by Aseem Garg

The transformational Ayushman Bharat (AB) scheme—the largest healthcare scheme in the world–has revolutionized Indian healthcare with the emphasis on taking everyone along, the continuum of healthcare and wellness approach. The singular scheme looks at preventive and promotive healthcare and achieves the goals of Equality & Inclusion, by ensuring the poorest of the poor also have access to quality care. Since its launch on September 23, 2018, approximately 35 million treatments worth more than Rs 42,000 crore have been provided. Nearly 10.74 crore poor and vulnerable families (approximately 50 crore beneficiaries) that form the bottom 40% of the Indian population have been provided the Ayuhsman Bharat cards, that enable health insurance benefits of Rs 5 lakh per family. To get the Ayushman card, a door-to-door card generation drive under the Apke Dwar Ayushman is being implemented. Beneficiaries can now create their Ayushman cards through an open platform developed by the National Health Authority (NHA). The aim of the Pradhan Mantri-Jan Arogya Yojana (PM-JAY), that comes under AB, is to help mitigate catastrophic expenditure on medical treatments, which push nearly 6 crore Indians into poverty each year.

All these benefits come as a big relief for patients of End Stage Renal Disease (ESRD) that topples finances of most fragile households, given that the costs of dialysis are upwards of Rs 1200 per session. In private hospitals, doctors recommend at least three dialysis a week. The costs go up with additional medications and routine checks that are required. The life-saving kidney transplant costs more than Rs 4-5 lakh per patient. In the revised Health Benefit Package 2.2, launched on April 6, 2022, 365 new procedures have been added and dialysis treatment relief has gone up from Rs 1,500 to Rs 1,800—to accommodate for inflationary trends over the years. The plan is that all 750 districts should have at least one dialysis centre each. Moreover, the portability feature of the scheme allows the beneficiary to avail treatment anywhere in the country—a big relief for kidney patients, many of whom have to travel miles and miles to reach the nearest dialysis centre that’s also easier on the pocket for them. Out of more than 24,000 hospitals empanelled under the scheme, many are from the private sector, giving beneficiaries multiple avenues to seek treatment.

Kidney disease is the sixth fastest-growing cause of mortality globally. As per various studies, every year about 2.2 lakh new patients of ESRD get added in India, resulting in additional demand for 3.4 crore dialysis every year. To add to the woes of kidney patients, India has one of the lowest nephrology workforce densities worldwide–only about 2,600 nephrologists (1.9 per million population), and a chronic shortage of reliable dialysis centres, nurses and technicians.

Hypertension, diabetes and obesity are the main causes of kidney failure. By 2030, India is expected to have the world’s largest population of patients with diabetes, and if not managed In time, the prevalence of kidney disease is going to be on the rise. Timely and routine screenings for those at risk of CKD can thus help kidney disease patients.

Early health screening and management of the illness need to be looked at closely. In-centre Hemodialysis (HD) was introduced in India in 1962, transplantation in 1971, and peritoneal dialysis (PD) which requires surgery to implant a PD catheter into the abdomen, was introduced in 1991. With the organ donation rate in India being 0.01%, most families have no option but to take patients to the nearest dialysis centres. Under AB, there is a plan to encourage organ donation in India and bust myths associated with it.

Ayushman Bharat puts the lens on India’s growing burden of NCDs, like stroke, kidney disease and cardiovascular disease and was brought in to bring in equity, affordability, universality, access, accountability, inclusivity, and decentralization to make the scheme highly dynamic and adaptive.

CKD patients are faced with huge barriers such as high costs of treatment, and low penetration of dialysis centres. Medicines to manage CKD are also not readily available to patients outside of big cities. All this is being addressed under AB, which also emphasises preventive care, by a proliferation of awareness drives against hypertension and diabetes, the prime causes of the ailment.

Moreover, under Ayushman Bharat’s Digital Health Programme for digital registry of health records, Ayushman Bharat Health IDs (called ABHA) will make available health data across multiple platforms, for easy access of specialists, so as to ensure timely detection of diseases, and a unified front to combat the disease right from the start stage. This too is a big relief as timely detection of kidney disease is important since there are no symptoms in the earlier stages.

Thus, AB looks in letter and in spirit to its end goal of Swasth Nagrik Abhiyan. The emphasis on early detection, digital registries, awareness drives against illnesses, against tobacco and alcohol abuse, addressing mental health, and providing relief for medical expenses incurred, will go a long way in improving the quality of life for kidney patients, and also in reducing the disease burden.

Aseem Garg, Founder and CEO, DCDC

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