SYNOPSIS FOR THESIS

“A DESCRIPTIVE STUDY TO ASSESS THE EFFECTIVENESS OF JAN AROGYA

YOJANA AMONG RURAL COMMUNITY IN SELECTED BLOCKS OF AMBALA
DISTRICT”

SUBMITTED TO
PT. B. D. SHARMA UNIVERSITY OF HEALTH SCIENCE,
ROHATAK

SUBMITTED BY
Mr. Kushal Singh
M. Sc. Nursing 1st Year
MAHABIR COLLEGE OF NURSING
BULLANA, AMBALA
“A DESCRIPTIVE STUDY TO ASSESS THE EFFECTIVENESS OF JAN AROGYA
YOJANA AMONG RURAL COMMUNITY IN SELECTED BLOCKS OF AMBALA
DISTRICT”

GUIDE
Mrs. Nisha Verma
Assistant Professor,
Mahabir College of Nursing
Bullana, Ambala City, Haryana
CO-GUIDE
Mrs. Archana
Assistant Professor,
Mahabir College of Nursing
Bullana, Ambala City, Haryana

PRINCIPAL
Mrs. Santosh Kumari
Mahabir College of Nursing
Bullana, Ambala

SUBMITTED BY
Mr. Kushal Singh
M. Sc. Nursing 1st Year
MAHABIR COLLEGE OF NURSING
BULLANA, AMBALA
INTRODUCTION
Background
As per the National Health Policy 2017, the Government of India launched a flagship scheme
Ayushman Bharat, to achieve the vision of Universal Health Coverage (UHC). This program has
been intended to meet Sustainable Development Goals (SDGs) and its underlining
commitment, which is to leave no one behind. 1

Ayushman Bharat is an attempt to move from sectorial and segmented approach of health
service delivery to a comprehensive need-based health care service. This scheme aims to
undertake path breaking interventions to holistically address the healthcare system (covering
prevention, promotion and ambulatory care) at the primary, secondary and tertiary level.
Ayushman Bharat adopts a continuum of care approach, comprising of Pradhan Mantri Jan
Arogya Yojana (PM-JAY) component.1

The MoHFW, India has introduced one of the world’s largest government-funded health
insurance scheme "the Ayushman Bharat - Pradhan Mantri Jan Aarogya Yojana (PM-JAY) to
cover over 100 Million poor and vulnerable families providing coverage up to ₹ 5 lakh per
family per year for accessing secondary and tertiary level care. Awareness about health
insurance schemes plays a vital role in influencing the coverage and acceptability of the
schemes amongst beneficiaries which in turn leads to effective utilization of health care
services and consequently poorer health outcomes among those not aware Several methods,
such as sending a personalized letter to the entitled beneficiaries, awareness campaigns at
the village level, and extensive use of mass media have been adopted to create awareness
among people of the PM-JAY, and to register them. 2,3,4,5

In addition, kiosks have also been established at empanelled hospitals to facilitate on the spot
registration to ensure that no one who is entitled to benefit from the PM-JAY is denied
hospital care, thereby reducing the risk of exclusion. However, in spite of this, there are
significant differences across states in terms of the proportion of potential beneficiaries who
are aware of the scheme, its features and benefits. The study aims to critically understand
levels of awareness regarding PM-JAY and its features amongst beneficiaries, and the
identification process in place to register them for accessing hospital care services. 2,3,4,5
Need for the Study
Success of this program depends on institution being adequately well equipped with
resources in implementation, delivery, and monitoring of the scheme. Regular monitoring of
Program is necessary so as to make sure it is getting implemented in a sustainable manner.
Scrutiny of adequate infrastructure in institutions is required and also readiness among the
health care providers is assessed who are crucial in effective implementation of the program.
Hence to ensure adequate readiness there is a need to generate awareness among health
care providers regarding administrative and programmatic aspects along with impact of
PMJAY on Indian Health system.
In this context we planned a study with an objective to assess knowledge and readiness of
health care providers regarding PMJAY in an empanelled tertiary care hospital at Ambala. This
helps in assessing the level of awareness and readiness among the study participants and
planning of further steps by the institution for hurdle free implementation of PMJAY.
It makes an attempt to explore and explain the challenges encountered during
implementation, and how such challenges could be addressed, which would concomitantly
empower beneficiaries and improve the performance of the scheme in the blocks in the
Ambala.

REVIEW OF LITERATURE
“Right to health” is central to exercise the basic human rights. However, till now our
constitution has not recognized health as a fundamental right of individual. Even many articles
and Honourable Supreme Court judgment make provision for “access to health” to the people
under the directive principles but is short of its inclusion in constitution as a fundamental right
including the right to seek.6
According to Bhore Committee report (1946), efforts are made by GOI and state government
to provide health care through countrywide network of 3 tier health-care institutions and
various national health programs. Successful eradication of communicable diseases-
smallpox, dracunculiasis, and regional elimination of leprosy, neonatal tetanus, controlling
diseases such as malaria and other vector-borne diseases, and reduction in MMR & IMR are
few of its achievements. However, the system has fail to provide quality curative and
rehabilitative care to the masses, especially in remote areas leading to inequality and inequity
in access of health care. In India, around 5-6% people are unable to seek health care because
of lack of financial capacity, and among those people who do, experiences are often
financially catastrophic consequences. Household out-of-pocket expenditure in India is 67%
of total health expenditure 12th highest globally and 6th highest among 50 low- middle
income nations.7
The government of India approved the Ayushman Bharat Pradhan Mantri Jan Arogya Yojana
on 21st March 2018 and has hailed the program as a historic step towards achieving UHC in
India. The scheme aims to publicly fund the healthcare of up to 50 crores people and, if it lives
up to its potential, represents a unique opportunity to institutionalize quality healthcare free
at the point of service for the most marginalized Indians, improving the health of the
population and drastically reducing or eliminating medical-related impoverishment. 8
Right to health is one among the significant components of basic human rights. Everybody on
the earth should be able to access preventive and curative aspects of health for a happy and
productive living. World health organization (WHO) theme for the year 2019, “Universal
Health Coverage (UHC) – Everyone and Everywhere”, envisages that access to healthcare
services without any financial constraints UHC is also one of the key components of United
Nations Sustainable Development Goals.9, 10
National health policy and various National Health Programs in India had a lot of success
stories such as eradication of diseases like small pox, neonatal tetanus, controlling diseases
like malaria, and reduction in maternal mortality and infant mortality. But these programs
proved unsuccessful for provision of quality healthcare services to the community,
particularly in rural communities. Also, due to financial inequality there is huge gap in
accessing the curative aspects of health in a developing country like India. 11
It was estimated that nearly 6% population of India, were unable to seek curative services due
to financial reasons. Even if they wish to seek health services, those people are experiencing
catastrophic costs dragging them into further more poverty. A large proportion of Indian
population i.e. 85% is not insured by any health insurance. Also, spending on health in India
is only 1% of the gross domestic product (GDP), which is lowest globally. As a result, India is
facing short comings related to workforce, infrastructure and availability of quality care in
Indian Health care system.12, 13
The Government of India had announced “Ayushman Bharat for a new India-2022”, in 2018-
2019 Parliament budget sessions. It has two major initiatives, construction of “Health and
Wellness Centres (HWC)” for strengthening primary care and National Health Protection
Scheme now named as “Pradhan Mantri Jan Arogya Yojana (PMJAY)” for enabling access to
secondary and tertiary health care services.14
This scheme intends to offer financial protection to nearly 500 million vulnerable Indians and
also prevents 50–60 million Indians to plunge into impoverishment due to escalating
healthcare expenses. Haryana is one of the states which are implementing Pradhan Mantri
Jan Arogya Yojana (PMJAY).15
In line with global efforts aimed at leaving no one behind while advancing universal health
coverage (UHC), recent health sector reforms in India have strived to expand social health
protection for the most vulnerable segments of society while simultaneously strengthening
delivery of quality healthcare services. This strategy has largely been pursued through the
implementation of government-funded health insurance (GFHI) schemes implemented at
either federal or state levels, aimed at improving access to quality health care while offering
financial protection to end users. The expansion of these schemes has led to a steady rise in
population insurance coverage, from approximately 5% of households in 2005 to 29% in
2015.16, 17
STATEMENT OF THE PROBLEM
A Descriptive Study to Assess the Effectiveness of Jan Arogya Yojana among Rural Community
in Selected Blocks of Ambala District.

OBJECTIVES & RESEARCH QUESTIONS

1. To assess effectiveness of PM-JAY and its various features amongst beneficiaries;
2. To examine various dimensions of the processes of creating awareness, beneficiary
identification; and
3. To explore the supply side constraints in the awareness-creation and identification
processes of the scheme.

OPERATIONAL DEFINITIONS
Ayushman Bharat Health and Wellness Centre (AB_HWC): Ayushman Bharat (AB) is an
attempt to move from a selective approach to health care to deliver comprehensive range of
services spanning preventive, promotive, curative, rehabilitative and palliative care. It has two
components which are complementary to each other. Under its first component, 1, 50,000
Health & Wellness Centres (HWCs) will be created to deliver Comprehensive Primary Health
Care that is universal and free to users, with a focus on wellness and the delivery of an
expanded range of services closer to the community.
Pradhan Mantri Jan Arogya Yojana (PM-JAY): Ayushman Bharat PM-JAY is the largest health
assurance scheme in the world which aims at providing a health cover of Rs. 5 lakhs per family
per year for secondary and tertiary care hospitalization to over 10.74 crores poor and
vulnerable families (approximately 50 crore beneficiaries) that form the bottom 40% of the
Indian population.

RESEARCH VARIABLES
Variables are characteristics that vary among the subjects being studied

DEPENDENT VARIABLE
The assessment of the program will be conduct through the opinion of the beneficiary of PMJAY
scheme.

INDEPENDENT VARIABLE
Hospitals which are providing PMJAY schemes to the beneficiaries in the
selected area of Ambala.

ASSUMPTION
Whether the pre design and pre-test tools or questionnaire help in assess the effectiveness
of Pradhan Mantri Jan Arogya Yojana in Ambala District.
DELIMITATIONS
The study will be time bond and area specific and only describe the present effectiveness of
the Program with selective tool in a defined population.
This study is limited to all Jan Arogya Yojana with all the eligible male and female population of the
selected area of Ambala district.

RESEARCH METHODOLOGY
Research Approach
The research approach used for this study is Quantitative approach

Research Design
The research design selected for this study is Cross sectional Descriptive Study Design

Data Analysis

SETTING OF THE RESEARCH STUDY

The study was conducted in defined are of Ambala. With more than 2,000 house hold. In that
the 200 household will be consider for this study.

POPULATION
The target population of the study households those how are the residence of
the defined area of selected district.
SAMPLE AND SAMPLING TECHNIQUE
The study sample comprises 200 household with or without getting benefits of the Pradhan Mantri
Jan Arogya Yojana in selected area of Ambala, those who fulfilled the inclusion criteria.

CRITERIA FOR SELECTION OF SAMPLE

Inclusion Criteria
The study participant will be both male and females those who are willing to participate in
this study.

Exclusion Criteria
Those who are not willing to give consent for including in this study.

DESCRIPTION OF THE TOOL

SECTION A:
Comprises demographic variables in which age, sex, marital status, education, religion,
occupation, residence, community area, any history of Scheme adopted, Awareness of the
scheme, Source of awareness, identification data of the scheme, etc.
SECTION B:
Assessment questionnaire comprised of some important items to evaluate level of knowledge
among beneficiaries of the PMJAY Scheme.

VALIDITY AND RELIABLITY OF THE TOOL

Questionnaire constituted items on knowledge and readiness based on “Operational
Guidelines on Ayushman Bharat National Health Protection Mission (AB-NHPM)”. There were
9 items in the questionnaire to assess awareness (yes, no or don’t know). Maximum possible
score for Awareness was 9. Readiness was assessed using Likert scale with 5 components and
maximum attainable score for readiness was 25. For validation, the study tool will be sent for
review by Public Health experts and HWC medical Officers and they will request to rate each
item on 4-point rating scale with “4-highly relevant, 3-quite relevant, 2-somewhat relevant
and 1-not relevant”. Content validity index will calculate for each item based on their rating.

DATA COLLECTION PLAN

Development of Conceptual Framework

Assess the effectiveness of

the PMJAY Scheme

Step 2 Step 3
Step 1 Identification
Ministration Validation

Collect the Demographic

Implement the Pre defined
Datafor assessing the
and pre tested Through applying statsical
effectivness of the PMJAY
Questionnaire and Identify anlysis methods
Scheme in Selected area of
the Effectiveness
Ambala
ETHICAL CONSIDERATION
The study objective, intervention and data collection procedures will be taken approval by the ethic
committee of the PT. B. D Sharma University of Health Science, Rohatak permission for conducting the
study, and Obtain from the Head of Department, Department of Community Health Nursing, Mahabir
College of Nursing Bullana, Ambala, and the each study subject before starting the data collection and
assurance will give that confidentiality and privacy would be maintained.

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