National Health Authority (NHA) is the apex body responsible for implementing India’s flagship public health insurance/assurance scheme called “Ayushman Bharat Pradhan Mantri Jan Arogya Yojana” & has been entrusted with the role of designing strategy, building technological infrastructure and implementation of “National Digital Health Mission” to create a National Digital Health Eco-system.
National Health Authority is the successor of the National Health Agency, which was functioning as a registered society since 23rd May, 2018. Pursuant to Cabinet decision for full functional autonomy, National Health Agency was reconstituted as the National Health Authority on 2nd January 2019, under Gazette Notification Registered No. DL –(N) 04/0007/2003-18.
NHA has been set-up to implement PM-JAY, as it is popularly known, at the national level. An attached office of the Ministry of Health and Family Welfare with full functional autonomy, NHA is governed by a Governing Board chaired by the Union Minister for Health and Family Welfare. It is headed by a Chief Executive Officer (CEO), an officer of the rank of Secretary to the Government of India, who manages its affairs. The CEO is the Ex-Office Member Secretary of the Governing Board.
To implement the scheme at the State level, State Health Agencies (SHAs) in the form of a society/trust have been set up by respective States. SHAs have full operational autonomy over the implementation of the scheme in the State including extending the coverage to non SECC beneficiaries.
NHA is leading the implementation for national Digital Health Mission NDHM in coordination with different ministries/departments of the Government of India, State Governments, and private sector/civil society organizations.
Functions of NHA under PM-JAY
- Formulation of various operational guidelines related to PM-JAY, model documents and contracts to ensure standardization and interoperability.
- Determine the central ceiling for premium (or maximum central contribution for trusts) per family per year to be provided to the States/UTs and review it from time to time, based on field evidence and actuarial analysis.
- Develop and enforce compliance with standards for treatment protocols, quality protocols, minimum documentation protocols, data sharing protocols, data privacy and security protocols, fraud prevention and control including penal provisions etc.
- Develop mechanisms for strategic purchasing of health care services through PM-JAY, so as to get best return on Government’s investment. Create conducive conditions for strategic purchasing by preparing a list of packages and their rates and updating them from time to time using a transparent, predictable and evidence-based process.
- Set up effective and efficient mechanisms to pay to the health care providers.
- Set up systems and processes for convergence of PM-JAY with other health insurance/assurance schemes. This will include schemes being implemented by both State and Central Governments. National Health Authority will also develop a pathway to converge PM-JAY with schemes targeting workers from both, the formal and informal sectors.
- Build a state-of-the-art health information technology ecosystem with requisite foundational components on which PM-JAY and other health systems can be hosted/linked; Information Technology standards will be developed in consultation with Ministry of Electronic and Information Technology (MeitY).
- Explore options including ways to link PM-JAY with the larger health care system, especially primary care, in consultation with the Ministry of Health and Family Welfare, Government of India.
- Work closely with Insurance Regulatory and Development Authority on development and implementation of Health Insurance Regulations targeting insurance companies, Third Party Administrators, hospitals and other stakeholders.
- Effective implementation of PM-JAY across the country and its regular monitoring including taking course corrections actions, as and when required.
- Coordination with various State Governments on regular basis for implementation of PM-JAY.
- Capacity building of State Health Agencies and other stakeholders continuously.
- Carrying out awareness activities for informing beneficiaries and other stakeholders about the scheme.
- Prevention, detection and control of fraudulent activities and abuse.
- Grievance redressal for all the stakeholders at various levels.
- Set up an efficient monitoring system for the scheme.
- Stimulate cross learning, sharing of best practices amongst States and documentation of these practices.
- Ensure interoperability, standardization and convergence amongst schemes of Central Ministries.
- Conduct and facilitate policy relevant research and evaluation studies including knowledge sharing and information dissemination at the national and international level.
- Develop strategic partnerships and collaboration with Central and State Governments, other public and private institutions including not-for-profit institutions, banks, insurance companies, academic institutions such as universities, missions, think tanks, and other national and international bodies of repute in areas relevant to the objectives of PM-JAY.
- Generate evidence for the policy makers from schemes’ data and other research/evaluations so as to facilitate evidence-based decision making and policy formulation by the Government.
- Act as apex body for State Health Agencies that have been set up to implement PM-JAY.
- Take any decision related to the implementation of the scheme, recruitment rules and hiring of staff, disbursement of grant-in-aid to the States and issue relevant directions from time to time, as required.
- And all other activities as assigned by the Government of India from time to time.
Key responsibilities of NHA under NDHM
- Administrative and technical leadership to the National Digital Health Mission
- Propose policy directions as required to the Mission Steering Group, Empowered Committee and MoHFW
- Development of models for self-financing of National Digital Health Mission
- Implementation of policies and decision approved by the Mission Steering Group and Empowered Committee
- Coordination with MoHFW and the States/UTs
- Engagement with all stakeholders including private sector and civil society organizations, and develop strategic partnerships to achieve the objectives of NDHM
- Resolution of technical and operation issues
- Recruitment of resources from Government and private sector at competitive market rates
- Management of day-to-day operations of NDHM
- Capacity building of various stakeholders for health informatics
The NHA is governed by a Governing Board chaired by the Union Minister for Health and Family Welfare, Government of India; and is headed by a full-time Chief Executive Officer (CEO) supported by Addl. CEO, Dy. CEO and Executive Directors. The CEO of the NHA functions as the Member Secretary of the Governing Board.
The Governing Board comprises of a Chairperson and 11 members.List of Members of the Governing Board:
- Chairperson: Union Minister for Health and Family Welfare, Govt. of India
- Member:Chief Executive Officer, NITI Aayog, Govt. of India (Ex Officio)
- Member: Secretary (Expenditure), Ministry of Finance, Govt. of India (Ex Officio)
- Member:Secretary (Health and Family Welfare), Ministry of Health and Family Welfare, Govt. of India (ex-officio)
- Member 4 and 5: two domain experts from the fields such as Administrative, Insurance, Public and Private Health care providers, Economics, Public Health, Management etc.
- Member (6-10): Five principal secretaries (Health) of the state government (one representing each of the five zones of the country viz; North, east, South, west and North east) on a rotational basis, and
- Member: Chief Executive Officer (CEO) of National Health Authority (Ex Officio)
- The Governing Board is the supreme decision-making authority of NHA and responsible for all matters related to PM-JAY and the Authority
- The Governing Board shall frame rules, regulations, guidelines and procedures for the selection, recruitment of the staff, personnel rules for the Authority
- All the major regulations issued in the name of Authority requires the approval of the Governing Board and shall follow a public consultation route in the interest of transparency
- The Governing Board may delegate the powers to CEO of NHA as deemed appropriate
- The Governing Board may form sub-committee for areas as deemed appropriate for smooth functioning of PM-JAY
- The Governing Board shall at least meet once a quarter to decide issues, protocols made by CEO of Authority
- The Governing Board shall periodically review the performance of NHA on such parameters as may be considered expedient by the board including expenditure of budgets allocated
- To effectively carry out tasks allotted, NHA through the Governing Board is responsible for the following
- Frame, amend and repeal policies and administrative and financial procedures related to hiring/retention/utilization/mobilization of resources, outsourcing of various tasks, budgetary support and release of funds including guidelines for bank accounts (escrow/other type of bank account as the case may be) for the management and administration of the Authority and for the conduct of the activities of the authority
- Acquire, hire or take on lease, construct property, movable or immovable, and provide their maintenance as may be necessary to carry out the objects of the Authority
- Initiate and enter into contracts and other such instruments by whatever names called to achieve the stated objects of Authority
- Receive budgetary support from the government of India. In addition, generate funds for the Authority if possible
- Develop strategic partnerships and collaborations with Central and State Governments, other Public and Private institutions including not-for profit institutions, banks, insurance companies, academic institutions including universities, missions, think tanks, and other national and international bodies of repute in areas relevant to the objectives of PM-JAY, and undertake any other role as required to reach its objectives effectively
Chief Executive Officer
A full time Chief Executive Officer (CEO), in the rank of Secretary to the Government of India, is appointed by Central Government at NHA. The CEO is the Ex-Officio Member Secretary to the Governing Board and has complete operational control over the NHA for implementation of PM-JAY. However, for all policy matters, the CEO reports to the Governing Board and works under their guidance. He exercises all administrative powers within the Authority and over its staff, delegated to him by the Governing Board. The CEO also exercises the financial power of a Secretary to the Government of India as envisaged under GFR and Financial Rules & regulations of Government of India.Powers and functions of the CEO :
- The day-to-day administration of the Authority. For this purpose, he shall report to the Chairperson of the Governing Board,
- Implementing the work programmes and decisions adopted by the Authority,
- Drawing up of proposal for the Governing Board’s decisions and work programmes,
- The preparation of the statement of the revenue and expenditure and the execution of the budget of the authority,
- Performing such other functions, or exercising such other powers, as may be specified by regulations,
- Ensure compliance to rules, procedure, regulations related to selection and recruitment of the staff for the Authority, as laid by the Governing Board; and
- Any other activities as assigned by the Government of India from time to time.
Dr. Indu Bhushan serves as the CEO of Ayushman Bharat – Pradhan Mantri Jan Arogya Yojana (AB - PMJAY) and the National Health Authority (NHA), Government of India.
Dr. Bhushan is an ex-Indian Administrative Service (IAS) officer of the Indian Civil Services, 1983 Rajasthan cadre. He holds a Doctorate in Health Economics and a Master of Health Sciences from the Johns Hopkins University, USA. He is an alumnus of the prestigious Indian Institute of Technology-Banaras Hindu University (IIT BHU) and IIT Delhi where he completed his B. Tech and Post-Graduate Diploma, respectively. He is also a Chartered Financial Analyst (CFA).
Dr. Bhushan is a bureaucrat-turned-economist with a career spanning 35 years across a multitude of sectors. He served for nine years in the IAS prior to leaving government service. Thereafter, he worked as Senior Economist with the World Bank Group prior to moving to ADB. Until his appointment as CEO, AB - PMJAY, he served as Director General, East Asia Department of the Asian Development Bank (ADB). He has held multiple positions within ADB including Director General, Strategy and Policy Department and led ADB’s engagement with the People's Republic of China (PRC), Hong Kong, Republic of Korea, Mongolia, and Taiwan including management of $12.6 billion portfolio comprising of 113 projects. Dr. Bhushan administered and provided oversight to sectors like energy, environment, natural resources and agriculture, transport, public management, financial sector and regional cooperation, urban and social development. He also supervised ADB’s resident missions in the People’s Republic of China and Mongolia.
Dr. Bhushan lives in an empty nest in New Delhi, with his wife, Anjana, an ex-IAS officer, who works with the World Health Organisation (WHO). He has two daughters, Devika and Ambika, who are both medical doctors and live in the USA. He likes to play bridge and catch the latest movies and theatrical shows on the weekend.
Additional Chief Executive Officer
Dr. Praveen Gedam is the Additional Chief Executive Officer (Addl. CEO) of the National Health Authority (NHA), mandated with the implementation of Ayushman Bharat – Pradhan Mantri Jan Arogya Yojana (AB PM-JAY) and recently, the National Digital Health Mission (NDHM)
As second-in-command at the NHA, he supervises the work of various verticals and coordinates with ministries, organizations, State Governments, and other stakeholders. He has been in charge of policy formulation, design, and implementation of flagship health care schemes of the Government of India. Ayushman Bharat: Pradhan Mantri Jan Arogya Yojana, which is the world’s largest government-sponsored health assurance scheme, and the National Digital Health Mission of India, which aims to revolutionize digital healthcare access for all.
A career bureaucrat, Dr. Gedam was also a qualified doctor before he joined the government service (IAS: 2002 Maharashtra). He has held several important positions in his career and was the Private Secretary to Union Cabinet Minister of Railways in the Government of India. He had earlier served the Government of Maharashtra in various capacities. He was Transport Commissioner of Maharashtra, where he spearheaded a massive computerization exercise. Dr. Gedam has also served as Municipal Commissioner and District Collector of numerous cities and districts.
At the cutting-edge field level, Dr. Gedam was responsible for critical government interventions concerning socio-economic development, including those in public health. He is known for the turnaround in Maternal and Child Health indicators in Latur, one of the most backward districts of the state, due to targeted interventions, systematic medical check-ups, and massive community mobilization exercises. In 2015, he was entrusted with organizing and managing the mega-event of Kumbhmela in Nashik which is one of the largest human congregations on earth.
Dy. Chief Executive Officer
Dr. Vipul Aggarwal is the Deputy Chief Executive Officer (Dy CEO) of the National Health Authority (NHA). He is the third highest officer in the organisational hierarchy and has been appointed by the Government of India to assist the CEO, NHA in managing the affairs of the organisation.Dy. CEO’s Profile
Dr. Vipul Aggarwal is a serving Indian Police Service (IPS) officer of 2001 batch, Gujarat cadre. He is a medical doctor turned cop who is known to be a pragmatic and proactive officer with more than 19 years of work experience behind him. A meritorious student all his life, Dr. Aggarwal was the All India Topper in the Secondary School Examination (Class X). He graduated from the prestigious Maulana Azad Medical College with a gold medal in forensic medicine. At the Sardar Vallabh Bhai National Police Academy (SVPNPA) he was the batch topper and the recipient of the coveted Home Minister’s Revolver and PM’s Baton for “Best All Round Officer Trainee.”
A committed knowledge seeker, Dr. Aggarwal has several diplomas and degrees under his belt. To name a few, he has a Master’s Degree in Police Management from Osmania University, a Master’s Degree in English Literature, a Master’s Degree in Business Administration from IGNOU and is currently pursuing PhD in Human Resource Management from Gujarat University.
As a visionary officer and change driver, Dr. Aggarwal is accustomed to overcoming numerous and seemingly impossible challenges. A dedicated officer with well-earned promotions at prominent government departments, he has contributed immensely to ensure effective policing throughout Gujarat, support community involvement in crime prevention and provide correctional services to the society. He was the Superintendent of Police of Porbandar, Banaskantha and Dahod districts. In his last assignment, he served as the Joint Commissioner of Police (Admin) of Ahmedabad city, a position with immense administrative responsibilities, human resource and finance management. Apart from this, he has also served in Gujarat state health department as MD, NRHM and MD, Gujarat Medical Services Corporation Limited.
State Health Agencies
SHA is a nodal agency responsible for implementation of PM-JAY in the state headed by The CEO. SHA can hire additional staff or engaged Implementation Support (ISA) to perform required tasks for implementation of the scheme. CEO, SHA is appointed by the State government and is ex-officio member secretary of the Governing Council of the SHA. Along with day to day operations of implementation of PM-JAY in the state, SHA is also responsible for data sharing, verification and validation of family members, IEC, monitoring of the scheme etc.Roles and responsibilities of SHA
- Policy related issues of State Health Assurance/ Insurance scheme and its linkage to PM-JAY
- Alliance of State scheme with PM-JAY
- Selection of Insurance Company through tendering process (if implementing PM-JAY through Insurance Companies)
- Selection of Implementation Support Agencies (in Trust/ society mode) if needed
- Awareness generation and demand creation
- Aadhaar seeding and issuing print out of E-card to validated beneficiaries
- Empanelment of network hospitals which meet the criteria
- Monitoring of services provided by health care providers
- Fraud and abuse control
- Punitive actions against the providers for fraud and corrupt practices
- Monitoring of pre-authorizations which are already approved by Insurer/ISA
- Administration of hospital claims which are already approved by Insurer/ ISA
- Package price revisions or adaptation of PM-JAY list
- Adapting PM-JAY treatment protocols for listed therapies to State needs
- Adapting operational guidelines in consultation with NHA, where necessary
- Forming grievance redressal committees and overseeing the grievance redressal function
- Capacity development planning and undertaking capacity development initiatives
- Development of proposals for policy changes –e.g. incentive systems for public providers and implementation thereof
- Management of funds through the Escrow account set up for purposes of premium release to Insurance Company under PM-JAY
- Data management
- Evaluation through independent agencies
- Setting up District level offices and hiring of staff for District
- Oversee District level offices
- Preparation of periodic reports based on scheme data and implementation status
- Implementing incentive systems for ASHA workers & public providers in line with national guidance
In addition to the State level entity, a District Implementation Unit (DIU) is also established to support the implementation in every district included under the scheme. This team will be in addition to the team deployed by the insurance company/ ISA. The DIU will be chaired by the Deputy Commissioner/ District Magistrate/ Collector of the district. This Unit is to coordinate with the implementing agency (ISA/insurer) and the network hospitals to ensure effective implementation and also send review reports periodically. The DIU has to work closely and coordinate with the District Chief Medical officer and his/her team.