A tale of two schemes – Ayushman Bharat and Smart Cities: Delhi’s disconnect with ground realities

Updated: December 6, 2018 7:31 AM

Both the Pradhan Mantri Jan Arogya Yojana (PMJAY)—as a part of Ayushman Bharat—and the Smart Cities Mission were big announcements. However, while the PMJAY has been progressing remarkably, the Smart Cities Mission is still a work in progress—the stated progress under this scheme is less than 10% of the target to be achieved by 2020-21 and only 2% of the funds released since 2015 have been utilised.

Grandiose announcements regarding schemes are made perhaps because it is considered to be a political necessity.

By- Anil Swarup

A recent visit to the remote district of Simdega in the state of Jharkhand revealed that two of its blocks, Bansjor and Kersai, did not have a single commercial bank branch. It is extremely difficult to explain this, except that perhaps it is on account of the disconnect that exists between Delhi and the field.
We revel in coming up with ideas and schemes without even caring to understand the ground realities. How do we expect a recipient of old-age pension to go down to a branch far distant from his/her residence to collect a small amount that he/she gets as pension from the government? Earlier, the postman did this job for such people. However, someone in Delhi came up with this brilliant idea of direct benefits transfer (DBT) and made bank accounts mandatory. The idea of DBT is extremely laudable, but without a bank branch close by, it makes no sense. The officers either did not have the courage to inform the decision-maker about the limitation of such a drive, or perhaps they were not aware of the ground reality. More often than not, the ideas are almost always pretty great, but unless they are practicable, there is little chance of their effective implementation.

Grandiose announcements regarding schemes are made perhaps because it is considered to be a political necessity. This is irrespective of the nature of the government. Let us understand why and how some schemes succeed, and most of them do not, so as to derive some lessons on how to make such ideas work.

For any idea to fructify and sustain in the government, it has to politically-acceptable, socially-desirable, technologically-feasible, financially-viable and administratively-doable. Let us now compare the Pradhan Mantri Jan Arogya Yojana (PMJAY) and the Smart Cities Mission. The comparison is in the context of the distance the two schemes have travelled in terms of benefit accruing to the masses.
Both the PMJAY—as a part of Ayushman Bharat—and the Smart Cities Mission were big announcements, though made during different years by the same government. However, there was a key difference between them. Right from the beginning, there was clarity of thought regarding Ayushman Bharat, while not many knew how the Smart Cities were to be defined. It was just a thought without a concrete action plan with defined targets, except perhaps the number of cities that were to be made “smart”.

From purely a technology point of view, both were dissimilar. However, technology was to play a critical role in both the schemes. Ironically, despite being technologically-driven, in the evolution of smart cities, the nature and extent was neither known nor defined. The disconnect between what was being designed in Delhi and the ground reality was clearly in evidence, and became one of the foremost causes of the scheme not happening at the desired pace on the ground. In sheer contrast, the PMJAY improved upon the technology used under Aarogyasri in Andhra Pradesh and the processes under the Rashtriya Swasthya Bima Yojana (RSBY).

In the context of ownership by the stakeholders, the states jumped on to the idea of smart cities, with a number of them vying to corner as many as they could. It was more in the hope of getting something out of this nebulous concept. How much they actually got was a different matter altogether. The PMJAY had diverse set of stakeholders. Hence, this scheme also faced problems initially with regard to outreach, but it recognised this and launched a massive communication campaign. This includes a letter addressed directly by the Prime Minister to all the beneficiaries. Massive capacity-building exercise has been launched to train those associated with the scheme at various levels. As a part of the information, education and communication (IEC) campaign, multilingual call centres have been put in place where, on an average, as many as 10,000 calls are being received every day. The feedback received is helping the scheme to mature. For those who were implementing the PMJAY, this connect was considered critical.
There was no problem with the availability of funds for either of the schemes—both being high-profile schemes, there was no dearth of funds, utilisation was.

Another difference between the schemes was the extent to which the ideas were “practicable” and the manner in which these schemes were actually implemented. In the absence of clear articulation of the concept of “smart” cities, there was a lack of clarity in role definition as well. For any scheme to be successfully implemented and sustained, there needs to be a clarity about what needs to be done, how will it be done, who will do it, and by when will it be done? The PMJAY has clarity on all these fronts. Not only are the national targets clearly defined, but the action plan also clearly outlines the tasks and roles at each level of operation. The state governments were taken into confidence. Members of the central team travelled the length and breadth of the country. They were on a mission to engage with the stakeholders and convey a value proposition to them. Going down to the field enabled them to assess ground realities that constituted very useful inputs in formulating policies. This was a game-changer. The intensity of engagement and the passion that went with it helped “buy-in” from the various stakeholders. The connect was established with each stakeholder.

The PMJAY hasn’t been in operation for long, but the initial progress has come as a surprise to all, including the critics. In the first 50 days of the scheme, as many as 5.77 lakh e-cards were issued for the verified beneficiaries. In fact, benefits amounting to `333 crore have already been availed and there are, on an average, 7,500 patients reaching hospitals every day. This is quite remarkable by any standard. As against this, the stated progress under the Smart Cities Mission is less than 10% of the target to be achieved by 2020-21. The 25th Report of the Standing Committee on Urban Development (2017-18) mentions that only 2% of the funds released since 2015 have been utilised. The disconnect with the ground realities and with the stakeholders is responsible for this dismal performance.

The author is former secretary, Government of India. 

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