India: Health care for half a billion people

More than 500 million people in India can access health care free of charge under the state health insurance scheme. During the coronavirus pandemic, the years of work put into setting up a national health insurance system have been a life-saver.

The coronavirus pandemic has India firmly in its grip. Its infection tally is second only to the US, with more than eight million cases already recorded. For many Indians, falling ill to the virus has serious consequences, as 80 per cent of the working population are in informal employment and therefore have no employer health insurance. This includes day labourers and taxi drivers, for example. Very few of them can afford to see a doctor.

In order to improve health care for the population, the Government of India more than ten years ago began to set up what is today the world’s largest public health insurance scheme (PM-JAY). More than half a billion people are registered in the programme and can obtain free health care services. On behalf of the German Federal Ministry for Economic Cooperation and Development (BMZ), the Deutsche Gesellschaft für Internationale Zusammenarbeit (GIZ) GmbH has been supporting the Government of India in this scheme from the very beginning. The Bill and Melinda Gates Foundation has also been providing financial support since 2017. GIZ is now working to further expand health care for the poor population during the coronavirus pandemic in collaboration with the Ministry of Health of India, the National Health Authority, which was established in 2018, and medical professionals.

Long-standing partnerships enable comprehensive cover

The state health insurance scheme is a project that will go down in history. PM-JAY has already enabled almost 12 million inpatient treatments in more than 10,000 hospitals. To manage this huge number of patients, it uses innovative digital tools which help to identify and settle costs of eligible treatments. To this end, GIZ is offering training for managers and experts from the health authorities that are introducing and implementing the health insurance scheme. A key objective is to enable as many public and private hospitals as possible to provide care under PM-JAY. This will allow even more people to access services and make claims under the insurance system across the nation.

The coronavirus pandemic is now stretching India’s health care system to the limit. GIZ and the regional governments are therefore pooling all their strength to stop the spread of the virus and relieve the pressure on the system. A major focus is on the northern states, where the health system is under particular strain. Many people from the north who moved to towns in the south for work have lost their jobs as a result of the pandemic. They are now returning home and putting additional pressure on health facilities.

Increasing testing capacity and expanding modern IT infrastructur

In order to stop the rapid spread of the virus, health authorities are relying on mandatory COVID-19 tests for respiratory infections. Already at the beginning of the pandemic, the Government of India determined that the insurance would cover the costs of testing and medicines for more than 100 million households. GIZ is also supporting existing public and private laboratories. It is working with the states to coordinate the tests and is subsidising the out-of-pocket expenses incurred by persons who have no access to the state insurance scheme. Additional laboratories are being established with GIZ’s support in order to cope with the enormous quantity of test samples.

Collecting data and raising awareness to fight the pandemic

The high number of infections in India makes it difficult to maintain an overview of the situation and to improve it. GIZ is therefore collecting data on hospital capacity utilisation and treatment of infected patients, and is subsequently evaluating this data for the regional governments. The authorities can use this data to respond to dynamic situations and adapt measures.

Social media are running information campaigns to heighten awareness among the population, and older people are receiving automated telephone calls with important information. In addition, the programme has further developed and digitalised health training for governments, municipalities and communities. The aim is to enable people to learn more about the pandemic and help to contain it.

Last revised: November 2020