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Final Report for Mott MacDonald Assessment of Deendayal Antyodaya Upachar Yojana in MP Poverty Monitoring & Policy Support Unit

248998/01/A - 1 August 2009/ P:\Noida\DMC\Projects\248998-MP Health scheme Assessment\REPORT\Final Report\Final Report\Final report DAUY.doc/MB

Poverty Monitoring & Policy Support Unit State Planning Commission I Floor, Vindhyachal Bhawan Bhopal - 462 004 Madhya Pradesh

Final Report for

Assessment of Deendayal Antyodaya Upachar Yojana in MP

August 2009 Mott MacDonald Pvt. Ltd. A-20, Sector 2 NOIDA – 201 301 Uttar Pradesh India

Tel: +91 120 254 3582 - 85

Fax: +91 120 2543562 e-mail: [email protected]

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Final Report for Mott MacDonald Assessment of Deendayal Antyodaya Upachar Yojana in MP Poverty Monitoring & Policy Support Unit

248998/01/A - 1 August 2009/ P:\Noida\DMC\Projects\248998-MP Health scheme Assessment\REPORT\Final Report\Final Report\Final report DAUY.doc/MB

Final Report for

Assessment of Deendayal Antyodaya Upachar Yojana in MP

Issue and Revision Record

Rev Date Originator

Checker

Approver

Description

00 09.04.09 Deepa Ahluwalia Anisur Rahman

Archana C.

Moumita Biswas

Shoma Majumdar Draft Report

01 18.05.09 Deepa Ahluwalia Anisur Rahman

Archana C.

Moumita Biswas

Shoma Majumdar Revised Draft

Report

02 15.06.09 Deepa Ahluwalia Anisur Rahman

Archana C.

Moumita Biswas

Shoma Majumdar Revised Draft

Report

03 01.08.09 Deepa Ahluwalia Anisur Rahman

Archana C.

Moumita Biswas

Shoma Majumdar Final Report

This document has been prepared for the titled project or named part thereof and should not be relied upon or used for any other project without an independent check being carried out as to its suitability and prior written authority of Mott MacDonald being obtained. Mott MacDonald accepts no responsibility or liability for the consequence of this document being used for a purpose other than the purposes for which it was commissioned. Any person using or relying on the document for such other purpose agrees, and will by such use or reliance be taken to confirm his agreement to indemnify Mott MacDonald for all loss or damage resulting therefrom. Mott MacDonald accepts no responsibility or liability for this document to any party other than the person by whom it was commissioned.

To the extent that this report is based on information supplied by other parties, Mott MacDonald accepts no liability for any loss or damage suffered by the client, whether contractual or tortious, stemming from any conclusions based on data supplied by parties other than Mott MacDonald and used by Mott MacDonald in preparing this report.

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List of Contents Page

Summary S-1

Chapters and Appendices

1 INTRODUCTION 1

1.1 Study Area - Madhya Pradesh 1

1.2 The Scheme - Deendayal Antyodaya Upachar Yojana 3

1.3 Other Health Schemes in the State 3 1.3.1 State Illness Assistance Fund 3 1.3.2 Rogi Kalyan Samiti 4 1.3.3 Deendayal Mobile Hospital Yojana 4 1.3.4 Dhanwantari Vikas Khand Yojana 4

1.4 The Client - Poverty Monitoring and Policy Support Unit 4

1.5 Project Brief 4

2 THE ASSESSMENT STUDY 5

2.1 Study Objectives 5

2.2 Scope of the Present Assessment Study 5

2.3 Target Population 5

2.4 Approach for the Study 6

2.5 Methodology for the Study 6 2.5.1 Team Mobilisation 6 2.5.2 Secondary Research 7 2.5.3 Primary Research 8 2.5.4 Pre-testing of the Tools 9 2.5.5 Sampling 10 2.5.6 Training of Field Investigators 13 2.5.7 Data Analysis and Report Submission 13

2.6 Limitations of the Study 14

3 PROFILE OF RESPONDENTS 15

3.1 Profile of Service Providers 15

3.2 Profile of Sample Urban Area/Villages 15 3.2.1 Social Structure 15 3.2.2 Health Profile 16 3.2.3 Status of Infrastructural Facilities 16 3.2.4 Disease patterns 18

3.3 Socio-economic Profile of Households in Sample Urban Area/Villages 18 3.3.1 Profile of Households 19 3.3.2 Social Profile of Households 21

3.4 Socio-economic Profile of Respondents 24

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3.4.1 Social Profile of Respondents 24 3.4.2 Economic Profile of Respondents 26

4 ANALYSIS OF THE SCHEME 28

4.1 The Scheme - Deendayal Antyodaya Upachar Yojana 28 4.1.1 Objectives of the Scheme 29 4.1.2 Issue of Family Health Cards under the Scheme 29 4.1.3 Eligibility Criteria for Benefited households 29 4.1.4 Eligible Health Services Providers 30

4.2 Scheme Coverage 30

4.3 Scheme Awareness 30 4.3.1 Overall awareness about the scheme 30 4.3.2 Source of Information Regarding the Scheme 34 4.3.3 Scheme Awareness among Services Providers 35

4.4 Training of Service Providers under the Scheme 36

4.5 Accessibility and Demand of Services under the Health Scheme 36 4.5.1 Perception of Benefited Households regarding Accessibility of the Scheme 37 4.5.2 Perception of Non-Benefited households regarding Accessibility of the

Scheme 42

4.6 Management Structure and Scheme Implementation 49 4.6.1 Role of District Level Officials 50 4.6.2 Role of Block Level Officials 50 4.6.3 Role of Multi Purpose Health Workers 51

4.7 Referral Mechanism 52

4.8 Monitoring & Evaluation and Management Information System 52

4.9 Fund Flow Mechanism for the Scheme 53 4.9.1 Fund Allocation to the Districts 53 4.9.2 Fund Allocation to the Blocks 53 4.9.3 Drug procurement and supply system 54

5 SCHEME ACHIEVEMENTS & EMERGING ISSUES 55

5.1 Physical Achievements 55

5.2 Direct Impact of the Scheme 58 5.2.1 Quality of Services Availed under the scheme 65 5.2.2 Satisfaction of the benefited Households/Respondents 65

5.3 Indirect Impact of the Scheme 67

5.4 Bottlenecks & Emerging Issues from the study 68 5.4.1 Scheme Awareness 68 5.4.2 Scheme Health Cards 68 5.4.3 Training 69 5.4.4 Infrastructure 69 5.4.5 Manpower 70 5.4.6 Supply of Medicine/Consumables 70 5.4.7 Inclusion of Transport Facility under the scheme 71 5.4.8 Behaviour of Service Providers 71 5.4.9 Misuse of scheme 73 5.4.10 Record keeping 73 5.4.11 Awareness amongst the Community 73

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6 CONCLUSION AND RECOMMENDATIONS 75

6.1 Awareness about Scheme 75 6.1.1 Awareness amongst the Community 75 6.1.2 Awareness amongst the Service providers 76

6.2 Institutional delivery mechanism of the scheme 76 6.2.1 Scheme Implementation 76 6.2.2 Management Information System (MIS)/Record keeping 77 6.2.3 Behaviour of Service Providers 78 6.2.4 Fund Flow 78 6.2.5 Inclusion of OPD Facilities 78 6.2.6 Inclusion of Transport Facility under the scheme 79 6.2.7 Improvement in the content of Health Card 79

Figures and Tables

Figure S.1: Proportion of Respondent Households Aware of the Scheme (Figures in Percent) ......... S10 Figure S.2: Management Structure for Implementation of the Health Scheme .................................. S17 Figure S.3: Perception of respondents regarding direct impact of the scheme ................................... S20 Figure 2.1: Methodology......................................................................................................................... 7 Figure 3.1: Education of Respondents (Figures in %)........................................................................... 25 Figure 4.1: Proportion of Respondent Households Aware of the Scheme (Figures in %).................... 31 Figure 4.2: Amount Spent for Persons who were ill and availed treatment under the scheme (Benefited

households) (Figures in %) ............................................................................................... 39 Figure 4.3: Perception of respondents regarding direct impact of the scheme (in %)........................... 42 Figure 4.4: Percent of Family members fell ill and were hospitalised (Non-benefited households)

(Figures in %) ................................................................................................................... 44 Figure 4.5: Amount Spent by Persons who were ill and availed treatment (Non-Benefited households)

(Figures in %) ................................................................................................................... 46 Figure 4.6: Management Structure for Implementation of the Health Scheme..................................... 50 Figure 4.7: Drug Procurement and Supply system................................................................................ 54 Figure 5.1: Perception of respondents regarding direct impact of the scheme (in %)........................... 59 Figure 5.2: Health Status of Benefited households after availing benefits of the scheme (in %) ......... 61 Figure 5.3: Impact on Non-benefited respondents’ borrowing money pattern for treatment before and

after the scheme ................................................................................................................ 64 Figure 5.4: Quality of Services availed (Rural)..................................................................................... 66 Figure 5.5: Quality of Services availed (Urban) ................................................................................... 66 Table S.1: Sample districts for Primary Survey .................................................................................... S3 Table 1.2: Profile of Households........................................................................................................... S6 Table S.3: Caste/Tribe of Respondents (Figures in Percent)................................................................. S6 Table S.4: Education status of the Respondents (Figures in Percent) ................................................... S7 Table S.5: Type of Houses of Respondents (Figures in Percent) .......................................................... S8 Table S.6: Proportion of Households having Agricultural land (Figures in Percent) ........................... S8 Table S.7: Amount Spent for persons who were ill & availed treatment under scheme (in Percent) . S13 Table S.8: Proportion of Family Members falling ill but not seeking Treatment (in Percent)............ S14 Table S.9: Amount Spent by Persons who were ill and availed treatment.......................................... S15 Table S.10: Reasons for not availing treatment under the Scheme (Figures in Percent) .................... S16 Table S.11: Number of Benefited Households & Expenditure incurred over last 3 years.................... 19 Table 1.1: Health profile of Madhya Pradesh as compared to India figures ........................................... 2 Table 1.2: Health Infrastructure of Madhya Pradesh .............................................................................. 2 Table 2.1: Selected Sample Districts and Blocks in each Division of Madhya Pradesh....................... 10 Table 2.2: Location-wise Samples for Primary Survey......................................................................... 12

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Table 3.1: Average number of maternal deaths, Infant deaths and Proportion of Institutional Delivery as reported in the Gram Sabha (in last one year) (Figures in %) ...................................... 16

Table 3.2: Drinking water facilities within the villages and urban slums (Figures in %) ..................... 17 Table 3.3: Disease patterns in the village and urban slums (Figures in %)........................................... 18 Table 3.4: Profile of Households........................................................................................................... 19 Table 3.5: Number of Households possessing Health cards and Labour cards (Figures in %)............. 20 Table 3.6: Type of Family of Respondents (Figures in %) ................................................................... 21 Table 3.7: Religion of Respondents (Figures in %) .............................................................................. 22 Table 3.8: Caste/Tribe of Respondents (Figures in %) ......................................................................... 22 Table 3.9: House Type of Respondent Households (Figures in %) ...................................................... 23 Table 3.10: Proportion of Households having Agricultural land (Figures in %) .................................. 24 Table 3.11: Social Profile of the Respondents (Figures in %) .............................................................. 25 Table 3.12: Education of the Respondents (Figures in %).................................................................... 26 Table 3.13: Main Source of Income of Households (Figures in %)...................................................... 27 Table 3.14: Monthly income of Households (Figures in %) ................................................................. 27 Table 4.1: Awareness of the Respondents classified by their levels of Education................................ 31 Table 4.2: Awareness of the Respondents classified by their Social Category (in %).......................... 32 Table 4.3: Awareness among the Households (Figures in %)............................................................... 33 Table 4.4: Source of Information Regarding the Scheme (Figures in %) ............................................. 35 Table 4.5: General Meetings for the Service Providers in the State...................................................... 36 Table 4.6: Number of family members who were sick and availed treatment under the scheme ......... 37 Table 4.7: Type of Diseases for which treatment was availed (Figures in %) ...................................... 38 Table 4.8: Percent of Households where any family members fell ill & hospitalised (Figures in %) .. 40 Table 4.9: Percent of Benefited households whose treatment amount exceeded Rs. 5000.00 (in %)... 41 Table 4.10: Benefited households whose treatment amount exceeded Rs. 5000.00 by their Caste/Tribe

(Absolute Figures) ............................................................................................................ 41 Table 4.11: Proportion of Family Members taken ill (Figures in %) .................................................... 42 Table 4.12: Percent of Non-Benefited households where anyone availed treatment (Figures in %) .... 43 Table 4.13: Type of Diseases for which treatment was availed (Figures in %) .................................... 44 Table 4.14: Proportion of Family Members fell ill but did not seek Treatment (Figures in %)............ 45 Table 4.15: Reasons for not availing treatment under the Scheme (Figures in %) ............................... 46 Table 4.16: Reasons for not availing treatment under the Scheme by Education of respondents

(Absolute Figures) ............................................................................................................ 47 Table 4.17: Loss of Man-days as Absent from Work (Figures in %) ................................................... 48 Table 4.18: Proportion of Non-Benefited households who borrowed money for treatment ................. 48 Table 4.19: Proportion of Non-Benefited households who borrowed money for treatment by Caste

(Absolute Figures) ............................................................................................................ 49 Table 5.1: Number of Health Card Holders, Beneficiaries and expenditure Incurred .......................... 56 Table 5.2: Number of Benefited Households & Expenditure Incurred over last 3 years...................... 58 Table 5.3: Percent of Respondent who spend more on seeking treatment prior to availing benefits of

the scheme (Figures in %)................................................................................................. 61 Table 5.4: Percent of Respondent who borrowed money for treatment ................................................ 62 Table 5.5: Percent of Respondent who borrowed money for treatment prior to availing scheme benefits

by Caste (Absolute Figures) ............................................................................................. 62 Table 5.6: Percent of Respondent who borrowed money for treatment after availing benefits of the

scheme (Figures in %) ...................................................................................................... 63 Table 5.7: Percent of Respondent who borrowed money for treatment after availing benefits of the

scheme by Caste (Absolute Figures)................................................................................. 63 Table 5.8: Percent of respondent who think that health has improved after availing treatment under the

scheme (Figures in %) ...................................................................................................... 65 Table 5.9: Percent of respondents who feel that the scheme is relevant in providing cost-free access of

health care services (Figures in %) ................................................................................... 65 Table 5.10: Indirect Impact of the Scheme as perceived by Benefited households (Figures in %) ...... 68

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List of Abbreviations

BMO Block Medical Officer

BPL Below Poverty Line

CMHO Chief Medical and Health Officer

CS Civil Surgeon

DAUY Deendayal Antyodaya Upachar Yojana

DM District Magistrate

FGDs Focus Group Discussions

GoI Government of India

GoMP Government of Madhya Pradesh

IDI In-Depth Interview

IMM Mott MacDonald India

IMR Infant Mortality Rate

MMR Maternal Mortality Rate

MO Medical Officer

MP Madhya Pradesh

PMPSUS Poverty Monitoring & Policy Support Unit Society

PPS Probability Proportional to Size

PRI Panchayati Raj Institution

SC Scheduled Caste

ST Scheduled Tribe

TFR Total Fertility Rate

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Executive Summary

S1.1 Introduction

Health is one of the five issues on which the state government has laid its priorities. In this concern the

first priority of the Health Department is to provide economic, easily accessible and quality health

services to the socially and economically backward classes of the state. The Government of Madhya

Pradesh realized that there was lack of treatment facilities especially for hospitalization to the weaker

sections and to the families belonging to vulnerable groups of the economy which was a major cause

of concern. Thus, to address the health needs of poor families, the Government of Madhya Pradesh

(GoMP) launched the Deendayal Antyodaya Upachar Yojana (DAUY). Under this Scheme, the BPL

families as well as those belonging to primitive tribes, and those possessing Mukhya Mantri Mazdoor

Suraksha card or Nirman Shramik card, are provided free medical services up to Rs. 20,000.00 (in one

financial year) under admission in any Government Hospital.

S1.2 Study Objectives

The main objective of the present study was to carry out a comprehensive external assessment of the

scheme – Deendayal Antodaya Upachar Yojana (DAUY) – with special reference to tap out the best

practices and bottlenecks of the scheme. The major objectives of this assessment were as follows:

1. To assess the extent to which the DAUY has met its envisaged objectives

2. To analyze programme achievements and emerging gaps, and identification of institutional

bottlenecks in effective delivery of DAUY

3. To suggest a detailed framework for improved programme effectiveness

4. To recommend the ways and means based on the detailed framework to improve the delivery of

DAUY

S1.3 Approach and Methodology

The assessment of the scheme was carried out by our in-house team of professionals. A team having

an in-depth understanding of the objectives of the proposed project, its perceived benefits and outcome

of the project was formed. A detailed planning for collecting information both from the primary and

secondary sources of the assignment was undertaken.

The project implementation team comprised of Project Director, Project Manager and key

Researchers. The core team included professionals with expertise in the fields of health, statistics,

social development and evaluation experts. Apart from the core team members/researchers, field

investigators, having the basic comprehension of field survey in social and health sector, were also

identified for data collection in the field.

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An onset meeting was organised with PMPSUS (the client) on 11th November 2008, wherein the key

team member of Mott MacDonald (the consultant) presented their understanding and requirements for

the proposed assignment and also discussed and shared the sampling procedure as well as quantitative

and qualitative tools with the client. Necessary modifications were made based on the feedback

received from the client and other key stakeholders. The consultant also used this opportunity to seek

the support and co-operation of the State and District Health Department personnel during the course

of execution of the assignment.

The assignment was carried out in three major stages, viz.: (1) Secondary/Desk Research; (2) Field

Survey, i.e., Primary Data Collection; and (3) Data Collation, Analysis and Report preparation.

Secondary Research

An attempt was made to collect all the relevant secondary data from various sources including the

internet, the State Health Directorate, etc. The documents and information related to the Scheme and

its guidelines, intended coverage, the district wise details of BPL households, the number of health

cards issued etc. and the district wise expenditure was provided by the State Health Directorate.

However, block wise scheme details were not available from the State Health Department(s). An

attempt was also made to seek the list of benefited households from the district and block headquarters

who have accessed the scheme so far. It was assumed that this would enable us in collating and

analysing the available data from the state and districts and thus prepare a profile of targeted benefited

households and those who have accessed the scheme so far; as well as an analysis of progress across

various districts. During Inception phase we came to know that, relevant data is not being maintained

by the respective districts.

Primary Research

Primary research was undertaken to derive relevant information for the present study. During the field

research, both benefited as well as non-benefited households were visited for interactions with the key

stakeholders. For primary research, the following research techniques/tools were used:

• Village Profile Schedule: In each village, our team of field researchers interacted and held discussions with villagers in the Gram Sabha and also with the Sarpanch/Panchayat representatives for collecting information about the village and preparing a village profile. Village profile schedule was developed to collect the detailed information about the village such as location of the village, population composition, accessibility in terms of distance from the main road/highway, availability of public health and educational facilities to the local community in the village.

• Household Schedule: A detailed household survey was conducted to collect the required information from both the benefited and non-benefited households. A structured interview schedule was designed to elicit information from the respondents.

� Benefited Households: A comprehensive structured household questionnaire was used to collect data from the benefited households; i.e., households who have accessed the scheme so far.

� Non-Benefited Households: A structured questionnaire was also canvassed to the non-benefited households in order to understand the level of awareness amongst the non-benefited respondents and the underlying reasons for the eligible BPL households not accessing the scheme benefits.

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• Key-Informant Interviews/In-Depth Interview Schedule: In-depth Interview Schedules are basic and most important instruments to be used during the qualitative data collection. In the present study, in-depth interviews were conducted with various key stakeholders and health care providers facilitating the scheme delivery at the block and district level in order to understand the delivery mechanism of the scheme and perceptions of the key stakeholders.

• Focus Group Discussions (FGDs): As part of the present assessment study, our team also conducted focus group discussions with the grass root level health care workers; i.e., multi-purpose male and female health workers (MPHWs). Three FGDs from each sample district were conducted, two from rural areas and one from the urban centre.

After the finalisation of the tools and FGD guidelines, the same were pre-tested in the field to ensure

the validity of each and every question posed in these tools. This was essential as it helped in fine-

tuning and finalising the tools and ensuring continuity and efficiency in smooth flow from one issue to

another during the data collection process. Subsequently, field visits were undertaken to check the

relevance and accuracy of each and every question posed in the data collection tools. Bairasya Block

of Bhopal District (non-sample district) was randomly selected for Pilot-testing all the tools – both

quantitative and qualitative questionnaires/tools. After field-testing, some of the questions were

reorganised and a few were modified and/or re-worded accordingly.

Sample Size

For the present assessment study, field work was carried out in 15 villages and 4 urban locations (2 in

each town/urban area); covering approximately 18 households in each location (urban/rural). Thus,

about 342 households were contacted from each sample block/district. The detailed break-up of the

sample size for the primary survey is given in the following table.

Table S.1: Sample districts for Primary Survey

Sample Size

CMHO

Civil

Surgeon

BMO

MO-

PHC

MPHWs/

ANMs

Number of

locations

No. of

Households

Division

/ Region

Name of

District

(IDI) (IDI) (IDI) (IDI) (FGDs) Village Towns

Sagar 1 1 1 1 3 15 4 344 Central

Sehore 1 1 1 1 3 15* 4 344

Neemuch 1 1 1 1 3 15* 4 337 Malwa

Jhabua 1 1 1 1 3 15 4 359

Shivpuri 1 1 1 1 3 15 4 344 Northern

Morena 1 1 1 1 3 15 4 343

Mandla 1 1 1 1 3 15 4 336 South

Chinndwara 1 1 1 1 3 15 4 343

Barwani 1 1 1 1 3 15 4 341 South-Western Hoshangabad 1 1 1 1 3 15 4 340

Satna 1 1 1 1 3 15* 4 343 Vindhya

Rewa 1 1 1 1 3 15** 4 330

Total 12 12 12 12 12 36 180 48 4104

Total Samples 48 36 228 4104 *One sample village each in these districts were found to be Un-inhabited.

** Two sample villages were found to be Un-inhabited.

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Further, interactions with the village level health officials, like – ANM and Multi-Purpose male and

female Health Workers (MPHW) were organized and relevant information regarding the scheme was

derived through Focus Group Discussions with health workers. Three FGDs were conducted in each

district – one in urban and two in rural areas.

S1.4 Profile of Surveyed Respondents

This section includes the profile and background information of the service providers as well as the

benefited and non-benefited households/respondents contacted during the study.

Profile of Service Providers

In-depth discussions and interactions were held with the district health care officials. Analysis of their

educational profile reveals that most of the CMHOs and Civil Surgeons were Medical Post Graduates,

with most of them having MBBS and specialisation as MD or MS. Most of the district level health

officials had an average experience of about 3 years. An analysis of the educational profile of the

Block Medical Officers (BMO) of the sample blocks reveals that almost all of them were Medical Post

Graduates having an experience of about 2-3 years. Similarly, most of the rural level Multi-Purpose

Health Workers (MPHW) contacted during the field study, were educated till high school. Most of

them had completed about 10-12 years of schooling and were trained for their job.

Profile of Sample Villages/Urban Areas

The data collected from the sample villages and towns/urban areas reveal that the average number of

maternal and infant deaths was generally low (less than 2) in most of the villages and urban localities.

However, the urban slums reported slightly higher number of maternal and infant deaths, wherein 21

percent of urban slums reported to have maternal deaths ranging between 2-5; and 29 percent reported

infant deaths ranging between 2-5 in last one year.

The institutional deliveries as reported by the gram sabha show better figures in the urban slums as

compared to the rural areas; the data shows that 94 percent of urban while only 42 percent of rural

areas reported institutional deliveries.

Disease patterns:

The villagers/participants of the Gram Sabha were asked about their perception on the prevalence of

the common diseases in their respective villages. In this regard, it has emerged that seasonal illnesses

like fever, cough, cold, etc. are more prevalent in both rural areas and urban slums. Further, water

borne diseases like diarrhoea, cholera etc are also mentioned by more than one-fifth of the sample

population. This may be perhaps due to the fact that one of the main sources of drinking water in rural

areas being wells. Similarly, Tuberculosis has been reported by 38 percent of rural and 41 percent of

urban areas; while Asthma is prevalent in 38 percent of rural areas and 30 percent of urban slums.

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Infrastructural Facilities

The infrastructural facilities in the sample villages and urban areas were assessed and are based on the

perception of the participants of the Gram Sabha. As opined by the participants during the Gram

Sabha, nearly 58 percent of the villages have good road connectivity (all-weather roads); with the

nearest towns being at a distance of 5-10 km in most districts. Most of the sample villages had access

to the nearest bus stations within 10 km distance, excepting in Mandla, Chinndwara and Sehore

districts, where bus stations were over 12 km away from the villages. A Post Office is also available

within 5-8 km distance in almost all the sample villages, with most of them being within 4-5 km. A

Bank is also available within 10 km distance in almost all the sample villages.

Regarding drinking water facilities, almost all the sample villages and urban areas are dependent on

hand-pumps. As high as 30 percent in rural and 11 percent in urban areas are also dependant on both

wells and hand pumps, while as high as 42 percent in urban slums are dependant on Hand pumps and

Tap water for drinking purposes. There are still some localities, where people are dependant on

pond/lake and/or river as the main source of drinking water supply.

The sample districts have good access to the educational facilities; most of the sample villages (87

percent) and almost all the urban slums (92 percent) have access to primary schools. However, there

are exceptional cases in Neemuch, Morena and Rewa districts where primary schools are a little

distance from the urban slums. Nearly 80 percent villages and 94 percent urban slums have access to

the Middle schools as well. Secondary and Higher Secondary schools are also accessible.

Majority of the villages have access to a health facility – either an Anganwadi or a Sub-centre.

However as opined by the Gram Sabha most of the area have limited access to a PHC having 24x7

health facilities; only 15 percent rural areas and 42 percent urban slums have access to such PHCs;

with an average distance being 6-11 km, except in Chinndwara and Shivpuri, where the average

distance to a 24x7 PHC is over 13 km away.

Socio-economic Profile of Households in Sample Villages/Urban Areas

Analysis of the household level data in the rural areas shows that nearly 69 percent households are

belonging to BPL category and could show their BPL cards. Another 30 percent in rural areas also

claim to be belonging to BPL, but could not show their cards at the time of our primary survey.

Similarly, in urban areas 68 percent are belonging to BPL category and did show their card to the field

researcher during the primary survey. Thus the total targeted household has been estimated to be 8.04

million in rural and 21928 in urban areas. In urban areas, since the data collection was through

purposive sampling in two slums of each selected town, having maximum BPL population; hence

estimation has not been done. Thus, the data pertains to only the slum households in the 24 selected

towns.

A negligible share of respondents (0.6 percent among rural and one percent in urban areas) mentioned

that they belong to Above Poverty Line (APL) and hence do not have a BPL card. Amongst the total

targeted households, 95 percent households in rural areas and 98 percent in urban areas are having the

Deendayal Antyodaya Upachar Yojana (DAUY) cards.

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Table 1.2: Profile of Households

Urban Rural Particulars n % n %

BPL households (BPL Card seen) 14881 67.86 5553662 69.11 BPL households (BPL Card not seen) 6833 31.16 2434446 30.29 APL households 214 0.98 47811 0.59 Total Targeted Households 21928 100.00 8035919 100.00

Total Households having DAUY cards 21481 97.96 7638729 95.06 Households where people fell ill 6147 28.62 2060200 26.97 Households where people required hospitalisation 1677 27.28 785749 38.14 Benefited Households 364 21.71 190106 24.19 Non-Benefited Households 5783 78.29 1870094 75.81 Source: Field survey (Household survey)

When analysed regarding the need for getting benefits of the scheme (DAUY), the data revealed that

only 27 percent in rural areas and 29 percent in urban slums fell ill and thus required the services of

the DAUY scheme. However amongst those who fell ill, 38 percent in rural areas and 27 percent in

urban slums required hospitalisation. And amongst those who required hospitalisation, only about 24

percent in rural areas and 22 percent in urban slums actually availed the benefits of the scheme; while

another 76 percent households in rural areas and 78 percent in urban slums did not avail benefits of the

scheme.

Social Profile of Surveyed Households

It is interesting to analyse that a majority of the targeted households lived in nuclear families. In rural

areas, only about 15 percent of non-benefited Households and about 22 percent of the benefited

respondents were living in joint families while remaining of the households reported to be living in

nuclear families.

Analysis of the data on religion of the targeted households shows that majority of respondents of the

present study were Hindus. In rural areas, about 92 percent of the benefited households and as high as

95 percent of the non-benefited households were Hindus. Similarly, in urban areas 71 percent of the

targeted households were Hindus both amongst the targeted benefited and non-benefited Households.

Besides, other respondents in the rural areas included Muslims (1.5 percent amongst benefited and 2.4

percent amongst non-benefited households), Sikhs (6.25 percent amongst benefited and 3 percent

amongst non-benefited households), and a very few Christians. In urban areas, the proportion of

Muslims was 27 percent and 29 percent among benefited and non-benefited households, respectively.

Table S.3: Caste/Tribe of Respondents (Figures in Percent)

Benefited Households Non-Benefited Households Target Group Caste/Tribe

Urban Rural Urban Rural Urban Rural

Schedule Caste 38.74 50.94 39.11 33.30 39.11 33.72 Schedule Tribe 12.09 27.06 8.85 41.74 8.91 41.39 OBC 38.46 17.21 48.28 19.47 48.12 19.41 General 10.71 4.79 3.76 5.49 3.87 5.47 Total 100 100 100 100 100 100

S.D. 1.08 0.90 1.00 0.86 1.04 0.88

95% CI 2.10-2.32 1.75-1.76 2.15-2.18 1.97-1.97 2.10-2.32 1.75-1.97 Source: Field Survey (Surveyed Households)

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More than half of the respondents belonged to Scheduled Castes. In rural areas, about 51 percent of

benefited Households and 33 percent non-benefited Households were SCs, while about 27 percent of

benefited and 42 percent of non-benefited Households were STs. Similarly, in urban areas the

proportion of SCs was relatively lower among benefited Households. It has also emerged that a higher

proportion of benefited Households belonging to OBCs were in the urban areas.

Education and literacy has huge impact on the level of awareness and understanding of ones rights.

However in the present study, an analysis of the literacy level of the respondents shows that more than

two-third of these respondents could not read and write in any language. This was explicit in both rural

as well as urban areas both among benefited and non-benefited households.

Table S.4: Education status of the Respondents (Figures in Percent)

Benefited Households Non-Benefited Households Target Group

Urban Rural Urban Rural Urban Rural

Proportion of Respondents who can read & write

Literate 33.52 35.29 35.37 26.68 35.34 26.88 Illiterate 66.48 64.71 64.63 73.32 64.66 73.12 Total 100 100 100 100 100 100

S.D. 0.47 0.48 0.48 0.44 0.47 0.46

95% CI 1.62-1.71 1.64-1.65 1.64-1.65 1.73-1.73 1.62-1.71 1.64-1.73 Source: Field Survey (Surveyed Households)

Amongst those who had some formal education, about 40 percent of the benefited households were

educated up to primary level; while only a marginal proportion of households have studied beyond

class XII, except among non-benefited households in urban areas where about 7 percent of the

households had completed more than 12 years of schooling.

Economic Profile of Surveyed households

Observations were made by the field researchers regarding the type of houses in which the

respondents were living in. It has emerged from the collected data that majority of households in rural

areas were living in kuccha houses. Only a negligible proportion of households lived in pucca houses;

the main reason being that most of the targeted households were from the socio-economically weaker

sections. It has interestingly emerged that even in urban areas the proportion of households living in

kaccha and/or semi-pucca households was significantly higher, mainly due to the reason was that

these houses were in slum areas.

However, the data on the ownership of households presented in shows that majority of the respondent

households lived in their own houses and almost all of them confirmed that they did not have any

other house of their own, apart from the one they were living in.

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Table S.5: Type of Houses of Respondents (Figures in Percent)

Benefited Households Non-Benefited Households Target Group House Type

Urban Rural Urban Rural Urban Rural

Type of Houses among Households Kaccha 62.09 87.11 72.15 90.58 71.99 90.50 Semi Pucca 30.22 10.99 23.35 8.00 23.46 8.07 Pucca 7.69 1.90 4.50 1.43 4.55 1.44 Total 100 100 100 100 100 100

S.D. 0.64 0.41 0.56 0.35 0.60 0.38

95% CI 1.39-1.52 1.15-1.15 1.32-1.33 1.11-1.11 1.32-1.52 1.11-1.15

Ownership of Households Own 89.84 97.43 93.24 94.35 93.19 94.42 Rented 10.16 2.57 6.76 5.65 6.813 5.58 Total 100 100 100 100 100 100

S.D. 0.30 0.16 0.25 0.23 0.28 0.14

95% CI 1.07-1.13 1.02-1.02 1.06-1.07 1.06-1.06 1.06-1.13 1.02-1.06 Source: Field Survey (Surveyed Households)

An attempt was made to understand the proportion of households who owned agricultural land. As

expected, relatively higher proportions of households in rural areas were land owners (26 percent

benefited households and 19 percent non-benefited households in rural areas). It was interesting to

note that even in urban areas about 4 percent of benefited and 2 percent of non-benefited households

were landowners. However in terms of quantity of land, about one-fourth of the households in rural

areas had land holding of less than an acre; while about 7 percent of benefited Households and 4

percent of non-benefited landowners in urban areas had more than 4 acres of land. However, none of

the targeted households in urban areas had land holding of more than 4 acres. Among urban areas

about 57 percent of benefited and 32 percent of non-benefited households had land below one acre.

Table S.6: Proportion of Households having Agricultural land (Figures in Percent)

Benefited

Households Non-Benefited

Households Target Group Agricultural land

Urban Rural Urban Rural Urban Rural

Households having Agricultural land

4.12 26.33 2.24 19.23 2.28 19.40

Households not having Agricultural land

95.88 73.67 97.76 80.77 97.72 80.60

Total 100 100 100 100 100 100

S.D. 0.20 0.44 0.15 0.39 0.18 0.42

95% CI 1.94-1.98 1.73-1.74 1.98-1.98 1.81-1.81 1.94-1.98 1.73-1.81

Size of the land Holding (in Acres)

No answer - - 0 0 0.20 0.07

0.1-1.0 57.14 24.32 31.60 28.31 32.26 28.17

1.0-2.0 21.43 27.71 45.46 31.95 44.69 31.79

2.0-3.0 14.29 38.61 19.12 17.93 19.04 18.57

3.0-4.0 7.14 1.93 3.82 7.00 3.81 6.83

4.0 & Above 0.00 7.43 0 14.81 0.00 14.57

Total 100 100 100 100 100 100

Average (Acres) 1.60 2.35 1.95 2.48 1.78 2.42 Source: Field Survey (Surveyed Households)

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The respondent households were enquired and categorised into occupational categories to understand

the main source of their household income. The occupational categories were designed based on the

Census of India’s classification categories of occupation. In urban areas, about 4 percent of benefited

and 6.5 percent of non-benefited households were engaged in farming or cultivation. Agricultural

labourers were the largest categories both in rural as well as in urban areas. However, a relatively

higher proportion of respondents were agricultural labourers in rural areas. Moreover, in rural areas

about 81 percent of the benefited as well as similar percent of non-benefited households were engaged

in primary activities. On the other hand, another interesting feature observed during the survey was

that as high as 43 percent of benefited and 50 percent of non-benefited households were also engaged

in agricultural related activities in urban areas.

Income is yet another important indicator for assessing the socio-economic status of the households.

For the present study, the households were inquired about the monthly income of their household. The

data shows that about 33 percent of households in urban and 46 percent of households in rural areas

among benefited households and as high as 40 percent of urban and 61 percent of the rural non-

benefited Households had their income below Rs. 1000.00. Similarly, it has emerged that about 66

percent of the benefited households in urban and 54 percent in rural areas and 56 percent of non-

benefited Households in urban and 38 percent in rural areas had their monthly income between Rs.

1000.00-3000.00.

S1.5 The Scheme - Deendayal Antyodaya Upachar Yojana

As mentioned earlier, the scheme is an outcome of the efforts of the government to provide free access

to various health care services to the poor and marginalised sections of the society. The scheme was

instituted on 25th September 2004 to address a situation whereby the poor in the state who were either

unable to access healthcare services owing to lack of finances or were being indebted, mainly with

exploitative moneylenders, to meet their healthcare needs, are provided free health care facilities.

Under the scheme, the eligible households can avail free medical treatment and investigation facilities

up to a limit of Rs. 20,000.00 per family per annum for treatment and investigation in all government

health facilities. However, discussions held with the state officials reveal that the benefits provided

under the scheme are limited to cover the cost of medicines and investigations, however, other costs

such as bed charges; physicians’ fees etc. are not accounted for. Benefits under the scheme are made

available only to hospitalized patients. Moreover, although the state officials mentioned that in case of

seriously ill patients, the limit of treatment amount is further being extended to Rs. 30,000.00 per

family per annum, but discussions with the district as well as block level officials showed that no such

information was conveyed and no circulars were received by them in this regard.

Analysis of the qualitative data shows that normally, very few families avail benefit up to the full

extent of Rs. 20,000. Moreover, it has also emerged from the discussions held with the state level

officials that the average benefit availed under the scheme was Rs. 1000.00 per family per annum.

Moreover, analysis of the data collected from primary research shows that average amount spent on

the benefited households is Rs.1747.00 per family per annum in urban areas, while in rural areas it is

Rs. 1314.00.

Scheme Coverage

• Discussions with the state level officials revealed that presently the scheme is being implemented

in all the districts of the state.

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• Further, discussions with the health officials at the district and block level revealed that although

the scheme was launched in September 2004, but in some blocks its implementation was delayed.

During the field survey, some of the sample blocks, like Jamai (Junnardeo) block in Chinndwara

district, Kolaras in Shivpuri district, Narayanganj block in Mandla, Rahatgarh block in Sagar and

Porsa in Morena district, reported delay in implementing the scheme at the block level.

Awareness of Scheme

It was understood that knowledge and awareness about the scheme was one of the most important

indicator to assess the performance and impact of the scheme among the local community. In this

regard, the targeted respondents were inquired regarding the awareness about the health scheme.

Figure S.1: Proportion of Respondent Households Aware of the Scheme (Figures in Percent)

82.69 85.38

38.86 45.52

17.31 14.62

61.1454.48

0

10

20

30

40

50

60

70

80

90

Aware Not Aware

Urban-Bene Rural-Bene Urban-Non Bene Rural-Non-Bene

A higher proportion of benefited households both in rural as well as urban areas were aware of the

scheme (85 percent in rural areas and 83 percent in urban slums). It was also interesting to observe

that even after availing the benefits under the scheme; some of the benefited households (15 percent in

rural areas and 17 percent in urban slums) claimed to be unaware about the scheme. Amongst non-

benefited households, as high as 39 percent of respondents in urban areas and 46 percent in rural areas

were aware about the scheme. Further, to understand the awareness about the scheme components, the

targeted respondents were asked about their understanding regarding the basic eligibility for availing

benefits under the scheme, the umbrella of services that are provided under the scheme, the place

where they can access the scheme benefits, and the grievance redressal mechanism. It has emerged

that,

• In general a majority of the respondents in urban areas (including both the targeted benefited – 82

percent, and non-benefited – 64 percent households) who had heard about the health scheme were

also aware about the basic eligibility required for the scheme. However in case of rural benefited

households, only about 7 percent of the respondents were aware of the scheme and gave correct

responses, while as high as 84 percent gave incorrect answers which show that they were either

partially aware or not aware about the eligibility criteria of the scheme. On the other hand, 72

percent of rural non-benefited households were aware of the basic eligibility criteria.

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• Analysis of the data in the rural areas shows that about 38 percent of benefited and about 28

percent of non-benefited households in rural areas could not provide correct answers regarding

their awareness and understanding of the benefits that can be availed under the scheme. It was

disheartening to see that even among benefited households only about half of the respondents in

urban areas (51 percent) and about 34 percent of respondents in rural areas were aware about the

services that can be accessed under the scheme.

• Although majority of respondents among the benefited households were aware that the health

scheme can be accessed at any of the government health facility having facilities for

hospitalisation but about one-third of the targeted non-benefited households were unaware about

this (30 percent). It was disheartening to find that even amongst the benefited households 77

percent respondents in rural areas were partially or completely unaware and hence gave wrong

answers.

• Only about one-fourth of the benefited households in urban areas were aware about the grievance

redressal mechanism while as high as 70 percent were unaware about any such provision under the

scheme. On the other hand, about 40 percent of the non-benefited households in rural areas and

about two-third of them in urban areas were aware regarding where and to whom they can

approach for their problems.

Sources of Information Regarding the Scheme

An effort was made to understand about the people and institutions/factors that were the major sources

of information dissemination among the local community. The targeted respondents were asked about

all the major sources of their awareness/information regarding the health scheme, and the data shows,

• In rural as well as urban areas the community level health workers (including MPWs, AWWs,

ASHA) as well as the PRI members and local leaders are the important stakeholders who have

disseminated information regarding the scheme. Thus, it is important to further involve these

people and strengthen them for IEC activities for awareness creation of not only this scheme but

also for all other community level issues.

• Media has also played a role in creating awareness among the community, but to a very limited

extent.

It is important to mention that there were differences in awareness of the target respondents. The

awareness level regarding the scheme and its major components were relatively higher for the

benefited households as compared to the non-benefited households; major reason being that the

benefited households had already accessed the scheme and thus was more familiar with the system.

Awareness among Services Providers

• It has surfaced that almost all the service providers were aware about the scheme and its

components. However, regarding the eligibility criteria for availing the benefits of the scheme

most of the service providers were aware about the fact that earlier only the SC, ST and OBC

households of BPL families were eligible for availing the benefits of the scheme and later in 2006

the criteria was revised and all the BPL households were taken under the umbrella of this health

scheme.

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• But it has emerged from the in-depth discussions held with health officials that some of the district

level officials and almost all the block level officials were unaware that the ‘primitive tribal

groups’ irrespective of their economic status, and families having ‘Mukhya Mantri Mazdoor

Suraksha Card’ and ‘Nirman Shramik Card’ are eligible for availing benefits of the scheme.

Accessibility and Demand of Services under the Health Scheme

In this section, it was endeavoured to understand the availability and accessibility of the services

available under the scheme. The targeted benefited and non-benefited households were inquired about

their demand/needs in terms of the number of members who required hospitalization in the last three

years and then availed treatment.

Perception of Benefited households regarding Accessibility of the Scheme

The targeted benefited households were specifically inquired about the number of family members

who were taken ill and were hospitalised since last three years. The reference period of three years was

taken to have synchronisation with the initiation of the scheme in the districts and blocks and was

discussed with the client while sharing the research tools with them. Almost all the benefited

households reported that any one or more family members were taken ill, since all these households

have availed some benefits under the scheme. Analysis of the primary data regarding the number of

family members who were ill and sought treatment shows that in almost all the benefited households

at least one member availed treatment under the scheme.

The respondents and the other family members were inquired about the type of disease for which the

patients sought treatment. These diseases were further categorised, and an analysis of the diseases for

which the benefits were availed under the scheme shows that mostly treatment was availed for

ailments like cold, cough and fever. About one-third of the total benefited households availed

treatment for the above mentioned diseases. About one-tenth (12 percent in urban and 10 percent in

rural) of the households also availed treatment for diseases related to the abdomen and stomach which

included appendicitis, diarrhoea, jaundice and other stomach infections.

It was interesting to observe that despite the ongoing Janani Surksha Yojana (JSY), only about 14

percent of households in urban areas and 28 percent households in rural areas availed benefits for

delivery related issues. On further probing, it was revealed that the scheme was running

complementary to other related health schemes and the benefits that were not covered under other

schemes were provided under the present scheme.

During primary research, the respondents were asked to show their health cards to verify the diseases,

for which treatment was taken, the amount spent, and the health care facility where treatment was

availed. However, it has emerged that the records in the health cards were not complete. In many

cases, the benefited households reported that the details of their illnesses were not recorded on the

cards by the health officials; while service providers mentioned that most of the times the patients

forgot to carry the card to the facility but even in these cases the treatment is provided to the patients,

and hence the cards did not have the record of the treatment sought by these households.

The amount spent on treatment for persons who were ill and availed treatment under the scheme,

could not be specified in about 39 percent of the households in urban areas and 44 percent in rural

areas; the reasons being no records on the health cards or unclear/unreadable records.

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Table S.7: Amount Spent for persons who were ill & availed treatment under scheme (Figures in Percent)

Benefited households Urban Rural

Amount Spent for Persons who

were ill and availed treatment

Absolute Percent Absolute Percent

No response/No records on card 140 38.5 84333 44.4 < 1000 148 40.7 66430 34.9 1001-3000 39 10.7 20689 10.9 3001-5000 18 4.9 5254 2.8 5001 & above 19 5.2 13399 7.0 Total 364 100.0 190106 100.0 Source: Field Survey (Surveyed Households)

On further probing to these respondents and their family members, it was understood that in most

cases the amount spent was not recorded on the health cards. When the same issue was discussed with

the service providers, they further stated that in many cases the patients did not bring the cards to the

health facility and hence no records of treatment, medicine given and respective amount spent, could

be made on the cards. Thus, one important bottleneck faced during primary research was absence of

details/records of the diseases, treatment, amount spent and the facility at which the treatment was

sought.

It has emerged that about 84 percent of the benefited households in urban areas and 75 percent of the

households in rural areas reported that they were taken ill and required hospitalisation for treatment

under the scheme. However, interestingly it has emerged that though the scheme benefits were given

only on hospitalisation, still a proportion (16 percent in urban and 25 percent in rural areas) of the

respondents mentioned that they were not hospitalised, but availed the benefits of the scheme.

This issue was further taken up with the service providers, through which it has emerged that they did

not require hospitalising all patients to give the scheme benefits. Service providers further revealed

that in some cases if the infrastructure in the facility, like the beds etc. were not sufficiently available

or sometimes if the doctors realised that the patients are not very seriously ill then they did not

hospitalise them but provided them the requisite benefits under the scheme.

Similarly, Chief Medical Officers and Block Medical Officer of one the sample district and block also

reportedly mentioned that in some cases ARV was also given under the scheme to the poor patients for

which they did not require hospitalisation. Some health service providers also revealed that sometimes

if the patients were discharged the same day, they felt that they weren’t hospitalised. However, the

actual scenario was that these patients were hospitalised and treated under the scheme, but were

discharged the same day, looking at their physical condition.

Perception of Non-Benefited households regarding Accessibility of the Scheme

An attempt was made to assess the demand for treatment in the study area. It has emerged that about

than one-fourth of the total targeted households were taken ill in the reference period. The data from

rural and urban areas separately show that a relatively higher proportion of households were taken ill

in rural areas (27 percent), as compared to 24 percent respondents in the urban areas. Almost all the

targeted households in urban areas and about 88 percent of the targeted households in rural areas who

were taken ill availed some kind of treatment, but outside the scheme.

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The respondents and the other family members were inquired about the type of disease for which the

patients sought treatment. These diseases were further categorised and an analysis of the diseases for

which the treatment was sought includes – minor ailments like cold, cough and fever (about 32-33

percent of the households). As was the case among benefited households, among non-benefited

households also about 15 percent households in urban areas and 22 percent of households in rural

areas, mentioned that they needed treatment during child birth related complications. About 11 percent

of the households in urban and 14 percent households in rural areas also availed treatment for diseases

related to the abdomen and stomach which included appendix, diarrhoea, jaundice and other stomach

infections. About one-fifth (20 percent) of the urban and as high as 17 percent of the respondents in

rural areas reportedly mentioned ailments like general weakness, anaemia and diabetes etc.

The data regarding proportion of households where any family member(s) were taken ill and

hospitalised for treatment shows that only about 24 percent of targeted households in urban and 35

percent of the households in rural areas were taken ill and were hospitalised. Households wherein a

member fell ill and was hospitalised is lower; only about one-fourth (24 percent) of the households

who were taken ill, in urban and one-third (34 percent) in rural areas were hospitalised for treatment.

The data shows that about 9 percent of the targeted urban and 5 percent of the rural households

reported that their family members fell ill and wanted to be treated, but did not avail any treatment

under the scheme. The analysis of the reasons for not availing the treatment shows in rural areas the

distance was the main reason for not availing treatment followed by uncooperative health

functionaries. On the other hand, in urban areas majority of the respondents could not do so because of

uncooperative health functionaries at the health facility.

Table S.8: Proportion of Family Members falling ill but not seeking Treatment (Figures in Percent)

Non-Benefited households Number of Members ill who wanted

but were Not Treated under the scheme Urban Rural

Availed Treatment under scheme 90.93 95.12 Did not avail treatment under scheme 9.07 4.88 Total 100 100

S.D. 0.29 0.22

95% CI 0.02-0.03 0.01-0.01

Reasons for not availing the treatment Physical distance 0 0.37 Lack of facilities in close vicinity 0 23.73 Un-helping/uncooperative health functionaries 84.96 44.95 Financial constraints 2.70 23.10 Any Other 12.33 7.86 Total 100 100 Source: Field Survey (Surveyed Households)

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The data also shows that the average expenditure on treatment was more in urban areas as compared to

rural areas. Nearly 14 percent of the households in urban areas and 28 percent did not specify any

amount spent on availing treatment, perhaps due to unawareness. Of the remaining households, who

specified the amount shows that in rural areas more than half of the respondents reportedly spent less

than Rs. 1000.00 for availing treatment, while a majority of respondents reported that they spent less

than Rs. 5000.00 for availing treatment.

Table S.9: Amount Spent by Persons who were ill and availed treatment

Non-Benefited households Urban Rural

Amount Spent

Absolute Percent Absolute Percent

No response/Do not know 1068 14.2 508087 27.8 < 1000 1759 32.2 590761 37.5 1001-3000 887 16.2 259462 16.5 3001-5000 142 2.6 72685 4.6 5001 & above 1895 34.7 216079 13.7 Total 5750 100.0 1647074 100.0 Source: Field Survey (Surveyed Households)

The non-benefited households who were taken ill were asked if they faced losses in terms of

absenteeism from work due to illnesses. A higher proportion of households in rural areas did not

mention any loss in the number of man/wage-days due to absence from work during illnesses. Among

the remaining who have reported loss, it has emerged that about one-third of respondents (33 percent

in urban and 43 percent in rural areas) reported that they lost about 1 to 5 man-days as absence from

work, while they were taken ill and availed treatment. More than half of the respondent households

(52 percent) in urban slums and a majority of respondents (74 percent) in rural areas reported a loss of

6 to 10 days due to illness.

One of the key objectives of the scheme was to reduce indebtedness amongst the marginalised sections

of the community. In this regard an attempt was made to analyse the proportion of non-benefited

households who were taken ill and had to borrow money for treatment. The data shows that about 24

percent of the non-benefited households in urban areas and 16 percent in rural areas, where family

members fell ill and needed to borrow money. In rural areas about one-fourth of the respondents

borrowed less than Rs. 1000.00.

Reasons for not availing treatment under the Scheme

It has emerged that of the total target non-benefited households 61 percent did not require treatment as

they were not taken ill. Of the remaining respondents, an analysis of the data shows that in rural areas

ignorance about the scheme, financial constraints and non-cooperative health functionaries were the

main reasons for not availing the treatment under the scheme. On the other hand, in urban areas the

targeted households mainly mentioned that they did not avail treatment under the scheme due to non-

cooperative health functionaries.

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Table S.10: Reasons for not availing treatment under the Scheme (Figures in Percent)

Non-Benefited households Reasons for not availing treatment under the

scheme Urban Rural

Was not aware of the scheme/Ignorance 8.97 17.67 Health provider did not guide us regarding this 7.37 5.82 Physical distance to the facility 9.23 3.28 Lack of government facilities in close vicinity 0.47 5.27 Un-helping/uncooperative health functionaries 39.81 32.00 Financial constraints 1.17 1.58 Was not referred by the doctor 0.90 1.49 Scheme is not attractive 1.53 1.18 Not required as did not fell ill 30.54 31.72 Total 100 100 Source: Field Survey (Surveyed Households)

Management Structure and Scheme Implementation

• Discussions with the state officials reveal that the Department of Public Health and Family

Welfare is the implementing agency for the scheme.

• At the district level the Chief Medical and Health Officers (CMHOs) of the respective districts are

responsible for issuing family health cards, for purchase of medicine, fund flow and monitoring

within the districts.

• However within the blocks, the Block Medical Officers (BMO) are assigned the responsibility of

issuing the health cards to the eligible benefited households as per the BPL list provided to them.

They further, assign this task to the grass root level health workers mainly the multi-purpose male

and female health workers to mobilise the local community and facilitate the process of issuing the

cards to the eligible benefited households.

• Some of the health workers were of the opinion that the scheme was not being implemented

properly. The ANMs and the MPHWs as well as the block level officials of some of the sample

blocks reported that in a number of the cases the ineligible people, particularly the influential

people (those having contacts with the authorities), availed maximum utilisation of the benefits

under the scheme while the poor (those who are actually eligible), could not access the required

benefits.

• Moreover, it was observed during Gram Sabha interactions that the scheme did not have the

desired effect (as was envisaged during its initiation) amongst the local community. The people in

general were not satisfied with the performance of scheme. However, they do realise that scheme

in its own is very good but they were of the opinion that it was not being implemented properly. A

number of people, even those who had availed the benefits under the scheme perceived that there

are many discrepancies in the smooth functioning of the scheme.

The following figure depicts the structure at various levels.

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Figure S.2: Management Structure for Implementation of the Health Scheme

Source: Field Survey (Discussions with Service providers)

• Another important point put forward by the service providers was that there is no referral

mechanism under the scheme wherein the patients could be referred from the lower level health

facilities (primary health care) to the tertiary health care facilities (CHC/civil hospital to district

hospital or medical college). Most officials opined that if such a process is adopted it will help in

facilitating their admission to the higher level facility as it would have the official consent of the

health official from the lower level.

Monitoring & Evaluation and Management Information System

The state health officials informed during the discussions that the Department of Health and Family

Welfare of the state government monitors the scheme through its administrative setup which has a

well established Management Information System. Further, discussions with the officials also showed

that the health facilities are required to send monthly progress reports of the scheme to the state

directorate through the Chief Medical and Health Officer.

The process involved is that the monthly progress reports of the scheme are made at the facilities

(CHC/Block), compiled block wise at the district level and sent to the State Health Directorate through

the CMHO. At the village level, the records and details of the card holders are maintained by the grass

root level health workers i.e., ANMs and MPHWs. These workers maintain information regarding the

name of the applicant, their address, their BPL card number, the health card code number and their

signature when they receive the card in their registers. However, analysis and field visits at the block

and district level officials showed that the record keeping at the facilities was not well organised.

Director Medical Services

State Health Commissioner

Joint Director

Deputy Director (Scheme In-Charge)

CMHO Civil Surgeon

BMO

Multi Purpose Health Workers

• PRI members • AWWs

• Local leaders/community

State level

District level

Block level

Village level

• Admin Head & in-charge of rural health services

• Sends requirement/demand for health cards

• Supply cards to Blocks • Monthly progress reporting to

state

• In-charge of health services in urban areas

• Nodal person at Block • Responsible for issue of health cards • Records at the CHC • Monthly progress reporting to CMHO

• Awareness creation • Facilitation in making health cards • Distribution of health cards

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Analysis of the data also shows that the block wise data regarding the number of BPL households,

number of health card holders, and number of benefited households at each facility along with budget

allocation and expenditure incurred was available at the various sample districts. However, visits to

the sample blocks revealed that the registers containing the scheme records were not maintained

properly at the CHCs and PHCs. It was analysed that although the block level officials send the

monthly progress reports to the district level authorities but the data of previous years has not been

managed properly. On further probing, it was reported that even though almost all the blocks have

computers but still the data was sent on a hand written Performa; the reason being that there were no

computer operators at the block level, and in some cases if the computer operators were appointed

under certain schemes, they were involved in other administrative work due to lack of manpower.

The block officials have also reported that not much feedback is received on the reports sent to the

higher authorities. They were also of the view that there should be some appreciation/awards for

meeting targets or good performance and efficiency, which would encourage them and/or other

officials to work harder.

Fund Flow Mechanism for the Scheme

• Funds are provided annually by the state government for providing the benefit of the scheme.

Funds are allocated according to the past performance of the various districts on a quarterly basis.

In addition in case of a demand from any district, additional allocation is made based on the

demand.

• The various sub-components of the allocated budget include – (i) medicines and supplies; (ii)

publicity; (iii) printing and stationery; (iv) contingency; and (v) other charges. Other charges

include components like, cost of transportation of health cards, cost of photograph of the card-

holders, etc.

• District level officials reported that there is no fixed criterion for budget allocation to the districts.

Mostly the budget is allotted on previous years’ expenditure pattern. Of the allocated budget, 70

percent is for procurement of additional medicines, which are not available through the central

drug procurement system, at the district level. Thus, the service providers have the authority to

spend about 30 percent of the allocation on local purchase.

• Similarly at the block level, the discussions with the BMOs of almost all the sample blocks show

that there is no fixed criterion for allotting funds to the blocks. Moreover, in most cases the BMOs

were not empowered for local purchases. Discussions with the BMOs of sample villages revealed

that in case of local purchases, the block level officials need to have a written permission from the

CMHOs prior to any type of purchase under the scheme.

S1.6 Physical Achievements of the Scheme

As on March 2008, about 47,90,668 households are estimated to have been provided health cards

(Source: State Health Directorate, Madhya Pradesh). As per the data received from the State Health

Authorities, the Family Health Cards have been issued to 47 Lakh families. The details of health

cardholders, benefited households and expenditure incurred at the state level are as follows.

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Field observations also show that the cardholders are definitely benefited from the scheme.

Discussions held with the gram sabha also revealed that in general the local community was of the

view that the scheme is pro-poor and is very beneficial for the backward and marginalised people.

Table S.11: Number of Benefited Households & Expenditure incurred over last 3 years

Year

Health

Cards

Issued

Benefited

Households

Budget

Allocation

(Rs. lakh)

Expenditure

Incurred

(Rs. lakh)

Per capita

Expenditure (Rs.

per Beneficiary) Percent

Utilization

2004-05 - 11087

2005-06 2107310 119110

2006-07 2111487 268041 1942.00 758.69 283 39.07

2007-08 4790668 556625 4006.00 1714.06 308 42.79

2008-09 5004553 15.47 lakh 2676.00 1760.00 169 65.77 Source: Directorate of Health Services, Madhya Pradesh

The present health scheme has definitely benefited a lot of BPL families of the state since its

inception. It has helped the people to avail the hospitalisation facilities which they could not have

afforded otherwise. This can also be substantiated by an increase in the number of cardholders and

beneficiaries in the last four years.

Direct Impact of the Scheme

• Discussions held with the district and block level health care officials in Sagar district revealed

that the officials were of the view that now since the BPL households have access to health care

services more easily under the scheme so various illnesses that were earlier not being treated are

now coming to the notice of the service providers. Thus, various diseases that were prevalent

among the local community have now become detectable.

• Discussions with local community reveal that there is considerable awareness regarding the

scheme among the people and now the villagers are getting the BPL cards made in order to avail

the benefits of the scheme which itself shows the popularity of the scheme.

• In-depth discussions with the service providers as well as the focus group discussions with the

multi-purpose health workers reveal that there have certainly been benefits from the scheme. The

benefits include access to free health care, saving in terms of number of man-days of absenteeism

from work, creation of assets and general increase in the overall standard of living.

• At the household level, the targeted benefited households were asked regarding their perception of

the direct impact of the health scheme. Both in urban as well as rural areas more than half of the

respondents perceived that the scheme has directly helped in improving the health of the people

and also facilitated in saving their health expenses. About 13 percent of the targeted respondents

in urban and about 12 percent of them in rural areas also perceived that the scheme has helped in

improving their economic/income status after saving man-days at work.

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Figure S.3: Perception of respondents regarding direct impact of the scheme

Regarding perceptions of

respondents, who availed

the scheme benefits, on the

status of health of the

family prior to availing the

benefits the scheme,

majority of the respondents

perceived that their health

was comparatively bad or

was even worse prior to

availing the benefits of the

scheme. On the other hand,

it was analysed that a higher

proportion of households

from the rural areas were of the view that their health was comparatively better prior to availing

benefits of the scheme. About 6 percent of the targeted households in urban areas and about 13 percent

in rural areas perceived that their health was comparatively good or better after availing the benefits of

the scheme. About 8 percent of the targeted households in rural areas and 6 percent in urban areas

believed that there was no change in their health.

Moreover, the targeted respondents were also asked about their perception regarding improvement in

their health status after availing the treatment under the scheme. It has emerged that majority of

respondents i.e., 78 percent in urban and about 70 percent of the targeted households in rural areas

mentioned that their health has improved after availing treatment under the scheme. Similarly, about

71 percent of the respondents from urban and 65 percent of the respondent households from rural areas

reported their health was comparatively better after availing treatment under the scheme, while about

17 percent perceived that they did not observe any change prior and after availing the treatment. It has

emerged that overall there was a positive response and feedback from the targeted households.

Majority of respondents perceived that their health status has improved and is comparatively better

after availing the treatment under the scheme.

Analysis of the data regarding the expenditure on seeking treatment made by the targeted benefited

households shows that majority of the respondents spent more on seeking treatment prior to availing

the benefits under the scheme (about 79 percent in urban and 69 percent in rural areas).

The data on proportion of households who borrowed money reflects an important component of the

impact of the scheme. About 14 percent of households mentioned that they borrowed money for

treatment prior to taking the benefits of the scheme. The analysis shows that of the people who

borrowed money, a higher proportion of respondents (37 percent) in rural areas borrowed less than Rs.

1000.00 as compared to urban areas (22 percent).

Similarly, the proportion of respondents who borrowed Rs. 10,000.00 and above was comparatively

higher in urban areas where about one-third of the respondents mentioned to have borrowed more than

Rs. 10,000.00 as compared to 17 percent in rural areas.

56.59

51.12

51.37

47.94

13.19

12.3

3.3

2.37

0 10 20 30 40 50 60

Improved health

Saving on health

Improvement in

economic status

Any other

Urban Rural

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The data regarding the proportion of respondents who borrowed money for treatment after availing

benefits of the scheme shows that about 7 percent of respondents in rural areas and only about 4

percent of the targeted households in urban areas borrowed money for treatment after availing the

benefits of the scheme. Analysis of the data for rural and urban areas shows that a higher proportion of

households borrowed money in rural areas as compared to urban areas even after availing the benefits

under the scheme.

However, when compared with the situation prior and after availing the health scheme, it was

observed that the proportion of households who had to borrow money for availing health facilities for

the family members has decreased significantly. The proportion of households who had to borrow

money after availing the benefits of the scheme, decreased by almost 50 percent in urban and by 67

percent in rural areas. Thus, it is understood that the proportion of households who needed to borrow

money for treatment has decreased significantly after the launch of the scheme which in itself

complements one of the main objectives of the scheme.

The benefited households were asked if there has been any change in their health status after availing

benefits under the scheme. Most of the respondents from both urban (77 percent) and rural (70

percent) areas gave an affirmative response, while a few also replied in negative (28 percent in rural

areas and 18 percent in urban slums).

Indirect Impact of the Scheme

During the primary research an attempt was made to understand as to how the scheme has benefited

the community indirectly.

• An open discussion was held to get the views of the local community in the Gram Sabha

conducted while profiling the villages. The people from the sample villages were enquired about

their perception of the indirect impact that the health scheme has had on the local community in

general. A variety of responses were received regarding this and the analysis of their responses

shows that majority of the people were ignorant regarding the possible indirect impacts of the

scheme. However, among the responses that were received, about half of them were of the view

that the after the introduction of the health scheme people have become more aware and conscious

about health related issues and their rights regarding the same. About one-third of the respondents

mentioned that now the people have more choice regarding the health services. The people now

save on the overall health expenditure and thus their economic as well as social status has

improved.

• About two-third of the targeted benefited households in urban areas and a little less than half (48

percent) in rural areas mentioned that the scheme has helped in improving the status of the people

in the society. Similarly, about one-third of the targeted benefited households also perceived that

the scheme has improved the educational status of the children among the poor families as now

the amount saved on seeking treatment is spent for educating the children. About 24 percent of

urban and about 38 percent of the rural households reported that it has also increased the life

expectancy at the community level.

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S1.7 Bottlenecks & Emerging Issues

Scheme Health Cards

• In almost all the districts, the services providers have reported that allotment of BPL cards was

itself a debatable issue, since many-a-times the affluent and well-to-do households have made the

BPL cards as well as the health cards for themselves.

• Although, the state officials reported that the number of cards printed was substantially higher

than the number demanded but in most sample blocks, the district, block and village level health

officials revealed that the number of cards provided to them was insufficient and much lesser than

what was demanded by them. In some sample blocks, the multi-purpose health workers reported

that in a number of villages, the eligible households do not have the BPL cards and this was a

major hindrance in the process of making the scheme health cards for these households. Thus,

these health workers perceived that the purpose of the scheme, to provide access to free health

care to the poor households, was itself defeated as the health cards for the deserving people were

not made and they were left out of the mainstream.

• Moreover, it was observed that the health cards have photograph of the head of the households

only, and in this regard our primary survey revealed that there were instances of misuse of the

health cards as there was no way of verifying the authenticity of the other family members in the

households. It was analysed that a number of eligible households could not be issued the health

cards because they could not afford the cost of photocopy of ration card and the photographs.

Infrastructure

• It was found out that there were no utilisation of the scheme at the PHC level. Even at the

CHC/block level, the number of benefited households availing the services is nominal.

• It has emerged that the facilities available at the institutions in terms of the wards, availability of

infrastructure (beds, linens, consumables) and manpower (doctors, nurses, ward boys etc.) is very

limited and hence in most cases the health officials from these facilities send the patients to

district/higher level health facilities. Discussions with the local community in the Gram Sabha

revealed that the wards at the health facility, especially at the block CHC/PHC level were very

dirty and unhygienic; and there was lack of sanitation, with no proper toilet facilities; the linens

being dirty, and the food/meals provided in the wards was of poor quality.

Supply of Medicine/Consumables

• Discussions with the district and block level officials revealed that the supply of medicines from

warehouses has improved considerably in the recent past. However, still the warehouses do not

have sufficient medicines and there was also lack of supply of surgical goods. Moreover, there

was usually delay in procuring medicine from the warehouses. The officials opined that the range

of medicines available in the warehouses needs to be expanded and many contemporary and

improved drugs should be incorporated in the list. They were also of the view that the medicines

like, insulin, ARV for dog-bites, and other life saving drugs and consumables/supplies, etc. should

be readily available at the health facilities.

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Inclusion of Transport Facility under the scheme

• Discussions with the benefited households and with the village level health workers showed that

most of them were of the view that there should be provision of transport facility under the

scheme. In this regard, they clarified that the scheme is for the BPL households and most

households are so poor that they could not even afford to reach the distant health care facilities on

their own expenses. Moreover, it was also realised that in absence of any transport facility under

the scheme, the patients from far-off areas were apprehensive to take the risk of travelling long

distances to the health facilities for treatment, at their own expenses, where they did not have any

acquaintances and relatives.

Behaviour of Service Providers

• It was revealed from the in-depth interactions and discussions with the service providers that at

times the doctors themselves were not concerned about providing treatment under the scheme due

to the hassles involved in the whole system. They revealed that the process of local purchase and

record keeping is tedious. Moreover, lack of infrastructure and manpower available at the health

facilities, and thus resultantly long working hours, restrict their performance in the long run.

• The local community and the cardholders also reported that the behaviour of the service providers

at times is very rude. They also opined that the doctors are unwilling to hospitalise them in many

cases. It has emerged from the interactions with the local community that there were instances

where the poor and needy villagers did not have the courage to avail the benefits of the scheme

after hearing discouraging experiences/stories narrated by the unsatisfied benefited households

and non-benefited households. Many cardholders who were in need of hospitalisation either could

not avail the services as they could not afford it, while others did not take the risk and availed the

treatment in private hospitals.

S1.8 Conclusion and Recommendations

Awareness about the Scheme

(i) Awareness amongst the Community

• An intensive IEC/BCC campaign should be designed for creating awareness amongst the local

community on the objective and the intended benefits of the scheme; through the wider utilisation

of communication channels, like community meetings, talk shows, local cable TV channels, etc.

• All channels of communication should be used which are accessible to local community:

- Mass Media should be utilized to a greater extent.

- Inter-personal communication through the MPHWs needs to be sustained.

- Professional social marketing agencies may be hired for increased awareness.

• Participation of NGOs and CBOs: Identification of suitable NGOs/CBOs working at the village

level should be done. They should be invited to proactively participate in the IEC/BCC activities.

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• Role of PRI members: As the study suggests that the PRI members play as significant role in

creating awareness about the scheme. Hence, they should be formally involved in the process of

making cards and information dissemination.

• Community Participation: We have seen that once a BPL cardholder avails benefit under this

scheme, there is communication spread within the community. Benefited households share their

perceptions about the scheme and the benefits availed with non-participants of the Scheme and thus

implicitly contribute in improving the reach of the programme. Thus, it is very important that the

scheme card-holders are adequately informed about the benefits (through verbally and written

pamphlets) so that they can properly communicate details about the scheme to their community.

• Funds: Specific funds should be earmarked for IEC/BCC activities for the scheme, which should

not only include printing of IEC materials (pamphlets) but involvement of Radio (community radio

if available), internet, television including local cable TV channels, puppet and talk shows in the

community as other channels of awareness. And these need to be monitored strictly for effective

utilisation.

(ii) Awareness amongst the Service providers

• All health care providers should have clear understanding about the scheme objectives, intended

beneficiaries and its implementation procedure. It is suggested that these may be provided in the

form of bi-lingual written materials and flip-charts.

• Bi-annual trainings and refresher courses should be organised for the capacity building of the

health care service providers at all levels for enhanced awareness amongst the health service

providers. To minimize the risk of distortion and dilution of scheme guidelines, a combination of

training in series and parallel is desirable. Detailed scheme guidelines and further modifications

should be communicated to the service providers.

Institutional delivery mechanism of the scheme

(i) Scheme Implementation

• Passiveness amongst the health care service providers should be replaced by ‘pro-activeness’ and it

should be managed professionally. Rewards or incentives should be provided to the health service

providers for extraordinary performance as part of the scheme, the same way as in JSY scheme.

Regular review of the work load of the line department handling the scheme operations to be done.

• Since the scheme does not provide any incentives for efficient performance, the service providers

do not feel inclined towards their duties. In this regard it is suggested that the department can make

suitable arrangements for recruiting manpower on contractual basis under the scheme.

• The scheme has been in place for about 4 years now and a review meeting (exclusively for this

scheme) for the same should be held at each district level. This discussion would help to pinpoint

the specific and generic problems at district and block levels. This review can also act as a

feedback loop, so that corrective steps are planned well in advance for easy implementation.

• Easy referral mechanism should be introduced under the scheme, so that patients do not face any

problems at the tertiary level health care facilities and minimise the time loss before admission.

Also, ambulance facility (if required) may be made available under the scheme.

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• Presently the scheme does not have any specific procedure/criteria for budget allocation. The

districts should be given funds based on some specific criteria like utilisation rate, total BPL

population or the percentage of BPL population having family health cards. There is a need for

having proper and systematic procedure for allocating budget under different sub components of

the scheme, and the same should be monitored regularly.

• It has emerged from the study that in sample blocks/districts various key posts such as that of

pharmacist, lab technician, anaesthetist, store keeper etc. are lying vacant since long. These posts

can be filled and the key personnel can be recruited. In this regard the concerned department can

also explore opportunities like, pooling, on call, etc.

(ii) Management Information System (MIS)/Record keeping

• Appropriate MIS format exclusively for the scheme should be developed for maintenance of

records at the various levels. It should be mandatory for all the blocks to record the data in digital

format for easy access and retrieval.

• Similarly, the health facilities also should maintain the data in similar format, with details of the

patient, place of residence and type of disease for which treatment was availed and details of

medicines with their cost be maintained in soft copy for easy access.

• The reporting mechanism at present follows a bottom-up approach. The MIS format should also

follow the similar approach. The centralised database should be compiled at the state level, which

would have the detailed information of each village level benefited household and the benefits

availed, which should scale up to the state level. This would give an accurate snapshot of the type

of beneficiaries who have been benefited under the scheme and would enable tracking of the

benefited and non-benefited households through the health workers.

(iii) Behaviour of Service Providers

• Motivation of the health care officials should be enhanced through review meetings and grievance

redressal at regular intervals. They should also be provided some incentives for outstanding

performances or even monetary incentives can be explored, as in other schemes.

• Behaviour of health care officials towards the patients should be courteous, and this can be ensured

through regular redressal of their own grievances.

(iv) Fund Flow

• The fund allocation should be made a bottom-up approach and the BMO should be provided some

independence on decision making regarding local purchase of drugs and consumables, so that there

is appropriate utilisation of available funds at the various levels.

(v) Inclusion of OPD Facilities

• OPD facilities should be included as part of the scheme benefits, rather than in-patient facilities

alone.

• Expensive treatments which do not require any admission should be provided as part of the OPD

facilities under the scheme - they may be defined based on a study of the disease pattern.

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(vi) Inclusion of Transport Facility under the scheme

• There should be some provision of ambulatory facilities for the patients who are being sent to

tertiary care health facilities, as is being done in other health schemes. This will enable patients

from far-flung villages to avail treatment at the CHC, District hospitals, etc.

(vii) Improvement in the content of Health Card

• The Health Cards should have photograph of all the family members to minimise misuse of the

card by the beneficiaries.

• The Health Card should mention the basic guidelines and the benefits that can be availed under the

scheme including the generic names of the illnesses, remedies that can be covered under the

scheme for better awareness of the service providers as well as the beneficiaries. This will also

allow the consistency of the service offerings under this scheme.

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1 INTRODUCTION

1.1 Study Area - Madhya Pradesh

Madhya Pradesh (MP) is the second largest Indian state in size with an area of 308,245 sq. kms,

having a total population of 60.348 million (2001 Census), the rural to urban ratio being

approximately 74:26. As per the 2001 Census, the percentage of Scheduled Caste (SC) population was

15.2 percent (9.155 million), while the Scheduled Tribe (ST) population was 20.3 percent (12.233

million).

Madhya Pradesh had 45 districts as per 2001 Census and six divisions, but recently the state has been

divided into 50 districts, which are grouped into eight divisions: Bhopal, Chambal, Gwalior, Indore,

Jabalpur, Rewa, Sagar and Ujjain. There are 52,143 inhabited villages grouped under 23,051 Gram

Panchayats and 313 Janpad or Block Panchayats. The average rural population under the purview of

a Zilla, Janpad and Gram Panchayat works out to 984000, 142000 and 2010, respectively. A revenue

village consists of a number of separate habitations known as tola or falia especially in tribal areas.

The total number of such habitations in Madhya Pradesh is estimated to be about 85,149. The urban

sector falls under the purview of 334 urban local bodies, out of which there are 237 Nagar Panchayats,

85 Nagar Palikas and 14 Municipal Corporations (Source: Medium Term Health Sector Strategy, Dept

of Public Health and Family Welfare, Govt. of MP).

Madhya Pradesh is a medley of races and tribes, castes and communities, which includes primitive

aborigines, as well as highly educated and modern societies. According to Census 2001, 91.1 percent

follow Hindu religion while others are Muslims (6.40 percent), Jain (0.9 percent), Christians (0.30

percent), Buddhists (0.30 percent), and Sikhs (0.20 percent). The scheduled castes and scheduled

tribes constitute a significant proportion of the population of the State. Tribals in Madhya Pradesh

include Baiga, Bhariya, Bhils, Gond, Halba, Kaul, Korku, Malto, Mariya, and Sahariya.

While taking into account the health indices, e.g. Total Fertility Rate (TFR), Infant Mortality Rate

(IMR), Maternal Mortality Rate (MMR) and Birth Rate, the State is one of the low performing states.

Population of the State has doubled in 30 years, between 1951 and 1981, from 26 million to 52

million, and it is estimated that, it will double again in the following 34 years, that is, in the year 2015

the state’s population would be around 105 million. Every year nearly 1.4 million people are added

into the state’s population.

The health statistics for the state of Madhya Pradesh places it far behind the Indian average. The Total

Fertility Rate of the State is 3.1. The Infant Mortality Rate is 72 and Maternal Mortality Ratio is 379

(SRS 2001-03) which are higher than the National average. The Sex Ratio in the State is 919 (as

compared to 933 for the country). Comparative figures of major health indicators are as follows:

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Table 1.1: Health profile of Madhya Pradesh as compared to India figures

S. No. Item MP India

1 Crude Birth Rate (SRS 2007) 28.5 23.1

2 Crude Death Rate (SRS 2007) 8.7 7.4

3 Total Fertility Rate (NFHS-III) 3.1 2.7

4 Infant Mortality Rate (SRS 2007) 72 55

5 Maternal Mortality Ratio (SRS 2001 - 2003) 379 301

The State is committed to provide health care facilities to the poorest of the poor in the society through

primary health care including preventive, curative and promotive care. State has 8834 Sub Centres,

1151 Primary Health Centres and 267 Community Health Centres to cater to the health needs of the

community in rural areas.

Table 1.2: Health Infrastructure of Madhya Pradesh

Madhya Pradesh has 8 Medical Colleges, 47 District Hospitals, 34 Ayurvedic Hospitals, 3 Unani

Hospitals and 21 Homeopathic Hospitals. The Health Institutions in the State are as follows:

Health Institution Number

Medical Colleges 8

District Hospitals 47

Ayurvedic Hospitals 34

Ayurvedic Dispensaries 1427

Unani Hospitals 3

Unani Dispensaries 50

Homeopathic Hospitals 21

Homeopathic Dispensaries 146

Particulars

Sub-centre 8834

Primary Health Centre 1151

Community Health Centre 267

Multipurpose Health Worker (Female)/ANM at Sub Centres & PHCs 8590

Health Worker (Male) MPW(M) at Sub Centres 6560

Health Assistant (Female)/LHV at PHCs 350

Health Assistant (Male) at PHCs 1168

Doctor at PHCs 869

Obstetricians & Gynaecologists at CHCs 41

Physicians at CHCs 287

Paediatricians at CHCs 49

Total specialists at CHCs 503

Pharmacist 215

Laboratory Technicians 489

Nurse/Midwife 901 Source: RHS Bulletin, March 2007, M/O Health & F.W., GOI

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1.2 The Scheme - Deendayal Antyodaya Upachar Yojana

Health is one of the five issues on which the state government has laid its priorities. In this concern the

first priority of the department is to provide economic, easily accessible and quality health services to

the socially and economically backward classes of the state. The poor families from Scheduled Castes

and Scheduled Tribes, due to extreme poverty either fail to avail health services or enter into the

vicious circle of indebtedness by mortgaging their money. The Government of Madhya Pradesh

realized that there was lack of treatment facilities especially for hospitalization to the weaker sections

and to the families belonging to vulnerable groups of the economy which was a major cause of

concern. Thus to address the health needs of poor families (those below the poverty line), the

Government of Madhya Pradesh (GoMP) launched the Deendayal Antyodaya Upachar Yojana

(DAUY), on the occasion of Birth Anniversary of Pandit Deendayal Upadhyay.

Under this Scheme, the BPL families as well as

those belonging to primitive tribes, and those

possessing Mukhya Mantri Mazdoor Suraksha

card or Nirman Shramik card, are provided free

medical services up to Rs. 20,000.00 for one

financial year under admission in any

Government Hospital. Moreover, to bring down

the maternal mortality rate and infant mortality

rate, the scheme encourages institutionalized

delivery facility to women of weaker sections

under the scheme. Under the Scheme, each BPL

family is provided with a Family Health Card,

which carries a photograph of the head of the family and details of all the family members. The

scheme can be availed by the card-holders at all state government hospitals which provide

hospitalization.

The scheme was started on 25th September 2004 in almost all the districts of the state. The details of

the scheme have been further discussed in detail in the second chapter.

1.3 Other Health Schemes in the State

1.3.1 State Illness Assistance Fund

The State Illness Assistance fund has been created in the state of Madhya Pradesh for providing grants

to below poverty line cases that need major surgical procedures within and outside the state. The

scheme has been launched by the State Government to save the life of the people below poverty line,

from 13 major diseases, who require surgery and treatment. Under the scheme, grant is given in the

range of Rs.25,000.00 to Rs.1,50,000.00; to below poverty line patients suffering from serious illness

and requiring surgical or medical interventions. The grant is permissible to only one member of the

family, only once. As of March 2008, a total of 1353 patients have been benefited as part of this

scheme (Source: www.health.mp.gov.in).

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1.3.2 Rogi Kalyan Samiti

Rogi Kalyan Samities are the registered societies constituted in the hospitals as an innovative

mechanism to involve the people's representatives in the management of the hospital with a view to

improve its functioning through levying user charges. The first RKS was constituted in 1997 at Indore,

and the other districts followed. The health facilities covered are all District and Civil Hospitals, and

Community Health Centres. A large number of Primary Health Centres too have now adopted the

system. User charges are not only a tool for ensuring efficient use and equitable financing of public

services; they also serve as an investment guide, because consumers' willingness to pay for services is

in many instances the only way in which the benefits of a service can be ascertained and compared

with the cost of providing the service. The hospitals have used these funds for renovations of

buildings, repair and maintenance of equipments, construction of additional wards and to install newer

and better equipments, and furniture. There has been an expenditure of Rs. 18.15 crores under the

RKS scheme, as of February 2009 (Source: www.health.mp.gov.in).

1.3.3 Deendayal Mobile Hospital Yojana

This scheme was launched on 26th May 2006 with the main objective of providing health facilities to

the far flung areas in the state; where there is maximum concentration of SC/ST population. As part of

this scheme, rural families are provided free-of-cost health facilities at their doorsteps in the form of

mobile health clinic. This scheme is currently running in the backward districts; and every month

approximately 100 patients are treated and nearly 300 pregnant women are screened and provided

ANC check-up facilities. Till 28th February 2009, approximately 22,99,758 patients have been

benefited as part of this scheme (Source: www.health.mp.gov.in).

1.3.4 Dhanwantari Vikas Khand Yojana

This scheme was launched on 15th August 2005 with the aim of attaining the best management

practices and effective implementation of the existing activities to ensure better health care to women,

children and marginalized people of the society. As part of the scheme, the main stress is given to

institutional delivery, so that there is reduction in the maternal and infant mortality in the state. The

main aim of this scheme is to create a society where every child is healthy and the health needs of all

men and women are fulfilled (Source: www.health.mp.gov.in).

1.4 The Client - Poverty Monitoring and Policy Support Unit

The Poverty Monitoring and Policy Support Unit Society (PMPSUS) is anchored within the Madhya

Pradesh State Planning Commission (MPSPC). The unit is involved in development work in

various sectors. It takes up studies in the field of poverty, livelihood, health, education etc.

1.5 Project Brief

The Poverty Monitoring and Policy Support Unit Society (PMPSUS) had proposed to hire the services

of a consultant firm to undertake the comprehensive external assessment of the Deendayal Antodaya

Upachar Yojana in Madhya Pradesh with special reference to tap out the best practices and

bottlenecks of the scheme. In this regard, Mott MacDonald was entrusted the assignment to conduct an

external evaluation of this health scheme.

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2 THE ASSESSMENT STUDY

2.1 Study Objectives

The main objective of the present study was to carry out a comprehensive external assessment of the

scheme – Deendayal Antodaya Upachar Yojana (DAUY) – of the Government of Madhya Pradesh

with special reference to tap out the best practices and bottlenecks of the scheme. The major objectives

of this assessment study were as follows:

1. To assess the extent to which the DAUY has met its envisaged objectives

2. To analyze programme achievements and emerging gaps, and identification of institutional

bottlenecks in effective delivery of DAUY

3. To suggest a detailed framework for improved programme effectiveness

4. To recommend the ways and means based on the detailed framework to improve the delivery of

DAUY

2.2 Scope of the Present Assessment Study

The following was the scope of work for the present study:

• To analyze the available data to create an updated status statement of the DAUY including a

profiling of those who have accessed the scheme so far (if the data is made available to us) and an

analysis of progress across the sample districts

• Selection of sample districts, blocks and villages/urban location for undertaking a mix of

quantitative and qualitative primary research, including interactions with targeted benefited

households/groups, that have actually availed of the DAUY, non-benefited households and health

care providers delivering the scheme at various levels

• Tracking of the institutional delivery of the programme from the State to District, Block and

Panchayat and the benefited households that have availed the scheme

• Assess the major direct and indirect impacts of the scheme and to identify the key issues,

challenges and bottlenecks that constrain targeted groups from accessing the scheme

• Provide recommendations and suggestions on the way forward with respect to the issues and

challenges reported and possible medium term options, if any, for the DAUY

2.3 Target Population

The Target population for the Deendayal Antyodaya Upachar Yojana (DAUY) is the BPL families

as well as primitive tribes and those having Mukhya Mantri Mazdoor Suraksha card or Nirman

Shramik cards. Those families, who are provided with a scheme health card, are eligible for the health

scheme.

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The households who have availed treatment under the DAUY scheme (using the health cards) are the

Beneficiaries or the Benefited households for the present study.

All the households who were having the BPL cards or scheme health cards and thus are eligible for

availing the benefits of the scheme, but did not avail any treatment under the scheme (either they

availed services in other health facilities/private health facilities, or did not require such services) are

the Non-Benefited households for the present study.

2.4 Approach for the Study

The assessment of the scheme was carried out by our in-house team of professionals. An expert team

having an in-depth understanding of the objectives of the proposed project, its perceived benefits and

outcome of the project was conceptualised. A detailed planning for collecting information both from

the primary and secondary sources of the assignment was commenced. The overall approach followed

for the present study includes:

• A multi-disciplinary team of appropriate personnel with adequate qualification and experience in

the relevant field was used and mobilized for the study

• The needs and the requirements of the client were understood thoroughly to prepare the action

plan for the study

• Considering the objectives of the study, the comprehensive data-collection tools/instruments

(including both qualitative and quantitative research tools) and analysis framework were designed

and further approved by the client (PMPSUS)

• To derive information as per the proposed assessment framework, field surveys were carried out

and the data was collected both from the service providers as well as the local community

• The data collected from the field was analysed and compiled as per the project objectives

• It is important to mention that the consultant was in close contact with the client and other

stakeholders during the project period. The inputs and feedback received from the client was

incorporated on a regular basis (in each deliverable) in achieving the project objectives

2.5 Methodology for the Study

2.5.1 Team Mobilisation

A multi-disciplinary team of appropriate personnel with experience in the relevant area and field

research were deployed for undertaking this assignment. The project implementation team comprised

of Project Director, Project Manager and key Researchers. The core team included professionals with

expertise in the fields of health, statistics, social development and programme evaluation. Apart from

the core team members/researchers, field investigators, having the basic comprehension of field survey

in social and health sector, were also identified for data collection in the field.

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Methodology

Secondary Research

Plan of Action

Primary Research

Analysis & Final Report

Data Processing & Analysis

Quantitative Data Collection Qualitative Data Collection

An onset meeting was organised with PMPSUS (the client) on 11th November, 2008. In this meeting,

the key team member of Mott MacDonald (the consultant) presented our understanding and

requirements for the proposed assignment and also discussed and shared the sampling procedure as

well as quantitative and qualitative tools with the client. Necessary modifications were made based on

the feedback received from the client and other key stakeholders. The consultant also used this

opportunity to seek the support and co-operation of the State and District Health Department personnel

during the course of execution of the assignment.

Figure 2.1: Methodology

`

The assignment was carried out in three major stages, viz.: (1) Secondary/Desk Research; (2) Field

Survey, i.e., Primary Data Collection; and (3) Data Collation, Analysis and Report preparation.

2.5.2 Secondary Research

Both secondary and primary sources were utilised for the present assessment study. An attempt was

made to collect all the relevant secondary data from various sources including the internet, the State

Health Directorate, etc. The documents and information related to the Scheme and its guidelines,

intended coverage, the district wise details of BPL households, the number of health cards issued etc.

and the district wise expenditure was provided by the State Health Directorate. However, block wise

scheme details were not available from the state health department(s). Based on the available

secondary level data and interactions with the client and other stakeholders; the work plan, reporting

schedules, expected deliverables and the associated timelines were finalised. The views of the client

were also incorporated while finalising the work plan.

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The initial preliminary meeting and the literature review based on the available secondary data formed

the basis of the inception report and the assessment framework and further helped in addressing the

overall objectives of the assignment. These included planning the scope and coverage of the primary

research, the stakeholders to be contacted, designing the interview schedule/questionnaires for data

collection, etc.

An attempt was also made to seek the list of benefited households from the district and block

headquarters who have accessed the scheme so far. It was assumed that this would enable us in

collating and analysing the available data from the state and districts and thus prepare a profile of

targeted benefited households and those who have accessed the scheme so far; as well as an analysis

of progress across various districts. But during Inception phase only we came to know that, relevant

data is not being maintained by the respective districts. The same has been confirmed by our study

team during our data collection (Primary as well as Secondary). During the course of study we also

came to know that health facilities only maintain data of patients who are have visited them and/or

availed services.

2.5.3 Primary Research

Primary research was undertaken to derive relevant information for the present study. During the field

research, both benefited as well as non-benefited households were visited for interactions with the key

stakeholders. The benefited households were targeted to get the information regarding their awareness

of the scheme, their accessibility, the type of medical facilities availed, their level of satisfaction,

problems faced (if any) while availing the facility, and their suggestions to further improve the

available facilities etc. Similarly, non-benefited households were contacted to know about their

awareness regarding the scheme, their accessibility, and the various reasons for not availing services

under the scheme etc. For primary research, the following research techniques/tools were used:

• Village Profile Schedule: In each village, our team of field researchers interacted and held discussions with villagers in the Gram Sabha and also with the Sarpanch/Panchayat representatives for collecting information about the village and preparing a village profile. Discussions with the local community in the Gram Sabha enabled us to understand the issues related to the scheme at the local level. Village profile schedule was developed to collect the detailed information about the village such as location of the village, population composition, accessibility in terms of distance from the main road/highway, availability of public health and educational facilities to the local community in the village. The same was signed/stamped by the Sarpanch/Municipality Chairperson or any other Gram Sabha member.

• Household Schedule: A detailed household survey was conducted to collect the required information from both the benefited and non-benefited households. A structured interview schedule was designed to elicit information from the respondents. The household schedule was developed consisting of closed-ended multiple response questions, and a few open-ended questions. The questions were pre-coded to facilitate the generation of output tables.

� Benefited Households: A comprehensive structured household questionnaire was used to collect data from the benefited households; i.e., households who have accessed the scheme so far. The purpose of this questionnaire was to assess the perceptions of the benefited patients (or their care-givers) regarding awareness about the scheme, accessibility of the scheme, perceived benefits of the scheme, direct and indirect impact of the scheme, major constraints (if any) faced while accessing services under the scheme, drawbacks and bottlenecks of the scheme; and feedback & suggestions of the respondents for further fine-tuning the scheme, so as to make it more effective/user-friendly.

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� Non-Benefited Households: A structured questionnaire was also canvassed to the non-benefited households in order to understand the level of awareness amongst the non-benefited respondents and the underlying reasons for the eligible BPL households not accessing the scheme benefits. These interactions were also aimed at identifying the key issues, challenges that constrain the target groups from accessing the scheme.

• Key-Informant Interviews/In-Depth Interview Schedule: In-depth Interview Schedules are basic and most important instruments to be used during the qualitative data collection. In the present study, in-depth interviews were conducted with various key stakeholders and health care providers facilitating the scheme delivery at the block and district level in order to understand the delivery mechanism of the scheme and perceptions of the key stakeholders.

First of all, discussions were held with the senior state level functionaries to understand the details of the scheme, its organisational and management structure, implementation mechanism and the fund flow and budgeting under the health scheme. Interactions with CMHO and Civil Surgeon at the district level, BMO at the block level and Medical officers at the CHC level were undertaken to understand the different aspects of the scheme. These interactions were aimed at tracking the institutional delivery of the programme from the State to District, Block and Panchayat and the benefited households that have availed the scheme.

• Focus Group Discussions (FGDs): As part of the present assessment study, our team also conducted focus group discussions with the grass root level health care workers; i.e., multi-purpose male and female health workers (MPHWs). Three FGDs from each sample district were conducted, two from rural areas and one from the urban centre.

This extensive household survey provided a core database on the perception of the benefited and non-benefited households regarding the scheme. Similarly, the qualitative information was obtained through Focus Group Discussions and the In-depth interviews that provided a comparative scenario of the scheme, both before and after implementation. Information on various issues, especially on the innovations, best practices and the dimensions and progress of the scheme was also collected through the In-depth interviews and FGDs. All the above research tools designed for data collection are attached as Annex 1.

2.5.4 Pre-testing of the Tools

After the finalisation of the tools and FGD guidelines, the same were pre-tested in the field to ensure

the validity of each and every question posed in these tools. This was essential as it helped in fine-

tuning and finalising the tools and ensuring continuity and efficiency in smooth flow from one issue to

another during the data collection process.

Subsequently, field visits were undertaken to check the relevance and accuracy of each and every

question posed in the data collection tools. Bairasya Block of Bhopal District (non-sample district)

was randomly selected for Pilot-testing all the tools – both quantitative and qualitative

questionnaires/tools. In-depth interviews with the Block Medical Officer and Medical Officer in-

charge of PHC were conducted in this block. Similarly, discussions were also organised with the

ANMs and Multi-Purpose male Health Workers to test the efficiency of the FGD checklist.

For pilot-testing the household questionnaires, field visit was made to village Ratua-Ratanpur in

Ratua-Ratanpur Gram Panchayat (Bairasya Block) for pre-testing. A set of household questionnaires

for the benefited and non-benefited households were also field-tested during this visit. After field-

testing, some of the questions were reorganised and a few were modified and/or re-worded

accordingly.

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The whole process of data collection was not very easy during pre-testing. The main reason for this

being the busy schedule of the respondents, as most of them left their houses very early for work. It

was difficult to interview these respondents at their work place as majority of the respondents were

involved in field work.

2.5.5 Sampling

(i) Sample Design

Madhya Pradesh has been divided into six regions (though at present 8 regions are present in MP),

hence two districts from each of the six region were selected for assessment of the scheme as was

suggested at the Request-for-proposal (RFP) stage. Hence, the present assessment study was carried

out for twelve selected districts (list provided by PMPSUS), based on Probability Proportional to Size

(PPS) method and the district-wise performance of the scheme – one high-performing and another

low-performing from each of the six regions.

Thus, out of the twelve sample districts, six were high-performing and remaining six were low-

performing districts. This sampling was done by PMPSUS (the client) and provided to the consultant.

(ii) Sampling Criteria

Stage I: Selection of Blocks

One sample block from each of the selected districts was selected for the field survey. The Probability

Proportional to Size (PPS) method was used to select the sample blocks, the methodology for which

was again finalised after discussions with the client (PMPSUS). The 2001 Census data for population

was used for this selection process.

The details regarding the sample districts and blocks in each region are highlighted in the table below.

Table 2.1: Selected Sample Districts and Blocks in each Division of Madhya Pradesh

S.No. Divisions Districts in each Division Sample Districts Sample Blocks

Sagar Rahatgarh 1 Central Bhopal, Vidisha, Damoh, Sagar, Raisen, Sehore Sehore Ashta

Neemuch Jawad 2 Malwa Neemuch, Shajapur, Ratlam, Indore, Ujjain, Rajgarh, Dewas, Dhar, Jhabua, Mandsaur

Jhabua Bhavra

Shivpuri Kolaras 3 Northern Bhind, Shivpuri, Datia, Guna, Gwalior, Sheopur, Morena, Ashoknagar Morena Porsa

Mandla Naryanganj 4 South Seoni, Dindori, Narsimhapur, Jabalpur, Mandla, Chhindwara, Katni, Balaghat Chinndwara Jamai

Barwani Niwali 5 South-Western

Harda, Burhanpur, Barwani, East Nimar, Hoshangabad, Betul, West Nimar Hoshangabad Babai

Satna Nagod 6 Vindhya Sidhi, Shahdol, Satna, Tikamgarh, Chhatarpur, Panna, Rewa, Umaria, Anuppur

Rewa Hanumana

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Stage II: Selection of Villages and Urban areas

Fifteen villages were selected within each sample block. Similar to the selection of blocks, the villages

were also selected using the PPS method and the 2001 Census data. However, in some selected

villages, the field researchers were unable to locate the desired samples as the number of households

was lower and even lesser number of benefited households. However, the same was communicated to

the client and the desired sample was compensated from the remaining sample villages of the sample

block in consultation with PMPSUS.

Probability Proportional to Size (PPS) technique was used for selecting the sample villages in a block.

For selection of sample villages, the list of villages was arranged along with their population. Then the

cumulative population was calculated and a random number (can be any number equal to or lower

than the population of the locations) was generated. Further, by dividing the total population with the

required number of villages/blocks, the sampling interval was worked out. By repeatedly

adding/subtracting (as per requirement) the interval to the random number, 15 villages were selected

for this study. The list of sample villages selected for the study is provided as Annex 2 for further

reference.

Two urban areas/towns were also to be selected from each sample block, as part of this study.

However, since many of the sample blocks did not have any urban population; hence two urban

towns/cities within the sample district were selected using PPS technique. This was done in

consultation with the client. Within each sample town/city, two slums were selected for the primary

survey, having maximum BPL population, after discussions with the concerned municipalities using

purposive sampling method. Thus, the urban areas in the sample district were selected, which are

having maximum BPL population. As a result, the sampling in urban areas was different from that of

the rural sampling with the result that the estimates in urban areas are different, in comparison with

rural areas. The list of towns/urban areas selected for the study is included in Annex 2 for further

reference.

Stage III: Selection of Households

A sample size of about 15-18 households was selected from each sample village. It was decided with

PMPSUS (the client), and a mix of both benefited and non-benefited households were selected to

understand the details of the schemes, its perceived benefits, impact of the scheme, its key issues,

challenges and bottlenecks in implementation of the scheme and suggestions for further improvement

of the scheme.

For the selection of households within a village, village profile was prepared in the Gram Sabha to

know about the location of the cardholders and benefited households in the village. The households

were contacted from all the segments/clusters of the village population to have an even and fair

representation of the households. However as mentioned earlier, in case where the sample fell short

(less than the proposed sample of 15 households), the remaining households were compensated from

the other sample villages of the same block (which was discussed and agreed upon with PMPSUS).

The household sample also covered families/households holding Mukhya Mantri Mazdoor Suraksha

card and/or Nirman Shramik card.

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(iii) Sample Size

For the present assessment study, field work was carried out in 15 villages and 4 urban locations (2 in

each town/urban area); covering approximately 18 households in each location (urban/rural). Thus,

about 342 households were contacted from each sample block/district.

Apart from the household survey comprising of benefited and non-benefited households, interactions

and discussions with the local community in the Gram Sabha also formed an important component of

village profiling which helped us in understanding the scheme related details, like the perception of the

local community regarding the understanding of the scheme, problems while availing the services and

bottlenecks/loopholes, impact of the scheme and suggestions to further improve the performance of

the scheme.

Discussions were also held with the village panchayat/local representatives for collecting information

for village and urban profiling. Further, interactions with the village level health officials, like – ANM

and Multi-Purpose male and female Health Workers (MPHW) were organized and relevant

information regarding the scheme was derived through Focus Group Discussions with health workers.

Three FGDs were conducted in each district – one in urban and two in rural areas.

Besides, interactions were also undertaken with the key stakeholders at the district and block level. In-

depth interviews with the Chief Medical and Health Officer (CMHO) and Civil Surgeon (CS) at the

district level and with the Block Medical Officer (BMO) and the Medical Officer/MO in-charge at the

CHC level were conducted to collect relevant information. The detailed break-up of the sample size

for the primary survey is given in the following table.

Table 2.2: Location-wise Samples for Primary Survey

Sample Size

CMHO

Civil

Surgeon

BMO

MO-

PHC

MPHWs/

ANMs

Number of

locations

No. of

Households

Division

/Region

District

(IDI) (IDI) (IDI) (IDI) (FGDs) Village Towns

Sagar 1 1 1 1 3 15 4 344 Central Sehore 1 1 1 1 3 15* 4 344 Neemuch 1 1 1 1 3 15* 4 337 Malwa Jhabua 1 1 1 1 3 15 4 359 Shivpuri 1 1 1 1 3 15 4 344 Northern Morena 1 1 1 1 3 15 4 343 Mandla 1 1 1 1 3 15 4 336 South Chinndwara 1 1 1 1 3 15 4 343 Barwani 1 1 1 1 3 15 4 341 South-

Western Hoshangabad 1 1 1 1 3 15 4 340 Satna 1 1 1 1 3 15* 4 343 Vindhya Rewa 1 1 1 1 3 15** 4 330

Total 12 12 12 12 12 36 180 48 4104

Total Samples 48 36 228 4104

*One sample village each in these districts were found to be Un-inhabited.

** Two sample villages were found to be Un-inhabited

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In addition, discussions and interactions with the Medical Superintendents of two Medical Colleges in

the state – one each in Bhopal and Rewa were also conducted. However, even after repeated follow-

ups, we couldn’t get the data pertaining to the fund received and expenditure, from these Medical

Colleges. Hence, data analysis was not possible for the Medical Colleges separately.

2.5.6 Training of Field Investigators

A one-day training was organised for the entire field team on in Bhopal, before launching the primary survey on 16th December 2008. This training included an orientation on the Scheme – Deendayal

Antyodaya Upachar Yojana, the Study objectives, and Study coverage. All the research tools were discussed in detail during this training.

In addition, the team was taken for hands-on practice in the field; the entire team along with Mott MacDonald core team of researchers travelled to a nearby village – Godawal (in Raisen district – non-

sample district) for getting a hands-on experience of canvassing the questionnaires.

Following this thorough training, the primary survey was launched on 18th December 2008 in all the 12 sample districts of the state.

2.5.7 Data Analysis and Report Submission

The information collected from the field and obtained from the secondary research have been recorded

and analysed by our in-house team. Weight has been calculated at each stage of sampling and

incorporated during data analysis.

The weights calculated at each stage of the sampling were multiplied to get the overall household level

weights at the state level. These household level weights were applied to the data-sets for getting an

estimation of the situation at the state level. Thus, the entire analysis was done using weights at the

household level, separately for both the benefited and the non-benefited households. Thus, state level

estimation was derived using weights. However, since purposive sampling was undertaken for

selection of two slums within each sample town/city in urban areas, in consultation with the client;

hence the weights for the district, block and urban town/city have been considered as “one” in case of

the urban level data-sets.

The output tables were generated and tabulated in the desired format according to the objectives and

requirements of the study. The information derived from both the benefited as well as non-benefited

households was compared and analysed in order to understand the penetration of the scheme and its

impact in the region.

(i) Estimation Procedure

The estimation of population (households) is based on the sample information and has been calculated

using multipliers. As mentioned earlier, two districts from each region has been selected after

stratification of districts on the basis of performance of scheme with probability proportion to size.

From each selected district, one block has been selected with probability proportion to size and

similarly 15 villages have been selected from each block of selected districts. In each village, the HHs

has been listed with the key parameters, such as benefited and non-benefited households. After the

listing, all the HHs has been stratified on the selected parameters.

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From each category or strata, the sample households have been selected randomly in proportion to

their population. The inverse of probability of selection of various unit of sample such as district,

block, village and households have been used as multiplier to estimate the state level parameters.

Thus, the final household level multiplier has been calculated as follows:

1 1 1 1 _______________ x ______________ x _________________ x ____________________ Probability of Probability of Probability of Probability of selection selection of district selection of block selection of villages of households in different category

However, since purposive sampling was undertaken for selection of two slums within each sample

town/city in urban areas, having maximum BPL population; hence the weights for the district, block

and urban town/city have been considered as “one” in case of the urban level data-sets, and the

estimation in case of urban household has not been done.

2.6 Limitations of the Study

There were certain limitations that have affected the speed and efficiency of this study.

• Non-availability of secondary data- Block wise information on number of BPL households,

card holders, budget allotted not available at state level

• Non-availability of compiled village wise list of BPL households- Village-wise or block-wise

list of Scheme Health card holders & list of benefited households at state level

• Non-availability of records related to number of Scheme Health cards issued & benefited

households at village level

• Non-Documentation of benefit details in scheme cards – this limited the selection of

beneficiaries

• Limited availability of the benefited respondents at village level

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3 PROFILE OF RESPONDENTS

This section includes the profile and background information of the service providers as well as the

benefited and non-benefited households/respondents contacted during the study.

3.1 Profile of Service Providers

As mentioned earlier, the Chief Medical and Health Officer (CMHO) and Civil Surgeons were

contacted at each of the sample districts during the process of data collection. In-depth discussions and

interactions were held with the district health care officials, which mainly included the Chief Medical

and Health Officers (CMHO) at the district level and the Civil Surgeons and Nodal Officers at the

Civil Hospitals. Analysis of their educational profile reveals that most of them were Medical Post

Graduates, with most of them having MBBS and specialisation as MD or MS. Most of the district

level health officials had an average experience of about 3 years.

An analysis of the educational profile of the Block Medical Officers (BMO) of the sample blocks

reveals that almost all of them were Medical Post Graduates having an experience of about 2-3 years.

Similarly, most of the rural level Multi-Purpose Health Workers (MPHW) contacted during the field

study, were educated till high school. Most of them had completed about 10-12 years of schooling and

were trained for their job.

3.2 Profile of Sample Urban Area/Villages

3.2.1 Social Structure

For the present study, a total of 12 districts were

selected wherein one sample block each was selected

through PPS technique. The field work was undertaken

in 19 locations within each sample district and block,

which included 15 villages and 4 urban areas in each

sample block/district. Thus, 228 locations

(villages/towns) were visited during the field research.

Analysis of social composition of the population of

these areas has been carried out in the following

section of the chapter.

The village profile was canvassed in the gram sabha. The main objective of filling-up/preparing the

village profile among the villagers was to have maximum participation from the local community and

derive accurate and first hand information. The main participants of the gram sabha included the

village Sarpanch, elected members of the Panchayat, and teachers of schools in the village, and other

residents of the village. Analysis of the data regarding the number of participants who attended the

gram sabha during collection of information on the village profile shows that on an average about 7-8

members attended this meeting in each sample block.

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Analysis of the social composition of the population data shows that nearly 28 percent (21 percent

rural and 38 percent urban) of the sample households belong to Schedule Castes, while 21 percent

belong to Schedule Tribes (27 percent rural and 13 percent urban), and another 31 percent belong to

Other Backward Classes (30 percent rural and 32 percent urban).

3.2.2 Health Profile

Health care facilities are the most crucial components of the social infrastructure of a region. The data

collected from the sample villages and towns/urban areas reveal that the average number of maternal

and infant deaths was generally low (less than 2) in most of the villages and urban localities. However,

the urban slums reported slightly higher number of maternal and infant deaths, wherein 21 percent of

urban slums reported having maternal deaths ranging between 2-5; and 29 percent reported infant

deaths ranging between 2-5 in last one year. However, the institutional deliveries as reported by the

gram sabha show better figures in the urban slums as compared to the rural areas; about 94 percent of

urban while only 42 percent of rural areas reported more than 50 institutional deliveries in last one

year (Table 3.1).

Table 3.1: Average number of maternal deaths, Infant deaths and Proportion of

Institutional Delivery as reported in the Gram Sabha (in last one year) (Figures in %)

Number of Maternal deaths Number of Infant deaths Number of Institutional

Delivery Particular

Urban Rural Urban Rural Urban Rural <2 77.1 92.5 54.2 80.5 0 52.8 2-5 20.8 7.4 29.2 16.6 0 0.1 5-10 2.1 0.1 12.5 2.2 0 0.7 10-50 0 0 2.1 0.6 6.3 4.2 50+ 0 0 2.1 0 93.8 42.2

Total 100.0 100.0 100.0 100.0 100.0 100.0 Source: Field Survey (Village Profile of 12 Sample districts)

3.2.3 Status of Infrastructural Facilities

The infrastructural facilities in the sample villages and urban areas were assessed and are based on the

perception of the participants of the Gram Sabha. As opined by the participants during the Gram

Sabha, nearly 58 percent of the villages have good roads connectivity (all-weather roads); with the

nearest towns being at a distance of 5-10 km in most districts.

As reported, most of the sample villages had access to the nearest bus stations within 10 km distance,

excepting in Mandla, Chinndwara and Sehore districts, where bus stations were over 12 km away from

the villages. A Post Office is also available within 5-8 km distance in almost all the sample districts,

with most of them being within 4-5 km. A Bank is also available within 10 km distance in almost all

the sample districts.

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(i) Drinking water facilities

Regarding drinking water facilities, almost all the sample villages and urban areas are dependent on

hand-pumps. As high as 30 percent in rural and 11 percent in urban areas were also dependant on both

wells and hand pumps, while as high as 42 percent in urban slums are dependant on Hand pumps and

Tap water for drinking purposes. As reported, there are still some localities, where people are

dependant on pond/lake and/or river as the main source of drinking water supply (Table 3.2).

Table 3.2: Drinking water facilities within the villages and urban slums (Figures in %)

Source of Drinking Water Urban Rural

Well 0.00 20.48

Hand Pump 10.42 16.74

Pond/Lake 0.00 0.00

River 0.00 0.31

Tap/Govt. supply 0.00 0.05

Well & Hand Pump 12.50 30.10

Well & Pond/Lake 0.00 1.20

Well & River 4.17 4.94

Well & Tap 10.42 6.28

Well & Any other 0.00 1.08

Hand Pump & Pond/Lake 4.17 2.40

Hand Pump & River 8.33 5.64

Hand Pump & Tap 31.25 6.67

Hand Pump & Any other 0.00 0.10

Pond/Lake & River 0.00 0.24

Pond/Lake & Tap 4.17 0.34

Pond/Lake & Any other 0.00 0.00

River & Tap 14.58 2.97

River & Any other 0.00 0.46

Total 100 100 Source: Field survey (Village Profile of 12 Sample districts)

(ii) Educational facilities

The sample villages have good access to educational facilities as opined by the Gram Sabha. Most of

the sample villages (87 percent) and almost all the urban slums (92 percent) had access to primary

schools, almost throughout the year. However, there are exceptional cases in Neemuch, Morena and

Rewa districts where primary schools are a little distant from the urban slums. Nearly 80 percent

villages and 94 percent urban slums have access to the Middle schools as well. Secondary and Higher

Secondary schools are also accessible to nearly all the sample villages and urban slums.

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(iii) Health care facilities

Majority of the villages also have access to a health facility – either an Anganwadi or a Sub-centre.

However analysis of the data shows that most of the areas have limited access to a PHC having 24x7

health facilities, it was revealed that only 15 percent rural areas and 42 percent urban areas have access

to such PHCs; with an average distance being 6-11 km, except in Chinndwara and Shivpuri, where the

average distance to a 24x7 PHC is over 13 km away.

3.2.4 Disease patterns

The villagers/participants of the Gram Sabha were asked about their perception on the prevalence of

the common diseases in their respective villages. In this regard, it has emerged that seasonal illnesses

like fever, cough, cold, etc. are more prevalent in both rural areas and urban slums. Further, water

borne diseases like diarrhoea, cholera etc are also mentioned by more than one-fifth of the sample

population. This may be perhaps due to the sources of the drinking water in the rural areas being wells

(67 percent). Similarly, Tuberculosis has been reported by 38 percent of the rural and 41 percent of

urban areas; while Asthma is prevalent in 38 percent of rural areas and 30 percent of urban slums

(Table 3.3).

Table 3.3: Disease patterns in the village and urban slums (Figures in %)

Diseases Urban Rural

Seasonal Illness 12.50 4.92

Water Borne Diseases 0.00 0.31

Tuberculosis 2.08 0.53

Asthma 0.00 0.00

Others 4.17 0.74

Seasonal Illness & Water Borne Diseases 16.67 17.61

Seasonal Illness & TB 14.58 12.02

Seasonal Illness & Asthma 12.50 12.04

Water Borne Diseases & TB 14.58 23.00

Water Borne Diseases & Asthma 14.58 16.93

Water Borne Diseases & Others 0.00 0.00

Tuberculosis & Asthma 8.33 11.90

Total 100 100 Source: Field survey (Village Profile of 12 Sample districts)

3.3 Socio-economic Profile of Households in Sample Urban Area/Villages

As mentioned earlier, household level survey was carried out at the local/village level to understand

the details of the scheme, its perceived benefits, its impact, the key issues and challenges, and the

bottlenecks in implementation of the scheme, as well as any suggestions for further improvement of

the scheme. The targeted benefited households were the BPL households who availed some benefits

under the scheme. A mix of both the benefited and non-benefited households in twelve sample blocks

were visited and interviewed for the present assessment study.

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3.3.1 Profile of Households

Analysis of the household level data in the rural areas shows that nearly 69 percent households are

belonging to BPL category and could show their BPL cards. Another 30 percent in rural areas also

claim to be belonging to BPL, but could not show their cards at the time of our primary survey.

Similarly, in urban areas 68 percent are belonging to BPL category and did show their card to the field

researcher during the primary survey. Thus the total targeted household has been estimated to be 8.04

million in rural and 21928 in urban areas (Table 3.4). In urban areas, since the data collection was

through purposive sampling in two slums of each selected town, having maximum BPL population;

hence estimation has not been done. Thus, the data pertains to only the slum households in the 24

selected towns.

Table 3.4: Profile of Households

Urban Rural Particulars

n % n %

BPL households (BPL Card seen) 14881 67.86 5553662 69.11 BPL households (BPL Card not seen) 6833 31.16 2434446 30.29 APL households 214 0.98 47811 0.59 Total Targeted Households 21928 100.00 8035919 100.00

Total Households having DAUY cards 21481 97.96 7638729 95.06 Households where people fell ill 6147 28.62 2060200 26.97 Households wherein people required hospitalisation 1677 27.28 785749 38.14 Benefited Households 364 21.71 190106 24.19 Non-Benefited Households 5783 78.29 1870094 75.81 Source: Field survey (Household survey)

A negligible share of respondents (0.6 percent among rural and one percent in urban areas) mentioned

that they belong to Above Poverty Line (APL) and hence do not have a BPL card. Amongst the total

targeted households, 95 percent households in rural areas and 98 percent in urban areas are having the

Deendayal Antyodaya Upachar Yojana (DAUY) cards.

When analysed regarding the need to get the benefits of the scheme (DAUY), the data revealed that

only 27 percent in rural areas and 29 percent in urban slums fell ill and thus required the services of

the DAUY scheme. However amongst those who fell ill, 38 percent in rural areas and 27 percent in

urban slums required hospitalisation. And among those who required hospitalisation, only about 24

percent in rural areas and 22 percent in urban slums actually availed the benefits of the scheme; while

76 percent households in rural areas and 78 percent in urban slums did not avail the benefits of the

scheme.

Mukhya Mantri Majdoor Suraksha Cards are issued to the poor daily wage labourers and these

cardholders are also eligible for getting the DAUY cards. About 46 percent of the targeted rural

households and majority of the urban households do not have Mukhya Mantri Majdoor Suraksha

cards. On the other hand, analysis of the primary data shows that amongst those possessing the DAUY

Health cards, nearly 18 percent of benefited households in urban areas and 60 percent in rural areas

possessed the Mukhya Mantri Majdoor Suraksha cards; thus a relative predominance of Majdoor

Suraksha cards in rural areas. However, only about 16 percent of households in rural areas and only 3

percent of the households in urban areas could show their cards at the time of the survey.

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In case of non-benefited Households only about 8 percent households in rural areas and 3 percent of

targeted households in urban areas could show their cards. As high as 47 percent of non-benefited

Households in rural areas and about 13 percent of non-benefited card holders in urban areas could not

show their cards although they accepted that they have the Mukhya Mantri Majdoor Suraksha cards.

Table 3.5: Number of Households possessing Health cards and Labour cards (Figures in %)

Benefited Households Non-Benefited Households Household category

Urban Rural Urban Rural

Proportion of Households having Scheme Health Card and Mukhya Mantri Majdoor Suraksha Card Have Health Scheme Card & MMMS card (Both Cards seen)

2.47 15.74 1.94 6.89

Have Health Scheme Card and MMMS card (Health Card seen but MMMS Card not seen)

13.74 41.64 12.57 44.53

Have Health Scheme Card (Health Card seen) and No MMMS card

76.10 36.79 80.00 37.76

Have Health Scheme Card (Health Card not seen) and MMMS card (Card seen)

0.82 0.29 0.32 0.59

Have Health Scheme Card and MMMS card (Both Cards not seen)

0.82 2.48 0.24 1.10

Have Health Scheme Card (Health Card not seen) and No MMMS card

5.22 2.75 2.87 4.08

Do not have Health Card but have MMMS Card (Card seen)

0.00 0.11 0.39 0.34

Do not have Health Card but have MMMS Card (Card not seen)

0.00 0.17 0.00 0.97

Do not have either of the two Cards 0.82 0.04 1.67 3.74

Total 100 100 100 100

Proportion of Households having Scheme Health Card and Nirman Shramik Card Have Health Scheme Card and NS card (Both Cards seen)

2.75 17.27 1.16 5.98

Have Health Scheme Card and NS card (Health Card seen but MMMS Card not seen)

12.36 36.89 16.24 31.27

Have Health Scheme Card (Health Card seen) and No NS card

77.20 39.83 77.10 51.93

Have Health Scheme Card (Health Card not seen) and NS card (Card seen)

0.27 0.12 0.19 0.86

Have Health Scheme Card and NS card (Both Cards not seen)

0.27 1.05 0.14 0.73

Have Health Scheme Card (Health Card not seen) and No NS card

6.32 4.25 3.10 4.18

Do not have Health Card but have NS Card (Card seen)

0.00 0.12 0.13 1.42

Do not have Health Card but have NS Card (Card not seen)

0.00 0.11 0.03 0.10

Do not have either of the two Cards 0.82 0.37 1.90 3.53

Total 100 100 100 100 Source: Field Survey (Surveyed Households)

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Similarly, Nirman Shramik Cards are issued to the daily wage earners/workers who are involved as

construction workers and these cardholders are also eligible for DAUY. Analysis of the rural and

urban data separately shows that as expected, the proportion of card holders in the above categories is

higher in rural areas. Majority of the targeted households in the urban areas (including both benefited

and non-benefited Households) did not have either the Mukhya Mantri Majdoor Suraksha or Nirman

Shramik cards.

The Table 3.5 shows that in rural areas about 56 percent of benefited and about 40 percent of non-

benefited households possessing the DAUY Health cards, also had the Nirman Shramik cards.

However, of these only about 18 percent of benefited and about 9 percent of non-benefited

Households could show the cards during the interview.

3.3.2 Social Profile of Households

It is interesting to analyse that a majority of the targeted households lived in nuclear families. In rural

areas, only about 15 percent of non-benefited Households and about 22 percent of the benefited

respondents were living in joint families while remaining of the households reported to be living in

nuclear families (Table 3.6). On further probing the reason for the same, it emerged that the

households preferred to report themselves as nuclear families in order to have separate BPL and other

scheme cards, so as to avail maximum benefits from different type of schemes and programmes

introduced by the government.

Table 3.6: Type of Family of Respondents (Figures in %)

Benefited Households Non-Benefited Households Target Group Type of

Family Urban Rural Urban Rural Urban Rural

Joint 23.63 21.72 19.95 14.86 20.01 15.02 Nuclear 76.37 78.28 80.05 85.14 79.99 84.98 Total 100 100 100 100 100 100

S.D. 0.43 0.41 0.40 0.36 0.41 0.38

95% CI 1.72-1.81 1.78-1.78 1.80-1.81 1.85-1.85 1.78-1.80 1.78-1.85 Source: Field Survey (Surveyed Households)

Analysis of the data on religion of the targeted households shows that majority of respondents of the

present study were Hindus. In rural areas, about 92 percent of the benefited Households and as high as

95 percent of the non-benefited Households were Hindus. Similarly, in urban areas 71 percent of the

targeted households were Hindus both amongst the targeted benefited and non-benefited Households.

Besides, other respondents in the rural areas included Muslims (1.5 percent amongst Benefited and 2.4

percent amongst Non-benefited households), Sikhs (6.25 percent amongst Benefited and 3 percent

amongst Non-Benefited households), and a very few Christians. In urban areas, the proportion of

Muslims was 27 percent and 29 percent among benefited and non-benefited Households, respectively.

Very few respondents also mentioned other religions like Buddhism, Jewism, Jainism, etc. The

various categories of religion of the respondent households are shown in Table 3.7 below.

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Table 3.7: Religion of Respondents (Figures in %)

Benefited Households Non-Benefited Households Target Group Religion of the

Household Urban Rural Urban Rural Urban Rural

Hindu 70.88 91.85 70.90 94.48 70.90 94.42

Muslim 26.92 1.50 28.74 2.41 28.71 2.39

Sikh 1.10 6.25 0.30 2.72 0.31 2.81

Christian 0.55 0.09 0.07 0.11 0.07 0.11

Others 0.55 0.31 0 0.27 0.01 0.28

Total 100 100 100 100 100 100

S.D. 6.44 4.85 2.26 4.56 4.35 4.75

95% CI 1.12-2.45 1.39-1.43 1.32-1.38 1.32-1.32 1.12-2.45 1.32-1.38

Source: Field Survey (Surveyed Households)

Amongst the respondents from all the 12 sample districts, more than half of the respondents belonged

to Scheduled Castes. In rural areas, about 51 percent of benefited Households and 33 percent non-

benefited Households were Scheduled Castes, while about 27 percent of benefited and 42 percent of

non-benefited Households were Schedule Tribes. Similarly, in urban areas the proportion of SCs was

relatively lower among benefited Households.

It has also emerged that a higher proportion of benefited Households belonging to Other Backward

Classes were in the urban areas. The various categories of religion of the respondent households in

rural and urban areas are shown in Table 3.8 below.

Table 3.8: Caste/Tribe of Respondents (Figures in %)

Benefited Households Non-Benefited Households Target Group Caste/Tribe

Urban Rural Urban Rural Urban Rural

Schedule Caste 38.74 50.94 39.11 33.30 39.11 33.72 Schedule Tribe 12.09 27.06 8.85 41.74 8.91 41.39 OBC 38.46 17.21 48.28 19.47 48.12 19.41 General 10.71 4.79 3.76 5.49 3.87 5.47 Total 100 100 100 100 100 100

S.D. 1.08 0.90 1.00 0.86 1.04 0.88

95% CI 2.10-2.32 1.75-1.76 2.15-2.18 1.97-1.97 2.10-2.32 1.75-1.97 Source: Field Survey (Surveyed Households)

(i) Economic Profile of households

Observations were made by the field researchers regarding the type of houses in which the

respondents were living in. It has emerged from an analysis of the collected data that majority of

households in rural areas were living in kuccha houses. Only a negligible proportion of households

lived in pucca houses; the main reason being that most of the targeted households were from the

socio-economically weaker sections. It has interestingly emerged that even in urban areas the

proportion of households living in kaccha and semi-pucca households was significantly higher, mainly

due to the reason was that these households were in slum areas. However, the data on the ownership of

households presented in Table 3.9 below shows that majority of the respondent households lived in

their own houses and almost all of them confirmed that they did not have any other house of their own,

apart from the one they were living in.

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Table 3.9: House Type of Respondent Households (Figures in %)

Benefited Households Non-Benefited Households Target Group House Type

Urban Rural Urban Rural Urban Rural

Type of Houses among Households Kaccha 62.09 87.11 72.15 90.58 71.99 90.50 Semi Pucca 30.22 10.99 23.35 8.00 23.46 8.07 Pucca 7.69 1.90 4.50 1.43 4.55 1.44 Total 100 100 100 100 100 100

S.D. 0.64 0.41 0.56 0.35 0.60 0.38

95% CI 1.39-1.52 1.15-1.15 1.32-1.33 1.11-1.11 1.32-1.52 1.11-1.15

Ownership of Households Own 89.84 97.43 93.24 94.35 93.19 94.42 Rented 10.16 2.57 6.76 5.65 6.813 5.58 Total 100 100 100 100 100 100

S.D. 0.30 0.16 0.25 0.23 0.28 0.14

95% CI 1.07-1.13 1.02-1.02 1.06-1.07 1.06-1.06 1.06-1.13 1.02-1.06

Proportion of Households having any other house

Having any other house

1.37 3.71 0.33 1.12 0.35 1.18

Not having any other house

98.63 96.29 99.67 98.88 99.65 98.82

Total 100 100 100 100 100 100

S.D. 0.12 0.19 0.06 0.11 0.09 0.15

95% CI 1.97-2.00 1.96-1.96 2.00-2.00 1.99-1.99 1.97-2.00 1.96-1.99 Source: Field Survey (Surveyed Households)

An attempt was made to understand the proportion of households who owned agricultural land. As

expected, relatively higher proportion of households in rural areas were land owners. In rural areas,

about 26 percent of benefited and 19 percent of non-benefited households were land-owners. It was

interesting to note that even in urban areas about 4 percent of benefited and 2 percent of non-benefited

households were landholders.

Category-wise analysis shows that in rural areas about one-fourth of the households had land holding

of less than an acre; while about 7 percent of benefited Households and 4 percent of non-benefited

landowners in urban areas had more than 4 acres of land. However, none of the targeted households in

urban areas had land in this category. Among urban areas about 57 percent of benefited and 32 percent

of non-benefited land owners had land below one acre (Table 3.10).

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Table 3.10: Proportion of Households having Agricultural land (Figures in %)

Benefited

Households Non-Benefited

Households Target Group Agricultural land

Urban Rural Urban Rural Urban Rural

Households having Agricultural land

4.12 26.33 2.24 19.23 2.28 19.40

Households not having Agricultural land

95.88 73.67 97.76 80.77 97.72 80.60

Total 100 100 100 100 100 100

S.D. 0.20 0.44 0.15 0.39 0.18 0.42

95% CI 1.94-1.98 1.73-1.74 1.98-1.98 1.81-1.81 1.94-1.98 1.73-1.81

Size of the land Holding (in Acres)

No answer - - 0 0 0.20 0.07

0.1-1.0 57.14 24.32 31.60 28.31 32.26 28.17

1.0-2.0 21.43 27.71 45.46 31.95 44.69 31.79

2.0-3.0 14.29 38.61 19.12 17.93 19.04 18.57

3.0-4.0 7.14 1.93 3.82 7.00 3.81 6.83

4.0 & Above 0.00 7.43 0 14.81 0.00 14.57

Total 100 100 100 100 100 100

Average (Acres) 1.60 2.35 1.95 2.48 1.78 2.42

Irrigated / Un-irrigated Land (in Acres)

Un-irrigated 26.67 31.00 50.21 37.83 49.50 37.61

0.1-1.0 63.64 62.40 66.67 41.20 33.47 26.17

1.1-2.0 27.27 16.72 33.33 33.37 16.63 20.45

2.0-3.0 0.00 14.76 0 11.50 0.00 7.25

3.0-4.0 9.09 1.94 0 2.98 0.20 1.84

4.1 & above 0.00 4.19 0 10.95 0.00 6.68

Total 100 100 100 100 100 100

Average (Acres) 1.13 1.16 0.75 0.25 0.94 0.71 Source: Field Survey (Surveyed Households)

3.4 Socio-economic Profile of Respondents

3.4.1 Social Profile of Respondents

Gender wise analysis of the data shows that the proportion of male respondents was higher in rural

areas where about 79 percent of benefited and 82 percent of non-benefited households were males. On

the other hand, in urban areas about two-third of the respondents were males, which mean that as high

as one-third of the respondents were females.

Age wise categorisation of the respondents shows that majority of the respondents were adults and

average age of respondents was 40 years (except amongst non-beneficiaries households in rural areas

where the average age was 41). However, Table 3.11 below shows those relatively higher proportions

of respondents were in less than 20 years category in urban areas.

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Table 3.11: Social Profile of the Respondents (Figures in %)

Benefited Households Non-Benefited Households Target Group

Urban Rural Urban Rural Urban Rural

Gender of Respondents

Male 65.66 79.29 69.69 82.51 69.62 82.44 Female 34.34 20.71 30.31 17.49 30.38 17.56 Total 100 100 100 100 100 100

S.D. 0.48 0.41 0.46 0.38 0.47 0.39

95% CI 1.29-1.39 1.21-1.21 1.30-1.31 1.17-1.18 1.29-1.31 1.17-1.21

Age of the Respondents (in Years)

Below 20 4.12 1.51 3.46 1.74 3.47 1.73 21-30 19.51 24.85 23.65 23.13 23.58 23.17 31-40 36.81 36.98 36.07 32.09 36.08 32.20 41-50 23.35 23.7 20.56 21.94 20.61 21.98 51-60 10.16 7.38 8.9 12.1 8.92 11.99 61 & Above 6.04 5.6 7.36 9 7.34 8.92 Total 100 100 100 100 100 100

Average Age (years) 40 40 40 41 40 40

S.D. 12.19 11.26 12.28 12.72 12.23 11.99

95% CI 38.75-41.26 39.50-39.60 39.55-39.88 40.95-40.96 38.75-41.26 39.50-40.96 Source: Field Survey (Surveyed Households)

Education and literacy has huge impact on the level of awareness and understanding of ones rights.

However in the present study, an analysis of the literacy level of the respondents shows that more than

two-third of these respondents could not read and write in any language. This was explicit in both rural

as well as urban areas both among benefited and non-benefited households.

Figure 3.1: Education of Respondents (Figures in %)

40.1

6

38.5

2

9.0

2

10.6

6

23.4

7

7.3

4

1.6

4

2.2

7

27.4

1

39.5

1

7.1

5

5.7

8

40.5

1

40.5

1

32.0

0

1.8

4

5.7

5

35.0

8

35.0

8

41.6

1

0

5

10

15

20

25

30

35

40

45

Less than Primary 6th-8th Class 9th-10th Class 11th-12th Class 12th Class & Above

Urban-Beneficiary Rural-Beneficiary Urban-Non Beneficiary Rural-Non-Beneficiary

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Analysis of the completed years of schooling of those who had some formal education shows that

about 40 percent of the benefited households were educated up to primary level. The data also shows

that only a marginal proportion of households have studied beyond class XII, except among non-

benefited households in urban areas where about 7 percent of the households had completed more than

12 years of schooling. It has emerged that there were no significant variations in rural and urban areas

in terms of number of years of schooling (Table 3.12).

Table 3.12: Education of the Respondents (Figures in %)

Benefited Households Non-Benefited Households Target Group

Urban Rural Urban Rural Urban Rural

Proportion of Respondents who can read & write

Literate 33.52 35.29 35.37 26.68 35.34 26.88 Illiterate 66.48 64.71 64.63 73.32 64.66 73.12 Total 100 100 100 100 100 100

S.D. 0.47 0.48 0.48 0.44 0.47 0.46

95% CI 1.62-1.71 1.64-1.65 1.64-1.65 1.73-1.73 1.62-1.71 1.64-1.73

Completed Years of schooling of the Respondents who can read & write

Less than 5th class 40.16 39.51 32 41.61 32.13 41.54 6th-8th class 38.52 27.41 40.51 35.08 40.48 34.84 9th-10th class 9.02 23.47 14.56 15.73 14.48 15.97 11th-12th class 10.66 7.34 5.78 5.75 5.86 5.80 12th class & Above 1.64 2.27 7.15 1.84 7.06 1.85 Total 100 100 100 100 100 100

S.D. 1.04 1.06 1.15 0.65 1.08 0.8

95% CI 1.99-2.74 2.57-2.61 2.68-2.79 1.83-1.83 1.99-2.79 1.83-2.61 Source: Field Survey (Surveyed Households)

3.4.2 Economic Profile of Respondents

The respondent households were enquired and categorised into occupational categories to understand

the main source of their household income. The occupational categories were designed based on the

Census of India’s classification categories of occupation. This was a multiple response question which

means that a respondent had the choice of more than one option. But analysis shows that majority of

them have mentioned that they were engaged in only one occupation, which is the major source of

their income.

As expected, the proportion of households engaged in primary activities was significantly higher in

rural areas while the percent of respondents engaged in secondary and tertiary activities was more in

urban areas, irrespective of the fact that the households had availed benefits under the scheme or not.

In urban areas, about 4 percent of benefited and 6.5 percent of non-benefited Households were

engaged in farming or cultivation. Agricultural labourers were the largest categories both in rural as

well as in urban areas. However, relatively a higher proportion of respondents were agricultural

labourers in rural areas.

Moreover, in rural areas about 81 percent of the benefited as well as similar percent of non-benefited

households were engaged in primary activities. On the other hand, another interesting feature observed

during the survey was that as high as 43 percent of benefited and 50 percent of non-benefited

households were also engaged in agricultural related activities in urban areas (Table 3.13).

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It was also interesting to observe that a significant proportion of households were classified in the

occupational category of ‘Others’. It has emerged that the main activities under this included the

people working in unorganised sector, such as – rickshaw pullers, hawkers, daily wage labourers (non-

agricultural), and the people who were taking tuitions, etc. which could not be captured in the

classified categories.

Table 3.13: Main Source of Income of Households (Figures in %)

Benefited Households Non-Benefited Households Target Group Occupation

Categories Urban Rural Urban Rural Urban Rural

Farming/ Cultivation 4.12 21.84 6.17 12.22 6.13 12.45 Agricultural labour 35.44 54.00 40.99 61.11 40.90 60.94 Livestock/forestry /fishing/orchards /allied activities

1.65 0.90 0.41 0.52 0.43 0.53

Mining & quarrying 0.00 0.08 0.30 0.18 0.29 0.18 Manufacturing 3.85 0.10 0.74 0.37 0.79 0.36 Construction 5.49 0.82 0.76 0.58 0.83 0.59 Petty Trader 2.20 0.01 0.48 0.36 0.51 0.35 Artisan 1.10 0.08 0.67 0.22 0.67 0.22 Business 3.30 0.19 1.12 1.00 1.15 0.98 Service (govt./ private) 3.02 1.01 1.01 0.41 1.04 0.43 Others 39.84 20.98 47.37 23.02 47.24 22.98 Total 100 100 100 100 100 100 Source: Field Survey (Surveyed Households)

Income is yet another important indicator for assessing the socio-economic status of the households.

For the present study, the households were inquired about the monthly income of their household. The

data shows that about 33 percent of households in urban and 46 percent of households in rural areas

among benefited households and as high as 40 percent of urban and 61 percent of the rural non-

benefited Households had their income below Rs. 1000.00. Similarly, it has emerged that about 66

percent of the benefited households in urban and 54 percent in rural areas and 56 percent of non-

benefited Households in urban and 38 percent in rural areas had their monthly income between Rs.

1000.00 to 3000.00. The analysis of the rural and urban variations reveals that the proportion of

households in the category of less than Rs. 1000.00 was higher in rural areas while the urban areas had

a relatively higher proportion of households in higher income categories (Table 3.14).

Table 3.14: Monthly income of Households (Figures in %)

Benefited Households Non-Benefited Households Target Group

Income Categories Urban Rural Urban Rural Urban Rural

No response 0 0 3.1 1.15 3.00 1.12 Less than 1000 33 45.5 39.4 60.86 39.33 60.49 1001-3000 65.4 54 56.5 37.56 56.64 37.95 3001-5000 1.6 0.5 0.8 0.34 0.78 0.34 5001 & Above 0 0 0.3 0.10 0.25 0.10 Total 100 100 100 100 100 100

Average Income (Rs.) 1301 1472 1349 1207 1325 1340 Source: Field Survey (Surveyed Households)

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District Sehore: FGDs with ANMs/MPWs (identity

withheld)

This is the case of one of the very poor woman living in

ward number 2 of Sehore town. This woman used to earn

her living as a maid servant and doing households chores

at various houses. She started feeling weak and developed

problems. Later she was treated for hysterectomy. Since

she was very poor but she did not have the health card of

the scheme. But with the help of local ANM, Smt. Ramrati

her scheme health card was made and she availed the

benefits under the scheme. She was very obliged and

perceived that the scheme has been a boon otherwise she

would have never been able to get treated for her ailment.

4 ANALYSIS OF THE SCHEME

4.1 The Scheme - Deendayal Antyodaya Upachar Yojana

As mentioned earlier, the scheme is an outcome of the efforts of the government to provide free access

to various health care services to the poor and marginalised sections of the society. It was realized by

the state government that there was lack of treatment facilities especially for hospitalization to the

weaker sections and to the families belonging to vulnerable groups which was a major cause of

concern. Thus, the Government of Madhya Pradesh has designed and implemented an innovative

scheme for socially and economically disadvantaged people of the society for providing access to

quality health care to the needy people like BPL families and primitive tribes. The scheme known as

Deendayal Antodaya Upachar Yojana, was instituted on 25th September 2004 to address a situation

whereby the poor in the state who were either unable to access healthcare services owing to lack of

finances or were being indebted, mainly with exploitative moneylenders, to meet their healthcare

needs, are provided free health care facilities.

Under the Scheme, each BPL household is issued a Family Health Card, carrying a photo of the Head

of the Household and details of other family members. Hospitalization and medical check-up details as

and when availed, are recorded on this card.

It was reported that presently all BPL families irrespective of the number of members in the family, all

members of the primitive tribal groups irrespective of their economic status, and all the families

having “Mukhya Mantri Mazdoor Suraksha Card” & “Nirman Shramik Card” are eligible for availing

benefits of the scheme.

Under the scheme, the eligible household can avail free medical treatment and investigation facilities

up to a limit of Rs. 20,000.00 per family per annum for treatment and investigation in all government

health facilities. However, discussions held with the state officials reveal that the benefits provided

under the scheme are limited to cover the cost of medicines and investigations, however, other costs

such as bed charges; physicians’ fees etc. are not accounted for. Benefits under the scheme are made

available only to hospitalized patients.

Moreover, although the state officials

mentioned that in case of seriously ill

patients, the limit of treatment amount

is further being extended to Rs.

30,000.00 per family per annum, but

discussions with the district as well as

block level officials showed that no

such information was conveyed and

no circulars were received by them in

this regard.

Analysis of the qualitative data shows

that normally, very few families avail

benefit up to the full extent of Rs. 20,000.00. Moreover, it has also emerged from the discussions held

with the state level officials that the average benefit availed under the scheme was Rs. 1000.00 per

family per annum. Moreover, analysis of the data collected from primary research shows that average

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amount spent on the benefited households is Rs.1747.00 per family per annum in urban areas, while in

rural areas it is Rs. 1314.00.

4.1.1 Objectives of the Scheme

The main objective of the scheme is to provide free treatment and investigation facilities to patients

belonging to below poverty line (BPL) families who are hospitalized in government hospitals. The

scheme seeks to provide social security coverage to the population belonging to the lower socio-

economic strata of the society and safeguard them from indebtedness arising out of illness.

Initially, the scheme was limited to the below poverty line (BPL) families belonging to the Schedule

Castes and Schedule Tribes. The scheme provides free treatment and investigation facility on

hospitalization without any exclusion, and the response was tremendous. Later, the scheme was

extended to cover all BPL families. Hence, the number of benefited households has been continually

increasing since the commencement of the scheme.

An innovative attempt to enable improved healthcare for the poor in Madhya Pradesh, the DAUY

envisages free-of-charge healthcare services up to a maximum limit of Rs. 20,000.00 in any financial

year, in any public health institutions to all Below Poverty Line (BPL) households in the State.

However, cash amount is not paid to any benefited household for this purpose.

Moreover, to bring down the maternal mortality rate and infant mortality rate, the scheme encourages

institutionalized delivery facility to women belonging to weaker sections of the society.

4.1.2 Issue of Family Health Cards under the Scheme

Family health cards are printed at the state level. The number of cards printed is based on the demand

sent from the respective districts based on the number of BPL households in the districts. However,

the state level officials mentioned that usually about 10 percent of the

required cards are printed extra. The cards are provided to the district

and block level institutions where these are issued by the Block

Medical Officers/Chief Medical and Health Officers in their

respective blocks/districts.

4.1.3 Eligibility Criteria for Benefited households

The scheme was launched in September 2004 and from its initiation till March 2006 only BPL

households who were SC and ST were eligible for the scheme. However, from July 2006 onwards all

BPL households are eligible for availing the benefits of the scheme. Thus, presently the eligibility

criteria for benefited households include:

• All BPL families irrespective of the number of members in the family

• All members of primitive tribal groups irrespective of their economic status

• Families of holders of Mukhya Mantri Mazdoor Suraksha Card and Nirman Shramik Card

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All families which are registered in the BPL list, issued by the Panchayat/urban local bodies, are

eligible to get the family health card. The BPL family who applies for the family health card are

provided with the health card. The process involves that the applicant has to provide a copy of BPL

card with details of all the members in it along with a photograph of the head of the family. The cards

once issued do not require renewal; though additional names can be added on the basis of ration card,

or else certification by a competent authority is needed, if ration card is not available.

Cost of photographs

According to the state officials, the cost of photograph of the head of the family is approximately Rs.

4-5 and is borne by the state government under the scheme.

However, ANMs as well as benefited households in most of the sample blocks reported that in some

cases, the cost for the photograph as well as the photocopy of the BPL card was borne by the

applicants themselves. On further probing, it emerged that although there was provision of providing

free photographs to all the applicants and in this regard a photographer was designated at the block

level but a significant proportion of applicants were not covered under this, as they were busy during

that time (at the time of photo shoot) and/or got delayed and hence had to bear the cost themselves.

4.1.4 Eligible Health Services Providers

All state government hospitals which provide hospitalization are eligible for providing the benefit of

the scheme. Benefits are also available for services provided by private providers for X-Ray, USG,

and Pathology etc. if the facility is not available in the government institutions.

However, interactions with the local community during the field visits shows that recommendation of

such services to the private facilities was very rare and was exclusively at the wish of the service

providers.

4.2 Scheme Coverage

Discussions with the state level officials revealed that presently the scheme is being implemented in

all the districts of the state. Further, discussions with the health officials at the district and block level

revealed that although the scheme was launched in September 2004, but in some blocks its

implementation was delayed. During the field survey, some of the sample blocks1, like Jamai

(Junnardeo) block in Chinndwara district, Kolaras in Shivpuri district, Narayanganj block in Mandla,

Rahatgarh block in Sagar and Porsa in Morena district, reported delay in implementing the scheme at

the block level.

4.3 Scheme Awareness

4.3.1 Overall awareness about the scheme

It was understood that knowledge and awareness about the scheme was one of the most important

indicator to assess the performance and impact of the scheme among the local community. In this

regard, the targeted respondent households were inquired regarding the awareness about the health

1 Based on discussions with the district and block health officials

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scheme. Analysis of the data collected during primary research is presented below in the following

table.

As expected, a higher proportion of benefited households both in rural as well as urban areas were

aware of the scheme (85 percent in rural areas and 83 percent in urban slums). It was also interesting

to observe that even after availing the benefits under the scheme, some of the benefited households (15

percent in rural areas and 17 percent in urban slums) claimed to be unaware about the scheme. Among

non-benefited households, as high as 39 percent of respondents in urban areas and 46 percent in rural

areas were aware about the scheme.

Figure 4.1: Proportion of Respondent Households Aware of the Scheme (Figures in %)

82.69 85.38

38.86 45.52

17.31 14.62

61.1454.48

0

10

20

30

40

50

60

70

80

90

Aware Not Aware

Urban-Bene Rural-Bene Urban-Non Bene Rural-Non-Bene

Table 4.1: Awareness of the Respondents classified by their levels of Education

Awareness regarding the scheme (Absolute Figures)

Beneficiaries Non-Beneficiaries

Urban Rural Urban Rural

Education

Aware of

Scheme

Not aware

of Scheme

Aware of

Scheme

Not aware

of Scheme

Aware of

Scheme

Not aware

of Scheme

Aware of

Scheme

Not aware

of Scheme

Upto class V

237 54 125809 23709 5647 10730 2829602 3794027

Upto class VIII

41 6 14845 3548 1765 1324 480488 253737

Upto class X

10 1 15581 166 582 529 165873 163264

Upto class XII

11 2 4551 375 151 290 63863 56505

Above class XII

2 0 1522 0 234 312 31644 6810

Total 301 63 162308 27798 8379 13185 3571470 4274343 Source: Field survey (Surveyed Households)

When the levels of awareness regarding the health scheme was tabulated with the education levels of

respondents, it was found that the awareness level was not directly proportional to the education levels

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of respondents; that means, the awareness level did not increase with the increase in the education

level (Table 4.1).

When the level of awareness regarding the health scheme was tabulated with the social categories of

respondents, it was found that amongst the benefited households, the awareness level was higher

across all the social groups. Although there was not much variation amongst the various social

categories, it was observed that awareness was highest amongst the General category and lowest

among the SCs (Table 4.2).

Table 4.2: Awareness of the Respondents classified by their Social Category (in %)

Awareness regarding scheme

Benefited Households Non-benefited Households

Social Category

Aware of Scheme Not aware of

Scheme Aware of Scheme Not aware of

Scheme

Schedule Caste 81.72 18.28 51.96 48.04

Schedule Tribe 88.35 11.65 34.48 65.52

OBC 89.31 10.69 56.55 43.45

General 93.29 6.71 51.17 48.83

Total 85.38 14.62 45.51 54.49

(i) Awareness regarding the details of the Scheme

Further, to understand the awareness about the scheme and its components, the targeted respondents

were asked about their understanding of the scheme, their awareness regarding the basic eligibility for

availing the benefits under the scheme. In this regard, both the benefited as well as the non-benefited

households were inquired about the basic eligibility that was required to avail the benefits of the

scheme. It has emerged from the data that in general a majority of the respondents (including both the

targeted benefited and non-benefited households) who had heard about the health scheme were also

aware about the basic eligibility required for the scheme. However in case of rural benefited

households, only about 7 percent of the respondents were aware of the scheme and gave correct

responses, while as high as 84 percent gave incorrect answers which show that they were either

partially aware or not aware about the eligibility criteria of the scheme.

An attempt was made to know the extent of knowledge of the target respondents regarding the

umbrella of services that is being provided under the scheme. It is an important component as it shows

the awareness of the local community and reflects about IEC activities undertaken to popularise the

scheme by the service providers. The respondents were asked about the type of the benefits they can

avail. Analysis of the data in the rural areas shows that about 38 percent of benefited and about 28

percent of non-benefited households could not provide correct answers regarding their awareness and

understanding of the benefits that can be availed under the scheme. It was disheartening to see that

even among Benefited households only about half of the respondents in urban areas and about 34

percent of respondents in rural areas were aware about the services that can be accessed under the

scheme (Table 4.3).

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Table 4.3: Awareness among the Households (Figures in %)

Benefited households Non-Benefited

households

Target Group

Urban Rural Urban Rural Urban Rural

Awareness Regarding eligibility of being a beneficiary

Aware 82.06 7.15 64.3 71.78 64.92 68.97 Ignorant/wrong answer 14.62 83.61 14.54 4.67 14.55 8.11 Do not Know/ Can’t Say 3.32 9.25 21.16 23.55 20.54 22.93 Total 100 100 100 100 100 100

S.D. 0.41 0.4 0.59 0.5 0.5 0.45

95% CI 1.07-1.16 1.02-1.02 0.92-0.94 0.81-0.81 0.92-1.07 0.81-1.02

Awareness regarding benefits they can avail

Aware 51.16 34.21 32.56 39.48 33.20 39.25 Ignorant/wrong answer 24.25 37.51 37.14 28.42 36.69 28.82 Do not Know/ Can’t Say 24.58 28.28 30.3 32.09 30.10 31.93 Total 100 100 100 100 100 100

S.D. 0.7 0.79 0.73 0.78 0.72 0.78

95% CI 0.92-1.07 0.94-0.94 1.05-1.08 0.96-0.96 0.92-1.07 0.94-0.96

Awareness about place where services can be availed

Aware 85.05 20.27 69.73 35.96 70.265 35.28 Ignorant/wrong answer 0 77.32 0 64.04 0 64.62 Do not Know/ Can’t Say 14.95 2.41 30.27 0 29.735 0.10 Total 100 100 100 100 100 100

S.D. 0.36 0.44 0.46 0.48 0.41 0.46

95% CI 0.81-0.89 0.82-0.82 0.68-0.71 0.64-0.64 0.64-0.89 0.64-0.82

Awareness regarding Grievance Redressal Mechanism

Aware 24.18 81.26 66.68 39.51 65.38 41.33 Ignorant/wrong answer 1.33 18.51 0.17 0.57 0.21 1.35 Do not Know/ Can’t Say 69.44 0.24 33.15 59.92 34.412 57.32 Total 100 100 100 100 100 100

S.D. 0.49 0.4 0.47 0.5 0.48 0.45

95% CI 0.26-0.38 0.19-0.19 0.66-0.68 0.41-0.41 0.26-0.68 0.19-0.41 Source: Field survey (Surveyed Households)

As mentioned under the scheme guidelines, the scheme benefits can be availed at any of the

government facilities where there are facilities of hospitalisation. In this regard, the respondents were

enquired about the place where they can access the scheme benefits. The data analysis shows that

although majority of respondents among the benefited households were aware that the health scheme

can be accessed at any of the government health facility having facilities for hospitalisation but about

one-third of the targeted non-benefited households were unaware about this. Wide variations have

been observed similar to their awareness regarding other components of the scheme. The ignorance

regarding where the services could be availed, was relatively higher in rural areas.

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In order to understand the overall grievance redressal mechanism wherein people can address their

complaints under the scheme, the target respondent households were inquired about the existing

grievance redressal mechanism under the scheme. It has emerged from the analysis of the data that

even among benefited households the awareness regarding the grievance redressal was lower among

urban households as compared to their rural counterparts. Only about one-fourth of the benefited

households in urban areas were aware about the mechanism while as high as 70 percent were unaware

about any such provision under the scheme. On the other hand, about 40 percent of the non-benefited

households in rural areas and about two-third of them in urban areas were aware regarding where and

to whom they can approach for their problems. Unlike in other indicators concerning the awareness of

the scheme here it has emerged from the analysis that the proportion of non-Benefited households

aware about the grievance redressal mechanism was higher than the Benefited households (Table 4.2).

4.3.2 Source of Information Regarding the Scheme

An effort was made to understand about the people and institutions/factors that were the major sources

of information dissemination among the local community. The targeted respondents were asked about

all the major sources of their awareness/information regarding the health scheme. The table given

below shows that in rural as well as urban areas the community level health workers (including

MPWs, AWWs, ASHA) as well as the PRI members and local leaders are the important stakeholders

who have disseminated information regarding the scheme. Thus, it is important to further involve

these people and strengthen them for IEC activities for awareness creation of not only this scheme but

also for all other community level issues. Media has also played a role in creating awareness among

the community, but to a very limited extent (Table 4.4).

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Table 4.4: Source of Information Regarding the Scheme (Figures in %)

Benefited households Non-Benefited

households Target Group Source of above information

Urban Rural Urban Rural Urban Rural

Health workers alone 7.25 4.75 6.56 3.51 6.91 4.13

ASHA alone 2.90 6.03 1.31 2.88 2.11 4.46

AWW alone 20.00 12.86 8.75 3.35 14.38 8.11

Doctors alone 8.41 1.97 2.63 1.07 5.52 1.52

PRI members alone 5.80 2.67 1.97 1.03 3.89 1.85

Media alone 0.58 0.12 1.09 0.36 0.84 0.24

Health workers & ASHA 4.06 9.50 6.13 8.88 5.10 9.19

Health workers & AWW 8.41 3.01 11.16 11.25 9.79 7.13

Health workers & Doctors 2.90 4.63 3.28 5.01 3.09 4.82

Health workers & PRI members

4.93 6.95 6.13 7.34 5.53 7.15

Health workers & Media 0.00 0.58 0.44 0.91 0.22 0.75

ASHA & AWW 6.67 4.87 10.28 11.09 8.48 7.98

ASHA & Doctors 2.03 3.94 3.50 3.87 2.75 3.91

ASHA & PRI members 5.22 10.31 7.88 7.85 6.55 9.08

ASHA & Media 0.29 0.46 0.44 1.18 0.37 0.82

AWW & Doctors 3.48 3.13 8.32 7.38 5.90 5.26

AWW & PRI members 12.17 14.14 13.35 10.89 12.75 12.52

AWW & Media 0.00 1.39 1.09 2.05 0.55 1.72

Doctors & PRI members 1.16 5.56 3.50 5.56 2.33 5.56

Doctors & Media 3.77 1.62 1.31 2.33 2.54 1.98

PRI members & Media 0.00 1.51 0.88 2.21 0.44 1.86

Total 100 100 100 100 100 100 Source: Field Survey (Surveyed Households)

It is important to mention that there were differences in awareness of the target respondents. The

awareness level regarding the scheme and its major components were relatively higher for the

benefited households as compared to non-benefited households; the major reason being that the

benefited households had already accessed the scheme and thus were more familiar with the system.

4.3.3 Scheme Awareness among Services Providers

It has surfaced that almost all the service providers were aware about the scheme and its components.

However, regarding the eligibility criteria for availing the benefits of the scheme most of the service

providers were aware about the fact that earlier only the SC, ST and OBC households of BPL families

were eligible for availing the benefits of the scheme and later in 2006 the criteria was revised and all

the BPL households were taken under the umbrella of this health scheme.

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But it has emerged from the in-depth discussions held with health officials from the sample districts

that some of the district level officials like CMHOs and Civil surgeons and almost all the block level

officials were unaware that the primitive tribal groups irrespective of their economic status and the

families having ‘Mukhya Mantri Mazdoor Suraksha Card’ and ‘Nirman Shramik Card’ are eligible for

availing the benefits of the scheme. Incidentally, CMHOs of most of the sample districts like –

Hoshangabad, Chinndwara, Morena, Rewa and Sehore mentioned that no circular was received by

them in this regard.

4.4 Training of Service Providers under the Scheme

No formal training was imparted to any of the health care providers under the scheme. However, the

state level officials reported that coordination meeting was done in the initial one or two years.

Moreover, introduction and orientation of the scheme was done during the general review meetings

held at the state, district and block levels. The details and the procedure for making the Health Card

was discussed and detailed out to the grass root level Multi-Purpose Health Workers during these

meetings. The details of the general meetings held at different levels have been presented in the

following Table 4.5.

Table 4.5: General Meetings for the Service Providers in the State

Level Frequency Particulars

State Level Quarterly Quarterly meeting of CMHOs at the state level

Division Level Quarterly Quarterly review meeting of BMOs at the Division level

District Level Monthly Monthly staff meeting of BMOs at the district level

Block Level Monthly Staff monthly meeting of Supervisors and MPW/ANMs at the block level

Sector Level Weekly Weekly meeting of MPHWs/ANMs at the sector level Source: Field Survey (Discussions with Service Providers)

IEC Activities

There is a separate section for IEC activities at the state level. Under the scheme, the IEC materials

like pamphlets, brochures etc. were provided to all the districts which were further circulated to the

block level. It has been reported that in all health care institutions having indoor facilities, it was

mandatory to paint/write about the details of schemes within the premises of the institution. Visits to

the facilities by our research team confirmed that most hospitals, CHCs and PHCs were abiding by

these instructions.

4.5 Accessibility and Demand of Services under the Health Scheme

In this section, it was endeavoured to understand the availability and accessibility of the services

available under the scheme. The targeted benefited and non-benefited households were inquired about

their demand/needs in terms of the number of members who required hospitalization in the last three

years and then availed treatment. The benefited households were also asked if any of the family

members were taken ill but they did not avail treatment under the scheme, the reasons for the same

and amount spent has also been analyzed for the respondents.

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4.5.1 Perception of Benefited Households regarding Accessibility of the Scheme

(i) Proportion of Family Members fell ill

The targeted benefited households were specifically inquired about the number of households where

family members were taken ill and were hospitalised since last three years. The reference period of

three years was taken to have synchronisation with the initiation of the scheme in the districts and

blocks and was discussed with the client while sharing the research tools with them. Almost all the

benefited households reported that any one or more family members were taken ill, since all these

households have availed some benefits under the scheme.

Analysis of the primary data regarding the number of family members who were ill and sought

treatment shows that in almost all the households at least one member availed treatment under the

scheme. On the other hand, only in about 2.16 percent of households in urban and 0.85 percent of rural

areas more than one member having availed benefits under the scheme. Table 4.6 below shows that all

the benefited households availed treatment under the scheme.

Table 4.6: Number of family members who were sick and availed treatment under the scheme

Benefited households Urban Rural

Number of family members fell ill and

sought treatment Absolute Percent Absolute Percent

One 359 97.03 189294 99.15

Two 4 2.16 812 0.85

Three 1 0.81 0 0

Total 364 100 190106 100 Source: Field Survey (Surveyed Households)

The respondents and the other family members were inquired about the type of disease for which the

patients sought treatment. These diseases were further categorised, and an analysis of the diseases for

which the benefits were availed under the scheme shows that mostly treatment was availed for

ailments like cold, cough and fever. About one-third of the total benefited households availed the

treatment for the above mentioned diseases. About one-tenth (12 percent in urban and 10 percent in

rural) of the households also reportedly availed treatment for diseases related to the abdomen and

stomach which included appendicitis, diarrhoea, jaundice and other stomach infections.

It was interesting to observe that despite the ongoing Janani Surksha Yojana (JSY), only about 14

percent of households in urban areas and 28 percent households in rural areas availed the benefits for

delivery related issues. On probing, it was conveyed that the scheme was running complementary to

other related health schemes and the benefits that were not covered under other schemes were

provided under the present Deendayal Antyodaya Upachar Yojana. Table 4.7 below shows variations

in the rural and urban areas regarding the type of diseases for which treatment was sought by the target

benefited households under the scheme. Since in some of the households, more than one person sought

treatment under the scheme; hence the denominator in case of disease pattern is more than the targeted

benefited and non-benefited households.

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Table 4.7: Type of Diseases for which treatment was availed (Figures in %)

Benefited respondents

Urban Rural

Diseases as mentioned by the Respondents

Absolute Percent Absolute Percent

No Response 21 5.49 3065 1.61

Heart Problem, Blood Pressure 10 2.75 1589 0.84

Abdominal Problem, Appendix, Diarrhoea, Jaundice 44 12.09 18349 9.65

Pain, Fever, Cold & Cough 120 32.97 68171 35.86

Skin Problem 2 0.55 867 0.46

Accident Cases 12 3.30 3607 1.90

Others (Weakness, Anaemic, Swelling, Diabetes) 46 11.26 17773 9.35

Asthma 7 1.92 4674 2.46

Cancer 0 0 1021 0.54

Chicken Pox 3 0.82 137 0.07

Delivery 49 13.46 52819 27.78

E.N.T. 6 1.65 1316 0.69

Typhoid 16 4.40 2194 1.15

T.B 16 4.40 8574 4.51

Brain Related Diseases 4 1.10 3154 1.66

Animal Bites 14 3.85 3607 1.90

Total 370 100 190918 100 Source: Field Survey (Surveyed Households)

* Note: Some households had more than one person who fell ill and availed benefit under the scheme; hence the totals are more

During primary research the usual procedure followed was that at the household level, the respondents

were asked to show their health cards to verify the diseases, for which treatment was taken, the

amount spent, and the health care facility where treatment was availed. However, it has emerged that

the records in the health cards were not complete. In many cases, the Benefited households reported

that entries regarding the details of their illnesses were not recorded on the cards; on the other hand,

service providers of the sample blocks also mentioned that most of the times the patients forgot to

carry the card to the facility but in these cases the treatment was provided to the patients2. Hence, the

cards did not have the record of the treatment sought by these households.

Hence, one important bottleneck faced during primary research was absence of details/records of the

diseases, treatment, amount spent and the facility at which the treatment was sought. Hence, the

researcher had to depend on the response given by the respondents for the diseases and treatment

related details.

2 Block Medical Officer of Bairasiya, Sehore and Sagar

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Figure 4.2: Amount Spent for Persons who were ill and availed treatment under the scheme (Benefited households) (Figures in %)

28.5

34.4

29.926.3

10.78.6

15.7

13.6

12.5

7.0

1.61.2

1.10.5

0 10 20 30 40

No response/ No records on card

<500

501-1000

1001-5000

5001-10000

10001-20000

>20000Rural

Urban

The data presents the details of the amount spent for persons who were ill and availed treatment under

the scheme. The data shows that in about 29 percent of the households in urban areas and 34 percent in

rural areas, the amount that was spent on them for treatment under the scheme could not be specified

(or interpreted by our survey team); as there were either no records on the health cards or there was

unclear/unreadable records.

On further probing to these households and other family members, it was understood that in most

cases the amount spent was not recorded on the health cards. When the same issue was discussed with

the service providers of the sample blocks as mentioned above they further stated that in many cases

the patients themselves did not bring the cards to the health facility and hence no records of treatment,

medicine given and respective amount spent, could be made on the cards.

An analysis of the secondary data from the State Health Directorate (Table 5.2) shows that the per

capita unit cost has been Rs. 283.00 in the year 2006-07 and this has increased to Rs. 308.00 in the

year 2007-08. This data shows variation from our primary data, perhaps due to the reasons that in most

cases the primary data that has been collected from the benefited households are on recall basis, since

the data was not available in the health cards.

(ii) Proportion of Family Members Hospitalized

It has emerged from the data that about 84 percent of the scheme Benefited households in urban areas

and 75 percent of the households in rural areas reported that they were taken ill and required

hospitalisation for treatment under the scheme. However, interestingly it has emerged that though the

scheme benefits were given only after hospitalisation, still a higher proportion (16 percent in urban

and 25 percent in rural areas) of the respondents mentioned that they were not hospitalised, but availed

the benefits of the scheme (Table 4.8).

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This issue was further taken up with the service providers, i.e. Block Medical Officers, CMHOs and

Civil Surgeons. It has emerged from the discussions with these health providers that they did not

require to hospitalise all the patients to give the scheme benefits.

The service providers3 further revealed that in some cases if the infrastructure in the facility, like the

beds etc. were not sufficiently available or sometimes if the doctors realised that the patients are not

very seriously ill then they did not hospitalise them but provided them the requisite benefits under the

scheme. Similarly, Chief Medical Officers and Block Medical Officer of one the sample district and

block also reportedly mentioned that in some cases the ARV were also given under the scheme to the

most deserving and poor patients for which they did not need hospitalisation.

Some health service providers also revealed that sometimes if the patients were discharged the same

day, they thought that they weren’t hospitalised. However, the actual scenario was that these patients

were hospitalised and treated under the scheme, but were discharged since they were not seriously ill.

Table 4.8: Percent of Households where any family members fell ill & hospitalised (Figures in %)

Benefited households Percent of Benefited households where family

members fell ill and were Hospitalised Urban Rural

Family member hospitalised 83.79 75.06

Not hospitalised but availed scheme 16.21 24.94

Total 100 100

S.D. 0 0

95% CI 0 0 Source: Field Survey (Surveyed Households)

Another interesting observation was that in certain instances, when more than one family member fell

ill, it was observed that the scheme was availed in case of one family member, while in the other case

the scheme was not availed at all. In other words, treatment was sought outside the scheme by some of

family members within the benefited households as well (about 5 percent in urban and 6 percent in

rural areas). These were mainly for minor ailments which may not have required any hospitalisation.

Another very negligible proportion of the benefited households also quoted that they some of their

family members fell ill (other than the one who benefited by the scheme), but did not avail the

treatment anywhere (0.07-0.55 percent). The main reasons for not availing treatment anywhere as

perceived by the respondents was mainly the long distance to the health facility especially mentioned

by the respondents from rural areas and uncooperative and/or rude behaviour of the health

functionaries at the facility as was mentioned by the respondents in urban areas.

(iii) Benefited Households whose treatment amount exceeded Rs. 5000.00

As was mentioned earlier under the scheme, the eligible household can avail free medical treatment

and investigation facilities up to a limit of Rs. 20,000.00 per family per annum for treatment and

investigation in all government health facilities. However, if the amount spent on one person at one

treatment span exceeded Rs. 5000.00, then there is a provision of continuing the treatment only if a

two member committee of doctors from the health facility approved the same.

3 CMHO Sehore, and BMOs of Ashta and Babai

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In this regard it was aimed to understand and analyse the proportion of benefited households who were

affected from this institutional mechanism.

The data shows that in about 15 percent of the Benefited households in urban areas and 17 percent of

households in rural areas, the amount for treatment exceeded the limit of Rs. 5,000. Of these, a higher

proportion of urban households (39 percent of the patients in urban areas and 22 percent in rural areas)

mentioned that they or their family members faced problem in continuing treatment after that (Table

4.9).

Table 4.9: Percent of Benefited households whose treatment amount exceeded Rs. 5000.00 (Figures in %)

Benefited households Proportion of Households where

treatment exceed Rs. 5000.00 Urban Rural

Treatment exceeded Rs. 5000.00 15.21 17.03 Treatment did not exceed Rs. 5000.00 84.79 82.97 Total 100 100

If Yes, How much did it exceed?

< 500 25.42 13.5 501-1,000 8.47 8.7 1,001-5,000 28.81 27.9 5,001-10,000 11.86 25.1 10,001-20,000 8.47 15.6 20,001 & above 16.95 9.2 Total 100 100

Proportion of Households who faced problem in continuing treatment after that

Faced problems in continuing treatment 38.98 21.7 No problems faced 61.02 78.3 Total 100 100.0 Source: Field Survey (Surveyed Households)

When tabulated with Caste, it was revealed that the treatment amount exceeded more amongst the

SCs, STs and OBCs than the those belonging to General category; perhaps the BPL are belonging to

these category more, than the General category of the population (Table 4.10).

Table 4.10: Benefited households whose treatment amount exceeded Rs. 5000.00 by their Caste/Tribe (Absolute Figures)

Caste/Tribe

Rural Urban

Particulars

SC ST OBC General Total SC ST OBC General Total

Treatment exceeded Rs. 5000.00

23554 1803 7359 1561 34277 14 10 28 7 59

Treatment did not exceed Rs. 5000.00

73281 49644 25358 7546 155829 127 34 112 32 305

Total 96835 51447 32717 9107 190106 141 44 140 39 364

Source: Field Survey (Surveyed Households)

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(iv) Impact of the Scheme as perceived by the benefited households

Regarding the impact of the scheme, a majority of the benefited households in both rural and urban

areas mentioned regarding improved health (51-57 percent) as well as savings on health expenses (48-

51 percent). Some of the benefited households also mentioned about an improvement in their

economic status due to savings in terms of man days of work.

Figure 4.3: Perception of respondents regarding direct impact of the scheme (in %)

56.59

51.12

51.37

47.94

13.19

12.3

3.3

2.37

0 10 20 30 40 50 60

Improved health

Saving on health

Improvement in economic

status

Any other

Urban Rural

4.5.2 Perception of Non-Benefited households regarding Accessibility of the Scheme

The targeted non-benefited households were asked about their requirements in terms of number of

members who were taken ill and needed hospitalization for availing treatment. These households were

also asked about the constraints faced and reasons for not availing treatment under the scheme, if not

availed treatment under the scheme.

(i) Proportion of Family Members fell ill

In this part of the section an attempt was made to assess the demand for treatment in the study area.

The table shown below shows the proportion of households who were taken ill in the last three years.

It has emerged that about than one-fourth of the total targeted households were taken ill in the

reference period.

Table 4.11: Proportion of Family Members taken ill (Figures in %)

Non-Benefited households Percent of Non-Benefited households

where family members fell ill Urban Rural

Family members fell ill 26.82 23.84 Did not fall ill 73.18 76.16 Total 100 100

S.D. 0.44 0.43

95% CI 1.73-1.74 1.76-1.76 Source: Field Survey (Surveyed Households)

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The data from rural and urban areas separately show that a relatively higher proportion of households

were taken ill in the rural areas (27 percent), as compared to 24 percent respondents in the urban areas

(Table 4.11).

(ii) Proportion of Family Members who were taken ill and availed treatment

In this section, an attempt was made to understand the percent of households who were taken ill and

availed treatment. The data shows that almost all the targeted households in urban areas and about

eighty-eight percent of the targeted households in rural areas who were taken ill availed some kind of

treatment, but not under the scheme (Table 4.12).

Table 4.12: Percent of Non-Benefited households where anyone availed treatment (Figures in %)

Non-Benefited households Percent of Non-Benefited households where

anyone availed treatment outside the scheme Urban Rural

Did not avail any treatment 0.57 11.93

Availed Treatment outside the scheme 99.43 88.07

Total 100 100

S.D. 0 0.41

95% CI 0.26-0.27 0.21-0.21 Source: Field Survey (Surveyed Households)

The respondents and the other family members were inquired about the type of disease for which the

patients sought treatment. These diseases were further categorised and an analysis of the diseases for

which the treatment was sought includes – minor ailments like cold, cough and fever. About one-third

of the targeted households availed the treatment for the above mentioned diseases. As was the case

among benefited households, among non-benefited households also about 15 percent households in

urban areas and 22 percent of households in rural areas mentioned that they needed treatment during

child birth related complications.

About 11 percent of the households in urban and 14 percent households in rural areas also reportedly

availed treatment for diseases related to the abdomen and stomach which included appendix,

diarrhoea, jaundice and other stomach infections. About one-fifth of the urban and as high as 17

percent of the respondents in rural areas reportedly mentioned ailments like general weakness,

anaemia and diabetes etc. Table 4.13 below shows that treatment was sought for a variety of

diseases/illnesses.

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Table 4.13: Type of Diseases for which treatment was availed (Figures in %)

Non-Benefited households Type of Diseases

Urban Rural

No Response 5.03 4.26 Heart Problem, Blood Pressure 0.72 1.30 Abdominal Problem, Appendix, Diarrhoea, Jaundice 11.10 13.62 Pain, Fever, Cold & Cough 32.68 31.72 Skin Problem 0 0 Accident Cases 11.43 2.73 Others (Weakness, Anaemic, Swelling, Diabetes) 19.65 16.68 Asthma 0.65 1.56 Cancer 0.48 0 Chicken Pox 0 0.04 Delivery 14.79 22.01 E.N.T. 1.32 1.28 Typhoid 0 0 T.B 0.49 1.33 Brain Related Diseases 1.44 2.69 Animal Bites 0.23 0.77 Total 100 100 Source: Field Survey (Surveyed Households)

(iii) Proportion of Family Members Hospitalized

The data regarding proportion of households where any family member(s) were taken ill and were

hospitalised for treatment shows that only about 24 percent of targeted households in urban and 35

percent of the households in rural areas that were taken ill were actually hospitalised. Percent of

households wherein a member fell ill and was hospitalised is lower in case of non-benefited

households (Figure 4.4).

Among non-benefited households, who were taken ill, only about one-fourth of the targeted

households in urban and one-third of these in rural areas were actually hospitalised for treatment. This

may be due to the reason that only serious and terminally ill patients agreed for hospitalisation.

Figure 4.4: Percent of Family members fell ill and were hospitalised (Non-benefited households) (Figures in %)

23.73

76.27

Familymembershospitalised

Nothospitalised

34.39

65.61

Familymembershospitalised

Nothospitalised

Urban Rural

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(iv) Proportion of Family Members fell ill but did not seek Treatment

The table below shows that about 9 percent of the targeted urban and 5 percent of the rural households

reported that the family members who were ill and wanted to be treated, but did not avail any

treatment. The analysis of the reasons for not availing the treatment shows in rural areas the distance

was the main reason for not availing treatment followed by uncooperative health functionaries. On the

other hand, in urban areas majority of the respondents could not do so because of uncooperative health

functionaries at the health facility (Table 4.14).

Table 4.14: Proportion of Family Members fell ill but did not seek Treatment (Figures in %)

Non-Benefited households Number of Members ill who wanted

but were Not Treated under the scheme Urban Rural

Availed Treatment under scheme 90.93 95.12 Did not avail treatment under scheme 9.07 4.88 Total 100 100

S.D. 0.29 0.22

95% CI 0.02-0.03 0.01-0.01

Reasons for not availing the treatment Physical distance 0 0.37 Lack of facilities in close vicinity 0 23.73 Un-helping/uncooperative health functionaries 84.96 44.95 Financial constraints 2.70 23.10 Any Other 12.33 7.86 Total 100 100 Source: Field Survey (Surveyed Households)

(v) Expenditure for availing treatment

The data also shows that the average expenditure on treatment was more in urban areas as compared to

rural areas. The table below shows that about 15 percent of the households in urban areas and 28

percent did not specify any amount spent on availing treatment, perhaps due to unawareness. Of the

remaining households, who specified amount shows that in rural areas more than half of the

respondents reportedly spent less than Rs. 1000.00 for availing treatment. Moreover, majority of

respondents reported that they spent less than Rs. 5000.00 for availing treatment.

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Figure 4.5: Amount Spent by Persons who were ill and availed treatment (Non-Benefited households) (Figures in %)

14.2

27.8

32.2

37.5

16.2

16.5

2.6

4.6

34.7

13.7

0 10 20 30 40

No response/Don't

know

<1000

1001-3000

3001-5000

>5001

Rural

Urban

(vi) Reasons for not availing treatment under the Scheme

The targeted households were asked as to why they did not seek treatment under the scheme. It has

emerged that of the total target non-benefited households 61 percent did not require treatment as they

were not taken ill. Of the remaining respondents, an analysis of the data shows that in rural areas

ignorance about the scheme, financial constraints and un-helping/uncooperative health functionaries

were the main reasons of not availing the treatment under the scheme. On the other hand, in urban

areas the targeted households mainly mentioned that they did not avail treatment under the scheme due

to un-helping/uncooperative health functionaries (Table 4.15).

Table 4.15: Reasons for not availing treatment under the Scheme (Figures in %)

Non-Benefited households Reasons for not availing treatment under the

scheme Urban Rural

Was not aware of the scheme/Ignorance 8.97 17.67

Health provider did not guide us regarding this 7.37 5.82

Physical distance to the facility 9.23 3.28

Lack of government facilities in close vicinity 0.47 5.27

Un-helping/uncooperative health functionaries 39.81 32.00

Financial constraints 1.17 1.58

Was not referred by the doctor 0.90 1.49

Scheme is not attractive 1.53 1.18

Not required as did not fell ill 30.54 31.72

Total 100 100

Source: Field Survey (Surveyed Households)

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When cross-tabulated with education of non-benefited households regarding the reasons for not

availing treatment, it was revealed that majority of the respondents in both rural areas and urban slums

who mentioned being not aware of the scheme, were educated up to secondary level. Even amongst

those non-benefited households who mentioned uncooperative nature of the health functionaries, were

mainly educated up to secondary level. This was same for both urban and rural areas (Table 4.16).

Table 4.16: Reasons for not availing treatment under the Scheme by Education of respondents (Absolute Figures)

Education of Non-Benefited Households

Urban Rural

Bottlenecks in effective

implementation

Up to

V

Up to

VIII

Up to

X

Up to

XII

Above

XII

Up to

V

Up to

VIII

Up to

X

Up to

XII

Above

XII

Was not aware of the scheme/Ignorance

0 103 43 0 0 9823 35010 36710 5255 0

Health provider did not guide us regarding this

130 118 42 0 56 13028 8277 1320 0 0

Physical distance to the facility

81 30 26 0 0 591 304 15785 0 0

Lack of government facilities in close vicinity

18 0 0 0 0 2049 55007 0 0 0

Un-helping/uncooperative health functionaries

133 227 114 40 6 85611 28426 85004 7271 312

Financial constraints 0 0 0 6 0 0 0 4715 5429 0

Was not referred by the doctor

28 0 0 0 0 211 0 0 0 0

Scheme was not attractive 0 0 0 0 28 3212 3344 0 0 0

Not required as did not fell ill

566 721 242 105 122 232803 153987 37110 71138 27445

Total 2441 3089 1111 440 545 200348 187211 157089 44113 10288 Source: Field Survey (Surveyed Households)

(vii) Amount Lost as Absent from Work

The non-benefited households who were taken ill were asked if they faced losses in terms of

absenteeism from work due to illnesses. The analysis of the data shows that a higher proportion of

households in rural areas did not mention any loss in the number of man/wage-days due to absence

from work during illnesses. Among the remaining who have reported loss, it has emerged that about

one-third of respondents (33 percent in urban and 43 percent in rural areas) reported that they lost

about 1 to 5 man-days as absence from work, since they had taken ill and availed treatment. More than

half of the respondent households (52 percent) in urban slums and a majority of respondents (74

percent) in rural areas reported a loss 1 to 10 days due to illness. The average man days lost was

observed to be 2-5 days (Table 4.17).

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Table 4.17: Loss of Man-days as Absent from Work (Figures in %)

Non-Benefited households Wage/Man days lost as absent

from work for people who fell ill Urban Rural

Did not mention any loss 8.94 20.17 1-5 32.81 42.91 6-10 18.98 31.42 11-20 27.48 8.99 21-30 6.99 14.45 31-60 3.19 1.23 60 & Above 10.54 1.00 Total 100 100

Average Man days loss(Days) 5 2 Source: Field Survey (Surveyed Households)

(viii) Proportion of Non-Benefited households who borrowed money for treatment

As we know that one of the key objectives of the scheme was to reduce and check indebtedness

amongst the marginalised sections of the community. In this regard all BPL households were eligible

for availing the treatment and other investigative facilities under the scheme. An attempt was made to

analyse the proportion of non-benefited households who were taken ill and had to borrow money for

treatment. The table below shows that about 24 percent of the non-benefited households in urban areas

and 16 percent in rural areas, where family members fell ill, needed to borrow money. Classification

of the amount which they were required to borrow shows rural-urban variations. In rural areas about

one-fourth of the respondents borrowed less than Rs. 1000.00, moreover about half of the respondents

borrowed less than Rs. 5000.00. Similarly about two-third of the respondent households needed to

borrow less than Rs. 5000.00 for their treatment (Table 4.18).

Table 4.18: Proportion of Non-Benefited households who borrowed money for treatment

Non-Benefited Households Urban Rural Proportion of Non-Benefited households

who borrowed money for treatment Absolute Percent Absolute Percent

Borrowed money 1380 24.00 258277 15.68 Did not borrow money 4370 76.00 1388797 84.32 Total 5750 100 1647074 100

If Yes, how much

1-1000 97 7.1 56639 21.9 1001-3000 135 9.8 42633 16.5 3001-5000 691 50.0 20931 8.1 5001 & above 457 33.1 138074 53.5 Total 1380 100.0 258277 100.0 Source: Field Survey (Surveyed Households)

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The following table shows that a majority of the households who borrowed money for treatment, belonged to Other Backward Classes and Scheduled Castes in the urban areas; while the rural area data shows that the majority of the households who borrowed money belonged to Schedule Tribes (Table 4.19).

Table 4.19: Proportion of Non-Benefited households who borrowed money for treatment by Caste (Absolute Figures)

Non-Benefited households by Caste Urban Rural

Non-benefited households

who borrowed money for

treatment SC ST OBC General SC ST OBC General

Borrowed money 563 20 767 30 68133 102236 68877 19030 Did not borrow any money 1708 408 2094 160 485939 434992 383715 84152 Total 2271 428 2861 190 554072 537228 452592 103182 Source: Field Survey (Surveyed Households)

4.6 Management Structure and Scheme Implementation

Discussions with the state officials reveal that the Department of Public Health and Family Welfare is

the implementing agency for the scheme. At the district level the Chief Medical and Health Officers

(CMHOs) of the respective districts are responsible for issuing family health cards, for purchase of

medicine, fund flow and monitoring within the districts. However within the blocks, the Block

Medical Officers (BMO) are assigned the responsibility of issuing the health cards to the eligible

benefited households as per the BPL list provided to them. They further, assign this task to the grass

root level health workers mainly the multi-purpose male and female health workers to mobilise the

local community and facilitate the process of issuing the cards to the eligible benefited households.

The responsibility of managing the scheme rests with CMHOs at the district level and with Civil

Surgeons at the Civil Hospitals. The Block Medical Officers are practically responsible for issuing

health cards to the eligible households. They involve the multi-purpose health workers for mobilising

the local community.

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Figure 4.6: Management Structure for Implementation of the Health Scheme

Source: Field Survey (Discussions with Service providers)

4.6.1 Role of District Level Officials

At the district level the responsibility of implementing the scheme rests with Chief Medical and Health

Officers (CMHO), while the Civil Surgeons (CS) does so at the Civil Hospitals. Moreover, at the Civil

Hospital there is a Nodal person appointed who looks after the scheme in the urban areas.

The CMHO is the administrative head, responsible for the rural health services at the district level. He

is also responsible for sending the monthly progress report of the district to the state health directorate.

The district level officials reported that the information/records received from the blocks and the civil

hospitals containing month wise details of number of health cards made, number of benefited

households at the (PHC and CHC) and the total expenditure incurred under the scheme is compiled at

the district level and sent to the State Health Directorate in Bhopal.

4.6.2 Role of Block Level Officials

The Block Medical Officer (BMO) is the nodal person at the block level. He is involved in making the

scheme health cards. The Block Medical Officers are practically responsible for issuing health cards to

the eligible households. On the basis of number of BPL households in the block, the BMO sends the

requisition for the number of health cards required from the district. BMO is the signing authority at

the block level.

Director Medical Services

State Health Commissioner

Joint Director

Deputy Director (Scheme In-Charge)

CMHO Civil Surgeon

BMO

Multi Purpose Health Workers

• PRI members • AWWs

• Local leaders/community

State level

District level

Block level

Village level

• Admin Head & in-charge of rural health services

• Sends requirement/demand for health cards

• Supply cards to Blocks • Monthly progress reporting to

state

• In-charge of health services in urban areas

• Nodal person at Block • Responsible for issue of health cards • Records at the CHC • Monthly progress reporting to CMHO

• Awareness creation • Facilitation in making health cards • Distribution of health cards

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BMOs involve the multi-purpose health workers for mobilising the local community and make the

health cards. BMO is also responsible for sending the monthly progress report to the CMHO office

every month. The information/records are recorded on a designated proforma and sent to the CMHO

office. This proforma contains month-wise details of the number of health cards issued, number of

benefited households and the expenditure incurred under the scheme.

4.6.3 Role of Multi Purpose Health Workers

The village level health workers i.e., multi-purpose health workers male and females and ANMs play

an important role in creating awareness among the local community and also in facilitating the overall

service delivery. Analysis of the field data shows that the MPHWs are involved in preparing list of

eligible benefited households, distributing the health cards to the eligible applicants, collecting the

duly filled cards, along with a photograph of head of the household and photocopy of BPL card as

well as verify the same for authenticity. Moreover, they also get the cards attested and stamped by

BMO and distribute the same to the applicants.

Some of the health workers were of the opinion that the scheme was not being implementing properly.

These health workers reported that the scheme in itself is very good but the problem lies in its

implementation. The ANMs and the MPHWs as well as the block level officials of some of the sample

blocks reported that in a number of the cases the ineligible people, particularly those who are strong

and well-established, i.e., influential people (those having contacts with the authorities), availed

maximum utilisation of the benefits under the scheme while the poor (those who are actually eligible),

could not access the required benefits.

Moreover, it was observed during Gram Sabha interactions that the scheme did not have the desired

effect (as was envisaged during its initiation) among the local community. The people in general were

not satisfied with the performance of scheme. However, they do realise that scheme in its own is very

good but they were of the opinion that it was not being implemented properly. A number of people,

even those who had availed the benefits under the scheme perceived that there are many discrepancies

in the smooth functioning of the scheme.

As per the scheme guidelines, the cost of medicines, materials and investigations are to be entered in

the health cards of the benefited households whenever a patient with a family health card is

hospitalized. However, discussions with the service providers as well as the health cardholders and

benefited households revealed that practically this is not being followed in most of the cases. Even the

field visits to the villages and discussions in the Gram Sabha revealed that the records of the

medicines and treatment details were not recorded in the family health cards of the benefited

households. On the other hand, while discussing the same with the service providers i.e., the doctors in

the wards, Medical Officers and Civil Surgeons of various hospitals, they accepted the fact that

sometimes there has been under-reporting due to lack of manpower but they also revealed that in most

cases the patients themselves forget to bring the health cards at the time of admission and hence the

details are not recorded on their cards. In this regard, the CMHO of Sehore opined:

“There is under-reporting of the expenditure incurred due to lack of record keeping

which in turn is due to shortage of staff”

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4.7 Referral Mechanism

Another important point put forward by the service providers was that there is no referral mechanism

under the scheme wherein the patients could be referred from the lower level health facilities (primary

health care) to the tertiary health care facilities (CHC to district hospital or medical college). When

discussed with the Block officials they mentioned that since there is no specific budget for transport

under the scheme and hence, it becomes difficult while referring a patient to the next level; however,

many-a-times patients do come with serious illnesses and service providers have to manage with the

available ambulance under the Rogi Kalyan Samiti.

Most health officials opined that if a specific referral mechanism is defined and is adopted under the

scheme, it will help in facilitating the admission of patients to the higher level health facilities as it

would have the official consent of the health officials from the lower level.

4.8 Monitoring & Evaluation and Management Information System

The state health officials informed during the discussions that the Department of Health and Family

Welfare of the state government monitors the scheme through its administrative setup which has a

well established Management Information System. Further, discussions with the officials also showed

that the facilities are required to send monthly progress reports of the scheme to the state directorate

through the district Chief Medical and Health Officer.

The process involves that the monthly progress reports of the scheme are made at the facilities

(CHC/Block), compiled block wise at the district level and sent to the State Health Directorate through

the district Chief Medical and Health Officer.

At the village level, the records and details of the card holders are maintained by the grass root level

health workers i.e., ANMs and MPHWs. These workers maintain information regarding the name of

the applicant, their address, their BPL card number, the health card code number and their signature

when they receive the card in their registers. However, the analysis and field visits at the block and

district level officials showed that the record keeping at the facilities was not well organised.

Analysis of the data also shows that the block wise data regarding the number of BPL households,

number of health card holders, and number of benefited households at each facility along with budget

allocation and expenditure incurred was available at the various sample districts. However, visits to

the sample blocks revealed that the registers containing the scheme records were not maintained

properly at the CHC and PHCs. It was analysed that although the block level officials send the

monthly progress reports to the district level authorities but the old data (data of previous years) has

not been managed properly. On further probing, it was reported that even though almost all the blocks

have computers but still the data was sent on a hand written proforma; the reason reported by officials

being that there were no computer operators at the block level, and in some cases if they (computer

operators) were appointed under certain schemes (like RCH) they were involved in other

administrative work due to lack of manpower at the CHCs.

It is understood that in the present scheme it is very important to maintain and update records relating

to the budget/finances and expenditures thoroughly. Facility wise registers having records of

medicines given to the patients, local purchase made, lab and test facilities done through private

service providers etc. are to be recorded not only in their (official) registers but also in the patient’s

family health cards.

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The block officials have also reported that not much feedback is received on the reports sent to the

higher authorities. They were also of the view that there should be some appreciation/awards for

meeting targets or good performance and efficiency, which would encourage them and/or other

officials to work harder.

4.9 Fund Flow Mechanism for the Scheme

The officials reported that there are no charges for entry to the scheme. The benefit is provided free of

cost to the eligible BPL families. The cost of family health card is approximately Rs. 8 per card and is

borne by the state government. The cost of photograph of the head of the family that is approx Rs. 4-5

is also borne by the state government.

Funds are provided by the state government, through the State Treasury under the DAUY according to

the past performance of the various districts on a quarterly basis. In addition in case of a demand from

any district, additional allocation is made based on the demand. The various sub-components of the

allocated budget include – (i) medicines and supplies; (ii) publicity; (iii) printing and stationery; (iv)

contingency; and (v) other charges. Other charges include components like, cost of transportation of

health cards, cost of photograph of the card-holders, etc.

Of the allocated budget, 70 percent is for procurement of additional medicines, which are not available

through the central drug procurement system, at the district level. Thus, the service providers have the

authority to spend about 30 percent of the allocation on local purchase.

It has been observed from the available secondary data that there has a gradual increase in the

allocated budget from 2006-07 to 2007-08, which shows a decrease during the year 2007-08 to 2008-

09; while in terms of the expenditure incurred there has been a steady increase each year, with the

increasing number of health card-holders and beneficiaries (Table 5.2). The data also shows an

increase in the per capita unit cost during the years 2006-07 and 2007-08 from Rs. 283.00 to Rs.

308.00.

4.9.1 Fund Allocation to the Districts

The district level officials reported that there is no fixed criterion for budget allotment to the districts.

Mostly the budget is allotted on previous years’ expenditure pattern; but further discussions with the

CMHOs of the sample districts revealed that here too influences and contacts at the state level played

an important role in budget allotment.

4.9.2 Fund Allocation to the Blocks

Similarly, at the block level the discussions with the BMOs of almost all the sample villages show that

there is no fixed criterion for allotting funds to the blocks. Moreover, in most cases the BMOs were

not empowered for local purchases. Discussions with the BMOs of sample villages revealed that in

case of local purchases, the block level officials need to have a written permission from the CMHOs

prior to any type of purchases under the scheme. In this regard the CMHO of Chinndwara reported:

“BMOs are not given any funds, but they do have the purchasing power, in the sense

that they can make local purchases and send the bills to the district.”

He justified the same, saying:

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“This is done to have central control and check fund flow because... in last few years

there were instances that in some blocks the fund were lying unused and hence lapsed

at the end of the year while the other blocks had to face financial crunch.”

4.9.3 Drug procurement and supply system

Drugs are supplied through the State Government Stores (Centrally Procured) to the districts (CMHO

Office). As reported by the State Officials, up to June this year 80 percent of the drug supplies to the

districts are through central warehouse/stores while the rest 20 percent is procured at the district level

through the CMHO office. However, from July this year (July 2009) the CMHOs will be authorised

for drug procurement at the district level, as discussed with the State Officials.

Figure 4.7: Drug Procurement and Supply system

State Govt. Stores

CMHO office

CHC

80% through Warehouse

20% procured

at District

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5 SCHEME ACHIEVEMENTS & EMERGING ISSUES

5.1 Physical Achievements

The Department of Public Health and Family Welfare, Government of Madhya Pradesh is the

implementing agency for the scheme – Deendayal Antyodaya Upachar Yojana. The Chief Medical

and Health Officers (CMHO) and Block Medical Officers (BMO) of the respective districts/blocks are

responsible for issuing the family health cards to the benefited households as per the BPL list. Besides,

they are also responsible for the purchase of medicine, fund flow and monitoring of the scheme within

the districts and blocks.

Funds are provided annually by the state government for providing the benefits of the scheme. The

average allocation per family has been Rs. 1000.00 per annum. This annual allocation is for procuring

additional medicines that are not available through the central drug procurement system and

warehouses. Besides, funds are also provided by the state government for publicity of the scheme and

administrative expenses. A total allocation of Rs. 39.5 crore was made for the year 2007-08. Funds are

allocated to the districts through the state treasury.

As on March 2008, about 47,90,668 households are estimated to have been provided health cards

(Source: State Health Directorate, Madhya Pradesh). The following Table 5.1 shows the total number

of Card holders and Benefited households for the last three years; as well as the Expenditure incurred.

The highlighted rows are the sample districts for this Assessment study.

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Table 5.1: Number of Health Card Holders, Beneficiaries and expenditure Incurred

Number

of BPL Number of Card Holders Number of Beneficiaries Expenditure Incurred

Beneficiaries as percentage of

Health Card Holders

S.No. District 2005-06 2005-06 2006-07 2007-08 2005-06 2006-07 2007-08 2006-07 2007-08 2005-06 2006-07 2007-08

1 Bhopal 29839 26113 26113 174655 2239 3331 13893 1440557 7806822 8.57 12.76 7.95

2 Sehore 26199 25797 25797 80765 3770 11372 24611 4549309 2108559 14.61 44.08 30.47

3 Raisen 44554 37456 37456 100090 1543 7037 11423 1318000 1628000 4.12 18.79 11.41

4 Rajgarh 31926 28920 28920 136474 1118 5527 13626 822884 2063190 3.87 19.11 9.98

5 Vidisha 31221 27669 27669 109193 1821 2597 7890 785764 1639765 6.58 9.39 7.23

6 Betul 62078 60057 60391 85868 1473 5954 13987 1194334 2477730 2.45 9.86 16.29

7 Hoshangabad 33988 32688 32688 78231 4988 9985 10826 4164350 2835343 15.26 30.55 13.84

8 Harda 17254 16900 16900 39511 554 1356 1302 1366064 933270 3.28 8.02 3.30

9 Gwalior 25620 21409 21409 33666 364 2564 4723 697207 7404041 1.70 11.98 14.03

10 Shivpuri 40242 38774 38774 106651 6412 8000 9331 945756 860406 16.54 20.63 8.75

11 Guna 30398 30632 97910 2247 14437 10092 376040 1444955 7.39 47.13 10.31

12 Ashoknagar 53675

23000 23000 41145 1343 4120 12256 221970 1134580 5.84 17.91 29.79

13 Datia 8681 9224 9224 20237 515 949 2035 251494 485939 5.58 10.29 10.06

14 Sheopur 19779 18079 18337 72528 3151 6165 10744 1557060 2137042 17.43 33.62 14.81

15 Morena 17187 17305 19305 66061 833 7045 11386 619774 2681652 4.81 36.49 17.24

16 Bhind 16613 15054 15054 56196 617 1171 1129 262939 352920 4.10 7.78 2.01

17 Sagar 63060 63833 63833 196674 1096 11809 19477 3965888 5604707 1.72 18.50 9.90

18 Damoh 49641 46313 46313 122618 1408 4014 8640 1578000 2518595 3.04 8.67 7.05

19 Panna 38135 37240 37340 97500 2302 2783 8616 2054580 3377488 6.18 7.45 8.84

20 Chattarpur 32152 29760 29760 70424 3029 3049 5347 962476 3372437 10.18 10.25 7.59

21 Tikamgarh 31507 30731 30731 63384 712 2387 4709 384481 765210 2.32 7.77 7.43

22 Indore 36630 47871 47871 139253 4285 6867 12726 3853877 8600747 8.95 14.34 9.14

23 Dhar 89841 84746 84746 123576 2307 6509 15643 936446 1586317 2.72 7.68 12.66

24 Jhabua 116716 116716 116716 141324 6097 20677 35889 2504873 3425025 5.22 17.72 25.39

25 Khargone 60954 64970 64970 135785 4591 1805 25304 895986 5791309 7.07 2.78 18.64

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Number

of BPL Number of Card Holders Number of Beneficiaries Expenditure Incurred

Beneficiaries as percentage of

Health Card Holders

S.No. District 2005-06 2005-06 2006-07 2007-08 2005-06 2006-07 2007-08 2006-07 2007-08 2005-06 2006-07 2007-08

26 Barwani 72680 71728 72735 135014 3877 5699 11517 1385106 4136197 5.41 7.84 8.53

27 Khandwa 38236 39646 39646 86451 1740 8556 8536 405480 730055 4.39 21.58 9.87

28 Burhanpur 20110 17007 17007 41937 600 1169 2611 290022 817291 3.53 6.87 6.23

29 Ujjain 40121 34754 34754 104840 3429 4705 9774 3115180 4463843 9.87 13.54 9.32

30 Devas 41973 40467 40467 95049 1996 7432 11112 1696669 5660730 4.93 18.37 11.69

31 Ratlam 44480 44494 44494 104524 6785 5169 9510 1645720 2590576 15.25 11.62 9.10

32 Jajpur 33321 33415 33415 121449 1963 4368 8798 995480 2260361 5.87 13.07 7.24

33 Mandsaur 22742 22051 22051 100849 2214 2084 15066 1960073 4139577 10.04 9.45 14.94

34 Neemuch 14888 17000 17000 64478 906 1385 2982 1005043 3149444 5.33 8.15 4.62

35 Jabalpur 78652 89030 89030 180000 4221 5969 21368 3802000 31060000 4.74 6.70 11.87

36 Katni 62261 55116 55116 54269 2967 12064 16931 1064289 3439221 5.38 21.89 31.20

37 Narsinghpur 37450 37750 37750 88766 1348 1877 7516 1269429 2844607 3.57 4.97 8.47

38 Chinndwara 83182 81944 81944 140938 4392 6305 21365 2449078 6406036 5.36 7.69 15.16

39 Seoni 53322 49878 49878 89222 2275 3995 7127 1443025 2118838 4.56 8.01 7.99

40 Mandla 77153 71220 71220 118703 2490 11037 14155 4319369 1864967 3.50 15.50 11.92

41 Dindori 49678 43673 43673 48547 2138 2309 3927 421472 651794 4.90 5.29 8.09

42 Balaghat 67411 63517 63517 63517 3171 5672 21701 2606153 2525391 4.99 8.93 34.17

43 Rewa 80848 80440 80440 153441 2491 4471 17216 1983550 8020289 3.10 5.56 11.22

44 Shahdol 51699 51943 106944 1371 2162 7301 1093983 1234332 2.65 4.16 6.83

45 Anuppur 81201

25775 25775 49330 333 2451 8370 348420 2284872 1.29 9.51 16.97

46 Umeria 27308 27308 27308 53886 2559 3994 8433 859366 3745776 9.37 14.63 15.65

47 Siddhi 83875 83875 83875 207494 4005 7321 11831 1542653 2512205 4.77 8.73 5.70 48 Satna 71284 74500 74500 191301 3024 6337 13873 2457407 1713158 4.06 8.51 7.25 Total 2159668 2107310 2111487 4790668 119110 268041 556625 75869076 171405609 296.40 674.09 588.13

Source: Directorate of Health Services, Madhya Pradesh

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The scheme has become popular in the recent years. The above table shows a gradual increase in the

number of cardholders during the years 2005-06 to 2007-08. In most of the districts the proportion of

benefited households to the cardholders was found to have increased in year 2006-07 from 2005-06,

although a sharp decrease was noticed in years 2007-08. In terms of the Expenditure incurred as part

of the scheme, the table shows an increase in most of the districts from year 2006-07 to 2007-08.

As per the data received from the State Health Authorities, the Family Health Cards have been issued

to 47 Lakh families, as of 2007-08. The details of health cardholders, benefited households and

expenditure incurred at the state level are as follows (Table 5.2).

Table 5.2: Number of Benefited Households & Expenditure Incurred over last 3 years

Year

Health

Cards

Issued

Benefited

Households

Budget

Allocation

(Rs. lakh)

Expenditure

Incurred

(Rs. lakh)

Per capita

Expenditure (Rs.

per Beneficiary) Percent

Utilization

2004-05 - 11087

2005-06 2107310 119110

2006-07 2111487 268041 1942.00 758.69 283 39.07

2007-08 4790668 556625 4006.00 1714.06 308 42.79

2008-09 5004553 15.47 lakh 2676.00 1760.00 169 65.77 Source: Directorate of Health Services, Madhya Pradesh

Field observations also show that the card holders are definitely benefited from the scheme.

Discussions held with the gram sabha also revealed that in general the local community was of the

view that the scheme is pro-poor and is very beneficial for the backward and marginalised people.

The present health scheme has definitely benefited a lot of BPL families of the state since its

inception. It has helped the people to avail the hospitalisation facilities which they could not have

afforded otherwise. This can also be substantiated by an increase in the number of cardholders and

beneficiaries in the last four years.

Discussions with the local rural community in the Chinndwara district revealed that there is

considerable awareness regarding the scheme among the people and now the villagers are getting the

BPL cards made in order to avail benefits of the scheme, which itself shows the popularity of the

Deendayal Antyodaya Upachar Yojana. Moreover, in-depth discussions with the service providers as

well as the focus group discussions with the multi-purpose health workers revealed that there have

certainly been several-fold benefits from the scheme. However, they clarified that no studies have

been done so far to substantiate and quantify the same.

According to them the benefits include access to free health care, savings in terms of the number of

man-days as absenteeism from work, creation of assets, and general increase in the overall standard of

living. Some people also opined that after availing the benefits of the scheme they had a speedy

recovery from illness and availed free medication and investigation facilities during hospitalisation.

5.2 Direct Impact of the Scheme

Discussions held with the district and block level health care officials in Sagar district revealed that the

officials were of the view that now since the BPL households can have access to health care services

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more easily under the scheme so various illnesses that were earlier ambiguous are now becoming more

visible and coming to the notice of the service providers. Thus, various new diseases and illnesses that

were prevalent among the local community have now become detectable.

Discussions with local community reveal that there is considerable awareness regarding the scheme

among the people and now the villagers are getting the BPL cards made in order to avail the benefits

of the scheme which itself shows the popularity of the scheme. In-depth discussions with the service

providers as well as the focus group discussions with the multi-purpose health workers reveal that

there have certainly been benefits from the scheme. The benefits include access to free health care,

saving in terms of number of man-days of absenteeism from work, creation of assets and general

increase in the overall standard of living.

It has emerged from the analysis of the data that in more than half of the sample locations the

participants of the Gram Sabha in rural areas and interactions with ward members in urban areas,

could not clearly and correctly mention the direct impact the present scheme. Analysis shows that a

higher proportion of the participants of the Gram Sabha were unaware about the direct impacts of the

health scheme.

Analysis of the responses of the participants of the Gram Sabha reveals that a little less than one-

fourth of the participants perceived that cost free treatment to all poor and marginalised section of the

society as an impact which is one of the most important and crucial impact of the present health

scheme. However, in about 15 percent of locations, the participants were of the view that it has lead to

saving money by the benefited households especially the poor households. Rural-urban variations

reveal that comparatively higher proportions of benefited households were of the similar view.

At the household level, the targeted benefited households were asked regarding their perception of the

direct impact of the health scheme. The analysis of the data regarding this shows that both in urban as

well as rural areas more than half of the respondents perceived that the scheme has directly helped in

improving the health of the people and also facilitated in saving their health expenses. About 13

percent of the targeted respondents in urban and about 12 percent of them in rural areas also perceived

that the scheme has helped in improving their economic/income status after saving man-days at work.

Figure 5.1: Perception of respondents regarding direct impact of the scheme (in %)

56.59

51.12

51.37

47.94

13.19

12.3

3.30

2.37

0 10 20 30 40 50 60

Improved health

Saving on health

Improvement in economic

status

Any other

Urban Rural

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Further, an attempt was made to understand and analyze as to how the targeted households got

benefited under the scheme and how the scheme has affected the health of the family members prior

and after availing the benefits under the scheme. The respondents were asked to answer a set of

questions regarding the status of the health of the family members prior to availing the benefits of the

scheme, the status of the health of the family members after availing the benefits of the scheme,

proportion of respondents who spent more on seeking health benefits prior to availing the benefits of

the scheme, proportion of respondents who had borrowed money for treatment/health prior to taking

the benefits of the scheme, and proportion who borrowed money even after taking the benefits of the

scheme.

Regarding perceptions of respondents, who availed the scheme benefits, on the status of health of the

family prior to availing the benefits of the scheme, majority of the respondents perceived that their

health was comparatively bad or was even worse prior to availing the benefits of the scheme (figure

below). On the other hand, it was analysed that a higher proportion of households from the rural areas

were of the view that their health was comparatively better prior to availing the benefits of the scheme.

The table below shows that about 6 percent of the targeted households in urban areas and about 13

percent in rural areas perceived that their health was comparatively good or better after availing the

benefits of the scheme. About 8 percent of the targeted households in rural areas and 6 percent in

urban areas believed that there was no change in their health.

Moreover, the targeted respondents were also asked about their perception regarding improvement in

their health status after availing the treatment under the scheme. It has emerged that majority of

respondents i.e., 78 percent in urban and about 70 percent of the targeted households in rural areas

mentioned that their health has improved after availing treatment under the scheme. Similarly, about

71 percent of the respondents from urban and 65 percent of the respondent households from rural areas

reported that their health was comparatively better after availing treatment under the scheme, while

about 17 percent perceived that they did not observe any change prior and after availing the treatment.

Of those who mentioned ‘No change’, their disease pattern was further analysed and found that they

are mainly suffering from minor ailments like cold, cough, fever, diarrhoea, weakness, etc.; which

implies that there has not been much changes in the disease pattern in the community prior and after

introduction of the scheme.

It has emerged that overall there was a positive response and feedback from the targeted households.

Majority of respondents perceived that their health status has improved and is comparatively better

after availing the treatment under the scheme. Rural-urban variations reveal that a relatively higher

proportion of benefited households from the urban areas perceived that their health has improved after

availing the treatment under the scheme.

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Figure 5.2: Health Status of Benefited households after availing benefits of the scheme (Figures in %)

71.7

65.3

17.0 17.7

9.115.1

2.2 1.9

0

10

20

30

40

50

60

70

80

Comparatively Good/Better No change Comparatively bad/worse Don’t Know/Can’t Say

Urban

Rural

Analysis of the data regarding the expenditure on seeking treatment made by the targeted benefited

households shows that majority of the respondents spent more on seeking treatment prior to availing

the benefits under the scheme. About 79 percent of the respondents in urban and 69 percent of the

targeted respondents in rural areas mentioned that they spent more on seeking treatment prior to

availing the benefits under the scheme (Table 5.3).

Table 5.3: Percent of Respondent who spend more on seeking treatment prior to availing benefits of the scheme (Figures in %)

Benefited Households Spend more on seeking Treatment prior to availing

benefits of the scheme Urban Rural

Spent more on treatment 79.12 68.45 Did not spend more on treatment 14.01 25.16 Do not know 6.87 6.38 Total 100 100

S.D. 19.21 18.51

95% CI 4.38-8.34 6.02-6.18 Source: Field Survey (Surveyed Households)

The data on proportion of households who borrowed money reflects an important component of the

impact of the scheme. The table below shows that on an average the per capita expenditure on seeking

treatment was more for people residing in urban areas than their rural counterparts. About 14 percent

of households mentioned that they borrowed money for treatment prior to taking the benefits of the

scheme. The analysis shows that amongst the people who borrowed money, a higher proportion (37

percent) in rural areas borrowed less than Rs. 1000.00 as compared to urban areas (22 percent).

Similarly, the proportion of respondents who borrowed Rs. 5,000 and above was comparatively higher

in urban areas where about over one-third of the respondents (41 percent) mentioned to have borrowed

more than Rs. 5,000.00 as compared to 36 percent in rural areas (Table 5.4).

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Table 5.4: Percent of Respondent who borrowed money for treatment

Benefited Households Urban Rural

Borrowed any money for treatment

prior to taking benefits of the scheme

n % n %

Borrowed money prior to taking scheme benefits 49 13.46 27318 14.37 Did not borrow money 315 86.54 162788 85.63 Total 364 100 190106 100

S.D. 0.34 0.35

95% CI 1.83-1.90 1.85-1.86

If Yes, How much amount borrowed

<1000 11 22.4 10148 37.1 1001-3000 10 20.4 4575 16.7 3001-5000 8 16.3 2680 9.8 5001 & above 20 40.8 9914 36.3 Total 49 100.0 27318 100.0

Average amount borrowed (Rs.) 1490 1791 Source: Field Survey (Surveyed Households)

When tabulated according to the Caste/Tribe, it was revealed the borrowing of money for health

related expenses was more commonly observed amongst the SCs, STs and OBCs than the General

category of the population. The Table 5.5 shows the same.

Table 5.5: Percent of Respondent who borrowed money for treatment prior to availing scheme benefits by Caste (Absolute Figures)

Caste/Tribe

Rural Urban

SC ST OBC General Total SC ST OBC General Total

Borrowed money

17337 3649 5143 1188 27317 16 6 22 5 49

Did not borrow money

79498 47798 27574 7919 162789 125 38 118 34 315

Total 96835 51447 32717 9107 190106 141 44 140 39 364 Source: Field Survey (Surveyed Households)

The data regarding the proportion of respondents who borrowed money for treatment after availing

benefits of the scheme shows that about 7 percent of respondents in rural areas and only about 4

percent of the targeted households in urban areas borrowed money for treatment after availing the

benefits of the scheme. Analysis of the data for rural and urban areas shows that a higher proportion of

households borrowed money in rural areas as compared to urban areas even after availing the benefits

under the scheme (Table 5.6).

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Table 5.6: Percent of Respondent who borrowed money for treatment after availing benefits of the scheme (Figures in %)

Benefited Households Urban Rural

Borrowed any money for treatment

after availing the benefits of the scheme

n % n %

Borrowed money after taking scheme benefits 16 4.40 13794 7.26 Did not borrow money 348 95.60 176312 92.74 Total 364 100 190106 100

S.D. 0.21 0.26

95% CI 1.93-1.98 1.93-1.93

If Yes, How much amount did you borrow?

< 1000 1 6.3 4234 30.7 1001-3000 4 25.0 1431 10.4 3001-5000 1 6.3 1442 10.5 5001 & above 10 62.5 6688 48.5 Total 16 100.0 13794 100.0

Average amount borrowed (Rs.) 602 1271 Source: Field Survey (Surveyed Households)

When tabulated according to the Caste/Tribe, it was revealed the borrowing of money for health

expenses was more commonly observed amongst the SCs, STs and OBCs than the General category of

the population, even after availing treatment under the scheme. The Table 5.7 shows the same.

Table 5.7: Percent of Respondent who borrowed money for treatment after availing benefits of the scheme by Caste (Absolute Figures)

Caste/Tribe

Rural Urban

Particulars

SC ST OBC General Total SC ST OBC General Total

Borrowed money 10844 774 2008 168 13794 5 2 7 2 16 Did not borrow money

85990 50674 30709 8939 176312 136 42 133 37 348

Total 96834 51447 32717 9107 190106 141 44 140 39 364 Source: Field Survey

However, when compared with the situation prior and after availing the health scheme, it was

observed that the proportion of households who had to borrow money for availing health facilities for

the family members has decreased significantly.

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Figure 5.3: Impact on Non-benefited respondents’ borrowing money pattern for treatment before and after the scheme

After Scheme,

13794

Before Scheme,

27318

0

5000

10000

15000

20000

25000

30000

Rural

After Scheme,

16

Before

Scheme, 49

0

10

20

30

40

50

60

Urban

The above figures show that the proportion of households who had to borrow money after availing the

benefits of the scheme decreased by almost 50 percent in urban and by 67 percent in rural areas. Thus,

it is understood that the proportion of households who needed to borrow money for treatment has

decreased significantly after the launch of the scheme which in itself complements one of the main

objectives of the scheme.

The benefited households were asked if there has been any change in their health status after availing

benefits under the scheme. Most of the respondents from both urban (77 percent) and rural (70

percent) areas gave an affirmative response, while a few also replied in negative (28 percent in rural

areas and 18 percent in urban slums). Table 5.8 shows the distribution of the same.

Reduced by 50%

Reduced by 67%

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Table 5.8: Percent of respondent who think that health has improved after availing treatment under the scheme (Figures in %)

Benefited Households Health has improved after

availing treatment under the scheme Urban Rural

Health status improved 77.47 69.69 Health status did not improve 17.58 27.94 Don’t Know/Can’t Say 4.95 2.37 Total 100 100

S.D. 16.46 11.54

95% CI 3.24-6.63 3.03-3.14 Source: Field Survey (Surveyed Households)

5.2.1 Quality of Services Availed under the scheme

The targeted benefited households were asked about their perception regarding relevance of scheme in

providing cost free access of health care services especially to the poor and marginalized section of the

society. The table below shows that majority (76 percent) of the benefited households in urban areas

and about two-third of them from rural areas who were interviewed replied in the affirmative.

However, it has emerged from the analysis of the data that a higher proportion of the targeted

respondents in rural areas (20 percent) perceived that the scheme was not relevant and successful in

achieving its objectives of providing cost free treatment (Table 5.9).

Table 5.9: Percent of respondents who feel that the scheme is relevant in providing cost-free access of health care services (Figures in %)

Benefited Households Relevance of the scheme

Urban Rural

Scheme provides cost-free treatment 76.10 62.88 No relevance of the scheme 7.42 19.74 Do not know 16.48 17.38 Total 100 100

S.D. 28.21 28.71

95% CI 10.69-16.51 14.28-14.54 Source: Field Survey (Surveyed Households)

5.2.2 Satisfaction of the benefited Households/Respondents

Data was collected to assess the satisfaction level of the respondents for services that they have availed

under the scheme. A set of twelve point indicators was designed in the schedule and canvassed to the

targeted benefited households to understand their perception. The indicators included time taken and

process of making scheme health cards; promptness in admission to the facility; availability of

facilities like – beds, medicines, clinical investigations, cleanliness; and behavior of medical and para-

medical staff at the health facility where treatment was availed. The households were asked to grade

the above indicators on a three-point scale. The respondents had to provide Grade 1 if they perceived

the service to be high, 2 if they considered it average, and 3 if they felt it was low; or in other words,

the services either required to ‘maintain current status’; ‘currently satisfactory but need improvement’;

or ‘required immediate action’.

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Figure 5.4: Quality of Services availed (Rural)

0%

20%

40%

60%

80%

100%

(In

Percen

t)

1 2 3 4 5 6 7 8 9 10 11 12 13

Indicators

Maintain

current status

Currently

satisfactory,

but Needs

improvement

Immediate

action

required

1- Time taken to get the health cards made

2- Process of getting the health cards made

3- Promptness in admission to the facility

4- Availability of bed at the facility

5- Availability of Medicines

6- Availability of investigative tests

7- Cleanliness of ward

8- Availability & cleanliness of toilets

9- General environment of the facility

10- Behaviour of Doctors

11- Behaviour of Para medical staff (Nurses and ward boys)

12- Grievance redressed mechanism

13- Overall Quality of service provided

Figure 5.5: Quality of Services availed (Urban)

0%

20%

40%

60%

80%

100%

(In

Per

cen

t)

1 2 3 4 5 6 7 8 9 10 11 12 13

Indicators

Maintaincurrent status

Currentlysatisfactory,but Needsimprovement

Immediateactionrequired

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The figure above shows that about half of the targeted benefited households (49 percent in rural and

54 percent in urban areas) perceived that the overall quality

of services provided under the scheme was average, or that it

required some improvement. Only about one-third of the

benefited households (30 percent in rural and 29.4 percent in

urban areas) opined that the satisfaction level of the overall

quality of services was above average or that they are

currently satisfactory. About 21 percent of the benefited

households in rural areas and 16 percent in urban areas

perceived that overall quality of service provided was low or

require immediate action. It has been found that most of the

services require better attention for improvement.

It was interesting to see that a higher proportion of households (both in rural as well as urban areas)

were satisfied with the time taken to get the health cards made and the process involved in making the

health cards. On the other hand, a relatively higher proportion of the respondents in rural areas

perceived that the behaviour of doctors (34 percent in rural as compared to 18 percent in urban areas)

and the paramedical staff (32 percent in rural and 27 in urban areas) at the health facility was not

satisfactory. Similarly, about one-third (34 percent of the respondents in rural and 33 in urban areas)

perceived that the grievance redressal mechanism is not satisfactory.

5.3 Indirect Impact of the Scheme

During the primary research an attempt was made to understand as to how the scheme has benefited

the community indirectly. An open discussion was held to get the views of the local community in the

Gram Sabha conducted while profiling the villages. The people from the sample villages were

inquired about their perception of the indirect impact that the health scheme has had on the local

community in general. A variety of responses were received regarding this and the analysis of their

responses shows that majority of the people were ignorant regarding the possible indirect impacts of

the scheme.

However, among the responses that were received, about half of them were of the view that the after

the introduction of the health scheme people have become more aware and conscious about health

related issues and their rights regarding the same. About one-third of the respondents mentioned that

now the people have more choice regarding the health services. The people now save on the overall

health expenditure and thus their economic as well as social status has improved.

The targeted benefited households were also inquired about their perception of the indirect impact that

the health scheme has had on them. The analysis of the data regarding this shows that about two-third

of the targeted respondents in urban areas and a little less than half (48 percent) of the respondents in

rural areas mentioned that the scheme has helped in improving the status of the people in the society.

Similarly, about one-third of the targeted benefited households also perceived that the scheme has

improved the educational status of the children among the poor families as now the amount saved on

seeking treatment is spent for educating the children. About 24 percent of urban and about 38 percent

of the rural households reported that it has also increased the life expectancy at the community level

(Table 5.10).

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District Chinndwara: FGDs with ANMs/MPWs (identity

withheld)

While having discussions with the ANMs and MPWs in one of

the sample districts a very interesting revelation was done by

these grass root level health workers. They reported that the

health cards that were supposed to be made by the village

health workers were practically taken away by local influential

people and issued to influential people/their relatives who were

issued the BPL cards on similar lines earlier.

They were of the view that even though the scheme is very good

and has been very fruitful for the poor and marginalised

sections of the society but sometimes it was being misused even

by the service providers. The misuse at the end of the guardians

of the society itself is very discouraging and a bad show and

hence the implementation of the scheme has to be very genuine

and sincere.

Table 5.10: Indirect Impact of the Scheme as perceived by Benefited households (Figures in %)

Benefited Households Particulars

Urban Rural

Improved social status 58.79 47.91

Improved education status for children 35.16 32.06

Increased life expectancy 24.18 37.68

Decrease in overall Mortality 19.51 29.05

Decrease in Maternal Mortality 17.58 24.43

Decrease in Infant Mortality 12.09 9.34

Any other 4.12 1.98

Total 100 100 Source: Field Survey (Surveyed Households)

5.4 Bottlenecks & Emerging Issues from the study

5.4.1 Scheme Awareness

Discussions revealed that the CMHOs and Civil Surgeons of some districts and the block level

officials of almost all the study blocks were unaware that the primitive tribal groups irrespective of

their economic status, and the families having ‘Mukhya Mantri Mazdoor Suraksha Card’ and/or those

having ‘Nirman Shramik Card’ are eligible for availing the benefits of the scheme. According to them,

this scheme is applicable for families belonging to BPL category. In this regard, CMHOs of most of

the sample districts like Hoshangabad, Chinndwara, Morena, Rewa and Sehore reported that no such

circular was received by them.

5.4.2 Scheme Health Cards

In almost all the districts, the services

providers have reported that allotment of

BPL cards was itself a debatable issue,

since many-a-times the affluent and well-

to-do households have made the BPL cards

as well as the health cards for themselves.

Moreover, these people carry their health

cards to the health facilities and try to take

OPD facilities under the scheme,

especially in serious cases, wherein

expensive treatments, like – availing ARV

for dog bites, knee replacements,

multiple/complicated fractures and during

accidents etc. And this causes problems for

the service providers and also increases the

pressure on the existing limited health care

infrastructure.

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Although, the state officials reported that the number of cards printed was substantially higher than the

number demanded but in most sample blocks, the district, block and village level health officials

revealed that the number of cards provided to them was insufficient and much lesser than what was

demanded by them.

In some sample blocks, the multi-purpose health workers reported that in a number of villages, the

eligible households do not have the BPL cards and this was a major hindrance in the process of

making the scheme health cards for these households. Thus, these health workers perceived that the

purpose of the scheme, to provide access to free health care to the poor households, was itself defeated

as the health cards for the deserving people were not made and they were left out of the mainstream.

Moreover, it was observed that the health cards have photograph of the head of the households only,

and in this regard our primary survey revealed that there were instances of misuse of the health cards

as there was no way of verifying the authenticity of the other family members in the households. The

CMHO of Sehore revealed that:

“Recently there was a casualty in Ashta block where a woman died after receiving the

treatment under the scheme. Later it was revealed that this woman was not the real

eligible benefited and carried her neighbour’s health card for seeking treatment…this

happened …since there is no way to find out if the person seeking treatment/carrying the

card is the same as mentioned in the health card?”

It was analysed that a number of eligible households could not be issued the health cards because they

could not afford the cost of photocopy of ration card and the photographs.

5.4.3 Training

Field investigations reveal that no formal training was imparted to the service providers under the

scheme. This has also led to discrepancies in the issue of health cards and the maintenance of records

at village level. It was also observed that the general meetings held at the sector and block levels had a

large number of issues and agenda to be discussed with a limited timeframe and eventually it became

merely a formality.

5.4.4 Infrastructure

It has surfaced that there were no utilisation of the scheme at the PHC level. Even at the CHC/block

level, the number of benefited households availing the services is nominal. On further probing, it has

emerged that the facilities available at these institutions in terms of the wards, availability of

infrastructure (beds, linens, consumables) and manpower (doctors, nurses, ward boys etc.) is very

limited and hence in most cases the health officials from these facilities send the patients to

district/higher level health facilities.

For example, it was observed during visits to Babai block of Hoshangabad district the building of the

CHC is in a very diphalated state. Moreover, the wards and the minor OT of the CHC are located at a

distance of about one kilometre from the CHC building which houses the medicine and store room.

Thus, this poses problems for the patients. Moreover, as mentioned earlier there has been no in-patient

facility for any diseases other than delivery in Babai block of Hoshangabad since last several months

which shows the exact performance of the scheme in the block.

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It was also analysed from the field observations that there is lack of facilities at the PHC and CHC

level; hence most of the cases were referred to the district and higher facilities, which created chaos

and substantial pressure at the district level health facilities. Moreover, in most sample districts limited

availability of resources/facilities, infrastructure and manpower at the district level again lead to

improper treatment of patients.

Discussions with the local community in the Gram Sabha revealed

that the wards at the health facility, especially at the block

CHC/PHC level were very dirty and unhygienic; and there was lack

of sanitation, with no proper toilet facilities; the linens being dirty,

and the food/meals provided in the wards was of poor quality. The

field visits to the institutions by our team also confirmed the same.

The local community also opined that there was so much mis-

management in the health facilities, that the patients did not want to

stay at these facilities for treatment.

5.4.5 Manpower

In some cases, lack of manpower like – doctors and other paramedical staff was a major hindrance to

the performance of the scheme. For example, in Hoshangabad District Civil Hospital, the post of

anaesthetist is lying unoccupied from a long time and since there is no provision of outsourcing

doctors under the scheme, hence no surgery (requiring the service of an anaesthetist) was performed in

the hospital.

Moreover, the district officials have reported that there has been no appointment at the health facilities

under the scheme and the workload on the existing staff is extremely high which has led to an

underperformance of the scheme.

In this regard the CMHO of Satna referred:

“The government has launched many schemes in the recent past which has led to an

inflow of patients for health care at public facilities but the present health care

institutions have not been upgraded to meet the existing demand…..presently there is lack

of health care infrastructure and the existing infrastructure is crumbling under the

pressure. In the present scheme too, there has not been any appointment under the

scheme and the workload on existing staff is extremely high.”

Similarly the village level multi-purpose health workers are also overburdened with work. Field visits

and discussions with them revealed that these workers are given too many villages/wards, which are

practically difficult to manage owing to the population to be covered and the distance. Similarly, it

was observed that in most Civil Hospitals, the multi-purpose health workers and ANMs who were

supposed to be visiting their wards have been doing duties in the other wards, vaccination/injection

rooms etc.

5.4.6 Supply of Medicine/Consumables

Discussions with the district and block level officials revealed that the supply of medicines from

warehouses has improved considerably in the recent past. However, still the warehouses do not have

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sufficient medicines and there was also lack of supply of surgical goods. Moreover, there was usually

delay in procuring medicine from the warehouses.

The officials opined that the range of medicines available in the

warehouses needs to be expanded and many contemporary and

improved drugs should be incorporated in the list. They were also

of the view that the medicines like, insulin for diabetic patients,

ARV for dog-bites, and other life saving drugs and

consumables/supplies, etc. should be readily available at the

health facilities.

District: Morena Block: Porsa Village: Ratan Basai

Respondent Category: Benefited person

Age: 40 years Occupation: Labourer

Shivkumar, lived in Ratan Basai village in Porsa. He had a wound in his leg which was not

healing investigations showed that he was Diabetic. Due to the wound he could not work and

hence was very upset, but he ignored the wound as he was very poor. According to Dr. Gupta

(BMO Porsa), proper medicine for the patient was not available in the block hospital and

Shivkumar’s poor financial conditions were limiting him to refer the patient outside or ask him to

buy medicines from private stores. The patient was so poor that to commute from his village to

hospital he had to borrow money. With Dr. Gupta’s reference he availed the scheme benefits from

the block hospital. He was admitted to the hospital and treated for the wound and diabetes.

Shivkumar’s condition became stable but he had to be discharged as his wound was healed and

they could not keep him longer. But he could not be given insulin on regular basis as it was not

covered under the scheme. Shivkumar perceives that although the scheme is very good and is a

blessing for the poor but other treatments like insulin for diabetics should also be covered to

widen the scope of the scheme.

On the other hand, discussions with the health card holders and the benefited households, in particular,

revealed that these benefited households were of the opinion that the medicines provided from the

government hospitals under the scheme are of sub-standard/poor quality and hence are less effective.

5.4.7 Inclusion of Transport Facility under the scheme

Discussions with the benefited households and with the village level health workers showed that most

of them were of the view that there should be provision of transport facility under the scheme. In this

regard, they clarified that the scheme is for the BPL households and most households are so poor that

they could not even afford to reach the distant health care facilities on their own expenses.

Moreover, it was also realised that in absence of any transport facility under the scheme, the patients

from far-off areas were apprehensive to take the risk of travelling long distances to the health facilities

for treatment, with their own expenses, where they did not have any acquaintances and relatives.

5.4.8 Behaviour of Service Providers

It was revealed from the in-depth interactions and discussions with the service providers that at times

the doctors themselves were not concerned about providing treatment under the scheme due to the

hassles involved in the whole system. They revealed that the process of local purchase is very long,

and record keeping is tedious, and also there are huge political/local pressures. Moreover, lack of

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District: Shivpuri District Block: Kolaras Village: Kolaras

Respondent Category: Non-benefited respondent

Age: 52 years old Occupation: Agricultural labourer

During our DAUY program visit in Kolaras block in Shivpuri district we reached the CHC of the

area. There we enquired about the program, but the Health Officer present there told us that he

has no knowledge of such program. Then we tried to contact the BMO of the area, and time was

taken to meet him.

We noticed that, the Madhya Pradesh Government allows the doctors to practice their private

clinics after their official hours at the government hospitals. Due to this reason, doctors run their

private clinics openly and also charge the fees from the patients during their official hours, i.e.

from 10 am to 3 pm. But when the poor family people come to the hospital with their health card,

doctors throw the card off or send them back without giving them the required treatment because

they do not have sufficient money to pay his fees.

We met a patient who was a health card holder, he told us that “I was send back from CHC saying

that there was no medicine in the hospital for my treatment, you should visit Shivpuri hospital.

When I visited the district hospital the same thing happened again. Then I approached the private

nursing home, where I got my ‘Pathiri’ operated. But for it I have to sell out my animal for

arrangement of money.” Though he was a cardholder, he could not get any benefit of the scheme.

infrastructure and manpower available at the

health facilities, and thus resultantly long

working hours, restrict their performance in the

long run.

The local community and the cardholders also

reported that the behaviour of the service

providers at times is very rude and

discourteous. They also opined that the doctors

are unwilling to hospitalise them in many

cases, and they do so only on their own

willingness. Sometimes the cardholders had to go to the district hospitals covering a distance of 50-60

km, and still they were not admitted. They informed that they were given few medicines which the

patients felt that they could have purchased from any nearby shop.

It has emerged from the interactions with the local community that there were instances where the

poor and needy villagers did not have the courage to avail the benefits of the scheme after hearing

discouraging experiences/stories narrated by the unsatisfied benefited households and non-benefited

households. Many cardholders who were in need of hospitalisation either could not avail the services

as they could not afford it, while others did not take the risk and availed the treatment in private

hospitals.

There are cases of negligence by the service providers at the

district level in treating the patient which are referred by the

block level health officials. Cases are reported by the grassroot

level service providers as well as the doctors at the block level

where patients had to return to the village without being cured.

The confidence level of the villagers has gone down. It was

reported that doctors at the district hospital of Neemuch didn’t

admit the patient from Bordiya village who had kidney problems

and was referred by BMO of Jawad block. It was a case of

disappointment which is also the case of negligence done by the

doctors at the district hospital.

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5.4.9 Misuse of scheme

(i) Misuse by service providers

a) It has emerged in many cases that even the service providers misuse the scheme for their personal

gains. In some sample districts there were cases where the doctors wrote certain medicines for

local purchase where they had vested interests (Hoshangabad, CMHO)

b) Similarly, in some cases, villagers from among the local community reported on terms of

anonymity that at some facilities illiterate benefited households were made to sign the local

purchase register prior to purchase of medicines and the registers were updated later

c) The focus group discussions with the multi-purpose health workers in Chinndwara themselves

accepted that the health cards that were supposed to be made by the village health workers were

practically taken away by local leaders/political people and their active workers. These cards were

later issued to influential people who were earlier issued the BPL cards on similar lines

(ii) Misuse by Cardholders

a) There were instances where some patients used the cards of their neighbours/family members’

relatives etc. to avail the scheme benefits

b) In some instances, the cardholders themselves tampered with the cards by adding/increasing the

number of family members in order to accommodate the extended family

c) There is lack of proper guidelines among the service providers regarding provision ARVs in cases

of animal bites (which is quite frequent in the rural areas/forests) under the scheme. Field studies

showed that the same was being given under the scheme in Sehore while in district Mandla it

wasn’t provided under the scheme

5.4.10 Record keeping

Field observations reveal that the maintenance of records at the health facilities is very poor. There

was lack of proper documentation both at the block as well as district level. Similarly, during the visits

to the sample villages, the field teams came across numerous instances where there were no proper

entries in the health cards. This was a regular phenomenon observed in many villages across all the

sample districts.

5.4.11 Awareness amongst the Community

It was realised from the discussions that most people from the local community consider the health

card to be a licence to all medical benefits including all medicines, covering all diseases as well as out-

patient facilities. Some people also perceived that they felt cheated and bluffed as they were of the

view that at the time of initiation of the scheme they had high expectations from the scheme. The local

community expressed that initially the scheme was portrayed as if it would provide free treatment to

the local community for the amount of Rs. 20,000.00; but the condition of being admitted to health

facility to avail the scheme was not communicated to them properly.

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The scheme is only an in-patient one but most of the patients are not interested in getting hospitalised.

They want to receive the medications and go back home if the disease was not very serious.

Moreover, most of the people were not willing to get admitted at the District Civil Hospitals because

of the distance of the health facility from their residence. Hence, they insisted on providing them the

benefits without being hospitalised, which poses problems for the service providers.

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6 CONCLUSION AND RECOMMENDATIONS

6.1 Awareness about Scheme

6.1.1 Awareness amongst the Community

The local community considers the health card to be a licence to all medical benefits including

medicines covering all diseases and out-patient facilities as well. The local community expressed that

initially they were informed (at least it was portrayed) that the scheme would provide free annual

treatment to each BPL family for total amount of Rs. 20,000.00 and they were not informed/

communicated that the scheme was for in-patient facilities. This reflects the lack of awareness

amongst the community regarding the scheme.

In view of the above conclusion, we would recommend that:

• An intensive IEC/BCC campaign should be designed for creating awareness amongst the local

community on the objective and the intended benefits of the scheme; through the wider utilisation

of communication channels, like community meetings, talk shows, local cable TV channels, etc.

• All channels of communication should be used which are accessible to local community:

- Mass Media should be utilized to a greater extent.

- Inter-personal communication through the MPHWs needs to be sustained.

- Professional social marketing agencies may be hired for increased awareness.

• Participation of NGOs and CBOs: Identification of suitable NGOs/CBOs working at the village

level should be done. They should be invited to proactively participate in the IEC/BCC activities.

• Role of PRI members: As the study suggests that the PRI members play as significant role in

creating awareness about the scheme. Hence, they should be formally involved in the process of

making cards and information dissemination.

• Community Participation: We have seen that once a BPL cardholder avails benefit under this

scheme, there is communication spread within the community. Benefited households share their

perceptions about the scheme and the benefits availed with non-participants of the Scheme and thus

implicitly contribute in improving the reach of the programme. Thus, it is very important that the

scheme card-holders are adequately informed about the benefits (through verbally and written

pamphlets) so that they can properly communicate details about the scheme to their community.

• Funds: Specific funds should be earmarked for IEC/BCC activities for the scheme, which should

not only include printing of IEC materials (pamphlets) but involvement of Radio (community radio

if available), internet, television including local cable TV channels, puppet and talk shows in the

community as other channels of awareness. And these need to be monitored strictly for effective

utilisation.

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6.1.2 Awareness amongst the Service providers

Interactions with the service providers revealed that no formal training was imparted to them for the

scheme, which led to discrepancies in understanding the scheme, issue of health cards and

maintenance of records at various levels, particularly at the village level. It was observed that many

Health Officials were unaware that the primitive tribal groups irrespective of their economic status and

families having ‘Mukhya Mantri Mazdoor Suraksha Card’ and ‘Nirman Shramik Card’ are eligible for

availing the benefits of the scheme.

In view of the above, we recommend that:

• All health care providers should have clear understanding about the scheme objectives, intended

beneficiaries and its implementation procedure. It is suggested that these may be provided in the

form of bi-lingual written materials and flip-charts.

• Bi-annual trainings and refresher courses should be organised for the capacity building of the

health care service providers at all levels for enhanced awareness amongst the health service

providers. To minimize the risk of distortion and dilution of scheme guidelines, a combination of

training in series and parallel is desirable. Detailed scheme guidelines and further modifications

should be communicated to the service providers for proper and efficient functioning of the

scheme.

6.2 Institutional delivery mechanism of the scheme

6.2.1 Scheme Implementation

It was the general observation of the study team that MPHWs have a lot of workload and hence are

over-burdened. Lack of time and motivation amongst the grass-root level health officials (MPHWs)

hinders the smooth implementation and monitoring of the scheme.

There is no referral mechanism under the scheme wherein the patients could be referred from the

lower level health facilities (primary health care) to the tertiary health care facilities (CHC/civil

hospital to district hospital or medical college hospital). Hence, most health officials opined that if

such a process is adopted it would help in facilitating their admission to the higher level facility

without much hassels, as it would have the official consent of the health officials from the lower level.

As per the scheme guidelines, if the treatment amount exceeds Rs. 5000.00, then it requires approval

of a committee for continuing the treatment further. In this regard about one-third of the people

reportedly mentioned that they faced problem in continuing treatment after this limit. Hence, it was

suggested that this amount be increased or the process need to be simplified keeping in mind the type

of clientele (BPL and marganalised) the department is catering to.

In view of the above, we would recommend that:

• Passiveness amongst the health care service providers should be replaced by ‘pro-activeness’ and it

should be managed professionally. Rewards or incentives should be provided to the health service

providers for extraordinary performance as part of the scheme, the same way as in JSY scheme.

Regular review of the work load of the line department handling the scheme operations should be

undertaken.

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• Since the scheme does not provide any incentives for efficient performance, the service providers

do not feel inclined towards their duties. In this regard it is suggested that the department can make

suitable arrangements for recruiting manpower on contractual basis under the scheme.

• The scheme has been in place for about 4 years now and a review meeting (exclusively for this

scheme) for the same should be held at each district level. This discussion would help to pinpoint

the specific and generic problems at district and block levels. This review can also act as a

feedback loop, so that corrective steps are planned well in advance for easy implementation.

• Easy referral mechanism should be introduced under the scheme, so that patients do not face any

problems at the tertiary level health care facilities and minimise the time loss before admission.

Also, ambulance facility (if required) may be made available under the scheme.

• Presently the scheme does not have any specific procedure/criteria for budget allocation. The

districts should be given funds based on some specific criteria like utilisation rate, total BPL

population or the percentage of BPL population having family health cards. There is a need for

having proper and systematic procedure for allocating budget under different sub components of

the scheme, and the same should be monitored regularly.

• It has emerged from the study that in sample blocks/districts various key posts such as that of

pharmacist, lab technician, anaesthetist, store keeper etc. are lying vacant since long. These posts

can be filled and the key personnel can be recruited. In this regard the concerned department can

also explore opportunities like, pooling, on call, etc.

6.2.2 Management Information System (MIS)/Record keeping

Although block officials send the monthly progress reports to the district level authorities but the data

of previous years is not being managed properly, because though they have computers, but there are

no computer operators at block level. It is very important to maintain and update records relating to the

data on beneficiaries and the benefits availed, budget/finances and expenditures, facility wise records

of medicines given to the patients, local purchase made, laboratory/test facilities done through private

service providers etc.

In view of the above, we would recommend that:

• Appropriate MIS format exclusively for the scheme should be developed for maintenance of

records at the various levels. It should be mandatory for all the blocks to record the data in digital

format for easy access and retrieval.

• Similarly, the health facilities also should maintain the data in similar format, with details of the

patient, place of residence and type of disease for which treatment was availed and details of

medicines with their cost be maintained in soft copy for easy access. This process would facilitate

access to the type of clientele to whom the facility was provided, type of diseases for which

treatment was sought, and the amount spent on particular diseases, etc.

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• The reporting mechanism at present follows a bottom-up approach. The MIS format should also

follow the similar approach. The centralised database should be compiled at the state level, which

would have the detailed information of each village level benefited household and the benefits

availed, which should scale up to the state level. This would give an accurate snapshot of the type

of beneficiaries who have been benefited under the scheme and would enable tracking of the

benefited and non-benefited households through the health workers.

6.2.3 Behaviour of Service Providers

It has emerged from the study that at times the health care providers at various health facilities are not

concerned about providing treatment under the scheme, due to the hassles involved in the whole

system; such as the process of local purchase is very long, as well as tedious record keeping process.

Behaviour of the service provider, at times is very rude, and at times they are unwilling to hospitalise

the patients.

In view of the above conclusion, we would recommend that:

• Motivation of the health care officials should be enhanced through review meetings and grievance

redressal at regular intervals. They should also be provided some incentives for outstanding

performances or even monetary incentives can be explored, as in other schemes.

• Behaviour of health care officials towards the patients should be courteous, and this can be ensured

through regular redressal of their own grievances.

6.2.4 Fund Flow

Funds are provided annually by the state government and the average allocation per family has been

Rs. 1000 per annum. This allocation is for providing additional medicines that are not available

through the central drug procurement system. Thus, the service providers have the authority to spend

about 30% of the allocation on local purchase.

In view of the above conclusion, we would recommend that:

• The fund allocation should be made a bottom-up approach and the BMO should be provided some

independence on decision making regarding local purchase of drugs and consumables, so that there

is appropriate utilisation of available funds at the various levels.

6.2.5 Inclusion of OPD Facilities

People carry their health cards to the health facilities even for getting OPD facilities, particularly in

serious cases, wherein expensive treatments are required, like ARV for dog bites, knee replacements,

multiple/complicated fractures, etc.

In view of the above conclusion, we would recommend that:

• OPD facilities should be included as part of the scheme benefits, rather than in-patient facilities

alone.

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• Expensive treatments which do not require any admission should be provided as part of the OPD

facilities under the scheme - they may be defined based on a study of the disease pattern.

6.2.6 Inclusion of Transport Facility under the scheme

In absence of any transport facility under the scheme, the patients from far-off areas are apprehensive

to take the risk of travelling long distances to the health facilities for treatment, particularly on their

own expenses, where they did not have any acquaintances and relatives.

In view of the above conclusion, we would recommend that:

• There should be some provision of ambulatory facilities for the patients who are being sent to

tertiary care health facilities, as is being done in other health schemes. This will enable patients

from far-flung villages to avail treatment at the CHC, District hospitals, etc.

6.2.7 Improvement in the content of Health Card

During the interactions with the service providers it was observed that there were instances wherein

some patients used the cards of their neighbours/other family members/relatives etc. to avail the

scheme benefits.

Also, there are no proper written guidelines for the service providers regarding provision ARVs in

cases of animal bites (which is quite frequent in the rural areas/forests) under the scheme; field study

shows that the same was provided under the scheme in Sehore while in district Mandla it wasn’t

provided. In view of these, we would recommend that:

• The Health Cards should have photograph of all the family members to minimise misuse of the

card by the beneficiaries.

• The Health Card should mention the basic guidelines and the benefits that can be availed under the

scheme including the generic names of the illnesses, remedies that can be covered under the

scheme for better awareness of the service providers as well as the beneficiaries. This will also

allow the consistency of the service offerings under this scheme.

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Annex Annex Annex Annex 1111

Research ToolsResearch ToolsResearch ToolsResearch Tools

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Assessment of Deendayal Antodaya Upchar Yojana abc

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In Depth Interview Guide for the Study Titled “ASSESSMENT OF DEENDAYAL ANTODAYA UPCHAR YOJANA IN MADHYA

PRADESH”

Respondent – State Official (Joint Director, State Health Department)

INTRODUCTION

I work for Mott MacDonald Pvt. Ltd., a reputed international consultancy organisation. From time to time, we conduct evaluation and assessment studies on various social and development issues. Currently on behalf of Poverty Monitoring & Policy Support Unit – Madhya Pradesh, we are assessing the Deendayal Antodaya Upachar Yojana (DAUP) with a motive to suggest government the ways and means of improving the programme implementation especially the accessibility of health facilities to all sections of people living below poverty line. I shall be grateful to you if you can spare some of your time to answer a few questions. Let me assure you that the information given by you will be strictly kept confidential and used for research purpose.

Identification

Name of Official: ________________________ Designation: ____________________________ Date and Time of Interview: __________________________________

1: PROFILE OF THE RESPONDENT

1.1 Educational Qualification:______________________________

1.2 Years of Experience:________________________

1.3 Total Portfolio presently handling:______________________________

2: DAUP-INTRODUCTION AND COVERAGE 2.1 Could please tell us about the Scheme (in details), its launching year, target beneficiary and its

present geographically spread in the State? ----------------------------------------------------------------------------------------------------------------------------

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2.2 Please tell us about the process of selection of beneficiary for the scheme and who all are responsible for this selection?

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2.3 Please tell us about the funding pattern in this project, means whether it is totally supported by

State Government or partly shared by Central Government? IF it is shared than what is the ratio of share?

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Please provide us following Data (Latest list to be procured from the concerned official if

available)

• Complete guideline of the scheme and yearly progress report • List of BPL card holders • List of health scheme card holders • List of beneficiaries (at State/District/Block/Panchayat/village level) • Progress/annual/monthly reports of the scheme • Any other related data/documents

3: RESPONSIBILITY AND CAPASITY BUILDING

3.1 Please tell us about your roles, responsibilities in DAUP scheme and project related activities? ----------------------------------------------------------------------------------------------------------------------------

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3.2 Did you have been received any training or capacity building for carrying out the functions under the scheme? IF YES THEN Please provide details of training.

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4: IMPLEMENTATION, MANAGEMENT STRUCTURE AND COORDINATION

4.1 What is the mechanism for implementation of the scheme? ----------------------------------------------------------------------------------------------------------------------------

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4.2 What is the Management/Organizational structure for implementing, coordination and management of the scheme (beginning from State to Panchayat level)? (If possible kindly help us in drawing an flow diagram of the same)

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4.3 Please tell us about the service providers of the scheme and do the following play any role in this scheme? IF YES, THEN WHAT?

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Service Providers Roles

ANMs

ASHA

AWW

Any Other

4.4 Can the benefits of the scheme be availed along with other health schemes like JSY etc.? Are there any conflicts in this regard?

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4.5 What are the major diseases in the state for which treatment is generally provide? ----------------------------------------------------------------------------------------------------------------------------

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4.6 Please tell us about the type diseases/services which are covered and benefits that are provided for

each?

Benefits

Medicines Laboratory Surgery Other specify ---

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Diseases/services

Yes No Yes No Yes No Yes No

Delivery

Water borne diseases like jaundice

Dog bite, Snake bite

Any other diseases (Please Specify-------------------------------------------------------------)

(Tick the appropriate box)

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Assessment of Deendayal Antodaya Upchar Yojana abc

- 4 -

4.7 Could you please tell about the coordination and cooperation you receive from the higher officials of your department and what type of support they provide you and how do you rate the extent of coordination and cooperation among the officials?

----------------------------------------------------------------------------------------------------------------------------

----------------------------------------------------------------------------------------------------------------------------

----------------------------------------------------------------------------------------------------------------------------

4.8 Is Information education and communication is also your one of the activity? IF NO, THEN who is responsible for it and IF YES then how you create awareness regarding the scheme at the grass root level? (Collect IEC material if available)

----------------------------------------------------------------------------------------------------------------------------

----------------------------------------------------------------------------------------------------------------------------

----------------------------------------------------------------------------------------------------------------------------

----------------------------------------------------------------------------------------------------------------------------

5: MONITORING AND EVALUATION/MIS

5.1 Please tell us how the records for the beneficiary’s treatment history/medicine maintained on card

as well as in the records? What are all the registers you maintain? How often do you update these registers? PROBE AND GET LIST OF REGISTERS

----------------------------------------------------------------------------------------------------------------------------

----------------------------------------------------------------------------------------------------------------------------

----------------------------------------------------------------------------------------------------------------------------

5.2 What are all the reports you receive from lower levels? ASK ABOUT EACH REPORT. What is the frequency of receiving these reports?

----------------------------------------------------------------------------------------------------------------------------

----------------------------------------------------------------------------------------------------------------------------

----------------------------------------------------------------------------------------------------------------------------

5.3 What are all the reports you send to higher authorities? ASK ABOUT EACH REPORT. Whom do you send this report and what is the frequency of sending reports?

----------------------------------------------------------------------------------------------------------------------------

----------------------------------------------------------------------------------------------------------------------------

----------------------------------------------------------------------------------------------------------------------------

6: FINANCIAL MANAGEMENT OF THE SCHEME

6.1 Please tell us about the flow of fund in this project? (PROBE: How the fund reaches to the lowest level/hospital)?

----------------------------------------------------------------------------------------------------------------------------

----------------------------------------------------------------------------------------------------------------------------

----------------------------------------------------------------------------------------------------------------------------

6.2 How the distribution of yearly budge is being done for the project, whether it is district wise

budgeting or it is hospital wise budgeting? ----------------------------------------------------------------------------------------------------------------------------

----------------------------------------------------------------------------------------------------------------------------

----------------------------------------------------------------------------------------------------------------------------

Page 119: Final Report for Mott MacDonald - Government of …mpplanningcommission.gov.in/international-aided-projects/pmpsu... · Final Report for Mott MacDonald ... 1.3.2 Rogi Kalyan Samiti

Assessment of Deendayal Antodaya Upchar Yojana abc

- 5 -

6.3 How the account for the budget provided is being maintained, who is responsible for reporting the budget details and to whom?

----------------------------------------------------------------------------------------------------------------------------

----------------------------------------------------------------------------------------------------------------------------

----------------------------------------------------------------------------------------------------------------------------

6.4 What is the frequency of financial reporting is what the lowest and highest unit of reporting is? ----------------------------------------------------------------------------------------------------------------------------

----------------------------------------------------------------------------------------------------------------------------

----------------------------------------------------------------------------------------------------------------------------

6.5 Please provide us some details of forward and backward linkages for this scheme? (If possible kindly help us in drawing an organogram/flow diagram of the same)

----------------------------------------------------------------------------------------------------------------------------

----------------------------------------------------------------------------------------------------------------------------

----------------------------------------------------------------------------------------------------------------------------

7: PERCEPTION ON SCHEME ACHIEVEMENTS AND BEST PRACTICES

7.1 In your perception what is the benefits of the scheme? ----------------------------------------------------------------------------------------------------------------------------

----------------------------------------------------------------------------------------------------------------------------

----------------------------------------------------------------------------------------------------------------------------

7.2 Do you perceive any direct impact of the scheme for the following:

Benefits received by the society Particulars

Yes No

Access to free health care for the BPL households

Economic benefits-saving in terms of man/wage days saved due to health reasons

Change in standard of living of the beneficiaries

(Tick the appropriate box)

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Assessment of Deendayal Antodaya Upchar Yojana abc

- 6 -

7.3 Do you think there are some indirect impacts of the scheme like the money saved is being used productively in education, decreasing debt ness, as investment in occupation etc.?

----------------------------------------------------------------------------------------------------------------------------

----------------------------------------------------------------------------------------------------------------------------

----------------------------------------------------------------------------------------------------------------------------

7.4 Do you think the scheme been successful in meeting its objectives so far? IF YES THEN Please give some indicators to support your comment?

----------------------------------------------------------------------------------------------------------------------------

----------------------------------------------------------------------------------------------------------------------------

----------------------------------------------------------------------------------------------------------------------------

----------------------------------------------------------------------------------------------------------------------------

7.5 Please educate us about some Best Practices of the scheme that could be replicated/any case studies etc. PROBE

----------------------------------------------------------------------------------------------------------------------------

----------------------------------------------------------------------------------------------------------------------------

----------------------------------------------------------------------------------------------------------------------------

----------------------------------------------------------------------------------------------------------------------------

----------------------------------------------------------------------------------------------------------------------------

----------------------------------------------------------------------------------------------------------------------------

8: BOTTLENECKS OF SCHEME IMPLEMENTATION

8.1 Major problems faced while implementing the scheme/bottlenecks in effective delivery of the

scheme? PROBE for the problems faced in each and every step like: in organizational structure/ fund flow/monitoring/evaluation etc.

----------------------------------------------------------------------------------------------------------------------------

----------------------------------------------------------------------------------------------------------------------------

----------------------------------------------------------------------------------------------------------------------------

----------------------------------------------------------------------------------------------------------------------------

8.2 What are the major gaps in this scheme which could be filled? PROBE awareness about the scheme, , acceptance from villagers, counseling villagers to accept, services at the facility etc

----------------------------------------------------------------------------------------------------------------------------

----------------------------------------------------------------------------------------------------------------------------

----------------------------------------------------------------------------------------------------------------------------

----------------------------------------------------------------------------------------------------------------------------

----------------------------------------------------------------------------------------------------------------------------

----------------------------------------------------------------------------------------------------------------------------

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Assessment of Deendayal Antodaya Upchar Yojana abc

- 7 -

9:RECOMMENDATIONS/SUGGESSTIONS FOR FURTHER IMPROVEMENT

9.1 What do you suggest to ensure following better:

Activities Suggestions

Overall coordination

Service delivery

To ensure better coordination between health and other departments

To make the scheme more effective

For Overall improvement of the scheme:

• At community level ( more awareness)

• In implementation (at institutional level)

• At management level

Suggestions in terms of Budget allocation

Suggestions for resolving key issues/challenges and minimizing bottlenecks for effective delivery of the scheme

THANKS & CLOSE

Page 122: Final Report for Mott MacDonald - Government of …mpplanningcommission.gov.in/international-aided-projects/pmpsu... · Final Report for Mott MacDonald ... 1.3.2 Rogi Kalyan Samiti

Assessment of Deendayal Antodaya Upchar Yojana abc

- 1 -

In Depth Interview Guide for the Study Titled “ASSESSMENT OF DEENDAYAL ANTODYA UPCHAR YOJANA IN MADHYA

PRADESH”

Respondent – District Health Officials (CMHO / Civil Surgeon)

INTRODUCTION

I work for Mott MacDonald Pvt. Ltd., a reputed international consultancy organisation. From time to time, we conduct evaluation and assessment studies on various social and development issues. Currently on behalf of Poverty Monitoring & Policy Support Unit – Madhya Pradesh, we are assessing the Deendayal Antodaya Upachar Yojana (DAUP) with a motive to suggest government the ways and means of improving the programme implementation especially the accessibility of health facilities to all sections of people living below poverty line. I shall be grateful to you if you can spare some of your time to answer a few questions. Let me assure you that the information given by you will be strictly kept confidential and used for research purpose.

Identification

Name of Official: ________________________ Designation: ____________________________ Date and Time of Interview: __________________________________

1: PROFILE OF THE RESPONDENT

1.1 Educational Qualification:______________________________

1.2 Years of Experience as BMO:________________________

1.3 Could you Please tell us about your Job responsibilities:---------------------------------------------------

----------------------------------------------------------------------------------------------------------------------------

----------------------------------------------------------------------------------------------------------------------------

----------------------------------------------------------------------------------------------------------------------------

1.4 How much area is under your jurisdiction (Number of CHCs, villages, and population covered)?

----------------------------------------------------------------------------------------------------------------------------

----------------------------------------------------------------------------------------------------------------------------

----------------------------------------------------------------------------------------------------------------------------

2: DAUP-INTRODUCTION AND COVERAGE 2.1 Could please tell us about the Scheme, its launching year, target beneficiary and its present

geographically spread in the State (progress of scheme over various Blocks/Rural-Urban Variations)?

----------------------------------------------------------------------------------------------------------------------------

----------------------------------------------------------------------------------------------------------------------------

----------------------------------------------------------------------------------------------------------------------------

----------------------------------------------------------------------------------------------------------------------------

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Assessment of Deendayal Antodaya Upchar Yojana abc

- 2 -

2.2 Please tell us about the process of selection of beneficiary for the scheme and who all are responsible for this selection?

----------------------------------------------------------------------------------------------------------------------------

----------------------------------------------------------------------------------------------------------------------------

----------------------------------------------------------------------------------------------------------------------------

----------------------------------------------------------------------------------------------------------------------------

2.3 What is the process of issuing of health cards, who are eligible for getting cards and who is responsible for issuing it and how they are mobilised?

----------------------------------------------------------------------------------------------------------------------------

----------------------------------------------------------------------------------------------------------------------------

----------------------------------------------------------------------------------------------------------------------------

----------------------------------------------------------------------------------------------------------------------------

----------------------------------------------------------------------------------------------------------------------------

----------------------------------------------------------------------------------------------------------------------------

Data Availability

(Latest list to be procured from the concerned official if available)

• Village wise list of BPL card holders • Village wise list of health card holders • Village wise list of beneficiaries (at District/Block/Panchayat/Village level) • Progress/annual/monthly reports of the scheme • Any other related data/documents

3: HUMAN RESOURCE AND TRAINING

3.1 Please tell us about your roles, responsibilities in DAUP scheme and project related activities? ----------------------------------------------------------------------------------------------------------------------------

----------------------------------------------------------------------------------------------------------------------------

----------------------------------------------------------------------------------------------------------------------------

----------------------------------------------------------------------------------------------------------------------------

3.2 Did you have been received any training or capacity building for carrying out the functions under the scheme? IF YES THEN Please provide details of training.

----------------------------------------------------------------------------------------------------------------------------

----------------------------------------------------------------------------------------------------------------------------

----------------------------------------------------------------------------------------------------------------------------

3.3 Are the other service providers/facilitators (Multi Purpose Male and Female Health Workers) has given any training for the same? WAS the training was mandatory? IF YES PLEASE provide details

----------------------------------------------------------------------------------------------------------------------------

----------------------------------------------------------------------------------------------------------------------------

---------------------------------------------------------------------------------------------------------------------------

4: IMPLEMENTATION, MANAGEMENT STRUCTURE AND COORDINATION

4.1 What is the mechanism for implementation of the scheme? ----------------------------------------------------------------------------------------------------------------------------

----------------------------------------------------------------------------------------------------------------------------

----------------------------------------------------------------------------------------------------------------------------

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Assessment of Deendayal Antodaya Upchar Yojana abc

- 3 -

4.2 What is the Management/Organizational structure for implementing, coordination (block/panchayat and village level) and management of the scheme (beginning from State to Panchayat level)? (If possible kindly help us in drawing an ornogram/flow diagram of the same)

----------------------------------------------------------------------------------------------------------------------------

----------------------------------------------------------------------------------------------------------------------------

----------------------------------------------------------------------------------------------------------------------------

4.3 Please provide the process involved from initial stage till the card is issued and the procedure involved when a patient comes for treatment/ is referral required for admission in health facility Elaborate and show in detail in flow diagram

----------------------------------------------------------------------------------------------------------------------------

----------------------------------------------------------------------------------------------------------------------------

----------------------------------------------------------------------------------------------------------------------------

4.4 Please tell us about the service providers of the scheme and do the following are playing any role in this scheme IF YES THEN WHAT?

----------------------------------------------------------------------------------------------------------------------------

----------------------------------------------------------------------------------------------------------------------------

----------------------------------------------------------------------------------------------------------------------------

Service Providers Roles

ANMs

ASHA

AWW

Any Other

4.5 Can the benefits of the scheme be availed along with other health schemes like JSY etc.? Are there any conflicts in this regard?

----------------------------------------------------------------------------------------------------------------------------

----------------------------------------------------------------------------------------------------------------------------

----------------------------------------------------------------------------------------------------------------------------

4.6 Please tell us about the type diseases/services which are covered and benefits that are provided for each?

Benefits

Medicines Laboratory Surgery Others (Specify)

Diseases/services

Yes No Yes No Yes No Yes No

Delivery

Water borne diseases like jaundice

Dog bite, Snake bite

Any other diseases (Specify----------------------------------------------------------------------)

(Tick the appropriate box)

Page 125: Final Report for Mott MacDonald - Government of …mpplanningcommission.gov.in/international-aided-projects/pmpsu... · Final Report for Mott MacDonald ... 1.3.2 Rogi Kalyan Samiti

Assessment of Deendayal Antodaya Upchar Yojana abc

- 4 -

4.7 What are the major diseases of your area for which you provide treatment? ----------------------------------------------------------------------------------------------------------------------------

----------------------------------------------------------------------------------------------------------------------------

----------------------------------------------------------------------------------------------------------------------------

4.8 Could you please tell about the coordination and cooperation you receive from the higher officials of your department and what type of support they provide you and how do you rate the extent of coordination and cooperation among the officials?

----------------------------------------------------------------------------------------------------------------------------

----------------------------------------------------------------------------------------------------------------------------

----------------------------------------------------------------------------------------------------------------------------

4.9 Is Information education and communication is also your one of the activity? IF NO THEN who is responsible for it and IF YES then how you create awareness regarding the scheme at the grass root level? (Collect IEC material if available)

----------------------------------------------------------------------------------------------------------------------------

----------------------------------------------------------------------------------------------------------------------------

----------------------------------------------------------------------------------------------------------------------------

5: MONITORING AND EVALUATION/ MIS

5.1 Please tell us how the records for the beneficiary’s treatment history/medicine maintained on card

as well as in the records? What are all the registers you maintain? How often do you update these registers? PROBE AND GET LIST OF REGISTERS

----------------------------------------------------------------------------------------------------------------------------

----------------------------------------------------------------------------------------------------------------------------

----------------------------------------------------------------------------------------------------------------------------

5.2 What are all the reports you send to higher authorities (at the block/district level)? ASK ABOUT

EACH REPORT. Whom do you send this report and what is the frequency of sending reports? ----------------------------------------------------------------------------------------------------------------------------

----------------------------------------------------------------------------------------------------------------------------

----------------------------------------------------------------------------------------------------------------------------

5.3 Who analyses these reports? Do you get feedback on your reports submitted? What kind of feedback do you normally get? Can you give any specific examples please? PROBE

----------------------------------------------------------------------------------------------------------------------------

----------------------------------------------------------------------------------------------------------------------------

----------------------------------------------------------------------------------------------------------------------------

5.4 Has the concerned person received any training on maintenance of registers /reports? PROBE AND GET DETAILS

----------------------------------------------------------------------------------------------------------------------------

----------------------------------------------------------------------------------------------------------------------------

----------------------------------------------------------------------------------------------------------------------------

6: FUNDS FLOW

6.1 Please tell us about the flow of fund in this project? (PROBE: How the fund reaches to the lowest

level/hospital)? ----------------------------------------------------------------------------------------------------------------------------

----------------------------------------------------------------------------------------------------------------------------

----------------------------------------------------------------------------------------------------------------------------

Page 126: Final Report for Mott MacDonald - Government of …mpplanningcommission.gov.in/international-aided-projects/pmpsu... · Final Report for Mott MacDonald ... 1.3.2 Rogi Kalyan Samiti

Assessment of Deendayal Antodaya Upchar Yojana abc

- 5 -

6.2 How the distribution of yearly budget is being done for the project, whether it is district wise

budgeting or it is hospital wise budgeting or what is the criteria for budgeting? ----------------------------------------------------------------------------------------------------------------------------

----------------------------------------------------------------------------------------------------------------------------

----------------------------------------------------------------------------------------------------------------------------

6.3 How the account for the budget provided is being maintained, who is responsible for reporting the budget details and to whom?

----------------------------------------------------------------------------------------------------------------------------

----------------------------------------------------------------------------------------------------------------------------

----------------------------------------------------------------------------------------------------------------------------

6.4 What is the frequency of financial reporting is what the lowest and highest unit of reporting is? ----------------------------------------------------------------------------------------------------------------------------

----------------------------------------------------------------------------------------------------------------------------

----------------------------------------------------------------------------------------------------------------------------

6.5 Please provide us some details of forward and backward linkages for this scheme? (If possible

kindly help us in drawing an flow diagram of the same) ----------------------------------------------------------------------------------------------------------------------------

----------------------------------------------------------------------------------------------------------------------------

----------------------------------------------------------------------------------------------------------------------------

7: SCHEME ACHIEVEMENTS AND BEST PRACTICES

7.1 In your perception what is the benefits of the scheme? ----------------------------------------------------------------------------------------------------------------------------

----------------------------------------------------------------------------------------------------------------------------

----------------------------------------------------------------------------------------------------------------------------

7.2 Do you perceive any direct impact of the scheme for the following:

Benefits received by the society Particulars

Yes No

Access to free health care for the BPL households

Economic benefits-saving in terms of man/wage days saved due to health reasons

Change in standard of living of the beneficiaries

(Tick the appropriate box)

Page 127: Final Report for Mott MacDonald - Government of …mpplanningcommission.gov.in/international-aided-projects/pmpsu... · Final Report for Mott MacDonald ... 1.3.2 Rogi Kalyan Samiti

Assessment of Deendayal Antodaya Upchar Yojana abc

- 6 -

7.3 Do you think there are some indirect impacts of the scheme like the money saved is being used productively in education, decreasing debt ness, as investment in occupation etc.?

----------------------------------------------------------------------------------------------------------------------------

----------------------------------------------------------------------------------------------------------------------------

----------------------------------------------------------------------------------------------------------------------------

7.4 Do you think the scheme been successful in meeting its objectives so far? IF YES THEN Please give some indicators to support your comment?

----------------------------------------------------------------------------------------------------------------------------

----------------------------------------------------------------------------------------------------------------------------

----------------------------------------------------------------------------------------------------------------------------

7.5 Please provide us about some Pre and post scheme experiences/changes at the community level ----------------------------------------------------------------------------------------------------------------------------

----------------------------------------------------------------------------------------------------------------------------

----------------------------------------------------------------------------------------------------------------------------

7.6 Please educate us about some Best Practices of the scheme that could be replicated/any case studies etc. PROBE

----------------------------------------------------------------------------------------------------------------------------

----------------------------------------------------------------------------------------------------------------------------

----------------------------------------------------------------------------------------------------------------------------

8: KEY ISSUESS AND CHALLENGES IN SCHEME IMPLEMENTATION

8.1 Major problems faced while implementing the scheme/bottlenecks in effective delivery of the

scheme? PROBE for the problems faced in each and every step like: in organizational structure/ fund flow/monitoring/evaluation etc.

----------------------------------------------------------------------------------------------------------------------------

----------------------------------------------------------------------------------------------------------------------------

----------------------------------------------------------------------------------------------------------------------------

8.2 What are the major gaps in this scheme which could be filled? PROBE awareness about the scheme, acceptance from villagers, counseling villagers to accept, services at the facility etc

----------------------------------------------------------------------------------------------------------------------------

----------------------------------------------------------------------------------------------------------------------------

----------------------------------------------------------------------------------------------------------------------------

8.3 Could you please suggest any measures to minimize the misuse of health cards? ----------------------------------------------------------------------------------------------------------------------------

----------------------------------------------------------------------------------------------------------------------------

----------------------------------------------------------------------------------------------------------------------------

----------------------------------------------------------------------------------------------------------------------------

----------------------------------------------------------------------------------------------------------------------------

8.4 What efforts are made for ensuring that benefits are availed by the most eligible households? ----------------------------------------------------------------------------------------------------------------------------

----------------------------------------------------------------------------------------------------------------------------

----------------------------------------------------------------------------------------------------------------------------

----------------------------------------------------------------------------------------------------------------------------

----------------------------------------------------------------------------------------------------------------------------

Page 128: Final Report for Mott MacDonald - Government of …mpplanningcommission.gov.in/international-aided-projects/pmpsu... · Final Report for Mott MacDonald ... 1.3.2 Rogi Kalyan Samiti

Assessment of Deendayal Antodaya Upchar Yojana abc

- 7 -

9:RECOMMENDATIONS/SUGGESSTIONS FOR FURTHER IMPROVEMENT

9.1 What do you suggest to ensure following better:

Activities Suggestions

Overall coordination

Service delivery

To ensure better coordination between health and other departments

To make the scheme more effective

For Overall improvement of the scheme

• At community level ( more awareness)

• In implementation (at institutional level)

• At management level

Suggestions in terms of Budget allocation

Suggestions for resolving key issues/challenges and minimizing bottlenecks for effective delivery of the scheme

9.3 Suggestions for resolving key issues/challenges and minimizing bottlenecks for effective delivery

of the scheme at the community as well as at the institutional level? ----------------------------------------------------------------------------------------------------------------------------

----------------------------------------------------------------------------------------------------------------------------

----------------------------------------------------------------------------------------------------------------------------

----------------------------------------------------------------------------------------------------------------------------

----------------------------------------------------------------------------------------------------------------------------

THANK & CLOSE

Page 129: Final Report for Mott MacDonald - Government of …mpplanningcommission.gov.in/international-aided-projects/pmpsu... · Final Report for Mott MacDonald ... 1.3.2 Rogi Kalyan Samiti

Assessment of Deendayal Antodaya Upchar Yojana abc

- 1 -

In Depth Interview Guide for the Study Titled “ASSESSMENT OF DEENDAYAL ANTODYA UPCHAR YOJANA IN MADHYA

PRADESH”

Respondent – Block Medical Officer (BMO)

INTRODUCTION

I work for Mott MacDonald Pvt. Ltd., a reputed international consultancy organisation. From time to time, we conduct evaluation and assessment studies on various social and development issues. Currently on behalf of Poverty Monitoring & Policy Support Unit, we are assessing the Deendayal

Antodaya Upachar Yojana (DAUP) with a motive to suggest government the ways and means of improving the programme implementation especially the accessibility of health facilities to all sections of people living below poverty line. I shall be grateful to you if you can spare some of your time to answer a few questions. Let me assure you that the information given by you will be strictly kept confidential and used for research purpose.

Identification Name of District: __________________________

CMHO Name: _____________________________

Date and Time of Interview: ____________________________________

1: PROFILE OF THE RESPONDENT

1.1 Educational Qualification:______________________________

1.2 Years of Experience as BMO:________________________

1.3 Could you please tell us about your Job responsibilities:----------------------------------------------------

----------------------------------------------------------------------------------------------------------------------------

----------------------------------------------------------------------------------------------------------------------------

----------------------------------------------------------------------------------------------------------------------------

1.4 How much area is under your jurisdiction (Number of CHCs, villages, and population covered)

----------------------------------------------------------------------------------------------------------------------------

----------------------------------------------------------------------------------------------------------------------------

----------------------------------------------------------------------------------------------------------------------------

2: DAUP-INTRODUCTION AND COVERAGE

2.1 Could please tell us about the Scheme (in details), its launching year, target beneficiary and its present geographically spread in the State?

----------------------------------------------------------------------------------------------------------------------------

----------------------------------------------------------------------------------------------------------------------------

----------------------------------------------------------------------------------------------------------------------------

----------------------------------------------------------------------------------------------------------------------------

----------------------------------------------------------------------------------------------------------------------------

Page 130: Final Report for Mott MacDonald - Government of …mpplanningcommission.gov.in/international-aided-projects/pmpsu... · Final Report for Mott MacDonald ... 1.3.2 Rogi Kalyan Samiti

Assessment of Deendayal Antodaya Upchar Yojana abc

- 2 -

2.2 Please tell us about the process of selection of beneficiary for the scheme and who all are responsible for this selection?

----------------------------------------------------------------------------------------------------------------------------

----------------------------------------------------------------------------------------------------------------------------

----------------------------------------------------------------------------------------------------------------------------

2.3 What is the process of issuing of health cards, who are eligible for getting cards and who is responsible for issuing it and how they are mobilised?

----------------------------------------------------------------------------------------------------------------------------

----------------------------------------------------------------------------------------------------------------------------

----------------------------------------------------------------------------------------------------------------------------

----------------------------------------------------------------------------------------------------------------------------

----------------------------------------------------------------------------------------------------------------------------

----------------------------------------------------------------------------------------------------------------------------

Please provide us following Data (Latest list to be procured from the concerned official if

available)

• Complete guideline of the scheme and yearly progress report • List of BPL card holders • List of health scheme card holders • List of beneficiaries (at State/District/Block/Panchayat/village level) • Progress/annual/monthly reports of the scheme • Any other related data/documents

3: HUMAN RESOURCE AND TRAINING

3.1 Please tell us about your roles, responsibilities in DAUP scheme and project related activities? ----------------------------------------------------------------------------------------------------------------------------

----------------------------------------------------------------------------------------------------------------------------

----------------------------------------------------------------------------------------------------------------------------

3.2 Did you have been received any training or capacity building for carrying out the functions under the scheme? IF YES THEN Please provide details of training.

----------------------------------------------------------------------------------------------------------------------------

----------------------------------------------------------------------------------------------------------------------------

----------------------------------------------------------------------------------------------------------------------------

3.3 Are the other service providers/facilitators (Multi Purpose Male and Female Health Workers) has given any training for the same? WAS the training was mandatory? IF YES Please provide details.

----------------------------------------------------------------------------------------------------------------------------

----------------------------------------------------------------------------------------------------------------------------

---------------------------------------------------------------------------------------------------------------------------

4: IMPLEMENTATION, MANAGEMENT STRUCTURE AND COORDINATION 4.1 What is the mechanism for implementation of the scheme? ----------------------------------------------------------------------------------------------------------------------------

----------------------------------------------------------------------------------------------------------------------------

----------------------------------------------------------------------------------------------------------------------------

----------------------------------------------------------------------------------------------------------------------------

Page 131: Final Report for Mott MacDonald - Government of …mpplanningcommission.gov.in/international-aided-projects/pmpsu... · Final Report for Mott MacDonald ... 1.3.2 Rogi Kalyan Samiti

Assessment of Deendayal Antodaya Upchar Yojana abc

- 3 -

4.2 What is the Management/Organizational structure for implementing, coordination (block/panchayat and village level) and management of the scheme (beginning from State to Panchayat level)? (If possible kindly help us in drawing an ornogram/flow diagram of the same)

----------------------------------------------------------------------------------------------------------------------------

----------------------------------------------------------------------------------------------------------------------------

----------------------------------------------------------------------------------------------------------------------------

4.3 Please provide the process involved from initial stage till the card is issued and the procedure involved when a patient comes for treatment/ is referral required for admission in health facility Elaborate and show in detail in flow diagram

----------------------------------------------------------------------------------------------------------------------------

----------------------------------------------------------------------------------------------------------------------------

----------------------------------------------------------------------------------------------------------------------------

4.4 Please tell us about the service providers of the scheme and do the following are playing any role in this scheme IF YES THEN WHAT?

----------------------------------------------------------------------------------------------------------------------------

----------------------------------------------------------------------------------------------------------------------------

----------------------------------------------------------------------------------------------------------------------------

Service Providers Roles

ANMs

ASHA

AWW

Any Other

4.5 Can the benefits of the scheme be availed along with other health schemes like JSY etc.? Are there any conflicts in this regard?

----------------------------------------------------------------------------------------------------------------------------

----------------------------------------------------------------------------------------------------------------------------

----------------------------------------------------------------------------------------------------------------------------

4.6 Please tell us about the type diseases/services which are covered and benefits that are provided for

each?

Benefits

Medicines Laboratory Surgery Other specify

Diseases/services

Yes No Yes No Yes No Yes No

Delivery

Water borne diseases like jaundice

Dog bite, Snake bite

Any other diseases (Specify----------------------------------------------------------------------)

(Tick the appropriate box)

Page 132: Final Report for Mott MacDonald - Government of …mpplanningcommission.gov.in/international-aided-projects/pmpsu... · Final Report for Mott MacDonald ... 1.3.2 Rogi Kalyan Samiti

Assessment of Deendayal Antodaya Upchar Yojana abc

- 4 -

4.7 What are the major diseases of your area for which you provide treatment? ----------------------------------------------------------------------------------------------------------------------------

----------------------------------------------------------------------------------------------------------------------------

----------------------------------------------------------------------------------------------------------------------------

4.8 Could you please tell about the coordination and cooperation you receive from the higher officials of your department and what type of support they provide you and how do you rate the extent of coordination and cooperation among the officials?

----------------------------------------------------------------------------------------------------------------------------

----------------------------------------------------------------------------------------------------------------------------

----------------------------------------------------------------------------------------------------------------------------

----------------------------------------------------------------------------------------------------------------------------

4.9 Is Information education and communication is also your one of the activity? IF NO THEN who is responsible for it and IF YES then how you create awareness regarding the scheme at the grass root level? (Collect IEC material if available)

----------------------------------------------------------------------------------------------------------------------------

----------------------------------------------------------------------------------------------------------------------------

----------------------------------------------------------------------------------------------------------------------------

5: MONITORING AND EVALUATION/ MIS

5.1 Please tell us how the records for the beneficiary’s treatment history/medicine maintained on card

as well as in the records? What are all the registers you maintain? How often do you update these registers? PROBE AND GET LIST OF REGISTERS

----------------------------------------------------------------------------------------------------------------------------

----------------------------------------------------------------------------------------------------------------------------

----------------------------------------------------------------------------------------------------------------------------

----------------------------------------------------------------------------------------------------------------------------

5.2 What are all the reports you send to higher authorities (at the block/district level)? ASK ABOUT

EACH REPORT. Whom do you send this report and what is the frequency of sending reports? ----------------------------------------------------------------------------------------------------------------------------

----------------------------------------------------------------------------------------------------------------------------

----------------------------------------------------------------------------------------------------------------------------

----------------------------------------------------------------------------------------------------------------------------

----------------------------------------------------------------------------------------------------------------------------

5.3 Who analyses these reports? Do you get feedback on your reports submitted? What kind of feedback do you normally get? Can you give any specific examples please? PROBE

----------------------------------------------------------------------------------------------------------------------------

----------------------------------------------------------------------------------------------------------------------------

----------------------------------------------------------------------------------------------------------------------------

----------------------------------------------------------------------------------------------------------------------------

----------------------------------------------------------------------------------------------------------------------------

5.4 Has the concerned person received any training on maintenance of registers/reports? PROBE AND GET DETAILS

----------------------------------------------------------------------------------------------------------------------------

----------------------------------------------------------------------------------------------------------------------------

----------------------------------------------------------------------------------------------------------------------------

----------------------------------------------------------------------------------------------------------------------------

Page 133: Final Report for Mott MacDonald - Government of …mpplanningcommission.gov.in/international-aided-projects/pmpsu... · Final Report for Mott MacDonald ... 1.3.2 Rogi Kalyan Samiti

Assessment of Deendayal Antodaya Upchar Yojana abc

- 5 -

6: FUNDS FLOW

6.1 Please tell us about the flow of fund in this project? (PROBE: How the fund reaches to the lowest

level/hospital)? ----------------------------------------------------------------------------------------------------------------------------

----------------------------------------------------------------------------------------------------------------------------

----------------------------------------------------------------------------------------------------------------------------

----------------------------------------------------------------------------------------------------------------------------

6.2 How the distribution of yearly budget is being done for the project, whether it is district wise budgeting or it is hospital wise budgeting or what is the criteria for budgeting?

----------------------------------------------------------------------------------------------------------------------------

----------------------------------------------------------------------------------------------------------------------------

----------------------------------------------------------------------------------------------------------------------------

----------------------------------------------------------------------------------------------------------------------------

----------------------------------------------------------------------------------------------------------------------------

6.3 How the account for the budget provided is being maintained, who is responsible for reporting the budget details and to whom?

----------------------------------------------------------------------------------------------------------------------------

----------------------------------------------------------------------------------------------------------------------------

----------------------------------------------------------------------------------------------------------------------------

----------------------------------------------------------------------------------------------------------------------------

6.4 What is the frequency of financial reporting is what the lowest and highest unit of reporting is? ----------------------------------------------------------------------------------------------------------------------------

----------------------------------------------------------------------------------------------------------------------------

----------------------------------------------------------------------------------------------------------------------------

6.5 Please provide us some details of forward and backward linkages for this scheme? (If possible kindly help us in drawing an flow diagram of the same)

----------------------------------------------------------------------------------------------------------------------------

----------------------------------------------------------------------------------------------------------------------------

----------------------------------------------------------------------------------------------------------------------------

----------------------------------------------------------------------------------------------------------------------------

----------------------------------------------------------------------------------------------------------------------------

Page 134: Final Report for Mott MacDonald - Government of …mpplanningcommission.gov.in/international-aided-projects/pmpsu... · Final Report for Mott MacDonald ... 1.3.2 Rogi Kalyan Samiti

Assessment of Deendayal Antodaya Upchar Yojana abc

- 6 -

7.1 In your perception what are the benefits of the scheme? ----------------------------------------------------------------------------------------------------------------------------

----------------------------------------------------------------------------------------------------------------------------

----------------------------------------------------------------------------------------------------------------------------

----------------------------------------------------------------------------------------------------------------------------

7.2 Do you perceive any direct impact of the scheme for the following:

Benefits received by the society Particulars

Yes No

Access to free health care for the BPL households

Economic benefits-saving in terms of man/wage days saved due to health reasons

Change in standard of living of the beneficiaries

(Tick the appropriate box) 7.3 Do you think there are some indirect impacts of the scheme like the money saved is being used

productively in education, decreasing debt ness, as investment in occupation etc.? ----------------------------------------------------------------------------------------------------------------------------

----------------------------------------------------------------------------------------------------------------------------

----------------------------------------------------------------------------------------------------------------------------

----------------------------------------------------------------------------------------------------------------------------

----------------------------------------------------------------------------------------------------------------------------

7.4 Do you think the scheme been successful in meeting its objectives so far? IF YES THEN Please give some indicators to support your comment?

----------------------------------------------------------------------------------------------------------------------------

----------------------------------------------------------------------------------------------------------------------------

----------------------------------------------------------------------------------------------------------------------------

7.5 Please provide us about some pre and post scheme experiences/changes at the community level. ----------------------------------------------------------------------------------------------------------------------------

----------------------------------------------------------------------------------------------------------------------------

----------------------------------------------------------------------------------------------------------------------------

----------------------------------------------------------------------------------------------------------------------------

----------------------------------------------------------------------------------------------------------------------------

7.6 Please educate us about some Best Practices of the scheme that could be replicated/any case studies etc. PROBE

----------------------------------------------------------------------------------------------------------------------------

----------------------------------------------------------------------------------------------------------------------------

----------------------------------------------------------------------------------------------------------------------------

----------------------------------------------------------------------------------------------------------------------------

----------------------------------------------------------------------------------------------------------------------------

----------------------------------------------------------------------------------------------------------------------------

----------------------------------------------------------------------------------------------------------------------------

7: SCHEME ACHIEVEMENTS AND BEST PRACTICES

Page 135: Final Report for Mott MacDonald - Government of …mpplanningcommission.gov.in/international-aided-projects/pmpsu... · Final Report for Mott MacDonald ... 1.3.2 Rogi Kalyan Samiti

Assessment of Deendayal Antodaya Upchar Yojana abc

- 7 -

8: KEY ISSUESS AND CHALLENGES IN SCHEME IMPLEMENTATION

8.1 Major problems faced while implementing the scheme/bottlenecks in effective delivery of the

scheme? PROBE for the problems faced in each and every step like: in organizational structure/ fund flow/monitoring/evaluation etc.

----------------------------------------------------------------------------------------------------------------------------

----------------------------------------------------------------------------------------------------------------------------

----------------------------------------------------------------------------------------------------------------------------

----------------------------------------------------------------------------------------------------------------------------

----------------------------------------------------------------------------------------------------------------------------

----------------------------------------------------------------------------------------------------------------------------

----------------------------------------------------------------------------------------------------------------------------

8.2 What are the major gaps in this scheme which could be filled? PROBE awareness about the scheme, acceptance from villagers, counseling villagers to accept, services at the facility etc

----------------------------------------------------------------------------------------------------------------------------

----------------------------------------------------------------------------------------------------------------------------

----------------------------------------------------------------------------------------------------------------------------

----------------------------------------------------------------------------------------------------------------------------

----------------------------------------------------------------------------------------------------------------------------

8.3 Could you please suggest any measures to minimize the misuse of health cards? ----------------------------------------------------------------------------------------------------------------------------

----------------------------------------------------------------------------------------------------------------------------

----------------------------------------------------------------------------------------------------------------------------

----------------------------------------------------------------------------------------------------------------------------

----------------------------------------------------------------------------------------------------------------------------

----------------------------------------------------------------------------------------------------------------------------

----------------------------------------------------------------------------------------------------------------------------

8.4 What efforts are made for ensuring that benefits are availed by the most eligible households? ----------------------------------------------------------------------------------------------------------------------------

----------------------------------------------------------------------------------------------------------------------------

----------------------------------------------------------------------------------------------------------------------------

----------------------------------------------------------------------------------------------------------------------------

----------------------------------------------------------------------------------------------------------------------------

----------------------------------------------------------------------------------------------------------------------------

----------------------------------------------------------------------------------------------------------------------------

Page 136: Final Report for Mott MacDonald - Government of …mpplanningcommission.gov.in/international-aided-projects/pmpsu... · Final Report for Mott MacDonald ... 1.3.2 Rogi Kalyan Samiti

Assessment of Deendayal Antodaya Upchar Yojana abc

- 8 -

9:RECOMMENDATIONS/SUGGESSTIONS FOR FURTHER IMPROVEMENT

9.1 What do you suggest to ensure following better: Activities Suggestions

Overall coordination

Service delivery

To ensure better coordination between health and other departments

To make the scheme more effective

For Overall improvement of the scheme:

• At community level ( more awareness)

• In implementation (at institutional level)

• At management level

Suggestions in terms of Budget allocation

Suggestions for resolving key issues/challenges and minimizing bottlenecks for effective delivery of the scheme

9.3 Suggestions for resolving key issues/challenges and minimizing bottlenecks for effective delivery

of the scheme at the community as well as at the institutional level? ----------------------------------------------------------------------------------------------------------------------------

----------------------------------------------------------------------------------------------------------------------------

----------------------------------------------------------------------------------------------------------------------------

----------------------------------------------------------------------------------------------------------------------------

----------------------------------------------------------------------------------------------------------------------------

THANK & CLOSE

Page 137: Final Report for Mott MacDonald - Government of …mpplanningcommission.gov.in/international-aided-projects/pmpsu... · Final Report for Mott MacDonald ... 1.3.2 Rogi Kalyan Samiti

Assessment of Deendayal Antodaya Upchar Yojana abc

- 1 -

In Depth Interview Guide for the Study Titled “ASSESSMENT OF DEENDAYAL ANTODAYA UPCHAR YOJANA IN MADHYA

PRADESH”

Respondent – Medical Officer - CHC

INTRODUCTION

I work for Mott MacDonald Pvt. Ltd., a reputed international consultancy organisation. From time to time, we conduct evaluation and assessment studies on various social and development issues. Currently on behalf of Poverty Monitoring & Policy Support Unit – Madhya Pradesh, we are assessing the Deendayal Antodaya Upachar Yojana (DAUP) with a motive to suggest government the ways and means of improving the programme implementation especially the accessibility of health facilities to all sections of people living below poverty line. I shall be grateful to you if you can spare some of your time to answer a few questions. Let me assure you that the information given by you will be strictly kept confidential and used for research purpose.

Identification

Name of Official: ________________________ Designation: ____________________________ Date and Time of Interview: __________________________________

1: PROFILE OF THE RESPONDENT

1.1 Educational Qualification:______________________________

1.2 Years of Experience:________________________

2: DAUP-INTRODUCTION AND COVERAGE

2.1 Could please tell us about the Scheme (in details), its launching year, target beneficiary and its present geographically spread in the State?

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2.2 Please tell us about the process of selection of beneficiary for the scheme and who all are responsible for this selection?

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2.3 Please tell us about the funding pattern in this project, means whether it is totally supported by State Government or partly shared by Central Government? IF it is shared than what is the ratio of share?

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2.4 What is the process of issuing of health cards, who are eligible for getting cards and who is responsible for issuing it?

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Data Availability

(Latest list to be procured from the concerned official (MO)

� Village wise list of BPL card holders � Village wise list of health card holders � Village wise list of beneficiaries (at CHC/PHC/Panchayat/Village level) � Progress/annual/monthly reports of the scheme sent to the district � Any other related data/documents

3: HUMAN RESOURCE AND TRAINING

3.1 Please tell us about your roles, responsibilities in DAUP scheme and project related activities? ----------------------------------------------------------------------------------------------------------------------------

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3.2 Did you have been received any training or capacity building for carrying out the functions under the scheme? IF YES THEN Please provide details of training.

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3.3 Are the other service providers/facilitators (Multi Purpose Male and Female Health Workers) has given any training for the same? WAS the training was mandatory? IF YES PLEASE provide details

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4: IMPLEMENTATION, MANAGEMENT STRUCTURE AND COORDINATION

4.1 What is the mechanism for implementation of the scheme? ----------------------------------------------------------------------------------------------------------------------------

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4.2 What is the Management/Organizational structure for implementing, coordination (block/panchayat and village level) and management of the scheme (beginning from State to Panchayat level)? (If possible kindly help us in drawing an flow diagram of the same)

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4.3 Please provide the process involved from initial stage till the card is issued and the procedure involved when a patient comes for treatment/ is referral required for admission in health facility Elaborate and show in detail in flow diagram

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4.4 Please tell us about the service providers of the scheme and do the following are playing any role in this scheme IF YES THEN WHAT?

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Service Providers Roles

ANMs

ASHA

AWW

Any Other

4.5 Can the benefits of the scheme be availed along with other health schemes like JSY etc.? Are there

any conflicts in this regard? ----------------------------------------------------------------------------------------------------------------------------

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4.6 Please tell us about the type diseases/services which are covered and benefits that are provided for each?

Benefits

Medicines Laboratory Surgery Other (specify)

Diseases/services

Yes No Yes No Yes No Yes No

Delivery

Water borne diseases like jaundice

Dog bite, Snake bite

Any other diseases (Specify----------------------------------------------------------------------)

(Tick the appropriate box)

4.7 What are the major diseases of your area for which you provide treatment? ----------------------------------------------------------------------------------------------------------------------------

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4.8 Could you please tell about the coordination and cooperation you receive from the higher officials of your department and what type of support they provide you and how do you rate the extent of coordination and cooperation among the officials?

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4.9 Is Information education and communication is also your one of the activity? IF NO THEN who is responsible for it and IF YES then how you create awareness regarding the scheme at the grass root level? (Collect IEC material if available)

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5: MONITORING AND EVALUATION/ MIS

5.1 Please tell us how the records for the beneficiary’s treatment history/medicine maintained on card

as well as in the records? What are all the registers you maintain? How often do you update these registers? PROBE AND GET LIST OF REGISTERS

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5.2 What are all the reports you send to higher authorities (at the block/district level)? ASK ABOUT

EACH REPORT. Whom do you send this report and what is the frequency of sending reports? ----------------------------------------------------------------------------------------------------------------------------

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5.3 Who analyses these reports? Do you get feedback on your reports submitted? What kind of feedback do you normally get? Can you give any specific examples please? PROBE

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5.4 Has the concerned person received any training on maintenance of registers /reports? PROBE AND GET DETAILS

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6: FUNDS FLOW

6.1 Please tell us about the flow of fund in this project? (PROBE: How the fund reaches to the lowest

level/hospital)? ----------------------------------------------------------------------------------------------------------------------------

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6.2 How the distribution of yearly budge is being done for the project, whether it is district wise budgeting or it is hospital wise budgeting?

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6.3 How the account for the budget provided is being maintained, who is responsible for reporting the budget details and to whom?

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6.4 What is the frequency of financial reporting is what the lowest and highest unit of reporting is? ----------------------------------------------------------------------------------------------------------------------------

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6.5 Please provide us some details of forward and backward linkages for this scheme? (If possible kindly help us in drawing an organogram/flow diagram of the same)

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7.1 In your perception what are the benefits of the scheme? ----------------------------------------------------------------------------------------------------------------------------

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7.2 Do you perceive any direct impact of the scheme for the following:

Benefits received by the society Particulars

Yes No

Access to free health care for the BPL households

Economic benefits-saving in terms of man/wage days saved due to health reasons

Change in standard of living of the beneficiaries

(Tick the appropriate box) 7.3 Do you think there are some indirect impacts of the scheme like the money saved is being used

productively in education, decreasing debt ness, as investment in occupation etc.? ----------------------------------------------------------------------------------------------------------------------------

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7.4 Do you think the scheme been successful in meeting its objectives so far? IF YES THEN Please give some indicators to support your comment?

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7.5 Please educate us about some Best Practices of the scheme that could be replicated/any case studies etc. PROBE

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7: SCHEME ACHIEVEMENTS AND BEST PRACTICES

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8: KEY ISSUESS AND CHALLENGES IN SCHEME IMPLEMENTATION

8.1 Major problems faced while implementing the scheme/bottlenecks in effective delivery of the

scheme? PROBE for the problems faced in each and every step like: in organizational structure/ fund flow/monitoring/evaluation etc.

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8.2 What are the major gaps in this scheme which could be filled? PROBE awareness about the scheme, acceptance from villagers, counseling villagers to accept, services at the facility etc

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9:RECOMMENDATIONS/SUGGESSTIONS FOR FURTHER IMPROVEMENT

9.1 What do you suggest to ensure following better:

Activities Suggestions

Overall coordination

Service delivery

To ensure better coordination between health and other departments

To make the scheme more effective

For Overall improvement of the scheme

• At community level ( more awareness)

• In implementation (at institutional level)

• At management level

Suggestions in terms of Budget allocation

Suggestions for resolving key issues/challenges and minimizing bottlenecks for effective delivery of the scheme

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9.3 Could you please suggest any measures to minimize the misuse of health cards? ----------------------------------------------------------------------------------------------------------------------------

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9.4 What efforts are made for ensuring that benefits are availed by the most eligible households? ----------------------------------------------------------------------------------------------------------------------------

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9.5 Suggestions for resolving key issues/challenges and minimizing bottlenecks for effective delivery

of the scheme at the community as well as at the institutional level? ----------------------------------------------------------------------------------------------------------------------------

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THANKS & CLOSE

Page 145: Final Report for Mott MacDonald - Government of …mpplanningcommission.gov.in/international-aided-projects/pmpsu... · Final Report for Mott MacDonald ... 1.3.2 Rogi Kalyan Samiti

DEEN DAYAL ANTODAYA UPCHAR YOJANAVILLAGE / TOWN QUESTIONNAIRE ¼xzke@dLck iz'ukoyh½

NAME OF THE DISTRICT :¼tuin dk uke½ %

TEHSIL/COMMUNITY DEVELOPMENT BLOCK¼rglhy@lkeqnkf;d fodkl [kaM ½

PSU ___________________________ Village-1 /Town-2

¼xzke&1@dLck&2½

Name of Village/Town ¼xzke@dLck dk uke½ (Record Census Code also in the box)

¼tux.kuk dkssM vfHkys[k ds vuqlkj ckD¡l esa fy[ksa ½ PARTICIPANTS’ NAME

1 Village Pradhan ¼xzke ç/kku½

2 Anyother Elected Member ¼vU; dksbZ fuokZfpr lnL;½

3 Teacher ¼v/;kid½

4 Any Other (Pl.Specify) dksbZ vU; ¼—I;k fy[ksa½

5 List of villagers attended the Meeting ¼ehfVax esa mifLFkr xzkeokfl;ksa dh lwph½

1- 5- 9-

2- 6- 10-

3- 7- 11-

4- 8- 12-

Q.1 Village/Town Profile¼xzke ;k dLck dk fooj.k½ (Record as told by the respondents and verify from records if available)

1 Number of Households in the Village/Town

¼xzke@dLck esa dqy ifjokjkas dh la[;k½

2 Number of SC Households ¼vuqlwfpr tkfr ds ifjokjksa dh la[;k½

3 Number of ST Households ¼vuqlwfpr tutkfr ds ifjokjksa dh la[;k½

4 Number of HHs from Primitive tribes ¼tutkfr ds ifjokjksa dh la[;k½+

5 Number of OBC Households ¼vU; fiNM+k oxZ ds ifjokjksa dh la[;k½

6 Number of Other Households ¼vU; ifjokjkas dh la[;k½

7 Number of BPL Households ¼xjhch js[kk ls uhps ds ifjokjksa dh la[;k½+

8 Number of APL Households ¼xjhch js[kk ls mij ds ifjokjksa dh la[;k½+

9 Number of HHs having Mukhya Mantri Majdoor Suraksha Cards

¼eq[;ea=h etnwj lqj{kk dkMZ /kkjd ds ifjokjksa dh la[;k½+

10 Number of HHs having Nirman Shramik Cards

¼fuekZ.k Jfed dkMZ ds ifjokjksa dh la[;k½+

11 Number of HHs having (DAUP) Scheme Health Cards

¼nhun;ky mik/;k; ;kstuk ds vUrxZr dkMZ /kkjdksa ds ifjokjksa dh la[;k½+

12 Number of Scheme Beneficiaries ¼;kstuk ds vUrxZr ykHkFkhZ@fgrxzgh dh la[;k½s

Please Specify ¼—I;k Li"V djsa½

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DEEN DAYAL ANTODAYA UPCHAR YOJANAVILLAGE / TOWN QUESTIONNAIRE ¼xzke@dLck iz'ukoyh½

Q.2 Health Statistics- ¼LOkkLF; lkaf[;dhaa½ (Give Numbers)

1 Maternity Mortality Rate ¼tuuh e`R;q nj½ Number

2 Infant Mortality rate ¼uotkr e`R;q nj½ Number

3 Proportion of Institutional Delivery ¼lkaLFkkfud çlo dk va'k½ (in Percent)

4 Any Other ¼vU; dksbZ½

Q.31 Distance to nearest town (in Km) ¼utnhd dLcs dh nwjh½ ___________

(Not Applicable for Towns) ¼dLcksa ds fy, ugha½

2 Distance to district head quarter (in Km) ¼xzke@'kgj dh tuin eq[;ky; ls nwjh½ _____________

Q.4 Distance to nearest ¼utnhdh nwjh½ BUS STATION ¼cl LVs'ku½ _______________Km

RAILWAY STATION ¼jsyos LVs'ku½__________Km

POST OFFICE ¼Mkd ?kj½__________________Km

BANK ¼cSad½____________________________Km

Q.5 Whether village/town is connected by all-weather road to other places¼D;k fdlh vU; LFkku ij tkus ds fy, vkids xkao@dLcs esa lHkh ekSle esa mi;qDr lM+d ls laca/k gS½ Yes 1 No. 2(Not Applicable for towns) ¼dLcksa ds fy, ugha½

Q.6 Main Source of Drinking water for the local Community

¼LFkkuh; leqnk; esa ikuh dk eq[; lzksr½(Multiple choice possible) Well ¼dqvka½………………………. 1

Handpump ¼uy½…………………… 2

(Circle all possible options) 3

Pond/Lake ¼rkykc@>hy½……………………… 4

River ¼unh½……………………………. 5

Tap/Govt. Supply VksVh@ljdkjh iwrhZ …………… 6

Any Other (Pl. Specify) dksbZ vU; ¼—I;k Li"V fy[ksa½ 7

Q.7 Availability of Education facilities ¼f’k{kk ds fy, miyC/k lqfo/kk,a½

(Within village/ Whether Accessible Record Distancetown or not) throughout the Year from main habitation¼dLck@xzke ds vUnj ¼lHkh ekSle esa mi;qDr½ ¼—I;k eq[; vkcknh lsgS vFkok ugha½ nwjh fy[ksa ½

Yes No Yes No

1. Primary School ¼çkFkfed fo/kky;½ 1 2 1 2 ______ ….kms

2 Middle School ¼mPp çkFkfed fo/kky;½ 1 2 1 2 ______ ….kms

3 Secondary School ¼ek/;fed fo/kky;½ 1 2 1 2 ______ ….kms

4 Higher. Sec. School ¼mPp ek/;fed fo/kky;½ 1 2 1 2 ______ ….kms

5 College ¼dkWyst½ 1 2 1 2 ______ ….kms

6 Madarsa ¼enjlk½ 1 2 1 2 ______ ….kms

7 Any other scheme(as Guruji Scheme)dksbZ vU; ;kstuk ¼tSls xq: ;kstuk½ 1 2 1 2 ______ ….kms

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DEEN DAYAL ANTODAYA UPCHAR YOJANAVILLAGE / TOWN QUESTIONNAIRE ¼xzke@dLck iz'ukoyh½

Q.8 Availability of Health Facilities ¼LokLF; ds fy, miyC/k lqfo/kk,a½

(Within village/ Whether Accessibletown or not) throughout the Year¼dLck@xzke ds vUnj ¼lHkh ekSle esa mi;qDr½gS vFkok ugh½

Yes No Yes No (Distance from main habitation/Tola)

1 ICDS/Anganwadi ¼vakxu okM+h½ 1 2 1 2 ______ ….kms

2 Sub Center ¼mi dsaUnz½ 1 2 1 2 ______ ….kms

3 PHC ¼çkFkfed LokLF; dsUnz½ 1 2 1 2 ______ ….kms

4 CHC / Referal Hospital¼lkeqnkf;d LokLF; dsanz@lanfHkZr vLirky½ 1 2 1 2 ______ ….kms

5 Govt. Dispensary ¼ljdkjh nok[kkuk½ 1 2 1 2 ______ ….kms

6 Govt. Hospital ¼ljdkjh vLirky½ 1 2 1 2 ______ ….kms

7 Private Clinic ¼futh Dyhfud½ 1 2 1 2 ______ ….kms

8 Private Hospital ¼futh vLirky½ 1 2 1 2 ______ ….kms

9 AYUSH Health Faciltyvk;qosZfnd LokLF; lqfo/kk dsanz 1 2 1 2 ______ ….kms

10 Chemist Shop ¼nokbZ dh nqdku½ 1 2 1 2

Q.9 1. Whether 24 X 7 PHC available in the village/town¼D;k vkids xkao@dLcs esa 24 x 7 çkFkfed LokLF; dsanz gS½

2. If not in the village/town then Distance in kms ¼;fn ugh rks vkids xkao@dLcs ls nwjh½……

3. Do not Know ¼ugha tkurk½

Q.10 Any other Health Services available to the community ¼D;k vkids xkao esa fuEu LokLF; lsok,a miyC/k gaS½

1. Moblie Van ¼lpy fpfdRlk okgu½

2. NGOs Providing basic health facilities ¼xSj ljdkjh laLFkkvksa }kjk çkFkfed LokLF; lqfo/kk dk feyuk½

3. Health Camps Organised ¼LokLF; dSai dh O;oLFkk½

4. Vaccination day Organised in the Village ¼xkao ds vUnj Vhdkdj.k fnol@O;oLFkk½

5. Any other Facility like eye camps etc. ¼vU; lqfo/kk,a tSls vkbZ dSEi vkfn½

Please Specify ¼Li"V dhft,½ _____________

Q.11 Health provider in the village ¼vkids xkao esa LokLF; çnkrk gS½Number Resident Visiting 1

1 Private Doctor ¼futh fpfdRld½ 1 2

2 Visiting Doctor ¼vkxarqd fpfdRld½ 1 2

3 ANM ¼ulZ½ 1 2

4 Trained Dai ¼çf'kf{kr nkbZ½ 1 2

5 Untrained Dai ¼vçf'kf{kr nkbZ½ 1 2

6 ASHA-Sahyogini ¼vk'kk&lg;ksxuhZ½ 1 2

7 RMP ¼jftLVMZ fpfdRld½ 1 2

8 Traditional Practioners ¼O;ogkfjd fpfdRld½ 1 2

If any other Facility please Specify ¼;fn dksbZ vU; lqfo/kk gks rks —I;k fy[ksa½ _____(Not Applicable for Towns) ¼dLcksa ds fy, ugha½

Yes No

1 2

77

If Yesgo to Q. 8

Kms

Yes No

1 2

1 2

1 2

1 2

1 2

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DEEN DAYAL ANTODAYA UPCHAR YOJANAVILLAGE / TOWN QUESTIONNAIRE ¼xzke@dLck iz'ukoyh½

Q.12 Where do the women usually go for the delivery ?vkerkSj ij efgyk,sa çLo ds fy, dgka tkrh gSa Home Delivery ¼?kj esa çlo½………...…........………….….1

(Circle all possible Answers) District Hospital ¼ftyk vLirky½……...…………........…...2

Private Hospital/Clinic ¼futh vLirky@fDyfud½…...........…3

CHC ¼lkeqnkf;d LokLF; dsUnz½…………………......….…….4

PHC ¼çkFkfed LokLF; dsUnz½……………………...…………5

Subcenter ¼midsUnz½……..............................................……6

TBA / Untrained Dai ¼çf'kf{kr tUe lgk;d@vçf'kf{kr ..........7

Other ¼vU;½ ( Li"V fy[ksa_______________ ) ....................... 8

Q.13 Disease Pattern in the Village If Any¼xzke ds vUnj fcekjh@jksx fd fLFkfr ;fn dksbZ gS½

1 Seasonal Illnesses ¼ekSle ds dkj.k chekjh½ 1

2 Water Borne Diseases ¼ikuh ls lacaf/kr jksx ½ 2

3 TuberClosis ¼risfnd jksx½ 3

4 Asthama ¼vLFkek½ 4

5 Any Other (Pl. Specify) dksbZ vU; ¼—I;k fy[ks½ 5 a.) ________________________

b.) ________________________

c.) ________________________

d.) ________________________

Q.14 To be Canvassed in Gram Sabha- ¼xzke lHkk ds ckjs esa lkekU; lwpuk½

1 About the Scheme in General- ¼;kstuk ds ckjs esa lkekU; tkudkjh½

2 Impact of the Scheme ¼;kstuk dk çHkko½ Direct Impact ¼çR;{k çHkko½

Indirect Impact ¼vçR;{k çHkko½3 Problems in the Scheme ¼;kstuk esa leL;k,sa½

1

2

3

4

4 Suggestions for further Improvement ¼;kstuk esa lq/kkj ds fy, lq>ko½

1

2

3

4

DATE

NAME OF THE INVESTIGATOR SIGNATURE OF THE INVESTIGATOR

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DEEN DAYAL ANTODAYA UPCHAR YOJANABENEFICIARY QUESTIONNAIRE ykHkkFkhZ@fgrxzgh ç’ukoyh

DISTRICT/tuin

TEHSIL/COMMUNITY DEVELOPMENT BLOCK/ rglhy@lkeqnkf;d fodkl [kaM

TYPE OF LOCAALITY: / {ksss= dk çdkj RURAL / xzkeh.k...…….….1 URBAN/“kgjh…....……...2GRAM PANCHAYAT IF RURAL / ;fn xzkfe.k {ks= gS rks xzke iapk;r dk uke

VILLAGE / URBAN WARD / xzke@'kgjh okMZ (Write Census Code)/ tux.kuk dksM fy[ksa

NAME OF THE RESPONDENT / mÙkjnkrk dk uke

NAME OF HEAD OF THE HOUSEHOLD / ?kj ds eqf[k;k dk uke ____________________________

NAME / uke

ADDRESS / irk

(TO BE ENTERED AT OFFICE) / dk;kZy; }kjk Hkjk tk,xk

SERIAL NUMBER OF THE HOUSEHOLD QUESTIONNAIRE / ikfjokfjd ç'ukoyh dh Øe la[;k..……DATE MONTH YEAR

INTERVIEWDATE

SPOT CHECKED BY FIELD EDITED BY OFFICE EDITED BY KEYED BY

NAME ________________________ ____________________ ____________________ ___________________

DATE ____________________ Code Code Code

___________________________ ____________________ ___________________________________NAME OF THE INVESTIGATOR SIGNATURE OF THE INVESTIGATOR

INTRODUCTION AND INFORMED CONSENT / ifjp; vkSj ?kks"k.kkMy name is ____________________________and I am working with MottMac Donalds We are conducting a state Level evaluation study about ahealth scheme ‘Deendayal Antodaya Upchar Yojana , for POVERTY MONITORING AND POLICY SUPPORT UNIT SOCIETY (PMPSUS) - MADHYAPRADESH. We would very much appreciate your participation in this survey. Several health and related topics will be discussed including the awarenessof health schemes, use of health services, the quality of health care and satisfaction level. This information will help the government to assess health andinformation needs and to plan better health services. The survey usually takes around half an hour to complete. Whatever information you provide willbe kept strictly confidential and will not be shown to other persons.

essjk uke ----------------------------------------------------- gSSa vkSSSSj eSa eksV eSd MksukYM ds lkFk dke djrk gw¡A ge jkT; Lrj ij nhun;ky vUr;ksn; mipkj ;kstuk dk ewY;kadu v/;;u djjgs gSaA bl ;kstuk dk ewY;kadu e/;çns'k xjhch ewY;kadu vkSj ik¡fylh lg;ksx bdkbZ lfefr ds }kjk djk;k tk jgk gSA bl LokLF; ;kstuk ds vUrXkZr fofHkUu eqn~nks dksfy;k x;k gS] tSls ;kstuk dh tkxz:drk] LokLF; lqfo/kkvksa dk mi;ksx] larq"Vh dk Lrj vkSj LOkkLF; dh xq.koÙkkA vki ds }kjk çnku dh xbZ lwpuk ljdkj dks LokLF;lsokvksa dks csgrj cukus esa enn djsaxhA losZ dks iw.kZ djus esa vk/kk ls ,d ?kaVk dk le; yxssxkA vki }kjk tks Hkh lwpuk çnku dh tk jgh gS oks iw.kZrk% xksiuh; gksxh vkSjfdlh dks fn[kk;k ugha tk,xkA

This information will help the government to assess health and information needs and to plan better health services. Currently, we are talking to variouskey stakeholders at different levels about their perception and involvement in the health and related issues. Your views and opinion based on theexperience are valuable for us in this direction to develop a good understanding about these issues and assist to improve scheme/programme delivery. Ishall be grateful to you if you can spare your time and answer the questions. The information provided by you will be kept confidential and your identitywill not be revealed anywhere.

LokLF; lsokvksa dks csgrj cukus ds fy, vki }kjk çnku dh xbZ tkudkjh ls ljdkj dks dkQh en~n feysxh orZeku le; esa ge fofHkUu Lrj ij tks Hkh LokLF; lacaf/kreqn~nksa ij dke dj jgs gSa] mu lHkh yksxksa ls ge ckr dj jgsa gSA vkidh jk; ds vk/kkj ij dk;ZØe dks csgrj cukus esa vkSj LokLF; lacaf/kr eqn~nksa ij ,d vPNh le>iSnk djds ge yksx ;kstuk esa lq/kkj ykus ,oe fØ;kU;ou djus dk iz;kl djsaxsA ;fn vki vius dherh le; esa ls gekjs ç”uksa dk mRrj nsaxs rks ge vkids vkHkkjh gksxasAtks Hkh lwpuk vki }kjk çnku dh tk jgh gS oks iw.kZr% xksiuh; j[kh tk,xhAParticipation in this survey is voluntary and if you choose to participate, you may interrupt / withdraw at any time. However, we hope that you will takepart in this survey since your participation is important.

bl losZ{k.k esa Hkkx ysuk LoSfPNd gS] vkSj ;fn vki blesa Hkkx ysrs gSa Rkks Hkh vki fdlh Hkh le; bls NksM+us ds fy;s LorU= gSaA gkyk¡fd ge vk'kkk djrs gSa fd vki bllosZ{k.k esa Hkkx ysaxs D;ksafd vki dk lg;ksx blds fy;s egRoiw.kZ gSA

At this time, do you want to ask me anything about the survey? vc bl le; losZ ds ckjs esa vki dqN tkudkjh pkgrs gS rks iqaNsAANSWER ANY QUESTIONS AND ADDRESS RESPONDENT’S CONCERNS BEFORE PROCEEDING WITH THE QUESTIONNAIRES.

fdlh Hkh iz'u dk mRrj nsa vkSj iz'udrkZ dh 'kadk dk lek/kku djsaA

Signature of interviewer ______________________________________________________________ / Date ________________________

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DEEN DAYAL ANTODAYA UPCHAR YOJANABENEFICIARY QUESTIONNAIRE ykHkkFkhZ@fgrxzgh ç’ukoyh

Q.No QUESTIONS AND FILTERS CODING CATEGORIES SKIP TOII HouseHold Profile ikfjokfjd fooj.k

2.1 Type of your family./ Ikfjokj ds çdkj Joint / la;qDr 1Nuclear / ,dkdh 2Other / vU; 88

2.2 Category of Household / ifjokj dh Js.kh BPL (Card Seen) / xjhch js[kk ls uhsps ¼dkMZ ns[kk½ 1

(Please Check the Ration Card/BPL Card and BPL Card Not Seen / xjhch js[kk ls uhsps 2write code numb& date of issue) / ¼—I;k jk'ku dkMZ ¼dkMZ ugh ns[kk½;k xjhch js[kk ls uhsps dkMZ nss[kas vkSj tkjh djus dh frfFk APL / xjhch js[kk ls mij 3vkSSj dksM la[;k fy[ksa½

2.3 Do you have a Family health Card / D;k vkids ikl Yes, Card Seen /gka] dkMZ ns[kk______________ 1ifjokj LoLF; dkMZ gSS \(Please Check the Card and write code number Yes Card not SEEN / gka] ¼dkMZ ugha ns[kk½ 2& date of issue) ¼—I;k dkMZ tkap ys vkSj dksM u- vkSjtkjh djus dh rkjh[k fy[ksa½ NO /ugh 3

2.4 Do you have a Mukhya Mantri Majdoor Yes, Card Seen / gka] dkMZ ns[kk______________ 1

Suraksha Card/ D;k vkids ikl eqa[;ea=h etnwj Yes Card not SEEN / gka] ¼dkMZ ugha ns[kk½ 2

lqj{kk dkMZ gS NO/ ugh 3

2.5 Do you have a Nirman Shrimik Card/ D;k vkids Yes, Card Seen/ gka] dkMZ ns[kk______________ 1ikl fuekZ.k Jfed dkMZ gS(Please Check the Card and write code number Yes Card not SEEN/ gka] ¼dkMZ ugha ns[kk½ 2& date of issue) ¼—I;k dkMZ tkap ys vkSj dksM u- vkSjtkjh djus dh rkjh[k fy[ksa½ No / ugha 3

2.6 What is the religion of the head of the Hindu / fgUnw 1

household?/ Ikfjokfjd ds eqf[k;k dk /keZ D;k gS\ Muslim / eqfLye 2

Sikh / fl[k 3

Christian / bZLkkb 4

Jain / tSu 5

Other (Specify) vU; ¼Li"V djsa½ 88

2.7 Is this a scheduled caste, a scheduled tribe, Schedule caste / vuqlwfpr tkfr 1other backward caste, or none of them?¼D;k vki vuqlwfpr tkfr] vuqlwfpr tu&tkfr] Schedule tribe / vuqlwfpr tu&tkfr 2vU; fiNMh tkfr ds gS] ;k buesa ls dksbZ ughaa gS½

Other Backward Castes / vU; fiNMh tkfr 3

None of them / buesa ls dksbZ ughaa 4

2.8 What is the caste or tribe of the head of the Caste / tkfr 1household?/ Ikfjokj ds eqf[k;k dh tkfr vFkoktu&tkfr D;k gS ? (Specify) /Li"V djsa

Tribe / vkfnoklh 2

(Specify) / Li"V djsa

No Caste / Tribe ¼u tkfr@tutkfr½ 3

Don’t know / ugha tkurk………….... 77

2.9 Type of house / edku dk çdkj Kaccha / dPpk 1

Semi Pucca / dqN iDdk 2

Pucca / iDdk 3

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DEEN DAYAL ANTODAYA UPCHAR YOJANABENEFICIARY QUESTIONNAIRE ykHkkFkhZ@fgrxzgh ç’ukoyh

Q.No QUESTIONS AND FILTERS CODING CATEGORIES SKIP TO

2.10 Is this house your own or rented. Own / Lo;a 1D;k Ekdku viuk gS ;k fdjk; dk Rented / fdjk; dk 2

2.11 Does this household own any other house? Yes / gka 1D;k bl ?kj ds vykok Lo;a dk dksbZ vkSj edku gS \ No / ugh 2

2.12 Does this household own any agricultural land? Yes / gka 1 Go toD;k vkids ikl Lo;a dh —f"k ;ksX; Hkwfe gS\ Next

No / ugh 2 Section

2.13 If Yes, How much? Mention in acres;fn gka] fdruh\ ,dM+ esa fy[ksa Acres /,dM……………................…........( if not in acre, specify size & unit );fn ,dM+ esa ugh gS] vkdkj ,oa bdkbZ fy[ksa

2.14 Out of this land, how much is irrigated?mijksDr tehu esa ls fdruh flafpr Hkwfe gS Acres / ,dM……………….......................( if not in acre, specify size & unit );fn ,dM+ esa ugh gS] vkdkj ,oa bdkbZ fy[ksa None / ugh…………………………00

III Respondents Profile

3.1 Name of the respondent?mRrnkrk dk uke

3.2 Gender of the Respondent Male / iq:"k 1mRrjnkrk dk fyax Female / efgyk 2

3.3 What is your age? vkidh mez D;k gS \ Age in completed years /mez iw.kZZ o"kkasZs esaa

3.4 Can you read and write? (any one language)D;k vki fdlh ,d Hkk"kk esa fy[k iM+ ldrs gS \ Yes / gka....... 1

No / ugh............ 2 Q-3.6

3.5 How many years of schooling have youcompleted? vkidh f'k{kk dqy fdrus o"kks± dh gSa \ Years / o"kZ

3.6 What is the main source of income of your Farming/Cultivation [ksrh ckMh 1household? vids ifjokj dh vk; dk eq[; lzksr D;k gS\

Agricultural labour/ —f"k etnwj…………….. 2

(Prioritize the responses as 1st, 2nd, 3rd, 4th Livcstook/forestry/fishing/orchards/and maximum upto 5th) allied activities Ik'kq/ku@ckxokuh@eNyhikyu@

esoksa dk ckx@vU; 3

Mining & quarrying / [kfut …….........…... 4

Manufacturing / fuekZ.k çfØ;k……………..... 5

Construction / fuekZ.k ……………......…........ 6

Petty Trader / jsMh okyk……………....…...... 7

Artisan / f'kYidkj 8

Business / O;kikj 9

Service (government/private)/ukSdjh ¼ljdkjh@futh½……............................... 10

Others (Specify) vU; ¼aLiLV½… ……....……. 88

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DEEN DAYAL ANTODAYA UPCHAR YOJANABENEFICIARY QUESTIONNAIRE ykHkkFkhZ@fgrxzgh ç’ukoyh

Q.No QUESTIONS AND FILTERS CODING CATEGORIES SKIP TO

3.7 What is the total monthly income of your Ask Approximate Annual/Monthlyhousehold? vkids ifjokj dh dqy ekfld vk; Income (in Rs.) okf"kZd@ekfld vk;D;k gS \ ¼:Ik;ksa esa yxHkx iawNs Rs_______

IV Awareness of the Respondents

4.1 Are you aware of Deendayal Antodaya Yojana? Yes / gka……………………………………… 1(Describe DAUP, if required) D;k vidks nhun;ky Q 4.3vUr;ksn; mipkj ;kstuk dh tkudkjh gS \ No / ugha........................................................ 2 END

Awareness regarding- tkx:drk ls lacaf/kr

1. Who can be the beneficiary /ykHkkFkhZ dkSu gks ldrk gS

2. What benefits can they avail /;kstuk dk ykHk dSls ys ldrs gS

3. Where can they avail the services /lsok,a dgka ls mi;ksx dh tk ldrh gS

4. where can they take their greviences/f'kdk;r dgka ns ldrs gS

4.2 If yes, From where did you get the information YES gka NO ughabout DAUP scheme? / ;fn gka] rks vkidks ;kstuk ds MPM/MPF cgqns'kh dehZ iq:"k@efgyk 1 2ckjs esa tkudkjh dgka ls feyh

(READ OUT ) ASHA / vk'kk 1 2

(MULTIPLE RESPONSES POSSIBLE) AWW / vkxuckMh dk;ZdrkZ.............. 1 2

dbZ tokc laHko Doctors / fpfdRld 1 2

PRI members / iapk;r lnL; 1 2

Media…/ fefM;k……………… 1 2

Others / vU;……………………… 88

(Please Specify) ¼—I;k Li"V djs½

4.3 Do you know who can be the beneficiary of YES / gka ...................................... 1DUAYscheme? /D;k vki tkurs gS;kstuk dk ykHkkFkhZ dkSu gks ldrk\ NO / ugha 2

DON’T KNOW/ ugha tkurk 77

4.4 Do you have a Family health Card Yes, Card Seen/ ¼gka \ dkMZ ns[kk½ 1¼D;k vkids ikl ifjokj LokLF; dkMZ gS \½ Yes Card not SEEN /

¼gka \ dkMZ ugha ns[kk½ 2NO/ ugha 3

V Access to the Scheme

5.1 Did any of the family members fell ill ? Yes /gka 1(Since the issue of the card)/ D;k vkids ifjokj dk NO/ ugh 2dksbZ lnL; chekj gqvk ¼dkMZ tkjh dh frfFk ls½

5.2 If Yes, was the person hospitalised? / Yes/ gka 1;fn gka] dksbZ vLirky esa Hkr+hZ gqvk Fkk \ No/ ugh 2

5.3 Did you avail any facility under the Yes/ gka 1DAUP scheme ? D;k vkius tkstuk ds vUrxZr No/ ugh 2fdlh lqfo/kk dk mi;ksx fd;k gS \ (Any time in the past) ¼chrs o"kks± esa½

Go toSection V

Go toSection V

Go toSection V

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DEEN DAYAL ANTODAYA UPCHAR YOJANABENEFICIARY QUESTIONNAIRE ykHkkFkhZ@fgrxzgh ç’ukoyh

Q.No QUESTIONS AND FILTERS CODING CATEGORIES SKIP TO

Date/Yearwhen

availed/mi;ksx djusdh rkjh[k,oa o"kZ

FacilityName Wheretreatmentwas availed/lqfo/kk dk uketgka ls mipkjdjk;k x;k

AmountSpent

(Rs.) in lastone year/[kpZdh xbZ /kujkf'k ¼fiNys,d lky esa½

VI. Medical/Treatment History of the family members (Since the issue of health cards)

6.1 No. of members who were sick and availed Treatment/HospitalisationTreatment under the Scheme / Details/Diseaseifjokj ds chekj lnL;ks dh la[;k ftudk mipkj for which treatment;kstuk ds vUrxZr fd;k x;kA Sought/ mipkj HkrhZ izfØ;k

dk fooj.k ftl chekjh dkfd;k x;k

Give the exact number/List of family members/ifjokj ds chekj lnL;ksa ds uke ,oe mudh la[;k

1

2

3

4

6.2 No. of members who were sick and availedtreatment but not under the scheme/ ifjokjds chekj lnL;ks ds uke ftUgksus ;kstuk dsvUrxZr mipkj ugh djk;k

Give the exact number/List of family members/ifjokj ds chekj lnL;ksa ds uke ,oe mudh la[;k

1

2

3

4

6.3 No. of members who were sick but did not Sickness details/ If Yes Go to Q 6.4 /;fn gka rksavailed treatment /chekj lnL;ksa dh la[;k chekjh dk fooj.k ç'u 6-4 ij tk,aftUgksaus mipkj ugh djk;k

1

2

3

4

6.4 Reasons for not availing treatment Physical distance /T;knk nwjh gksuk 1

mipkj dk mi;ksx u djus dk dkj.k Lack of facilities in close viccinity/utnhd lqfo/kk dk vHkko 2

(Record if 6.3 is applicable) Unhelping/uncooperative healthfunctionaries /LokLF; dehZ dk lg;ksx@lgk;rk u feyuk 3

Financial constraints/ foÙkh; dfBukbZ 4

Any Other / dksbZ vU; 77

6.5 Did your treatment exceed 5000/- rupees? Yes /gka 1D;k vkids mipkj dk [kpZZZ ikap gtkj ls vfrfjDr gqvk\ No /ugha 2

6.6 If Yes, How much? What was the amountof the bills? ;fn gka] rks fdruk\ fcy dh /kujk'khfdruh Fkh \ Rs………………………..

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DEEN DAYAL ANTODAYA UPCHAR YOJANABENEFICIARY QUESTIONNAIRE ykHkkFkhZ@fgrxzgh ç’ukoyh

Q.No QUESTIONS AND FILTERS CODING CATEGORIES SKIP TO

6.7 Did you face any problem in continuing Yes/ gka 1the treatment after that? D;k vkidks mipkj No/ ugha 2dks tkjh j[kus esa fdlh çdkj dh leL;k dk lkeukdjuk iM+k?

6.8 Did you any member avail the scheme facility Yes/gka 1for delivery? D;k vkids ifjokj ds fdlh lnL; us No/ ugha 2 Q 6.12izlo ds fy, fdlh izdkj dh lqfo/kk dk iz;ksx fd;k\

6.9 Did you avail the transport facility Yes/ gka 1for delivery under the scheme? D;k vkius ;kstuk No/ ugha 2 Q 6.12ds vUrxZr ifjogu lqfo/kk dk mi;ksx fd;k?

6.10 If Yes, What was approx. cost of Rs.transport? ;fn gka] rks ifjogu dh ykxr yxHkxfdruh Fkh \ Don’t Know / ugh tkurk ………………. 77

6.11 Who paid for the transport facility ? Under the scheme hence was freeifjokgu lqfo/kk dk Hkqxrku fdlus fd;k? ;kstuk ds vUrxZr eq¶r Fkk 1(Multiple Response Possible)/ ¼dbZ tokc laHko½

Family member but later reembursedifjokj ds lnL; us] ysfdu ckn esa Hkqxrku fey x;k 2

Shared under the scheme and by self ascost was high /bl ;kstuk ds vUrxZr LOk;a dkva'knku D;ksadh ykxr vf/kd Fkh 3

Other (Specify)/ vU; ¼Li"V½ __________ 88

6.12 Why did you choose the above health facility Refered by the Doctor/lower levelfor availing the treatment? (May have multiple Health facility / LokLF; lqfo/kk dkoptions) /mijksDr LokLF; lqfo/kk dk pquko mipkj MkDVj }kjk funsZ'k nsuk 1ds fy, D;ksa fd;k ¼dbZ tokc gks ldrs gS½

To utilise the benefit of the scheme/;kstuk ds vUrZxr LokLF; lqfo/kk dk mi;ksx 2djus ds fy;s

No other option available / 3vU; mik;ksa dk u gksuk

Others / vU; 88

6.13 Who advised you to go to health facility Doctor at lower level / 1for availing the health service? fdldh lykg fupyss Lrj ds MkDVj }kjkls vkius LokLF; lqfo/kkvksa dk mi;kssx djus ds fy, x;ss

LHV /efgyk LOkkLF; dehZ 2

MPM/F/NURSE/MIDWIFE/

(cgqqns'kh; dehZ iq:"k@efgyk@ulZ@nkbZ 3

4

ASHA/ vk'kk ………………………… 5

OTHER / vU;___________________ 88

(SPECIFY) Li"V djsa

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DEEN DAYAL ANTODAYA UPCHAR YOJANABENEFICIARY QUESTIONNAIRE ykHkkFkhZ@fgrxzgh ç’ukoyh

Q.No QUESTIONS AND FILTERS CODING CATEGORIES SKIP TO

VII Impact of the Scheme /;kstuk dk çHkko

VII. 1 Prior to availing the benefits/ ;kstuk ds mi;ksx ls iwoZ ykHk

7.1 Status of health of the family prior to availing Comparatively Good/Better/the benefits the scheme/ ¼;kstuk ds ykHk ds mi;ksx rqyuk esa vPNk@cgqr vPNk 1ls iwoZ ifjokj ds LokLF; dh fLFkfr½ Comparatively bad/worse

rqyuk esa [kjkc@cgqr [kjkc 2

No change/ dksbZ ifjorZu ugh 3

DK/CS ugh tkurk@dg ugh ldrk 77

7.2 Did you spend more on seeking health Yes/ gka 1benefits pior to availing the benefits of the No /ugha 2scheme / D;k LokLF; lsokvksa ij vkidk [kpZ] ;kstukdh lsok;sa ysus ls iwoZ vf/kd FkkA Do Not Know/ ugha tkurk 77

7.3 Did you borrow any money for treatment/ Yes/gka 1health reasons prior to taking the benfitsof the scheme? D;k vkius ;kstuk ds ykHk ls No/ ugha 2 Q 8.1iwoZ mipkj ;k LokLF; dj.kksa ds fy, fdlh ls_.k@m/kkj fy;k ?

7.4 If Yes, How much amount did you borrow? Specify the amount/ /kujkf'k fy[ksa;fn gka] vkius fdruh /kujkf'k m/kkj yh ?

VII. 2 After availing the Scheme benefits/ ;kstuk ds ykHk dk mi;ksx ds ckn dk çHkko

7.5 Did you need to borrow any money for Yes/ gka 1treatment/health reasons after availing thebenfits of the scheme? D;k vkidks ;kstuk ds ykHk No/ ugha 2 Q 8.3ysus ds ckn] mipkj ;k LokLF; dkj.kksa ds fy,_.k ysus dh vko';drk iM+h\

7.6 If Yes, How much amount did you borrow? Specify the amount/ /kujkf'k fy[ksa;fn gka] vkius fdruk /kujk’kh m/kkj fy;k gS

7.7 Do you think that the health has improved Yes / gka 1after availing the treatment under the scheme No/ ugha 2D;k vki ,slk lksprs gS fd ;kstuk ds vUrxZr mipkjdjokuss ls LokLF; dh fLFkfr esa lq/kkj gqvk gS Do Not Know/ esa ugh tkurk 77

7.8 Status of health of the family after availing the Comparatively Good/Betterbenefits the scheme ;kstuk ds ykHk dk mi;ksx rqyuk esa vPNk@cgqr vPNk 1djus ds Ik'pkr~ ifjokj ds LokLF; dh fLFkfr Comparatively bad/worse

rqyuk esa [kjkc@cgqr [kjkc 2

No change/ dksbZ ifjorZu ugha 3

DK/CS/ ugha tkurk@dg ugha ldrk 77

7.9 What do perceive are the direct impact of the Improved health / LokLF; esa lq/kkj 1scheme / vkids Åij ;kstuk dk çR;{k çHkko Saving on health expenses/fdl :Ik esa gqvk (Multiple Answers possible) LokLF; [kpZ dh cpr 2¼dbZ tokc laHko½ Improvement in econimic/income status

after saving mandays at work/ vkfFkZdvkenuh dh fLFkfr esa lq/kkj ls dk;Z fnol dh cpr 3Any other (Please Specify)vU; dksbZ ¼—I;k fy[ksa½ 88

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DEEN DAYAL ANTODAYA UPCHAR YOJANABENEFICIARY QUESTIONNAIRE ykHkkFkhZ@fgrxzgh ç’ukoyh

Q.No QUESTIONS AND FILTERS CODING CATEGORIES SKIP TO

7.10 What do you think are the indirect impact Improved social status/of the scheme D;k vki lksprs gSa fd ;kstuk dk lkekftd fLFkfr esa lq/kkj 1vçR;{k çHkko D;k gS Improved education status for children/(Multiple Answers possible) cPpksa dh f'k{kk dh fLFkfr esa lq/kkj 2¼dbZ tokc laHko½ Increased life expectancy/

thou izR;k'kk 3Decrease in overall Mortality Rate/lEiw.kZ e`R;q nj esa deh 4Decrease in Maternal Mortality Rate/tPpk e`R;q nj esa deh 5Decrease in Infant Mortality Rate/uotkr e`R;q nj esa deh 6Any other (Please Specify)/dksbZ vU; Li"V djsa 88

VIII Quality of services Availed mi;ksx dh xbZ lsokvks dh xq.koRrk

In this section the level of satisfaction of the respondent is measured. The responsesare recorded on a 5 point scale. Record 1-Very High, 2-High, 3- Average, 4-low and5 very Low (in terms of level of satisfaction) bl [kaM esa mRrjnkrk dh larqf"V ds Lrj dks Scoreekiuk gS xq.koRrk dks 1 ls 5 ds Lrj esa uEcj nsuk gSA

8.1 Time taken to get the health cards made/LokLF; dkMZ cuokus esa yxk le;

8.2 Process of getting the health cards made/LOkkLF; dkMZ cukus dh çfØ;k ,oa çkIr djuk

8.3 Promptness in admission to the facility/lqfo/kkvksa dk ç;ksx djus ds fy, tYnh nkf[kyk feyuk

8.4 Availability of bed at the facility/csM lqfo/kk dh miyC/krk

8.5 Availability of Medicines /nokvksa dk miyC/k gksuk

8.6 Availability of investigative tests/fpfdRlk ijh{k.k dh miyC/krk

8.7 Cleaniliness of ward /okMZ dk lkQ gksuk

8.8 Availability & cleanliness of toilets/'kkSpky; dh lQkbZ

8.9 General environment of the facility/miyC/k LokLF; lqfo/kkvksa dk lkekU; okrkoj.k

8.10 Behaviour of Doctors/fpfdRld@MkDVj dk O;ogkj

8.11 Behaviour of para medical staff(Nurses and ward boys) /fpfdRld deZpkjh dkO;ogkj fo'ks"k dj ulZ vkSj okMZ Cok; dk

8.12 Grievence redressal mechanism /f'kdk;r çdks"V dh çfd;k

8.13 Overall Quality of service provided /çnku dh xbZ lsokvksa dh lEiw.kZ xq.koRrk

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DEEN DAYAL ANTODAYA UPCHAR YOJANABENEFICIARY QUESTIONNAIRE ykHkkFkhZ@fgrxzgh ç’ukoyh

Q.No QUESTIONS AND FILTERS CODING CATEGORIES SKIP TO

IX Satisfaction of the respondents mRrjnkkrk dk larqf"Vdj.k

9.3 Do you feel that the scheme is relevent/ Yes/gka 1helpful in providing cost-free access ofhealth care services to the economically No/ugha 2weaker sections/BPL households.D;k vkidks ,slk eglwl gksr gS dh ;kstuk esa tks Do Not Know/ ugh tkurk 77eq¶r lsok,a xjhch js[kk ls uhps ;k vkfFkZd :Ik ls fiNMs+oxks± ds fy, nh tk jgh gS og dkQh mi;kxh ,oalgk;d gS \

9.4 In your view, what additional measures can be taken to improve the service deliverymechanism? vkids vuqlkj] LokLF; lsokvks dks csgrj cukus ds fy, D;k dne mBk;s tk ldrk gS\

9.5 Has there been regular display of list of Yes / gka 1DUAP beneficiaries at sub centre/health facility? No / ugha 2D;k midsaUnz ;k vU; LokLF; lqfo/kk dsUnz ij nhun;kyvUr;ksn; mipkj ;kstuk ds fgrxzgh@ykHkFkhZ fd lwph Do Not Know / esa ugha tkurk 77çfrfnu yxh jgrh gSA

9.6 What are your experiences on critical incidences/cases - urgent operations etc. RkRdkyhu vkijs'ku dh ifjfLFkr ds fo"k; esa vkidk D;k vuqHko gS\

9.7 What are the bottlenecks in efective implementation of the scheme/;kstuk dks lqpk: :Ik ls fØ;kUo;u djus esa D;k dfBukbZ gSA

Thank the respondent and record Time Hours MinutesmRrjnkrk dks /kU;okn vkSj le; fy[ksa

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DEEN DAYAL ANTODAYA UPCHAR YOJANANON-BENEFICIARY QUESTIONNAIRE xSj-ykHkkFkhZ@fgrxzgh ç’ukoyh

DISTRICT/tuin

TEHSIL/COMMUNITY DEVELOPMENT BLOCK/ rglhy@lkeqnkf;d fodkl [kaM

TYPE OF LOCALITY / {ksss= dk çdkj RURAL / xzkeh.k.………….….1 URBAN/“kgjh…....…...2GRAM PANCHAYAT IF RURAL / ;fn xzkfe.k {ks= gS rks xzke iapk;r dk uke

VILLAGE/URBAN WARD/xzke@'kgjh okMZ (Write Census Code)/ tux.kuk dksM fy[ks

NAME OF THE RESPONDENT/ mÙkjnkrk dk uke

NAME OF HEAD OF THE HOUSEHOLD / ?kj ds eqf[k;k dk uke

NAME / uke

ADDRESS / irk

(TO BE ENTERED AT OFFICE) / dk;kZy; }kjk Hkjk tk,xk

SERIAL NUMBER OF THE HOUSEHOLD QUESTIONNAIRE / ikfjokfjd ç'ukoyh dh Øe la[;k..……DATE MONTH YEAR

INTERVIEWDATE

SPOT CHECKED BY FIELD EDITED BY OFFICE EDITED BY KEYED BY

NAME ________________________ ____________________ ____________________ ___________________

DATE ____________________ Code Code Code

___________________________ ____________________ ___________________________________NAME OF THE INVESTIGATOR SIGNATURE OF THE INVESTIGATOR

INTRODUCTION AND INFORMED CONSENT / ifjp; vkSj ?kks"k.kkMy name is ____________________________and I am working with MottMac Donalds We are conducting a state Level evaluation study about ahealth scheme ‘Deendayal Antodaya Upchar Yojana , for POVERTY MONITORING AND POLICY SUPPORT UNIT SOCIETY (PMPSUS) - MADHYAPRADESH. We would very much appreciate your participation in this survey. Several health and related topics will be discussed including the awarenessof health schemes, use of health services, the quality of health care and satisfaction level. This information will help the government to assess health andinformation needs and to plan better health services. The survey usually takes around half an hour to complete. Whatever information you provide willbe kept strictly confidential and will not be shown to other persons.

essjk uke gSSa vkSSSSj esa eksV eSd MksukYM ds lkFk dke djrk gw¡A ge jkT; Lrj ij nhun;ky vUr;ksn; mipkj ;kstuk dk ewY;kadu v/;;u dj jgs gSaA bl ;kstuk dkewY;kadu e/;çns'k xjhch ewY;kadu vkSj ik¡fylh lg;ksx bdkbZ lfefr ds }kjk djk;k tk jgk gSA bl LokLF; ;kstuk ds vUrXkZr fofHkUu eqn~nksa dks fy;k x;k gSA tSls;kstuk dh tkxz:drk] LokLF; lqfo/kkvksa dk mi;ksx@larq"Vh dk Lrj vkSj LOkkLF; dh xq.koÙkkA vki }kjk çnku dh xbZ lwpuk] ljdkj dks LokLF; lsokvksa dks csgrj cukusesa enn djsxhA losZ dks iw.kZ djus esa vk/kk ls ,d ?kaVk dk le; yxssxkA vki }kjk tks Hkh lwpuk çnku dh tk jgh gS oks iw.kZrk% xksiuh; gksxh vkSj fdlh dks fn[kk;k ughatk,xkA

This information will help the government to assess health and information needs and to plan better health services. Currently, we are talking to variouskey stakeholders at different levels about their perception and involvement in the health and related issues. Your views and opinion based on theexperience are valuable for us in this direction to develop a good understanding about these issues and assist to improve scheme/programme delivery. Ishall be grateful to you if you can spare your time and answer the questions. The information provided by you will be kept confidential and your identitywill not be revealed anywhere.

LokLF; lsokvksa dks csgrj cukus ds fy, vki }kjk çnku dh xbZ tkudkjh ls ljdkj dks dkQh enn feysxh orZeku le; esa ge fofHkUu Lrj ij tks Hkh LokLF; lacf/kreqn~nksa ij dke dj jgs gS] mu lHkh yksxksa ls ge ckr dj jgsa gSaA vkidh lksp ,oa fopkj ds vk/kkj ij dk;ZØe dks csgrj cukus esa vkSj LokLF; lacf/kr eqn~nksa ij ,d vPNhle> iSnk djds ge yksxksa dks ;kstuk esa lq/kkj ykus ,oe fØ;kU;ou djus esa lgk;rk feysxhA ;fn vki vius dherh le; esa ls gekjs ç'uksa dk mRrj nsaxs rks ge vkidsvkHkkjh gksxasA tks Hkh lwpuk vki }kjk çnku dh tk jgh gS oks iw.kZr% xksiuh; ,oa vkidh igpku j[kh tk,sxhAParticipation in this survey is voluntary and if you choose to participate, you may interrupt/withdraw at any time. However, we hope that you will takepart in this survey since your participation is important.

bl losZ{k.k esa Hkkx ysuk LoSfPNd gS vkSj ;fn vki blesa Hkkx ysrs gSa Rkks Hkh vki fdlh Hkh le; bls NksM+us ds fy;s LorU= gSaA gkyk¡fd ge vk'kk djrs gSa fd vki bllosZ{k.k esa Hkkx ysaxs D;ksafd vki dk lg;ksx blds fy;s egRoiw.kZ gSA

At this time, do you want to ask me anything about the survey? vc bl le; losZ ds ckjs esa vki dqN tkudkjh pkgrs gS rks iqaNsAANSWER ANY QUESTIONS AND ADDRESS RESPONDENT’S CONCERNS BEFORE PROCEEDING WITH THE QUESTIONNAIRES.

fdlh Hkh iz'u dk mRrj nsa vkSj iz'udrkZ dh 'kadk dk lek/kku djsaA

Signature of interviewer ______________________________________________________________ / Date ________________________

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DEEN DAYAL ANTODAYA UPCHAR YOJANANON- BENEFICIARY QUESTIONNAIRE xSj-ykHkkFkhZ@fgrxzgh ç’ukoyh

Q.No QUESTIONS AND FILTERS CODING CATEGORIES SKIP TO

II HouseHold Profile / ikfjokfjd fooj.k

2.1 Type of your family./ Ikfjokj ds çdkj Joint / la;qDr 1Nuclear / ,dkdh 2Other / vU; 88

2.2 Category of Household / ifjokj dh Js.kh BPL (Card Seen) / xjhch js[kk ls uhsps ¼dkMZ ns[kk½ 1

(Please Check the Ration Card/BPL Card and BPL Card Not Seen / xjhch js[kk ls uhsps 2write code numb& date of issue)/¼—I;k jk'ku dkMZ ¼dkMZ ugha ns[kk½;k xjhch js[kk ls uhsps dkMZ nss[kas vkSj tkjh djus dh frfFk APL/ xjhch js[kk ls mij 3vkSSj dksM la[;k fy[ks½

2.3 Do you have a Family health Card / D;k vkids ikl Yes, Card Seen / gka] dkMZ ns[kk_______ 1ifjokj LoLF; dkMZ gSS \(Please Check the Card and write code number Yes, Card not Seen / gka] ¼dkMZ ugha ns[kk½ 2& date of issue) ¼—I;k dkMZ tkap ys vkSj dksM ua- vkSjtkjh djus dh rkjh[k fy[ksa½ NO /ugha 3

2.4 Do you have a Mukhya Mantri Majdoor Yes, Card Seen / gka] dkMZ ns[kk_______ 1

Suraksha Card ¼D;k vkids ikl eq[;ea=h etnwj Yes Card not SEEN/ gka] ¼dkMZ ugha ns[kk½ 2

lqj{kk dkMZ gS½ NO/ ugha 3

2.5 Do you have a Nirman Shrimik Card ¼D;k vkids Yes, Card Seen/ gka] dkMZ ns[kk______ 1ikl fuekZ.k Jfed dkMZ gS½(Please Check the Card and write code number Yes Card not SEEN/ gka] ¼dkMZ ugha ns[kk½ 2& date of issue) ¼—I;k dkMZ tkap ys vkSj dksM u- vkSjtkjh djus dh rkjh[k fy[ksa½ No/ugha 3

2.6 What is the religion of the head of the Hindu / fgUnq 1

household?/ Ikfjokj ds eqf[k;k dk /keZ D;k gS\ Muslim / eqfLye 2

Sikh / fl[k 3

Christian / bZLkkbZ 4

Jain / tSu 5

Other (Specify) / vU; ¼Li"V djs½ 88

2.7 Is this a scheduled caste, a scheduled tribe, Schedule caste/ vuqlwfpr tkfr 1other backward caste, or none of them?¼vki vuqlwfpr tkfr] vuqlwfpr tu&tkfr] Schedule tribe /vuqlwfpr tu&tkfr 2vU; fiNM+h tkfr ds gSa ;k buesa ls dksbZ ughaa gaS½

Other Backward Castes/ vU; fiNM+h tkfr 3

None of them / buesa ls dksbZ ughaa 4

2.8 What is the caste or tribe of the head of the Caste/ tkfr 1household?/ Ikkfjokj ds eqf[k;k dh tkfr vFkoktu&tkfr D;k gS ? (Specify) / ¼Li"V djsa½

Tribe / vkfnoklh 2

(Specify) / ¼Li"V djsa½

No Caste / Tribe ¼tkfr@tutkfr ugha ½ 3

Don’t know / ugha tkurk@tkurh 77

2.9 Type of house/ edku dk çdkj Kaccha / dPpk 1

Semi Pucca / dqN iDdk 2

Pucca / iDdk 3

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DEEN DAYAL ANTODAYA UPCHAR YOJANANON- BENEFICIARY QUESTIONNAIRE xSj-ykHkkFkhZ@fgrxzgh ç’ukoyh

Q.No QUESTIONS AND FILTERS CODING CATEGORIES SKIP TO

2.10 Is this house your own or rented? Own / Lo;a 1D;k ;g Ekdku viuk gS ;k fdjk;s dk \ Rented / fdjk; dk 2

2.11 Does this household own any other house? Yes / gka 1D;k bl edku ds vykok Lo;a dk vkSj dksbZ edku gS \ No / ugha 2

2.12 Does this household own any agricultural land? Yes / gka 1 Go toD;k vkids ikl Lo;a dh —f"k ;ksX; tehu gS \ Next

No / ugha 2 Section

2.13 If Yes, How much? Mention in acres;fn gka] fdruh \ ,dM+ esa fy[ksa Acres / ,dM+……………................…........( if not in acre, specify size & unit )¼;fn ,dM+ esa ugh gS] rks vkdkj ,oe bdkbZ fy[ksa½

2.14 Out of this land, how much is irrigated?mijksDr tehu esa ls fdruh flafpr Hkwfe gS \ Acres / ,dM+………………........................( if not in acre, specify size & unit )¼;fn ,dM+ esa ugh gS] rks vkdkj ,oe bdkbZ fy[ksa½ None / ugha………………………00

III Respondents Profile

3.1 Name of the respondentmRrjnkrk dk uke

3.2 Gender of the Respondent Male /iq:"k 1mRrjnkrk dk fyax Female/ efgyk 2

3.3 What is your age? vkidh mez D;k gS \ Age in completed years /mez iw.kZZ o"kkasZs esaa

3.4 Can you read and write? (any one language)D;k vki fdlh ,d Hkk"kk esa fy[k iM+ ldrs gaS \ Yes / gka....... 1

No / ugha............ 2 Q-3.6

3.5 How many years of schooling have youcompleted? vkidh f'k{kk dqy fdrus o"kks± dh gSa\ Years / o"kZ

3.6 What is the main source of income of your Farming /Cultivation [ksrh ckM+h 1household? vkids ifjokj dh vk; dk eq[; lkszr D;k gS\

Agricultural labour / —f"k etnwj…………….. 2

(Prioritize the responses as 1st, 2nd, 3rd, 4th Livcstook/forestry/fishing/orchards/and maximum upto 5th) allied activities Ik'kq/ku@ckxokuh@eNyhikyu@

esoksa dk ckx@vU; 3

Mining & quarrying / [kfut …….........…... 4

Manufacturing / fuekZ.k çfØ;k……………..... 5

Construction / fuekZ.k …………......…........ 6

Petty Trader / jsMh okyk……………....…...... 7

Artisan / f'kYidkj 8

Business / O;kikj 9

Service (government/private)/ukSdjh ¼ljdkjh@futh½……............................... 10

Others (Specify) vU; ¼aLi"V djsa½ ……....……. 88

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DEEN DAYAL ANTODAYA UPCHAR YOJANANON- BENEFICIARY QUESTIONNAIRE xSj-ykHkkFkhZ@fgrxzgh ç’ukoyh

Q.No QUESTIONS AND FILTERS CODING CATEGORIES SKIP TO

3.7 What is the total monthly income of your Ask Approximate Annual/Monthlyhousehold? vkids ifjokj dh dqy ekfld vk; Income (in Rs.) okf"kZd@ekfld vk;D;k gS \ ¼:Ik;ksa esa yxHkx iqaNs½ Rs_______

IV Awareness of the Respondents

4.1 Are you aware of Deendayal Antodaya Yojana? Yes/ gka……………………………………… 1(Describe DAUP, if required) D;k vidks nhun;ky Q 4.3vur;ksn; mipkj ;kstuk dh tkudkjh gS \ No./ugha........................................................ 2 END

Awareness regarding-tkx:drk ls laca/khr If Yes / gka1. Who can be the beneficiary /

ykHkkFkhZ dkSu gks ldrk gS \

2. What benefits can they avail /;kstuk dk ykHk dSls ys ldrs gSa \

3. Where can they avail the services /lsok,a dgka ls mi;ksx dh tk ldrh gSa \

4. where can they take their greviences /f'kdk;r dgka ns ldrs gSa \

4.2 If yes, From where did you get the information YES gka NO ughabout DAUP scheme? / ;fn gka] vkidks ;kstuk ds MPM/MPF cgqns’kh dehZ iq:"k@efgyk 1 2ckjs esa tkudkjh dgka ls feyh \

(READ OUT ) ASHA / vk'kk 1 2

(MULTIPLE RESPONSES POSSIBLE) AWW / vkxuckMh dk;Zd=h.............. 1 2

¼dbZ tokc laHko½ Doctors / fpfdRld 1 2

PRI members / iapk;r lnL; 1 2

Media… / fefM;k……………… 1 2

Others / vU;…………………… 88

(Please Specify) ¼—I;k Li"V djas½

4.3 Do you know who can be the beneficiary of YES /gka a...................................... 1DUAY scheme? /D;k vki tkurs gS fd;kstuk dk ykHkkFkhZ dkSu gks ldrs gSa \ NO / ugha 2

DON’T KNOW / ugha tkurk. 77

4.4 Do you have a Family health Card Yes, Card Seen/ ¼gka \ dkMZ ns[kk½ 1¼D;k vkids ikl ifjokj LokLFk; dkMZ gS \½ Yes Card not SEEN /

¼gka\ dkMZ ugha ns[kk½ 2NO / ugha 3

V Access to the Scheme

5.1 Did any of the family members fell ill ? Yes / gka 1(Since the issue of the card)/ D;k vkids ifjokj dk NO / ugha 2dksbZ lnL; chekj gqvk ¼dkMZ tkjh dh frfFk ls½

5.2 If Yes, was the person hospitalised? / Yes / gka 1;fn gka] dksbZ vLirky esa Hkr+hZ gqvk Fkk \ NO / ugha 2

5.3 Did you avail any facility under the Yes/ gka 1DAUP scheme ? D;k vkius tkstuk ds vUrxZr No/ ugha 2fdlh lqfo/kk dk mi;ksx fd;k gS \ (Any time in the past) ¼chrs o"kks± esa½

Go toSection V

Go toSection V

Go toSection V

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DEEN DAYAL ANTODAYA UPCHAR YOJANANON- BENEFICIARY QUESTIONNAIRE xSj-ykHkkFkhZ@fgrxzgh ç’ukoyh

Q.No QUESTIONS AND FILTERS CODING CATEGORIES SKIP TO

VI. Medical/Treatment History of the family members

Family Members ¼ifjokj ds lnL;½ Treatment /Hospitalised for what Amount Spenttreatment ¼mipkj @ HkrhZ çfØ;k dk (Rs.) in lastfooj.k ftldk mipkj fd;k x;k ½½½½½ one year/ [kpZ

dh xbZ /ku jk’kh¼fiNys ,d lky esa½

6.1 No. of members who were sick andavailed treatmentifjokj ds chekj lnL;ks dh la[;k ftudk mipkjfd;k x;kA

Give the exact number/List of family members/ifjokj ds chekj lnL;ksa ds uke ,oe mudh la[;k

1

2

3

4

5

6.2 No. of members who were sick but did not avail treatmentifjokj ds chekj lnL;ksa ds uke ftUgksus mipkj ugha djk;k

1

2

3

4

5

6.3 Reasons for not availing treatment any where/dgha Hkh mipkj u djus dk dkj.k Physical distance/ T;knk nwjh gksuk 1

Lack of facilities in close viccinity/utnhd lqfo/kk dk vHkko 2

Unhelping/uncooperative health functionaries/LokLF; dehZ dk lg;ksx@lgk;rk u feyuk 3

Financial constraints /foÙkh; dfBukbZ 4

Any Other/ dksbZ vU; 77

6.4 Total amount spent on seeking treatmentchekjh ds mipkj ij dqy [kpZ dh xbZ /kujk'kh Amount in Rs.¼/kujk'kh :Ik;ksa esa½

6.5 Total Amount lost as absent from work¼dke ij vuqifLFkr jgus ds dkj.k dqy fdruh /kujk'kh Mandays ¼dk;Zfnol½dk uqdlku gqvk½

6.6 Any Other Loss (Please Specify) Amount in Rupees ¼/kujk'kh :Ik;ksa esa½dksbZ vU; gkfu —I;k fy[ksa

6.7 Did you borrow any money for treatment/ Yes / gka 1health reasons in the last one year?¼D;k vkius fiNys lky LokLF;@mipkj ds fy, fdlh No ugha 2dksbZ /kujk'kh m/kkj yh gS

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DEEN DAYAL ANTODAYA UPCHAR YOJANANON- BENEFICIARY QUESTIONNAIRE xSj-ykHkkFkhZ@fgrxzgh ç’ukoyh

Q.No QUESTIONS AND FILTERS CODING CATEGORIES SKIP TO

6.8 If Yes, How much amount did you borrow? Specify the amount ¼/kujk'kh fy[ksa½¼;fn gk¡] rks vkius fdruh jde m/kkj yh gS \½

6.9 Reasons for not seeking the treatment under Was not aware of the scheme/the sheme? ¼;kstuk ds vUrxZr mipkj u djokus Ignorance ;kstuk ds ckjs esa tkudkjhdk dkj.k D;k gS \½ u gksuk@Vkyuk 1

Health provider did not guide usregarding this LokLFk;drkZ }kjk;kstuk ds ckjs esa lykg@tkudkjh u çnku djuk 2

Physical distance to the facilitylqfo/kk LFky dk nwj gksuk 3

Lack of government facilities in close viccinityutnhd esa ljdkjh lqfo/kkvksa dk u gksuk 4

Unhelping/uncooperative health functionariesLokLFk; dehZ dk lg;ksx@lgk;rk u feyuk 5Financial constraints fofÙk; dfBukbZ 6

Was not reffered by the doctorMkDVj }kjk jsQj u djuk 7

Scheme was not attractive;kstuk dk vkd"kZd u gksuk 8Any Other vU; dksbZ 77

Thank the respondent and record Time

Hours Minutes

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MPM_F FGD Guide

1

FGD Guide for the Study Titled “ASSESSMENT OF DEENDAYAL ANTODYA UPCHAR YOJANA IN MADHYA

PRADESH”

Participants – Multi Purpose Health Workers

001. Name of Moderator : ______________________________________ 002. Date : ______________________________________

Introduction- Introduce Yourself

Identification-

Name of District: _______________________ Block: _____________________________

1. PROFILE

1.1 To start with all of you please tell your name, education and years of experience as Multi Purpose Male and Multi Purpose Female Health Workers? PROBE: CLASS STUDIED

1.2 Please tell me about your job functions in general and scheme related in particular? PROBE: ROLES AND RESPONSIBILITIES RELATED TO THE SCHEME,

NUMBER OF VILLAGES, POPULATION COVERED ETC

2. HUMAN RESOURCE AND TRAINING

2.1 Please tell if you all are aware of the health scheme Deendayal Antyodaya Upachar

Yojana (DUAP)?

2.2 Please tell me about the scheme? 2.3 Please tell me about your roles and responsibilities as part of the DUAP scheme.

a) What are the activities that you are supposed to carry out? Probe and Get list of

activities 2.2 How do you all carry out these duties as MPM/F health Worker? 2.4 Were you given some sort of training for carrying out the functions under the scheme?

Can you please tell us about it? 2.5 Procedure involved from making the health card till the services are availed/provided

3. SCHEME COORDINATION

3.1 How the scheme is being coordinated? How do you all rate the extent of coordination and

cooperation from the higher officials of your department?

a) What is the nature of support they provide to you? Are there any constraints in coordination? PROBE

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MPM_F FGD Guide

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b) What do you suggest to ensure better coordination? What more do you all expect from them, which will improve the service delivery? PROBE

3.2 What is the role of ASHAs and AWW for the scheme and if they are involved then what is the extent of cooperation from them?

4. SCHEME IMPLEMENTATION

You might be aware that the scheme was implemented with the objective of providing free treatment and investigation facilities to patients belonging to the BPL families who are hospitalized in government hospitals. Regarding the same I wish to talk to you about specific programme initiatives for improving the health services to the BPL households. 4.1 Do you feel that the scheme is being implemented properly? 4.2 Please tell me whether you have any difficulties in implementing the scheme?

Constraints in effective implementation

a) Please tell me a specific case, which was difficult to implement DUAP? PROBE: Educating villagers about the scheme, acceptance/resistance from

villagers, counseling villagers to accept services etc.

b) Can you please tell us about specific measures undertaken in your area to ensure the main objective of providing free treatment and investigation facilities to patients belonging to the BPL families? PROBE

4.3 What are the problems / constraints you face in implementing the health scheme in particular? What are the limitations to implement programmes?

a) What do you all suggest to resolve these issues? PROBE

5. INSTITUTIONAL MECHANISM

5.1 How is the community participation towards various activities? 5.2 Nearest government health facilities for inpatient treatment of the villagers? 5.4 What are the referral services at village level? Are there any gaps/issues? Are any

initiatives taken up to improve the referral services? Probe and get details 5.5 Kindly list out the community health problems (common diseases pattern) in the village

during 2007-2008? 5.6 What initiatives are taken to resolve the health problems in the village? Probe and get

details

6. SCHEME PERFORMANCE

6.1 How useful has been the DUAP in your sub-center area?

6.2 What changes did you notice in the village Post DUAP implementation? Direct and

indirect impacts

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6.3 How has it benefited to the people and community at large? Probe: Decrease in disease

pattern, increase in demand for institutional delivery, increase in child and mother

survival rate… (Probe) 6.4 What constraints / limitations do you face in smooth implementation of the scheme?

PROBE 6.5 What are your suggestions for improving the performance of the scheme?

7. MIS

7.1 Do you maintain any records/data of the beneficiaries/card holders etc?

7.2 If Yes, Do you face any problem in maintaining the records for the scheme? If yes, what are these problems?

This is the end of our discussion. Do you wish to add any thing else before we close?

THANK AND CLOSE

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Annex Annex Annex Annex 2222

List of List of List of List of Sample Villages and Sample Villages and Sample Villages and Sample Villages and

TownsTownsTownsTowns

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List of Sample Villages

Name of

District

Name of Selected

Block

Average

Distance of

Medical

Facility in

Km

Total

Number

of

Villages

Total

Number of

Village to be

Covered

Name of Selected

Village

Talwada Deb 0 11 2

Dawana 1 9 1 Mehgaon

Shahpura 2 12 2

Khurampura Golata Umariya Gholanya Banjari Bajaha Pipalya Deb Bilwadeb Rangaondeb Uchawad

Barwani Thikri

3 70 10

Ghatwa 0 3 0

Manakwada 1 18 2

Khamariya Kursidhana Chargaon Rajthari Kharsali

2 38 5

Padrai Thakur Chhirpani Patha Kodapdarai Imaliya Hanotia Rechhoda Daryao Nayagaon

Hoshangabad Bankedi

3 66 8

Anhai 0 5 0

Badkuwa 1 15 2

Kaliya Bada Badliya Tikadimoti Sajwanichhoti Kotda

2 42 5

Kardawad Kalan(Badi) Pitol Khurd Dhawadipada

Jhabua Jhabua

3 70 8

Umariya Banjari

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Name of

District

Name of Selected

Block

Average

Distance of

Medical

Facility in

Km

Total

Number

of

Villages

Total

Number of

Village to be

Covered

Name of Selected

Village

Kallipura Parwat Bisoli Sandala Bawadi Badi

0 9 0 Hiwari Sangam Gangatwara

1 29 5

Piplanarayanwar Karli Mogra Dhokdoh Dhotki

2 41 5

Nimni Ghoghari Gajandoh F.V. Bhivadoni Koparawadi Khurd Amla F.V.

Chindwara Sausar

3 64 6

Bramhan Pipla 0 6 1 Tilai

Kamta Mal. 1 20 2

Pondi Barbaspur Sara Ryt. 2 31 3 Hirapur Atariya Khursipar Dungariya Chargaon Khohri Ghateri Kokiwada Bori

Mandla Nainpur

3 107 9

Murgatola F.V. Janakpur Jhantala 0 67 3 Nayagaon Gulsari Nim Ka Kheda 1 61 3 Bawalnai Bhimsukh

Neemunch Jawad

2 103 5 Nanpuriya

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Name of

District

Name of Selected

Block

Average

Distance of

Medical

Facility in

Km

Total

Number

of

Villages

Total

Number of

Village to be

Covered

Name of Selected

Village

Kheda Bhangota Mukera Borkhedi Govindpura Parwani Jetliya

3 93 4

Suntholi 0 33 1 Raipur

Ghodidha 1 34 2

Khabhara Kalan Gadargawan Purwatir Sarui

2 62 4

Kuthila Phutaundha Bilara Majhiyari Usargaon Jamai Kalan Bans Kankar

Rewa Teonthar

3 165 8

Majhigawan 0 2 0

Bhajpura 1 9 2

Hingawali Dohrota Konthar Khurd Sainthra Ahir

2 18 4

Rajaudha Tehara Kundauna Ratha Chapak Tarsama Pali Nagra Porsa Ratan Basai

Sagar Khurai

3 46 9

Raipur 0 2 0

Banka Pura Dohara 1 16 3 Thara Gadhiya Ambah

Morena Ambah

2 16 4 Kakarari

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Name of

District

Name of Selected

Block

Average

Distance of

Medical

Facility in

Km

Total

Number

of

Villages

Total

Number of

Village to be

Covered

Name of Selected

Village

Rithona Sihoniya Arrusi Gilapura Mahuri Aroli Sangoli Dimani Bhonpura

3 41 8

Tareni 0 36 1 Baboopur

Khamha Sonor 1 38 3 Sohawal Khujha Lalpur 2 59 3 Bhaiswar Jhanda Gaura Kalhari Korgawan Mand Khamhariya Tiwari Bhanwar

Satna Satna (Sohawal)

3 132 8

Madhawgdha 0 20 1 Kothri Kalan

Bhati Kheda 1 33 2

Anandipura Dalpatpura Sobha Khedi Patariya Goyal

2 65 4

Pagariya Chor Nimawara Barkhedi (Siddiqueganj) Kakariya Khedi Hajipur Shyampur Tappa Badkhola Shyampura Magarda

Sehore Ashta

3 147 8

Nogaon 0 19 1 Umri Kalan

Raipura Shivpuri Pichhore

1 13 2 Labheda

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Name of

District

Name of Selected

Block

Average

Distance of

Medical

Facility in

Km

Total

Number

of

Villages

Total

Number of

Village to be

Covered

Name of Selected

Village

Pagra Bhagwan Gurkudwaya

2 34 4

Badarwas Maniyar Dagariya Barela Pareshwar Gochoni Kumharauwa Alias Bagwaj Kakrauwa Alias Thuni

3 79 8

Pipra Pichhore Total 2109 181

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List of Sample Towns

District Name of Selected Town No. of Locations/Slums

Barwani • Barwani (M) • Pansemal

2 2

Chindwara • Jamai • Chindwara

2 2

Hoshangabad • Itarsi • Babai

2 2

Jhabua • Jhabua • Ranapur

2 2

Mandla • Mandla (M) • Mandla (M+OG)

4

Morena • Morena • Porsa (M)

2 2

Neemunch • Neemuch • Jawad

2 2

Rewa • Rewa • Hanumana

2 2

Sagar • Rahatgarh • Sagar

2 2

Satna • Satna • Nagaod

2 2

Sehore • Ashta • Sehore

2 2

Shivpuri • Kolaras • Shivpuri

2 2

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Annex Annex Annex Annex 3333

Output TablesOutput TablesOutput TablesOutput Tables

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Output Tables

Type of Family

Beneficiary Households Non- Beneficiary Households

Urban

Rural

Urban

Rural

Type of

Family

Absolute Percent Absolute Percent Absolute Percent Absolute Percent

Joint 86 23.63 41296 21.72 4301 19.95 1165787 14.86

Nuclear 278 76.37 148810 78.28 17263 80.05 6680025 85.14

Total 364 100 190106 100 21564 100 7845813 100

S.D. 0.43 0.41 0.40 0.36

95% C.I. 1.72-1.81 1.78-1.78 1.80-1.81 1.85-1.85

* Source: Field Survey

Type of Household Category

Beneficiary Households Non- Beneficiary Households

Urban Rural Urban Rural

Type of

Household

Category Absolute Percent Absolute Percent Absolute Percent Absolute Percent

BPL (Card

Seen)

241 66.21 124401 65.44 14640 67.89 5429261 69.20

BPL Card Not

Seen

122 33.52 65705 34.56 6711 31.12 2368741 30.19

APL 1 0.27 0 0 213 0.99 47811 0.61

Total 364 100 190106 100 21564 100 7845813 100

S.D. 0.48 0.48 0.49 0.48

95% CI 1.29-1.39 1.34-1.35 1.32-1.34 1.31-1.31

* Source: Field Survey

Availability of Family Health card

Beneficiary Households Non- Beneficiary Households

Urban Rural Urban Rural

Family Health

Card

Absolute Percent Absolute Percent Absolute Percent Absolute Percent

Yes (Card Seen) 336 92.31 178688 93.99 20379 94.51 6997177 89.18

Yes but (Card not seen)

25 6.87 10286 5.41 741 3.44 452578 5.77

No Card 3 0.82 1131 0.60 444 2.06 396058 5.05

Total 364 100 190106 100 21564 100 7845813 100

S.D. 0.31 0.27 0.33 0.48

95% CI 1.05-1.12 1.06-1.07 1.07-1.08 1.16-1.16

* Source: Field Survey

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Households having Mukhya Mantri Majdoor Suraksha Card Beneficiary Households Non- Beneficiary Households

Urban Rural Urban Rural

Mukhya Mantri Majdoor Suraksha Card

Absolute Percent Absolute Percent Absolute Percent Absolute Percent

Yes (Card Seen) 12 3.30 30398 15.99 572 2.65 613547 7.82

Yes but (Card not seen)

53 14.56 83987 44.18 2761 12.81 3656527 46.60

No Card 299 82.14 75721 39.83 18231 84.54 3575739 45.58

Total 364 100 190106 100 21564 100 7845813 100

S.D. 0.48 0.71 0.45 0.63

95% CI 2.74-2.84 2.24-2.24 2.81-2.82 2.38-2.38

* Source: Field Survey

Proportion of Households having Nirman Shramik Card

Beneficiary Households Non- Beneficiary Households

Urban Rural Urban Rural

Nirman Shramik

Card

Absolute Percent Absolute Percent Absolute Percent Absolute Percent

Yes (Card Seen) 11 3.02 33292 17.51 319 1.48 648314 8.26

Yes but (Card not seen)

46 12.64 72314 38.04 3540 16.42 2518039 32.09

No Card 307 84.34 84500 44.45 17705 82.10 4679459 59.64

Total 364 100 190106 100 21564 100 7845813 100

S.D. 0.46 0.74 0.43 0.64

95% CI 2.77-2.86 2.27-2.27 2.80-2.81 2.51-2.51

* Source: Field Survey

Religion of head of the Households

Beneficiary Households Non- Beneficiary Households

Urban Rural Urban Rural

Religion

Absolute Percent Absolute Percent Absolute Percent Absolute Percent

Hindu 258 70.88 174617 91.85 15288 70.90 7412968 94.48

Muslim 98 26.92 2848 1.50 6198 28.74 189064 2.41

Sikh 4 1.10 11873 6.25 64 0.30 213714 2.72

Christian 2 0.55 180 0.09 14 0 8538 0.11

Other (Specify) 2 0.55 588 0.31 21564 0.07 21528 0.27

Total 364 100 190106 100 15288 100 7845813 100

S.D. 6.44 4.85 2.26 4.56

95% CI 1.12-2.45 1.39-1.43 1.32-1.38 1.32-1.32

* Source: Field Survey

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Caste/Tribe of Respondent Households Beneficiary Households Non- Beneficiary Households

Urban Rural Urban Rural

Caste/Tribe

Absolute Percent Absolute Percent Absolute Percent Absolute Percent

Schedule caste 141 38.74 96835 50.94 8434 39.11 2612826 33.30

Schedule tribe 44 12.09 51447 27.06 1909 8.85 3274775 41.74

Other Backward Castes

140 38.46 32717 17.21 10411 48.28 1527390 19.47

None of them 39 10.71 9107 4.79 810 3.76 430823 5.49

Total 364 100 190106 100 21564 100 7845813 100

S.D. 1.08 0.90 1.00 0.86

95% CI 2.10-2.32 1.75-1.76 2.15-2.18 1.97-1.97

* Source: Field Survey

House Type of Respondent Households

Beneficiary Households Non- Beneficiary Households

Urban Rural Urban Rural

House Type

Absolute Percent Absolute Percent Absolute Percent Absolute Percent

Kaccha 226 62.09 165608 87.11 15559 72.15 7106564 90.58

Semi Pucca 110 30.22 20893 10.99 5035 23.35 627286 8.00

Pucca 28 7.69 3606 1.90 970 4.50 111963 1.43

Total 364 100 190106 100 21564 100 7845813 100

S.D. 0.64 0.41 0.56 0.35

95% CI 1.39-1.52 1.15-1.15 1.32-1.33 1.11-1.11

* Source: Field Survey

House Ownership

Beneficiary Households Non- Beneficiary Households

Urban Rural Urban Rural

House

own/rented

Absolute Percent Absolute Percent Absolute Percent Absolute Percent

Own 327 89.84 185227 97.43 20107 93.24 7402225 94.35

Rented 37 10.16 4880 2.57 1457 6.76 443588 5.65

Total 364 100 190106 100 21564 100 7845813 100

S.D. 0.30 0.16 0.25 0.23

95% CI 1.07-1.13 1.02-1.02 1.06-1.07 1.06-1.06

* Source: Field Survey

Household Owns any other house or not

Beneficiary Households Non- Beneficiary Households

Urban Rural Urban Rural

Any other house

Absolute Percent Absolute Percent Absolute Percent Absolute Percent

Yes 5 1.37 7050 3.71 72 0.33 88115 1.12

No 359 98.63 183056 96.29 21492 99.67 7757697 98.88

Total 364 100 190106 100 21564 100 7845813 100

S.D. 0.12 0.19 0.06 0.11

95% CI 1.97-2.00 1.96-1.96 2.00-2.00 1.99-1.99

* Source: Field Survey

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Proportion of Households having Agricultural land Beneficiary Households Non-Beneficiary Households

Urban Rural Urban Rural

Households

having

Agricultural

land Absolute Percent Absolute Percent Absolute Percent Absolute Percent

Yes 15 4.12 50056 26.33 484 2.24 1508844 19.23

No 349 95.88 140050 73.67 21080 97.76 6336969 80.77

Total 364 100 190106 100 21564 100 7845813 100

S.D. 0.20 0.44 0.15 0.39

95% CI 1.94-1.98 1.73-1.74 1.98-1.98 1.81-1.81

If Yes, How much? (in Acres) No answer 1 - 1031 - 0 0 0 0

0.1-1.0 8 57.14 11924 24.32 153 31.60 427157 28.31

1.0-2.0 3 21.43 13584 27.71 220 45.46 482021 31.95

2.0-3.0 2 14.29 18928 38.61 93 19.12 270584 17.93

3.0-4.0 1 7.14 945 1.93 18 3.82 105552 7.00

4.0 & Above 0 0.00 3644 7.43 0 0 223530 14.81

Total 15 100 50056 100 484 100 1508844 100

Average (Acres) 1.60 2.35 1.95 2.48

If Yes, proportion Irrigated

Un-irrigated 4 26.67 15517 31.00 243 50.21 570854 37.83

0.1-1 Acre Irrigated

7 63.64 21551 62.40 160 66.67

386463 41.20

10.0-2.0 Irrigated

3 27.27 5774 16.72 80 33.33

312974 33.37

2.0-3.0 Irrigated 0 0.00 5097 14.76 0 0 107876 11.50

3.0-4.0 Irrigated 1 9.09 669 1.94 0 0 27958 2.98

4 acre & Above Irrigated

0 0.00 1448 4.19 0 0

102719 10.95

Total 15 100 50056 100 484 100 1508844 100

Average (Acres) 1.13 1.16 0.75 0.25

* Source: Field Survey

Gender of Respondents

Beneficiary Households Non-Beneficiary Households

Urban Rural Urban Rural

Gender

Absolute Percent Absolute Percent Absolute Percent Absolute Percent

Male 239 65.66 150726 79.29 15027 69.69 6473724 82.51

Female 125 34.34 39380 20.71 6537 30.31 1372089 17.49

Total 364 100 190106 100 21564 100 7845813 100

S.D. 0.48 0.41 0.46 0.38

95% CI 1.29-1.39 1.21-1.21 1.30-1.31 1.17-1.18

* Source: Field Survey

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Age of Respondent of Targeted Households Beneficiary Households Non-Beneficiary Households

Urban Rural Urban Rural

Age of the

Respondent

Absolute Percent Absolute Percent Absolute Percent Absolute Percent

Below 20 15 4.12 2864 1.51 746 3.46 136479 1.74

21-30 71 19.51 47233 24.85 5100 23.65 1814667 23.13

31-40 134 36.81 70302 36.98 7778 36.07 2517577 32.09

40-50 85 23.35 45046 23.70 4434 20.56 1721295 21.94

51-60 37 10.16 14023 7.38 1920 8.90 949589 12.10

61 & Above 22 6.04 10638 5.60 1587 7.36 706206 9.00

Total 364 100 190106 100 21564 100 7845813 100

Average Age

(Yrs)

40 40 40 41

S.D. 12.19 11.26 12.28 12.72

95% CI 38.75-41.26 39.50-39.60 39.55-39.88 40.95-40.96

* Source: Field Survey

Proportion of Respondent Households who can read & write

Beneficiary Households Non-Beneficiary Households

Urban Rural Urban Rural

Read & Write

Absolute Percent Absolute Percent Absolute Percent Absolute Percent

Yes 122 33.52 67093 35.29 7627 35.37 2093001 26.68

No 242 66.48 123013 64.71 13937 64.63 5752812 73.32

Total 364 100 190106 100 21564 100 7845813 100

S.D. 0.47 0.48 0.48 0.44

95% CI 1.62-1.71 1.64-1.65 1.64-1.65 1.73-1.73

* Source: Field Survey

Education Status of the Respondents

Beneficiary Households Non- Beneficiary Households

Urban Rural Urban Rural

Years of schooling

Absolute Percent Absolute Percent Absolute Percent Absolute Percent

Less than Primary (5th)

49 40.16 26505 39.51 2441 32.00 870817 41.61

6-8 class 47 38.52 18393 27.41 3090 40.51 734226 35.08

9-10 class 11 9.02 15747 23.47 1111 14.56 329137 15.73

11-12 class 13 10.66 4926 7.34 441 5.78 120368 5.75

12th class & Above 2 1.64 1522 2.27 545 7.15 38454 1.84

Total 122 100 67093 100 7627 100 2093001 100

S.D. 1.04 1.06 1.15 0.65

95% CI 1.99-2.74 2.57-2.61 2.68-2.79 1.83-1.83

* Source: Field Survey

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Main Source of Income of Respondent Households Beneficiary Households Non-Beneficiary Households

Urban Rural Urban Rural

Main Source of

Income

Absolute Percent Absolute Percent Absolute Percent Absolute Percent

Farming/Cultivation 16 4.40 44310 23.31 1408 6.53 1070012 13.64

Agricultural labour 136 37.36 107772 56.69 9243 42.86 5269833 67.17 Livestock/forestry/ fishing/orchards/ allied activities

6 1.65 1906 1.00 95 0.44 133780 1.71

Mining & quarrying 0 0 216 0.11 155 0.72 77573 0.99

Manufacturing 14 3.85 1406 0.74 352 1.63 59245 0.76

Construction 22 6.04 3218 1.69 428 1.99 268122 3.42

Petty Trader 12 3.30 14 0.01 498 2.31 50597 0.64

Artisan 4 1.10 158 0.08 297 1.38 30623 0.39

Business 12 3.30 381 0.20 296 1.37 114563 1.46

Service (government/private)

11 3.02 1973 1.04 246 1.14 52440 0.67

Others (Specify) 149 40.93 42586 22.40 10388 48.17 1859806 23.70

* Source: Field Survey

Monthly income of Respondent Households Beneficiary Households Non-Beneficiary Households

Urban Rural Urban Rural Income

Categories Absolute Percent Absolute Percent Absolute Percent Absolute Percent

No response 0 0 0 0 658 3.05 90015 1.15 Less than 500 28 7.69 26761 14.08 1823 8.72 1207627 15.57 501-1000 92 25.27 59729 31.42 6681 31.96 3566033 45.98 1001-2000 192 52.75 73646 38.74 11065 52.92 2476819 31.94 2001-3000 46 12.64 28980 15.24 1118 5.35 470983 6.07 3001-4000 6 1.65 742 0.39 101 0.48 18360 0.24 4001-5000 0 0 247 0.13 64 0.31 8329 0.11 5001 & Above 0 0 0 0.00 55 0.26 7645 0.10 Total 364 100 190106 100 21564 100 7845813 100

Average Income

(Rs.) 1472 1334 1282 1095

* Source: Field Survey

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Awareness of the Scheme Beneficiary Households Non-Beneficiary Households

Urban Rural Urban Rural

Aware of DAUY

Scheme

Absolute Percent Absolute Percent Absolute Percent Absolute Percent

Yes 301 82.69 162308 85.38 8379 38.86 3571469 45.52

No 63 17.31 27798 14.62 13185 61.14 4274343 54.48

Total 364 100 190106 100 21564 100 7845813 100

S.D. 0.38 0.35 0.49 0.50

95% CI 1.13-1.21 1.14-1.15 1.60-1.62 1.54-1.55

* Source: Field Survey

Awareness regarding the eligibility for Availing the Scheme (open ended)

Beneficiary Households Non-Beneficiary Households

Urban Rural Urban Rural

Aware of

eligibility

Absolute Percent Absolute Percent Absolute Percent Absolute Percent

Aware 247 82.06 11601 7.15 5388 64.30 2563450 71.78 Ignorant/wrong answer

44 14.62 135701 83.61 1219 14.54 166936 4.67

Do not Know/Can’t Say

10 3.32 15006 9.25 1773 21.16 841083 23.55

Total 301 100 162308 100 8379 100 3571469 100

S.D. 0.41 0.40 0.59 0.50

95% CI 1.07-1.16 1.02-1.02 0.92-0.94 0.81-0.81

* Source: Field Survey

Awareness regarding benefits that can be availed under the Scheme (open ended)

Beneficiary Households Non-Beneficiary Households

Urban Rural Urban Rural

Aware of

benefits

Absolute Percent Absolute Percent Absolute Percent Absolute Percent

Correct Answer 154 51.16 55526 34.21 2728 32.56 1410165 39.48

Ignorant/wrong answer

73 24.25

60890

37.51

3112

37.14

1015044

28.42

Do not Know/Can’t Say 74 24.58

45893

28.28

2539

30.30

1146260

32.09

Total 301 100 162308 100 8379 100 3571469 100

S.D. 0.70 0.79 0.73 0.78

95% CI 0.92-1.07 0.94-0.94 1.05-1.08 0.96-0.96

* Source: Field Survey

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Proportion of Respondent Households who are aware regarding type of services that can

be availed (open ended) Beneficiary Households Non-Beneficiary Households

Urban Rural Urban Rural

Avail the

services

Absolute Percent Absolute Percent Absolute Percent Absolute Percent

Correct Answer 256 85.05 32896 20.27 5843 69.73 1284230 35.96

Ignorant/wrong answer

0 0

125498

77.32 0 0

2287240

64.04

Do not Know/Can’t Say 45 14.95

3914

2.41

2536

30.27 0 0

Total 301 100 162308 100 8379 100 3571469 100

S.D. 0.36 0.44 0.46 0.48

95% CI 0.81-0.89 0.82-0.82 0.68-0.71 0.64-0.64 * Source: Field Survey

Proportion of Households who are aware regarding Grievance Redressal Mechanism

(open ended)

Beneficiary Households Non-Beneficiary Households

Urban Rural Urban Rural

Grievances

Absolute Percent Absolute Percent Absolute Percent Absolute Percent

Correct Answer 88 24.18 131884 81.26 5587 66.68 1411252 39.51 Ignorant/wrong answer

4 1.33

30037 18.51 14 0.17

20338 0.57

Do not Know/Can’t Say 209 69.44

387

0.24 2778 33.15

2139879 59.92

Total 301 100 162308 100 8379 100 3571469 100

S.D. 0.49 0.40 0.47 0.50

95% CI 0.26-0.38 0.19-0.19 0.66-0.68 0.41-0.41 * Source: Field Survey

Source of information regarding the Scheme

Beneficiary Households Non-Beneficiary Households

Urban Rural Urban Rural

Any other house

Absolute Percent Absolute Percent Absolute Percent Absolute Percent

MPM/MPF 70 23.26 46921 28.91 2226 27.05 1227037 34.36

ASHA 56 18.60 71469 44.03 1905 22.74 1386675 38.83

AWW 152

50.50 101152 62.32

5040 60.15 2056578 57.58

Doctors 54 17.94 32239 19.86 2238 26.71 750492 21.01

PRI members 79 26.25 55771 34.36 2111 25.19 890106 24.92

Media 16 5.32 2039 1.26 377 4.50 164323 4.60

Others 49 16.28 5688 3.50 0 0 426239 11.90 * Source: Field Survey

*Multiple Responses

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Percent of Respondent Households where any family members fell ill

Beneficiary Households

Urban Rural

Family members fell ill

Absolute Percent Absolute Percent

Yes 364 100 190106 100

No 0 0 0 0

Total 364 100 190106 100

S.D. 0 0

95% CI 0 0

* Source: Field Survey

Non-Beneficiary Households

Urban Rural

Family members fell ill

Absolute Percent Absolute Percent

Yes 5783 26.82 1870094 23.84 No 15781 73.18 5975719 76.16 Total 21564 100 7845813 100

S.D. 0.44 0.43

95% CI 1.73-1.74 1.76-1.76 * Source: Field Survey

Percent of Respondent Households where family members fell ill and were Hospitalised Beneficiary Households

Urban Rural

Family members fell ill

and were Hospitalised

Absolute Percent Absolute Percent

Yes 305 83.79 142702 75.06

No 59 16.21 47404 24.94

Total 364 100 190106 100

S.D. 0 0

95% CI 0 0

* Source: Field Survey

Non- Beneficiary Households

Urban Rural

Family members fell ill

and were Hospitalised

Absolute Percent Absolute Percent

Yes 1372 23.73 643047 34.39

No 4411 76.27 1227047 65.61

Total 5783 100 1870094 100

S.D. 0.43 0.48

95% CI 1.75-1.77 1.66-1.66

* Source: Field Survey

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Percent of Respondent Households who availed any facility under scheme (for

beneficiary households only)

Beneficiary Households

Urban Rural

Availed any facility

under scheme

Absolute Percent Absolute Percent

Yes 364 100 190106 100

No 0 0 0 0

Total 364 100 190106 100

S.D. 0.15 0

95% CI 1.00-1.03 1.01-1.01

* Source: Field Survey

Percent of Respondent Households who were sick and availed treatment under the

scheme

Beneficiary Households

Urban Rural

Sick and Availed treatment

under the scheme

Absolute Percent Absolute Percent

One 359 97.03 189294 99.15

Two 8 2.16 1624 0.85 Three 3 0.81 0 0

Total 370 100 190918 100

* Source: Field Survey

Type of Diseases for which treatment was availed

Beneficiary Households

Urban Rural Type of Diseases

Absolute Percent Absolute Percent

No Response 21 5.49 3065 1.61

Heart Problem, Blood Pressure 10 2.75 2.87 1589 0.84 0.85

Abdominal Problem, Appendix, Diarrhoea, Jaundice 44 12.09 12.61 18349 9.65 9.77

Pain, Fewer, Cold & Cough 120 32.97 34.38 68171 35.86 36.29

Skin Problem 2 0.55 0.57 867 0.46 0.46

Accident Cases 12 3.30 3.44 3607 1.90 1.92

Others (Weakness, Anaemic, Swelling, Diabetes, 46 11.26 13.18 17773 9.35 9.46

Asthma 7 1.92 2.01 4674 2.46 2.49

Cancer 0 0 0.00 1021 0.54 0.54

Chicken Pox 3 0.82 0.86 137 0.07 0.07

Delivery 49 13.46 14.04 52819 27.78 28.12

E.N.T. 6 1.65 1.72 1316 0.69 0.70

Typhoid 16 4.40 4.58 2194 1.15 1.17

T.B 16 4.40 4.58 8574 4.51 4.56

Brain Related Diseases 4 1.10 1.15 3154 1.66 1.68

Animal Bites 14 3.85 4.01 3607 1.90 1.92

Total 370 100 190918 100 * Source: Field Survey

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Amount Spent (in each category) by Persons who were taken ill and availed Treatment Beneficiary Households

Urban Rural

Amount Spent for

Persons who

were ill and availed

treatment Absolute Percent Absolute Percent

0 (no record on card) 120 28.46 84233 34.36 10-500 109 29.94 50103 26.27 501-1,000 39 10.72 16428 8.56 1,001-5,000 57 15.65 25943 13.63 5,001-10,000 29 12.45 10291 7 10,001-20,000 6 1.64 2218 1.2 20,001 & above 4 1.14 890 0.54 Total 364 100 190106 100

Average Amount (Rs.) 1747 1314 * Source: Field Survey

* Percents have been calculated from the respondents only. Hence, No responses has been excluded while calculating percentage

Percent of Households who were ill and sought treatment but not under the scheme

Beneficiary Households

Urban Rural

Were ill and sought

treatment but not

under the scheme

Absolute Percent Absolute Percent

Availed under scheme 346 95.05 179434 94.39

Did not avail under scheme 18 4.95 10672 5.61

Total 364 100 190106 100

S.D. 0.22 0.23

95% CI 0.03-0.07 0.06-0.06

* Source: Field Survey

Non-Beneficiary Households

Urban Rural

Were ill and sought

treatment but not

under the scheme

Absolute Percent Absolute Percent

Availed under scheme 33 0.57 223020 11.93

Did not avail under scheme 5750 99.43 1647074 88.07

Total 5783 100 1870094 100

S.D. 0 0.41

95% CI 0.26-0.27 0.21-0.21

* Source: Field Survey

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Type of Diseases for which treatment was availed (Beneficiary Households) Beneficiary Households

Urban Rural

Diseases

Absolute Percent Absolute Percent

No Response 14 77.78 3948 36.99 Heart Problem, Blood Pressure 1 5.56 0 0 Abdominal Problem, Appendix, Diarrhoea, Jaundice 0 0

1166 10.92

Pain, Fewer, Cold & Cough 0 0 5558 52.08 Skin Problem 1 5.56 0 0 E.N.T. 1 5.56 0 0 Typhoid 1 5.56 0 0 Total 18 100 10672 100 * Percent from those who mentioned being ill and sought treatment * Source: Field Survey Type of Diseases for which treatment was availed (Non-Beneficiary Households)

Non-Beneficiary Households Urban Rural

Type of Diseases

Absolute Percent Absolute Percent

No Response 289 5.03 70195 4.26 Heart Problem, Blood Pressure 41 0.72 21371 1.30 Abdominal Problem, Appendix, Diarrhoea, Jaundice 638 11.10 224386 13.62 Pain, Fewer, Cold & Cough 1879 32.68 522494 31.72 Skin Problem 0 0 0 0 Accident Cases 657 11.43 45026 2.73 Others (Weakness, Anaemic, Swelling, Diabetes) 1130 19.65 274807 16.68 Asthma 37 0.65 25662 1.56 Cancer 28 0.48 0 0 Chicken Pox 0 0 712 0.04 Delivery 850 14.79 362471 22.01 E.N.T. 76 1.32 21031 1.28 Typhoid 0 0 T.B 28 0.49 21980 1.33 Brain Related Diseases 83 1.44 44312 2.69 Animal Bites 13 0.23 12627 0.77 Total 5750 100 1647074 100 * Source: Field Survey

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Amount Spent (in each category) by Persons who fell ill and availed treatment

Beneficiary Households

Urban Rural Amount Spent

(in each category) Absolute Percent Absolute Percent

0 15 83.33 6393 59.91

10-500 0 0 0 2753 25.80 64.34

501-1,000 0 0 0 511 4.79 11.94

1,001-5,000 0 0 0 823 7.71 19.23

5,001-10,000 1 5.56 33.33 69 0.65 1.61

10,001-20,000 1 5.56 33.33 0 0 0.00

20,001 & above (100000) 1 5.56 33.33 123 1.15 2.87

Total 18 100 100 10672 100 100

Average Amount 143 38 * Source: Field Survey

Amount spent by Persons who were ill & availed treatment (Non-Beneficiary

Households)

Non-Beneficiary Households

Urban Rural Amount Spent

(in each category) Absolute Percent Absolute Percent

0 851 14.81 457686 27.79

10-500 768 13.36 15.68 270177 16.40 22.72

501-1,000 1017 17.68 20.76 359177 21.81 30.20

1,001-5,000 1135 19.74 23.17 340307 20.66 28.61

5,001-10,000 128 2.23 2.61 27696 1.68 2.33

10,001-20,000 491 8.55 10.02 154533 9.38 12.99

20,001 & above(100000) 1359 23.63 27.75 37500 2.28 3.15

Total 5750 100 100 1647074 100 100

Average Amount 8658 643 * Source: Field Survey

Percent of Respondent Households where family members were ill but did not avail any

treatment anywhere

Beneficiary Households

Urban Rural

Family members were ill

but did not avail any treatment

Absolute Percent Absolute Percent

Availed Treatment under scheme 362 99.45 189971 99.93

Did not avail treatment anywhere 2 0.55 135 0.07

Total 364 100 190106 100

S.D. 0.07 0.27

95% CI 0-0.01 0-0

* Source: Field Survey

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Proportion of Households who did not avail any treatment

Non-Beneficiary Households

Urban Rural

Family members were ill

but did not avail any treatment

under the scheme Absolute Percent Absolute Percent

Availed Treatment under scheme 5228 90.93 1566709 95.12

Did not avail treatment under scheme 521 9.07 80365 4.88

Total 5750 100 1647074 100

S.D. 0.29 0.22

95% CI 0.02-0.03 0.01-0.01

* Source: Field Survey

Type of Diseases for which treatment was availed (Beneficiary Households)

Beneficiary Households Urban Rural

Type of Diseases

Absolute Percent Absolute Percent

Pain, Fewer, Cold & Cough 0 0 135 100 Typhoid 1 50.00 0 0 T.B 1 50.00 0 0 Total 2 100 135 100

Reasons for not availing the treatment

Physical distance 0 0 135 100 Un-helping/uncooperative health functionaries 2 100 0 0 Total 2 100 135 100 * Source: Field Survey

Reasons for not availing the treatment (Non-Beneficiary Households)

Non-Beneficiary Households Urban Rural

Reasons for not availing the treatment

Absolute Percent Absolute Percent

Physical distance 0 0 304 0.37 Lack of facilities in close vicinity 0 0 19578 23.73 Un-helping/uncooperative health functionaries 443 84.96 37090 44.95 Financial constraints 14 2.70 19065 23.10 Any Other 64 12.33 6485 7.86 Total 521 100 82521 100 * Source: Field Survey

Total Amount Spent by Persons who were ill and availed treatment but not under the

scheme

Non-Beneficiary Households Urban Rural

Amount (in Rs.) Absolute Percent Absolute Percent

No response 700 12.17 404524 24.56 1-500 802 13.95 15.88 272612 16.55 21.94 501-1,000 1030 17.91 20.40 375868 22.82 30.25 1,001-5,000 1108 19.27 21.94 368217 22.36 29.63 5,001-10,000 101 1.76 2.00 31425 1.91 2.53 10,001-20,000 623 10.83 12.34 156928 9.53 12.63 20,001 & above 1386 24.11 27.45 37500 2.28 3.02 Total 5750 100 100 1647074 100 100 * Source: Field Survey

*All respondents did not specify amount

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Percent of Respondent Households whose treatment amount exceeded Rs 5000

Beneficiary Households

Urban Rural

Whose treatment amount

exceeded Rs 5000

Absolute Percent Absolute Percent

Yes 59 15.21 34278 17.03 No 305 84.79 155829 82.97 Total 364 100 190106 100

If Yes, by how much above 5000/-?

25-500 15 25.42 4644 13.5 501-1,000 5 8.47 2972 8.7 1,001-5,000 17 28.81 9563 27.9 5,001-10,000 7 11.86 8603 25.1 10,001-20,000 5 8.47 5336 15.6 20,001 & above(200000) 10 16.95 3161 9.2 Total 59 100 34278 100.0

Average amount spend in Rs. 1841 2217 Face any problem in continuing the treatment

Yes 23 38.98 7435 21.7 No 36 61.02 26842 78.3 Total 59 100 34278 100.0 * Source: Field Survey

Proportion of Wage/Man days lost as being absent from work (for people who fell ill)

Non-Beneficiary Households Urban Rural

Proportion of Wage/Man days lost

as being absent from work

(for people who fell ill) Absolute Percent Absolute Percent

Did not mention any loss 514 8.94 332292 20.17 1-5 1718 29.87 32.81 564116 34.25 42.91 6-10 994 17.29 18.98 413068 25.08 31.42 11-20 1439 25.03 27.48 118238 7.18 8.99 21-30 366 6.37 6.99 190037 11.54 14.45 31-60 167 2.90 3.19 16178 0.98 1.23 60 & Above 552 9.60 10.54 13145 0.80 1.00 Total 5750 100 100 1647074 100 100

Average Man days loss(Days) 5 2

Borrowed Money for treatment

Yes 1380 24.00 258277 15.68 No 4370 76.00 1388797 84.32 Total 5750 100 1647074 100

If Yes, how much

1-500 46 3.34 29944 11.59 501-1,000 51 3.72 26695 10.34 1,001-5,000 826 59.85 63564 24.61 5,001-10,000 174 12.63 17249 6.68 10,001-20,000 166 12.00 99371 38.47 20,001 & above 117 8.46 21455 8.31 Total 1380 100 258277 100

Average amount (Rs.) 553 332 * Source: Field Survey

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Percent of Beneficiary Households who availed the scheme facility for delivery Beneficiary Households

Urban Rural

Who availed the scheme

facility for delivery

Absolute Percent Absolute Percent

Yes 35 9.62 46144 24.27 No 329 90.38 143962 75.73 Total 364 100 190106 100

Availed transport facility for delivery under the scheme?

Yes 14 40.0 13476 29.20 No 21 60.0 32668 70.80 Total 35 100.0 46144 100.0

If Yes, What was the approx. cost of transport?

1-500 14 100 8461 62.79 501-1,000 0 0 3636 26.98 1,001-5,000 0 0 1379 10.24 Total 14 100 13476 100

Average cost of transportation 7 47 Who paid for the transport facility?

Under the scheme hence was free 2 14.29 6245 46.15 Family member but later reimbursed 7 50.00 6524 48.22 Shared under the scheme and by self as cost was high 0 0 445 3.29 Other 5 35.71 317 2.34 Total 14 100 13531 100 * Source: Field Survey

*Multiple Response

Reason of choosing the health facility for availing treatment

Beneficiary Households Urban Rural

Reason of choosing the health

facility for availing treatment Absolute Percent Absolute Percent

Referred by the Doctor/lower level Health facility 139 38.19 77094 40.55 To utilise the benefit of the scheme 213 58.52 105225 55.35 No other option available 19 5.22 5382 2.83 Others 5 1.37 5373 2.83 Total 376 100 193074 100 * Source: Field Survey *Multiple Responses

Source of information for availing benefit under the health facility

Beneficiary Households

Urban Rural

Reason of choosing the health

facility for availing Health Facility

Absolute Percent Absolute Percent

Doctor at lower level 109 29.95 37384 19.66 LHV 88 24.18 60051 31.59 MPM/F/NURSE/MIDWIFE 128 35.16 79189 41.66 ASHA 41 11.26 43519 22.89 OTHER 102 28.02 35370 18.61 Total 468 100 255513 100 *Source: Field Survey *Multiple Responses

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IMPACT OF THE SCHEME

Prior to availing the benefits

Status of health of the family prior to availing the benefits the scheme

Beneficiary Households Urban Rural

Status of health of the family

prior to availing

the benefits the scheme Absolute Percent Absolute Percent

Comparatively Good/Better 23 6.32 24314 12.79 Comparatively bad/worse 298 81.87 136323 71.71 No change 13 3.57 14831 7.80 Don’t Know/Can’t Say 30 8.24 14637 7.70 Total 364 100 190106 100

S.D. 20.66 20.01

95% CI 6.02-10.28 7.63-7.81 * Source: Field Survey

Percent of Respondent who spent more on seeking health benefits prior to availing

benefits of the scheme

Beneficiary Households

Urban Rural

Spend more money

Absolute Percent Absolute Percent

Yes 288 79.12 130137 68.45 No 51 14.01 47840 25.16 Do not know 25 6.87 12130 6.38 Total 364 100 190106 100

S.D. 19.21 18.51

95% CI 4.38-8.34 6.02-6.18 * Source: Field Survey

Percent of Respondent who borrowed money for treatment/health reasons prior to

taking the benefits of the scheme

Beneficiary Households

Urban Rural

Borrowed money for

treatment/health reasons

Absolute Percent Absolute Percent

Yes 49 13.46 27318 14.37 No 315 86.54 162788 85.63 Total 364 100 190106 100

S.D. 0.34 0.35

95% CI 1.83-1.90 1.85-1.86

If Yes, How much amount did you borrow? 1-500 2 4.08 5241 19.18 501-1,000 9 18.37 4907 17.96 1,001-5,000 18 36.73 7255 26.56 5,001-10,000 5 10.20 5014 18.36 10,001-20,000 8 16.33 1853 6.78 20,001 & above 7 14.29 3047 11.15 Total 49 100 27318 100

*Average amount borrowed by the

Respondent for treatment in Rs 6661 1911 * Source: Field Survey

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After availing the Scheme benefits

Percent of Respondent who borrowed money for treatment/health reasons after availing

benefits of the scheme

Beneficiary Households

Urban Rural

Borrowed money for

treatment/health reasons

after availing benefits of the scheme Absolute Percent Absolute Percent

Yes 16 4.40 13794 7.26 No 348 95.60 176312 92.74 Total 364 100 190106 100

S.D. 0.21 0.26

95% CI 1.93-1.98 1.93-1.93

If Yes, How much amount did you borrow? 1-500 1 6.25 3192 23.14 501-1,000 0 0 1042 7.55 1,001-5,000 5 31.25 2872 20.82 5,001-10,000 5 31.25 3331 24.15 10,001-20,000 2 12.50 842 6.11 20,001 & above 3 18.75 2514 18.23 Total 16 100 13794 100.0

*Average amount borrowed by the

Respondent for treatment in Rs 603 1036 * Source: Field Survey

Percent of respondent who think that health has improved after availing treatment

under the scheme Beneficiary Households

Urban Rural

Health has improved after

availing treatment under

the scheme Absolute Percent Absolute Percent

Yes 282 77.47 132480 69.69 No 64 17.58 53112 27.94 Don’t Know/Can’t Say 18 4.95 4514 2.37 Total 364 100 190106 100

S.D. 16.46 11.54

95% CI 3.24-6.63 3.03-3.14 * Source: Field Survey

Status of health of the family after availing the benefits the scheme

Beneficiary Households

Urban Rural

Status of health of the family

after availing

the benefits the scheme Absolute Percent Absolute Percent

Comparatively Good/Better 261 71.70 124105 65.28 Comparatively bad/worse 33 9.07 28693 15.09 No change 62 17.03 33684 17.72 Don’t Know/Can’t Say 8 2.20 3624 1.91 Total 364 100 190106 100

S.D. 11.12 10.35

95% CI 1.96-4.25 2.91-3.00 * Source: Field Survey

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Percent of respondents who perceived direct impact of scheme (Beneficiary Households)

Beneficiary Households

Urban Rural

Direct impact of the scheme

Absolute Percent Absolute Percent

Improved health 206 56.59 97188 51.12 Saving on health expenses 187 51.37 91129 47.94 Improvement in economic/income status after saving man days at work

48 13.19 23389 12.30

Any other 12 3.30 4497 2.37 Total 453 100 216203 100 * Source: Field Survey

Percent of respondents who perceived indirect impact of the scheme

Beneficiary Households

Urban Rural

Indirect impact of the

scheme

Absolute Percent Absolute Percent

Improved social status 214 58.79 91083 47.91 Improved education status for children

128 35.16 60956 32.06

Increased life expectancy 88 24.18 71624 37.68 Decrease in overall Mortality Rate

71 19.51 55220 29.05

Decrease in Maternal Mortality Rate

64 17.58 46436 24.43

Decrease in Infant Mortality Rate

44 12.09 17762 9.34

Any other 15 4.12 3760 1.98 Total 624 100 346841 100 * Source: Field Survey

Percent of respondents who feel that the scheme is relevant in providing cost-free access

of health care services

Beneficiary Households

Urban Rural

Providing cost-free access

of health care services

Absolute Percent Absolute Percent

Yes 277 76.10 119533 62.88 No 27 7.42 37526 19.74 Do not know 60 16.48 33047 17.38 Total 364 100 190106 100

S.D. 28.21 28.71

95% CI 10.69-16.51 14.28-14.54 * Source: Field Survey

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Measures to improve the service delivery mechanism (Beneficiary Households)

Beneficiary Households

Urban Rural

Measures to improve the

service delivery mechanism

Absolute Percent Absolute Percent

Can't say/ don’t know 471 57.83 241354 63.60 Behaviour of paramedical Staff 6 2.33 715 0.52 Behaviour of doctors 15 5.84 6478 4.69 Infrastructure 37 14.40 10288 7.45 Availability of doctors 17 6.61 13529 9.79 Medicines made available/ patients should be admitted

119 46.30 55931 40.48

Transport Facility 6 2.33 12295 8.90 Process is tedious/ work done in time

5 1.95 1338 0.97

low IEC activities 9 3.50 7868 5.69 Expecting cash Benefits 2 0.78 2523 1.83 Others(corruption ,etc) 1 0.39 2110 1.53 No suggestions 14 5.45 2624 1.90 Doing well 26 10.12 22459 16.26 Total 728 100 379512 100

S.D. 3.56 3.90

95% CI 3.39-4.12 4.29-4.33 * Source: Field Survey

Regular display of scheme beneficiaries list at sub centre/ health facility (Beneficiary

Households)

Beneficiary Households

Urban Rural

Regular display of scheme

beneficiaries

Absolute Percent Absolute Percent

Yes 76 20.88 40160 21.13 No 145 39.84 81385 42.81 Do not know 143 39.29 68562 36.06 Total 364 100 190106 100

S.D. 36.85 36.18

95% CI 27.46-35.05 28.67-29.00 * Source: Field Survey

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Experiences on critical incidences/cases (Beneficiary Households)

Beneficiary Households

Urban Rural

Experiences on critical

incidences/cases

Absolute Percent Absolute Percent

Can't say/ don’t know 191 52.47 122119 64.24

Doctors experience/ behaviour

33 19.08 6913 10.17

Facilities at govt hospital/ private clinics

7 4.05 719 1.06

Poor Infrastructure/camps/ cleanliness

19 10.98 3575 5.26

Non- Availability of doctors and other workers/ referred to other hospitals

10 5.78 2820 4.15

Non -Availability of medicines/ patients should be admitted/facility to card holders/ lack of treatment

36 20.81 30589 44.99

No Transport 0 0.00 1264 1.86

Lack of time/ more paper work involved

7 4.05 2839 4.18

low IEC activities/publicity

0 0.00 146 0.21

No money to spend/ doctors demand for money

1 0.58 634 0.93

Others(corruption, no photos on card, law and order ,etc)

11 6.36 4819 7.09

No suggestions 14 8.09 8657 12.73

Doing well 35 20.23 5011 7.37

Total 364 100 190106 100

* Source: Field Survey

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Bottlenecks in effective implementation (Beneficiary Households)

Beneficiary Households

Urban Rural

Bottlenecks in effective

implementation

Absolute Percent Absolute Percent

Can't say/ don’t know/ Doing well/no suggestions

257 70.60 126393 66.49

Doctors experience/ behaviour

0 0 861 0.34

Facilities at govt hospital/ private clinics

6 5.61 323 0.13

Poor Infrastructure/camps/ cleanliness

3 2.80 2025 0.80

Non-Availability of doctors and other workers/ referred to other hospitals

4 3.74 5806 2.29

Non-Availability of medicines/ patients should be admitted/facility to card holders/ lack of treatment

21 19.63 5343 2.11

No Transport Facility 1 0.93 11585 4.56

Lack of time/ more paper work

3 2.80 273 0.11

low IEC activities/publicity

24 22.43 14077 5.55

No money to spend/ doctors demand for money

3 2.80 5758 2.27

Others(corruption, no photos on card, law and order, etc)

15 14.02 17662 6.96

No 27 25.23 190106 74.90

Total 364 100 126393 100

* Source: Field Survey

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Bottlenecks in effective implementation (Non-Beneficiary Households)

Non-Beneficiary Households

Urban Rural

Bottlenecks in effective

implementation

Absolute Percent Absolute Percent

Ignorance 516 2.39 276340 16.78

Health provider did not guide us regarding this

424 1.97 95784 5.82

Physical distance to the facility

531 2.46 54010 3.28

Lack of government facilities in close vicinity

27 0.13 86736 5.27

Un-helping/uncooperative health functionaries

2289 10.61 527094 32.00

Financial constraints 67 0.31 25985 1.58

Was not referred by the doctor

52 0.24 24548 1.49

Scheme was not attractive 88 0.41 19405 1.18

Delivery case so availed JSY

0 0 0 0

Any Other 17570 81.48 537171 32.61

Total 21564 100 1647074 100

* Source: Field Survey

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Quality of Services availed

Beneficiary Households (Rural)

Very High High Average Low Very Low Total

Quality of Services availed

Absolute Percent Absolute Percent Absolute Percent Absolute Percent Absolute Percent Absolute Percent

Time taken to get the health cards made

31666 16.66 89868 47.27 59206 31.14 8683 4.57 684 0.36 190106 100

Process of getting the health cards made

30790 16.20 72879 38.34 58779 30.92 24328 12.80 3329 1.75 190106 100

Promptness in admission to the facility

24965 13.13 48626 25.58 79092 41.60 31530 16.59 5893 3.10 190106 100

Availability of bed at the facility

26699 14.04 45224 23.79 72927 38.36 37768 19.87 7488 3.94 190106 100

Availability of Medicines 23951 12.60 41282 21.72 69250 36.43 36364 19.13 19260 10.13 190106 100

Availability of investigative tests

26583 13.98 55100 28.98 58688 30.87 31736 16.69 17999 9.47 190106 100

Cleanliness of ward 17918 9.43 47109 24.78 82909 43.61 35135 18.48 7035 3.70 190106 100

Availability & cleanliness of toilets

17605 9.26 39980 21.03 79932 42.05 42318 22.26 10272 5.40 190106 100

General environment of the facility

24142 12.70 35378 18.61 79564 41.85 43793 23.04 7230 3.80 190106 100

Behaviour of Doctors 14343 7.54 56101 29.51 55938 29.42 39724 20.90 23999 12.62 190106 100

Behaviour of Para medical staff (Nurses and ward boys)

26607 14.00 45959 24.18 56623 29.78 32598 17.15 28320 14.90 190106 100

Grievance redressed mechanism

18708 9.84 33464 17.60 72565 38.17 33291 17.51 32078 16.87 190106 100

Overall Quality of service provided

28005 14.73 28421 14.95 93293 49.07 29413 15.47 10973 5.77 190106 100

* Source: Field Survey

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Quality of Services availed

Beneficiary Households (Urban)

Very High High Average Low Very Low Total

Quality of Services

availed Absolute Percent Absolute Percent Absolute Percent Absolute Percent Absolute Percent Absolute Percent

Time taken to get the health cards made

65 17.86 135 37.09 147 40.38 11 3.02 6 1.65 364 100

Process of getting the health cards made

46 12.64 171 46.98 114 31.32 24 6.59 9 2.47 364 100

Promptness in admission to the facility

15 4.12 138 37.91 152 41.76 49 13.46 10 2.75 364 100

Availability of bed at the facility

37 10.16 111 30.49 137 37.64 60 16.48 19 5.22 364 100

Availability of Medicines 54 14.84 110 30.22 119 32.69 55 15.11 26 7.14 364 100

Availability of investigative tests

31 8.52 126 34.62 121 33.24 63 17.31 23 6.32 364 100

Cleanliness of ward 49 13.46 109 29.95 131 35.99 60 16.48 15 4.12 364 100

Availability & cleanliness of toilets

43 11.81 72 19.78 152 41.76 83 22.80 14 3.85 364 100

General environment of the facility

41 11.26 106 29.12 158 43.41 40 10.99 19 5.22 364 100

Behaviour of Doctors 33 9.07 142 39.01 123 33.79 43 11.81 23 6.32 364 100

Behaviour of Para medical staff (Nurses and ward boys)

27 7.42 91 25.00 149 40.93 68 18.68 29 7.97 364 100

Grievance redressed mechanism

18 4.95 89 24.45 137 37.64 91 25.00 29 7.97 364 100

Overall Quality of service provided

35 9.62 72 19.78 199 54.67 26 7.14 32 8.79 364 100

* Source: Field Survey

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Average number of maternal deaths, Infant deaths and Proportion of Institutional

Delivery as reported in the Gram Sabha (in last one year)

Number of Maternal deaths Number of Infant deaths Number of Institutional

Delivery Urban Rural Urban Rural Urban Rural

Particular

n % n % n % n % n % n %

<2 37 77.1 5641 92.5 26 54.2 4910 80.5 0 0 3217 52.8 2-5 10 20.8 451 7.4 14 29.2 1014 16.6 0 0 9 0.1 5-10 1 2.1 5 0.1 6 12.5 135 2.2 0 0 40 0.7 10-50 0 0 0 0 1 2.1 39 0.6 3 6.3 258 4.2 50+ 0 0 0 0 1 2.1 0 0 45 93.8 2573 42.2

Total 48 100.0 6097 100.0 48 100.0 6097 100.0 48 100.0 6097 100.0 Source: Field Survey (Village Profile)

Drinking water facilities within the villages and urban slums

Urban Rural Source of Drinking Water

Absolute Percent Absolute Percent

Well 0 0.00 854 20.48

Hand Pump 5 10.42 698 16.74

Pond/Lake 0 0.00 0 0.00

River 0 0.00 13 0.31

Tap/Govt. supply 0 0.00 2 0.05

Well & Hand Pump 6 12.50 1255 30.10

Well & Pond/Lake 0 0.00 50 1.20

Well & River 2 4.17 206 4.94

Well & Tap 5 10.42 262 6.28

Well & Any other 0 0.00 45 1.08

Hand Pump & Pond/Lake 2 4.17 100 2.40

Hand Pump & River 4 8.33 235 5.64

Hand Pump & Tap 15 31.25 278 6.67

Hand Pump & Any other 0 0.00 4 0.10

Pond/Lake & River 0 0.00 10 0.24

Pond/Lake & Tap 2 4.17 14 0.34

Pond/Lake & Any other 0 0.00 0 0.00

River & Tap 7 14.58 124 2.97

River & Any other 0 0.00 19 0.46

Total 48 100 4169 100 Source: Field survey

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Disease patterns in the village and urban slums

Urban Rural Diseases

Absolute Percent Absolute Percent

Seasonal Illness 6 12.50 205 4.92

Water Borne Diseases 0 0.00 13 0.31

Tuberculosis 1 2.08 22 0.53

Asthma 0 0.00 0 0.00

Others 2 4.17 31 0.74

Seasonal Illness & Water Borne Diseases 8 16.67 734 17.61

Seasonal Illness & TB 7 14.58 501 12.02

Seasonal Illness & Asthma 6 12.50 502 12.04

Water Borne Diseases & TB 7 14.58 959 23.00

Water Borne Diseases & Asthma 7 14.58 706 16.93

Water Borne Diseases & Others 0 0.00 0 0.00

Tuberculosis & Asthma 4 8.33 496 11.90

Total 48 100 4169 100 Source: Field survey

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Annex Annex Annex Annex 4444

List of Service Providers List of Service Providers List of Service Providers List of Service Providers

ContactedContactedContactedContacted

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List Of Service Providers Interviewed During The Study

S. No

Region Name of Service Provider

Designation Place Schedule

1 State Health Official

Dr. Rakesh Munshi Joint Director Bhopal IDI

2 State Health Official

Dr. Rajeev Srivastava

Deputy Director Bhopal IDI

3 District Health Officials

Dr. Kansotia CMHO Bhopal Informal Discussion

4 Medical College Dr. Upadhayay Medical Suprimtendent, Incharge

Bhopal IDI

5 Medical College Mr. Manohar Sohni Scheme Incharge

Bhopal Informal Discussion

6 District Health Official

Dr. A.L Marawi CMHO Sehore IDI

7 District Health Official

Dr. D N Chaturvedi Civil Surgeon District Hospital, Sehore

IDI

8 District Health Official

Dr. Rajendra Singh CMHO Hoshangabad IDI

9 District Health Official

Dr. Hasan Civil Surgeon Hoshangabad IDI

10 District Health Official

Dr. J S Gogia (Additional charge)

CMHO Chhindwara IDI

11 District Health Official

Dr. J S Gogia Civil Surgeon Chhindwara IDI

12 District Health Official

Dr S.S Baghel CMHO Barwani IDI

13 District Health Official

Dr B.K Sawner Civil Surgeon Barwani IDI

14 District Health Official

Dr S.S Waskale CMHO Neemuch IDI

15 District Health Official

Dr S.L Mittal Civil Surgeon Neemuch IDI

16 District Health Official

Dr. G S Rawat CMHO Jhabua IDI

17 District Health Official

Dr. A S Vishnar Civil Surgeon Jhabua IDI

18 District Health Official

Dr B K Jhariya CMHO Mandla IDI

19 District Health Official

Dr R K Shrivastava Civil Surgeon Mandla IDI

20 District Health Official

Dr. Piperay Nodal Officer Mandala Informal Discussion

21 District Health Official

Dr. R S Pandey CMHO Satna IDI

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S. No

Region Name of Service Provider

Designation Place Schedule

22 District Health Official

Dr. D.N.Gautam Civil Surgeon (In charge)

Satna IDI

23 District Health Official

Dr. Padmawati Pande

CMHO Rewa IDI

24 District Health Official

Dr. I M Sharma Civil Surgeon Rewa IDI

25 District Health Official

Dr. Pradeep Shukla Nodal Officer Rewa Informal Discussion

26 District Health Official

Dr. N.P. Pandey Doctor Rewa Informal Discussion

27 District Magistrate, Rewa

Dr M.Geeta District Magistrate

Rewa Informal Discussion

28 Medical Collge, Rewa

Dr C.P.Shukla Superintendent Rewa IDI

29 GMH, Rewa Dr S.K.Pathak CMHO & Nodal officer,

Rewa Informal Discussion

30 GMH Rewa Dr. Yatnesh Tripathi Asst. Lecturer, Rewa Informal Discussion

31 District Health Official

Dr. Atulkar CMHO Morena IDI

32 District Health Official

Dr. A K Dubey Civil Surgeon Morena IDI

33 District Health Official

Dr. P.K. Godre CMHO Sagar IDI

34 District Health Official

Dr. Ajay K. Barotiya

Civil Surgeon Sagar IDI

35 District Health Official

Dr. H S Sharma CMHO Shivpuri IDI

36 District Health Official

Dr. G.P. Gupta Civil Surgeon Shivpuri IDI

37 Block Health Officer

Dr D.K Dev BMO Niwali, Barwani

IDI

38 Block Health Officer

Dr Mukesh Dange M.O Niwali, Barwani

IDI

39 Block Health Officer

Dr Verma M.O Barwani IDI

40 District admin staff

Mr Promde Mahajan MIU Operator Niwali, Barwani

Informal Discussion

41 District admin staff

Mr Mois Hussain Accountant Niwali, Barwani

Informal Discussion

42 Block Health Officer

Dr Mukesh Srivastava

BMO Jawad, Neemuch

IDI

43 Block Health Officer

Dr S .Jain M.O Jawad, Neemuch

IDI

44 Block Health Officer

Mr Dandodiya BMO Jawad, Neemuch

Informal Discussion

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S. No

Region Name of Service Provider

Designation Place Schedule

45 District Admin Staff

Mr R Rathod MIU Incharge Jawad, Neemuch

Informal Discussion

46 Block Health Officials

Dr. R C Gupta BMO Ashta, Sehore IDI

47 Block Health Officials

Dr. N.K. Saini BMO Rahatgarh, Sagar

IDI

48 Block Health Officials

Dr. Rajeev Rakwar

MO Rahatgarh, Sagar

IDI

49 Block Health Officials

Dr. Abhishek Verma Nodal Officer Sagar Informal Discussion

50 Block Health Officials

Mr. Praja Pati Pharmacist Sagar Informal Discussion

51 Block Health Officials

Mr. P.S. Narvaya CO. Janpad Office

Sagar Informal Discussion

52 Block Health Officials

Dr. S.M. Mewafarosh

BMO Porsa, Morena IDI

53 Block Health Officials

Dr. D.K. Gupta MO Porsa, Morena Informal Discussion

54 Block Health Officials

Mr. Abhay Verma CO Jila Panchayat

Morena Informal Discussion

55 Block Health Officials

Mr. Sajay Kumar Jain

UDC, Urban Welfare Dept.

Morena Informal Discussion

56 Block Health Officials

Dr. M L Kasera BMO Kolaras, Shivpuri

IDI

57 Block Health Officials

MO

58 Block Health Officials

Dr. Neeraj Singh Block office Shivpuri Informal Discussion

59 Block Health Officials

Mr. H.S. Raja SOI Shivpuri Informal Discussion

60 Block Health Officials

Dr. B K Tiwari BMO Hanumana, Rewa

IDI

61 Block Health Officials

Dr. B.L. Dipankar MO Hanumana, Rewa

IDI

62 Block Health Officials

Dr. V K Tiwari BMO Nagod, Satna IDI

63 Block Health Officials

Dr Pramod Prajapati

MO Nagod, Satna IDI

64 Block Health Officials

Dr. Vijay Paigwar BMO Narayanganj, Mandla

IDI

65 Block Health Officials

Dr. P.L.Kori MO Narayanganj, Mandla

IDI

66 Block Health Officials

Dr. R K Verma BMO Bairasiya, Bhopal

IDI

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S. No

Region Name of Service Provider

Designation Place Schedule

67 Block Health Officials

Dr. A K Ojha MO Bairasiya, Bhopal

IDI

68 Block Health Officials

Dr. H V Badgaiyan MO Ashta, Sehore IDI

69 Block Health Officials

Mr. Malkhan Singh BEE Ashta, Sehore Informal Discussion

70 Block Health Officials

Dr. R S Meena BMO Babai, Hoshangabad

IDI

71 Block Health Officials

Dr. Narendra Rajput MO Babai, Hoshangabad

IDI

72 Block Health Officials

Mr. Pillai Lab Technician Babai, Hoshangabad

Informal Discussion

73 Block Health Officials

Mrs. Rekha BEE Babai, Hoshangabad

Informal Discussion

74 Block Health Officials

Dr. Y K S Thakur BMO Jamai, Chhindwara

IDI

75 Block Health Officials

Dr. R K Gupta MO Jamai, Chhindwara

IDI

76 Block Health Officials

Dr. A K Rai MO Jamai, Chhindwara

IDI

77 Block Health Officials

Dr. R.R Singh MO Jamai, Chhindwara

IDI

78 Block Health Officials

Mr. N.C Pagre BEE Jamai, Chhindwara

Informal Discussion

79 Multi Purpose Health Workers_Male and Females

Focus group discussions were held with all the Multi Purpose Health Workers both males and Females for all sample villages and towns