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Leveraging Ayushman Bharat PM-JAY ecosystem to help Transgender Community

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By: Dr. R S Sharma,

To drive Universal Health Coverage (UHC), inclusivity is as essential to the core of a public healthcare system as transparency is to governance. These endeavours for public health in India were bolstered when the Ayushman Bharat Pradhan Mantri Jan Arogya Yojana (AB PM-JAY) was launched on 23rd September, 2018 by our Hon’ble Prime Minister. As we celebrate four years of Ayushman Bharat PM-JAY next month, we will also be celebrating a landmark addition to the biggest public health assurance scheme in the world.

The healthcare benefits under AB PM-JAY are now being extended to the transgender community through a collaboration between the National Health Authority (NHA, MoHFW) and the Ministry of Social Justice and Empowerment (MoSJE) under the Support for Marginalized Individuals for Livelihood and Enterprise (SMILE). This is in continuation to the objectives of AB PM-JAY scheme for fostering equity and inclusivity in the delivery of healthcare services. This collaboration would add to the efforts of upliftment of the transgender community, which has been marginalized due to decades of stigma and exclusion from the care benefits accorded to the larger society.

Through this collaboration, any individual holding a “Transgender Certificate” issued by the National Portal for Transgender Persons can avail the healthcare benefits with dignity and self-reliance at any AB PM-JAY empanelled hospital across the nation. As per the countrywide census conducted in 2011, the estimated number of transgender populations stood at 487,803. Till now, 8,172 Transgender certificates have been issued for transgender persons. As efforts are made to drive education and awareness of the scheme, many more such certificates shall be issued in the days to come. Till now, transgenders had not been able to avail benefits of health insurance schemes in our country for various healthcare procedures such as facilitating gender re-affirmation surgeries. In many instances, the individuals undergoing such operations did so at their own risk, without any accountability from health facilities. In extreme cases, transgenders ended up availing such treatments from unqualified individuals in often hazardous circumstances.

To put an end to this practice and enable individuals from the transgender community to lead a healthy life, the scheme will provide various healthcare services free of cost at its empanelled hospitals. Apart from the treatment packages covered under AB PM-JAY, around 50 more packages have been defined specifically for the transgender community, which also include the packages on Sex Reassignment Surgery (SRS). The construct of the packages includes genital surgeries, hormone therapy, laser therapy, and follow-up packages for certain procedures to ensure the continuum of care for transgenders. Additionally, health facilities which specialize in providing SRS have been identified and will be empanelled under the scheme to provide a bigger network for availing health benefits.

The AB PM-JAY scheme is at the same time fulfilling its primary objective of significantly reducing the out-of-pocket expenditures (OOP) of the beneficiaries and rapidly expanding its reach of providing healthcare benefits to people across rural and urban areas.

Since its implementation, Ayushman Bharat PM-JAY has steadily expanded its footprint across the country and into the lives of the beneficiaries. As of 29thAugust 2022, a total of 18.9 Crore beneficiaries have been enrolled under the scheme and provided with Ayushman cards. Approximately 3.78 Crore hospital admissions have been authorized, with hospitalization expenses worth over ₹45,000 Crores, under the scheme through a network of 25,000 hospitals.

Ayushman Bharat PM-JAY also envisages the integration and consolidation of the health insurance landscape in India. Henceforth, after the launch of AB PM-JAY, the National Health Authority (NHA) started the convergence of health insurance/assurance programs through the NHA IT platform, creating an ecosystem catering to different beneficiary categories like ESIS, Ayushman CAPF, BoCW, CGHS and PM CARES for Children schemes.

With its vision of inclusivity and healthcare for all, NHA has embarked its journey for helping the communities which require the utmost attention. This momentous program will be a significant step in that direction. Transgender social inclusion and equality is a pivotal path to developing the community, which will not only help in gaining trust with the community but shall also provide equity in terms of health care services and reduce the social stigma attached to it.

The writer is CEO, National Health Authority, Ministry of Health and Family Welfare

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