s, 10 percent. For Union Territories without legislatures, the Central Government may provide up to 100 percent on a case-tocase basis. In the spirit of cooperative federalism, various meetings, workshops and conclaves were held between Centre and States. Also, keeping in mind variations across the States, considerable flexibility was incorporated in the scheme design and implementation. States have been provided flexibility in terms of the following parameters: a. b. c. Mode of implementation: States can choose the implementation model and can implement the scheme through Trust, Insurance company or Mixed model. Usage of beneficiary data: PM-JAY uses SECC data for targeting the beneficiaries. However, States have been provided the flexibility to decide on the dataset for this purpose, if they are covering more beneficiaries than SECC defined numbers. However, the State will need to ensure that all beneficiaries eligible as per SECC data are covered. Expansion of cover to more people: States can cover a greater number of families than those defined as per SECC data. For these additional families, full cost will need to be borne by the States.