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Building Capacity for Ayushman Bharat in Uttar Pradesh: Best Practices & Program Overview

Discover the unique approach of Uttar Pradesh's State Health Agency in implementing Ayushman Bharat, covering beneficiary data, capacity building initiatives, challenges addressed, and best practices. Learn how the agency conducts training programs, bridges stakeholder gaps, and implements fraud prevention measures effectively.

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Building Capacity for Ayushman Bharat in Uttar Pradesh: Best Practices & Program Overview

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  1. State Health Agency – Uttar Pradesh Ayushman Bharat Capacity Building Presentation

  2. UP is spread across 2.4 lakh km, with population of 23 crore 1.89 lakh 1.18 Cr 214.4 cr 49.5 lakhs Golden cards Beneficiary Households Pre-auth amount Total pre-auths ₹11,438 6.47 cr ₹1.76 lakhs 200.6 cr Total beneficiaries Claim amount Average claim size Claims submitted 1677 (88%) 1220 (64%) 1945 2951 claims worth ₹5.2 cr Total empanelled hospitals Total active with atleast 1 preauth Total active with atleast 4 preauth Portability cases treated in UP Launched Mukhya Mantri Jan Aarogya Abhiyan for 8.47 lakh beneficiary families

  3. What makes Uttar Pradesh unique for PMJAY implementation? Ayushman Implementation is Greenfield 1 Shares border with 8 States 2 Widespread Geographical and Cultural Differences 3 Large number of districts (75) 4 For PMJAY implementation, state divided into 4 clusters 5 6 6 SHA operates through not 1 but 4 ISAs given the large size of UP Time taken to travel extent of State is >=2 days 7

  4. How does Uttar Pradesh approach Capacity Building Assessment? 2 • State Training Calendar • Trainings related to on-ground fraud management • Maintenance of capacity-related metrics at SHA level

  5. Identified Stakeholder Gaps - resolved by training 2A Arogya Mitra ISA Private and Public EHCPs • Regular Trainings to Newly added EHCPs • Issue with package cost • Issues with procurement & usage of drugs and logistics • Lack of standard treatment guideline • Lack of Infra and permanent AM staff (Public) • Low Technical Knowledge • Errors in document upload • Wrong package selection • High Attrition Rate - additional trainings • Data from 2011 - multiple requests for name change • Soft Skills to be developed • Constant handholding reqd (high attrition) • Multiple cases of erroneously approved cases • Weak on technical strength • Lack of standard operating protocols

  6. Capacity Building Programme: Types of Trainings Conducted Orientation Trainings • Basic s/w trainings for all stakeholders • Regular trainings for changing participants Cascading Awareness Trainings Fraud-Specific Training Specific Needs Based Trainings • Trainings to DIUs and ISAs to cascade awareness to primary health touchpoints • Fraud-detection and sensitization • AM  Documents for verification • ISA and DIU  Ground Audits • Trainings focused on identified gaps • (E.g: High rejects in BIS Arogya Mitra needs to be sensitized about all possible documents)

  7. Best Practices of UP SHAOverall and Capacity-Specific

  8. Best Practices by the State (Overall Scheme) 3 IEC and Awareness • AyushmanSarathibeneficiary app • Plastic Card Distribution • Bulk SMSs • Periodic Newsletter • Transport and Radio advertising • Distribution of Arogya Plastic card Beneficiary focused drives • AyushmanPakhwadas in all 75 districts in July 2019 • Village-level 100% Saturation Effort Encouragement to Public-Sector EHCPs • Adoption of CHCs by DIUs • Meeting with medical colleges under chairmanship of Chief Secretary • Allocation of corpus funds of 1 crto government medical colleges • Allocation of 80,000 per kiosk Fraud Prevention Measures • Capacity training of ISAs and DIUs for Medical intervention by SHA • Internal list of triggers for M&E • Developed online fraud reporting format • M&E team onboarded for regular follow-up

  9. Best Practices for Capacity Building 4 Inputs for Capacity Addition Development of State Tracker • State tracker for scheduling training • Maintenance of Capacity-trainings • Development of a Training Calendar • AVIGNA – team of super-specialists (from AIIMS) for critical medical inputs • Partnerships for technical assistance with experts from Bill and Melinda Gates Foundation Cascading Information to Health Workers Mapping of DIUs and CHCs (Adopt a CHC programme) has led to an improvement in CHC Performance • Awareness camps for ASHA and Block workers by DIUs • Awareness in ASHA Sammelans • NukkadNataks by ASHA in a village • Distribution of Hospital Booklets

  10. Uttar Pradesh has undertaken a total of 150+ trainings across >=3 rounds for each stakeholders 4A

  11. Best Practices by the State (Capacity) 4B

  12. Capacity Building Timeline of Activities in UP 4C 1st Round training of all Medical Colleges Orientation training for all stakeholders Training to all EHCPs ISAs and Arogya Mitras • 2nd and 3rd round trainings • DIUs • ISAs • ArogyaMitras Nov – Dec 2019 Regional workshops- District reachouts NSDC training of Arogya Mitras Aug 2019 Mar 2019 Oct 2018 May 2019

  13. Case Study: Medical Colleges given specific trainings to resolve grievances • Medical Colleges faced a host of operational issues w.r.t scheme implementation • 15 Medical colleges trained to improve the pre authorization and claim processing • Process Flow to be followed from all department • Hands on training for BIS and TMS software • Resolving queries in claim processing which increased flow of cases

  14. Impact of SHA-adopted Initiatives Number of Rejections Reduced in BIS/TMS Beneficiary Satisfaction recorded as 95% Less Grievances Registered Reduction in queries posed by CPD and Auditors Greater empanelment and participation of public health facilities Claim payment disposal increased by 30% to 75% Minimal Fraud recorded

  15. Way Forward • Capacity Building of all new EHCPs and Arogya Mitras • Round-Table Conference with Top-Tertiary Care Hospitals • Orientation for new Bronze Certification programme introduced by NHA • Exploration of potential partnerships with progressive health academia and think-tanks (e.gGramvani) • Awareness and outreach with Gram Pradhansin Villages through PRI dept • Trainings of Anganwadi workers in unexplored districts • Distribution of Hospital Booklets to Field Functionaries

  16. Thank you

  17. Case Study: Field Officers train other health workers • Asha Workers are the primary touch points for all health-related queries in villages • Hence, their awareness is of primary importance for the scheme to run smoothly Return

  18. Review Workshops to improve district performance held cluster-wise Review Workshops held in Varanasi (Eastern UP), Lucknow (Central), Agra (Western UP) Return Slide

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