What are the key differences between Ayushman Bharat and National Health Mission?
Of course. Let's break down the differences between these two landmark health initiatives from a Polity and Governance perspective.
Opening
Both the National Health Mission (NHM) and Ayushman Bharat (AB) are flagship health initiatives of the Government of India, aimed at realising the constitutional vision of public health. While they share the common goal of improving health outcomes, they differ significantly in their approach, scope, and operational framework. Understanding these differences is crucial for analysing the evolution of India's public health policy, a key topic in Governance. Both schemes are rooted in the Directive Principles of State Policy (DPSP), particularly Article 47, which mandates the State to raise the level of nutrition and the standard of living and to improve public health.
Comparison Table
| Feature | National Health Mission (NHM) | Ayushman Bharat (AB) |
|---|---|---|
| Launch Year | Launched as National Rural Health Mission (NRHM) in 2005. Subsumed National Urban Health Mission (NUHM) in 2013 to become NHM. | Launched on 23rd September 2018. |
| Core Focus | Systemic Strengthening: Focuses on strengthening public health infrastructure, human resources, and service delivery, primarily at the primary and secondary levels. | Insurance & Access: Focuses on providing financial protection against catastrophic health expenditure and creating a network of primary care centres. |
| Approach | Input-based, supply-side intervention. Aims to build and improve the public healthcare system (PHCs, CHCs, District Hospitals). | Outcome-based, demand-side intervention. Empowers beneficiaries to demand services from both public and private hospitals. |
| Key Components | 1. National Rural Health Mission (NRHM) 2. National Urban Health Mission (NUHM) 3. Tertiary Care Programmes 4. Human Resources for Health & Medical Education | 1. Health and Wellness Centres (HWCs): Comprehensive primary care. 2. Pradhan Mantri Jan Arogya Yojana (PM-JAY): Health insurance for secondary and tertiary care. |
| Financial Protection | Indirectly, by providing free or highly subsidised services in public facilities. No specific insurance cover. | Direct financial protection via an insurance cover of ₹5 lakh per family per year for secondary and tertiary hospitalisation. |
| Target Beneficiaries | Universal: Aims to serve the entire population through the public health system. | Targeted: PM-JAY targets over 10.74 crore poor and vulnerable families (approx. 50 crore individuals) based on Socio-Economic Caste Census (SECC) 2011 data. |
| Implementation Model | Primarily through state government health departments and their existing infrastructure. | PM-JAY: Implemented through a trust model, insurance model, or a hybrid model by states. HWCs: Upgradation of existing Sub-Centres and Primary Health Centres. |
| Federal Nature | A classic Centrally Sponsored Scheme where funds are shared between the Centre and States, reflecting cooperative federalism. | A more complex model. PM-JAY is also a Centrally Sponsored Scheme, but its implementation involves private sector empanelment and portability across states, adding a layer of competitive federalism. |
Key Differences Explained
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Shift in Paradigm: NHM represents a traditional, supply-side approach. The core belief is that by building hospitals, training staff (like ASHAs), and providing medicines, the health system will improve. Ayushman Bharat, particularly PM-JAY, marks a significant paradigm shift to a demand-side, entitlement-based approach. It gives beneficiaries a "health wallet" (the insurance cover) to purchase services from an empanelled provider of their choice, be it public or private.
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Focus on Care Levels: NHM has a foundational focus on strengthening primary and secondary healthcare infrastructure. Its success is measured by indicators like Infant Mortality Rate (IMR) and Maternal Mortality Ratio (MMR). Ayushman Bharat bifurcates its focus: the HWC component addresses comprehensive primary care, while the PM-JAY component is exclusively for secondary and tertiary hospitalisation, tackling high-cost, catastrophic illnesses. NHM did not have a dedicated, large-scale component for tertiary care financing.
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Role of the Private Sector: While NHM engages the private sector through Public-Private Partnerships (PPPs), its core remains the public health system. Ayushman Bharat, through PM-JAY, integrates the private sector as a core service provider on a massive scale. It creates a marketplace where public and private hospitals compete to provide services to beneficiaries, a significant governance change.
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Constitutional Linkage: Both schemes are instruments to enforce the DPSP under Article 47. However, their approach relates differently to the landmark Supreme Court judgment in Paschim Banga Khet Mazdoor Samity vs. State of West Bengal (1996), which interpreted the Right to Life under Article 21 to include the right to health and medical care. NHM addresses this by strengthening government facilities. PM-JAY addresses it by providing a financial instrument to access care, even if government facilities are unavailable or inadequate, thus making the right more portable and enforceable.
UPSC Framing
From a UPSC perspective, examiners are not looking for a simple list of differences. They expect a nuanced analysis of the evolution of public policy and its governance implications.
- Continuity and Change: Frame your answer by showing Ayushman Bharat as both a continuation and a departure. The HWC component of AB is a direct evolution of the primary healthcare goals of NHM. However, PM-JAY is a radical departure towards an insurance-based model.
- Federalism: Discuss how these schemes impact Centre-State relations. NHM is a classic example of cooperative federalism. PM-JAY introduces elements of competitive federalism (states compete to implement better) and challenges in inter-state portability, requiring a new level of federal cooperation.
- Governance Issues: Highlight the governance challenges. For NHM, it was about infrastructure gaps, absenteeism, and fund utilisation. For Ayushman Bharat, the challenges are different: regulating private hospitals, preventing fraud (e.g., fake billing, unnecessary procedures), ensuring quality of care, and ensuring the financial sustainability of the insurance model.
- Rights-Based Approach: Analyse the shift from a welfare-based approach (NHM) to a more explicit entitlement or rights-based framework (PM-JAY). An aspirant should be able to argue how PM-JAY makes the judicially-affirmed 'Right to Health' under Article 21 more tangible for the beneficiary.
Your answer should demonstrate an understanding that these are not mutually exclusive schemes but are part of a larger, evolving health policy ecosystem. NHM builds the foundational public system, while Ayushman Bharat provides a financial safety net and expands choice.