Impact Assessment Study on Rasthtriya Swasthya Bima …...Impact Assessment Study on Rasthtriya Swasthya Bima Yojana (RSBY) Study Report Submitted to Poorest Area Civil Society (PACS),

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Impact Assessment Study on Rasthtriya

Swasthya Bima Yojana (RSBY)

Study Report Submitted to Poorest Area Civil Society (PACS),

New Delhi

Study Team:

Sumit Mazumdar

Prashant Kumar Singh

Sudheer Kumar Shukla

Ashwani Kumar

POPULATION HEALTH & NUTRITION RESEARCH PROGRAMME (PHN-RP)

INSTITUTE FOR HUMAN DEVELOPMENT, NEW DELHI

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Table of Contents Chapters Description Page no.

EXECUTIVE SUMMARY 3

Section I INTRODUCTION

Chapter 1 Introduction 10

1.1 Background

1.2 Aim and objectives

1.3 Review of literature

Chapter 2 Date and Methodology 20

2.1 Evaluation Research Design

2.1.1 Evaluation methodology

2.1.2 Sample selection

2.2 Study tools and techniques

Section II MAJOR FINDINGS

Chapter

3

Description of Study Population 29

3.1 Sample distribution

3.2 Health status and healthcare services utilization

3.2.1 Morbidity and healthcare utilization

3.2.2 Hospitalization

3.2.3 Out-of-pocket (OOP) expenditure

Chapter 4 RSBY: Awareness, Coverage and Utilization 38

4.1 PACS interventions in two selected states: A brief

4.2 RSBY in Jharkhand & West Bengal: An overview

4.3 Awareness

4.3.1 Overall awareness of RSBY scheme

4.3.2 Depth of awareness

4.3.3 Source of awareness

4.4 Enrolment

4.4.1 Coverage of RSBY scheme

4.4.2 Source of motivation

4.4.3 Help during enrolment process

4.4.4 Post enrolment visit for detailed information

4.5 Utilization

4.6 Effect of PACS interventions on awareness, enrolment and

utilization of RSBY scheme: Multivariate regression analysis

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4.6.1 Effect on overall and specific awareness of RSBY

Scheme

4.6.2 Effect on utilization of RSBY scheme during

hospitalization

4.7 Finings from Qualitative Survey

4.7.1 Finding from Focus Group Discussions (FGDs)

4.7.2 Finding from In-Depth Interviews (IDIs)

Reference 66

Statistical Appendix 70

Technical Appendix: Sampling

Appendix: Household Questionnaire (Jharkhand)

Appendix: Household Questionnaire (West Bengal)

Appendix: Qualitative Guidelines and Domains

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Executive Summary

In India, where around 28% of the total population lies below poverty line, it has been

observed that health care expenditure is one of the most important reasons for indebtedness. More

than 80% of the expenditure on health in India is through out of pocket which is one of the highest

in the world. To improve upon this scenario, Government has in the past launched a number of

health insurance schemes at both Central and State levels but most of these schemes have not

worked well in terms of reaching the desired objectives of reducing out of pocket expenditure and

improving access to health care. After taking into consideration, all the lessons learnt from these

insurance schemes and also after reviewing other successful models of health insurance across the

world in similar settings, Rashtriya Swasthya Bima Yojana was designed.

The Rashtriya Swasthya Bima Yojana (RSBY) attempts to insure poor people against shocks

from a low level of healthcare security. In the absence of any such security, the vulnerability of

people living at the margins or below the poverty line (BPL) increases and they get caught in a

“medical poverty trap”. It was to safeguard BPL/poor people from catastrophic out of pocket

(OOP) health spending that RSBY was launched in 2008 as a flagship scheme of the Government

of India. In the six years since, RSBY has been successful in enrolling a fair number of targeted

beneficiaries in the scheme yet the gap in its implementation need to be understood better.

Recognizing that performance of RSBY like many schemes in eastern Indian states, needs

to improve, PCAS with active support from the state and local government worked on raising the

overall awareness, enrolment and utilization of services in some of the poorest performing and

backward districts. Towards, this end PACS initiated number of activities and innovative ideas

with the involvement of local people to effectively communication hard-to-reach sections of

society. This study is an attempt to investigate the effectiveness of interventions led by PACS on

specific awareness, enrolment, and utilization of RSBY scheme in target districts across two states

– Jharkhand and West Bengal. Study selected two districts that had PACS actively involved and

two non-intervention districts where PACS had no intervention to compare outcomes including

awareness, enrolment and utilization of RSBY scheme.

Mixed methods approach was adopted with the inclusion of both quantitative and

qualitative research techniques. The evaluation methodology, in the absence of appropriate

baseline data in the intervention districts/communities, relies upon a treatment-control design. This

is done by separately sampling households from districts which are covered under the PACS

programmes (‘intervention’ group) and which are not (‘non-intervention’ group), in both the states.

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Sample-level matching is followed to ensure that the study communities/villages selected from

both the groups are broadly similar in terms of socioeconomic characteristics.

The tools used were a household survey using semi-structured interview schedules, with

the data being subject to quantitative analyses, and qualitative interviews from other stakeholders.

While the quantitative approach has allowed assessing the impacts on a set of output indicators

such as levels of awareness about the programme and its benefits, enrolment in RSBY and/or

renewal of Smart Cards (program participation), The quantitative data measured the actual usage

of the during hospitalization events. The qualitative evidence was gathered to assess the process

dimensions of the interventions being conducted through in-depth interviews with district and field

level officials, representatives from insurance companies, third party administrators, smart card

providers, non-governmental organizations personnel, health service providers from empaneled

and non-empaneled hospitals and focus group discussions with community level functionaries

such as Anganwadi worker, Accredited Social Health Activists (ASHAs), male and female

beneficiaries.

This study was conducted in 8 selected districts – four each from PACS intervention and

non-intervention districts of Jharkhand and West Bengal. Districts were chosen to compare

‘target’ population proportion, even as the areas are not physically contagious. The selected

districts were West Singhbhum and Deogarh in Jharkhand, and Jalpaiguri and Murshidabad in

West Bengal that were selected as the PACS sample (‘treatment’) districts; while the control

districts were chosen as Khunti and Godda (Jharkhand), and Birbhum and Coochbehar (West

Bengal). The selection of blocks follow a slightly different logic: all blocks in the 8 districts

identified above were chosen on the basis of combined proportion of scheduled castes and tribes

as an indicator of vulnerable socioeconomic groups and female literacy rate, as per the latest

Census of India 2011 data based on the Primary Census Abstract. To select the blocks from the

PACS-sub sample, decisions were made based on discussions/feedback from respective state

teams and CSO partners. The identification of ‘treatment’ blocks defined target blocks to be of

similar socioeconomic standing in terms of the two indicators identified from the ‘control’ or non-

PACS sub-sample. Two Gram Panchayats within each of these blocks were then randomly chosen

through a random selection of sample of 1300 households. These households included 575 (500

beneficiaries or RSBY card-holders, 75 non-beneficiaries) from Jharkhand and 725 (625

beneficiaries, 100 non-beneficiaries) from West Bengal.

The preliminary sampling approach had envisaged a rapid houselisting exercise with a twin

objective of (a) identifying RSBY Smart-Card holders (beneficiaries) and non-beneficiaries, and

(b) stratifying the sample on the basis of key socioeconomic parameters, belonging to different

social/religious group affiliations and education levels. Subsequently higher costs both in financial

and time resources terms led to choosing an alternative. An updated list of beneficiary households

(‘RSBY rolls’), as available from the respective State Nodal Agencies and/or other agencies

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(including the state PACS teams/CSO partners) was utilized as the sampling frame for selecting a

beneficiary sample of 1125 households. Thus purposive sampling was adopted to capture the

maximum households with RSBY card holders. This strategy allowed the assessment of the entire

process of the scheme, starting from awareness, motivation, enrolment processes, utilization of

scheme and its experience.

Finding shows substantial gap in overall awareness about the scheme in both selected states

and between intervention and non-intervention districts. In Jharkhand, about 80 percent of the

respondents from the non-intervention districts were aware about the scheme. However, in

intervention districts this awareness level is almost 95 percent. On the other hand poor RSBY

awareness i.e 24 percent was evident in West Bengal, particularly in intervention districts.

Awareness about specific components of RSBY scheme was recorded higher in

intervention districts of Jharkhand as the finding reveal that 50 percent respondents in non-

intervention districts were aware that Rs 30,000 is available under the RSBY scheme for a

year as compared to 75% in the intervention districts. The finding did not show variation

between intervention and non-intervention districts of West Bengal on six other specific

components of RSBY scheme.

The awareness about maximum amount available in each year under the RSBY scheme

among STs of intervention districts of Jharkhand was 85 percent – much higher than the

STs, living in non-intervention districts which was 49 percent. Thus, finding clearly

demonstrates, not only overall awareness about the RSBY scheme is higher in intervention

districts.

The major source of RSBY awareness in Jharkhand is the ASHA/AWW, followed by

RSBY Mitras. However, finding of the qualitative survey clearly shows prior to RSBY Mitra

appointment in their respective villages, none of the ASHA or AWW knew about the RSBY

scheme. Thus, one could very effectively conclude that although, majority of respondents

reported ASHA or AWW as the major source of RSBY scheme awareness, it is PACS

promoted RSBY Mitras who actually initiated the information and dissemination in the

community.

In case of West Bengal, about 55 percent respondents came to know about the RSBY

scheme by PACS community mobilizers, followed by friends and relatives (23 percent). This

clearly shows that across all four intervention districts of both states, PACS led initiatives is

playing very vital role in information and dissemination of RSBY scheme. This finding was

supported by qualitative results conducted across different stakeholders including users,

which categorically appraised the initiatives like RSBY Mitra in Jharkhand and Community

Moblizers in West Bengal. Results further shows higher reach of mass media campaigns

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regarding RSBY scheme among marginalized sections population including STs and poor in

intervention districts as compare with non-intervention districts.

Based on both quantitative and qualitative results, this study identified critical gaps that

need to be addressed in future so that both overall and specific awareness of the scheme could

reach majority of population, particularly in West Bengal. For instance, in many cases lower

proportion of respondents from the intervention districts of West Bengal noticed awareness

activities including mike announcements, rallies, drama and wall writing. It is true that when

comparing these activities with the non-intervention districts, intervention districts performed well

in majority of actives but still more frequent activities is required to reach maximum households.

Result of this study shows higher enrolment rates across all intervention and non-

intervention districts in both states. Over 80 percent of the respondents covered in the sample from

both intervention and non-intervention districts enrolled in the scheme. The findings did not show

significant difference in overall enrolment by selected socioeconomic characteristics between

intervention and non-intervention districts. This pattern is expected since; the overall conversion

ratio (statistical appendix 1 and 2) of both states is over 50 percent, with majority of districts having

conversion ratios over 60-70 percent. However, this pattern could be explained based on

observations received during FGDs and IDIs. For instance, during FGDs in both states almost

every participant has been enrolling their family/household under RSBY scheme either since 2010

or 2011. Similarly, finding from IDIs from different stakeholders also supports the previous

arguments that villagers or community members have been enrolling under RSBY scheme over

last three to four years. However, it is very imperative to note that in spite of high enrolment under

the scheme none of them availed any benefits of the scheme due to lack of proper knowledge.

The utilization of RSBY scheme during hospitalization shows tremendous

improvement in intervention districts in comparison to the non-intervention districts, i.e in

Jharkhand. For instance, the logistic regression analysis after adjusting key socioeconomic

characteristics in the model revealed that the utilization of RSBY scheme is over four times

higher in the PACS intervention districts as compared with non-intervention districts of

Jharkhand. Moreover, utilization of RSBY scheme for hospitalization by marginalized

sections of society is considerably higher in intervention districts in comparison to the

nonintervention districts. For example, about 83 percent respondents from the ST

community in intervention districts utilized RSBY scheme for hospitalization which is

considerable higher than the STs of non-intervention districts (22 percent). Similarly, in

intervention districts of Jharkhand over 80 percent respondents from the poorest (MPCE)

household utilized RSBY scheme, whereas the corresponding figure in non-intervention

districts is less than 10 percent. This clearly suggest huge effect of PACS led intervention

programmes in Jharkhand and its subsequent outcomes in case of high use of RSBY scheme

across all sections of society.

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However, in case of West Bengal study did not find significant variations in case of

utilization of scheme during hospitalization between intervention and non-intervention districts.

Moreover, in unadjusted cross tabulation, finding shows higher utilization rates in non-intervention

districts than to intervention districts. Although, regression analysis doses show higher odds of

RSBY use during hospitalization in intervention districts than to non-intervention districts but

depicts week statistical power to support this finding.

The higher utilization of RSBY scheme in intervention districts of Jharkhand and no

significant difference in case of West Bengal could be explained with the support of few

observations based on both quantitative and qualitative surveys. For instance, in intervention

districts of Jharkhand over 30 percent respondents said that during the enrollment process PACS

community mobilizes/ or RSBY Mitra helped them. Further, nearly 30 percent respondents in

intervention districts of Jharkhand said that RSBY Mitra visited their homes few days after the

enrolment and provide detailed information about the scheme. However, in case of West Bengal

comparatively lower proportion of respondents said about post enrolment visit by community

mobilize.

One could also link lower utilization of RSBY scheme in interventions areas of West

Bengal is the lack of timing and involvement of entire family members in tea gardens. As

mentioned above in the qualitative findings, many families who willing to either enroll or wanted

to use RSBY scheme during hospitalization could not do so due to non conducive work or

infrastrural issues such as not getting leave from work or not being able to organize transport to

reach the health facility. The lack of transportation remains of the big challenge in study areas. In

these circumstances, many families prefer to visit locally available traditional healers or health

providers for most illness. This has also been highlighted during in-depth interviews of community

mobilizes of one of the intervention districts in West Bengal. However, the effect of other

unobserved factors such availability and functional status of available health facilities and quality

dimensions could not be captured in this study.

To conclude, it has been observed from this study that there is a clear pattern of

increasing awareness, enrolment and most importantly utilization of RSBY scheme in

intervention districts as compared with the non-intervention districts. The pattern is much

apparent in Jharkhand than in case of West Bengal. Due to PACS led interventions programmes

in intervention districts, general and specific awareness about the RSBY scheme and its

benefits has increased in last few years. The most imperative change that PACS led initiative

programme is successful in bringing families to the health facility and subsequently use of

RSBY card for hospitalization. As people started utilizing RSBY scheme, the overall health

expenditure of households reduced. Now, people feel more secure during illness and

hospitalization after their being enrolled under the RSBY scheme. Hard-to-reach sections of the

society including SCs/STs and poor started utilizing this scheme to a greater extent.

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Additionally, the PACS led interventions apart from targeting individuals or

households towards increasing the benefits of RSBY scheme, worked as a ‘catalyst

instrument’ that assisted in unlocking the community potentials, while involving different

stokeholds including PRI members, local leaders, and community workers that ultimately

leads towards more sustainable positioning of RSBY scheme in the community. Nevertheless,

in-spite of encouraging results much more work needs to be done to raise the utilization of RSBY

scheme. In case of West Bengal, special support and strategic analysis is needed to reach enhanced

the utilization of RSBY scheme, in particular.

Section – I:

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Introduction

1.1 Background

Access to quality health care is still a distant reality for majority of population in India,

particularly for vulnerable groups like Scheduled Castes/Scheduled Tribes, and poor – in spite its

status as a rising economic power. As per WHO statistics in 2011, 26 % of total population in India

is living below poverty line which is about 300 million of total population. Burden of

communicable and non communicable diseases are increasing in India and this is

disproportionately affecting the vulnerable sections of the population. According to an estimate,

about 40% of the poor had to borrow money from lenders with high interest rates or have to sell

their assets in order to ensure quality medical care (Ahuja & Narang, 2005). In India, the central,

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state and local governments together contribute only 20% of the total health expenditure while

71% of the total is contributed by individual households through out-of-pocket (OOP) expenditure

at the time of illness (Seshadri et al., 2011). This high level of OOP expenditure by individual

households is one of the highest amongst low and middle income countries, thus ranking India low

in terms of financial protection (Ellis et al., 2000).

The health care delivery system in India consists of private, public and mixed ownership

institutions. It has been estimated that the private sector accounts for more than 80% of the total

healthcare spending in India. In addition to private sector spending, the share of out of pocket

expenditure in the country runs high which ultimately creates a financial burden on the households,

pushing them increasingly towards poverty. According to Berman et al., (2010) more than ten

million households in India were pushed below the poverty line (BPL) due to spiraling healthcare

spending in 2004. The burden of costs incurred for accessing medical care has increased over the

last two decades. The latest data of the National Sample Survey (NSS) shows that on average,

households spent Rs 295 for outpatient care and Rs 7,116 for in-patient care. The National Sample

Survey 61st round, moreover, reports per capita expenditure in India to be Rs. 804 in the rural area

and Rs. 958 in the urban area (Gupta 2009). In India, health expenditure constitutes approximately

5% of the total household outlay (Gupta 2009). More ironically, the analysis of the NSS 60th round

suggests that around 6% of the total households (7% in the rural areas and 5% in the urban areas)

fell below the poverty line as a result of healthcare spending in 2004 (Berman et al 2010). It has

been estimated that about 2–3% of Indians are impoverished every year because of health care

expenditure. All these figures are aggregate, the picture is worse if one disaggregates along the

divides of socioeconomic strata including place of residence (urban/rural), gender, social groups

(upper/lower caste), household economic status, etc.

Financial constraints are the major barriers for access to healthcare in India, particularly

for marginalized sections of society where health care expenditure is a major cause of

impoverishment. Unequal distribution of health care facilities, socioeconomic conditions and

existing social and gender norms all play an important role in significantly reduced access to health

care especially by poor population. This scenario is exacerbated by reduction in governmental

health spending and high cost for health care services in private sector. The inequality in health

care services between public and private sector and economic constrains are found to affect health

of the poor sector of population which constitutes majority of India.

Over the past decades many low-and-middle income countries have found it increasingly

difficult to sustain sufficient financing for health care particularly for the poor and have been active

in recommending a range of suitable measures (Lagarde et al., 2009; Ekman 2004). In this

sequence, a focus on Social Health Insurance (SHI) schemes has been gaining strength in majority

of countries, including India (Gupta &Trivedi, 2006; Gupta &Trivedi, 2005). For instance, the

WHO in 2005 passed a resolution that it would support a strategy to mobilize more resources for

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health, increase access to health care for the poor and deliver quality health care in all its member

states but especially in low income countries (WHO, 2005). In latter stage this strategy was also

supported by the World Bank (Hsiao, 2007).

The SHI schemes are generally understood as health insurance schemes provided by

governments to its citizens, especially to low and middle income populations.Most social health

insurance schemes combine different sources of funds, with government often contributing on

behalf of people who cannot afford to pay themselves (WHO, 2005). Social health insurance

differs from ‘tax based financing’ which typically entitles all citizens (and sometimes residents) to

services thereby giving universal coverage. However, social health insurance entitlement is linked

to a contribution made by, or on behalf of, specific individuals in the population (WHO, 2005).

Social health insurance pools both the health risks of its members, on the one hand, and the

contributions of enterprises, households and government, on the other, and is generally organized

by national governments (Carrin& James, 2004; WHO, 2005).

The government is committed to provide ‘Health for All’ set by the Alma Ata1 declaration

in 1978 and adequate financing is critical to ensure it. Universal Health Coverage (UHC) which

has subsequently replaced the “Health for All” agenda, defines “ensuring that all people can use

the promotive, preventive, curative and rehabilitative health services they need, of sufficient

quality to be effective, while also ensuring that the use of these services does not expose the user

to financial hardship2”.The government of India has decided to increase its health spending to

increase demand for healthcare and ensure equity in access to healthcare. To accomplish this in

the wake of high out of pocket health spending is a challenging task. This in turn requires

alternative security measures for those who cannot pay for healthcare. Coverage by other public

and private health insurance is limited in India. Hence, to provide universal health coverage in a

country like India, where most people are either unemployed, or employed informally in the

unorganized sector, is not only challenging but also expensive. These challenges are further

intensified due to the disparity in health systems across states and between rural and urban areas.

The RSBY Scheme

In order to achieve an equitable health system and move towards universal health coverage

in India, The Ministry of Labour and Employment launched the RashtriyaSwasthyaBimaYojana

(RSBY) for the poor (BPL) families of India. This National Health Insurance Scheme was

1Primary Health Care: Report of the International Conference on Primary Health Care. Alma-Ata, USSR, 6-12

September 1978. World Health Organization, Geneva, 1978

(http://whqlibdoc.who.int/publications/9241800011.pdf). 2WHO website. What is universal coverage?

(http://www.who.int/health_financing/universal_coverage_definition/en/index.html).

http://whqlibdoc.who.int/publications/9241800011.pdf

http://www.who.int/health_financing/universal_coverage_definition/en/index.html

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launched in April 2008 and the scheme is being functioning in all states. Around 37 million

households have been enrolled across the country and around 6.6 million people have benefitted

so far. More than 10,000 hospitals have been empanelled in the scheme and thirteen Insurance

Companies (both public and private sector) implement the scheme (Seshadri et al., 2011).

Main Objectives of RSBY

To provide financial protection against catastrophic health costs by reducing out of pocket expenditure

for hospitalization

To improve access to quality health care for below poverty line households and other vulnerable groups

in the unorganized sector

Provide beneficiaries the power to choose from a national network of providers

Provide a scheme which even the illiterate can use easily

Eligibility and Benifits

o Smart card based cashless and paperless social health insurance scheme

o Registered BPL families, MANREGA workers, registered daily wage labourer etc.

o Annual hospitalization coverage of up to Rs 30000/- for a family of five members through

health insurance companies

o Families pay a registration fee of Rs 30/- for accessing empanelled hospitals across the country

o Coverage is for inpatient treatment

o Transportation expenses of up to Rs 1000/- annually (with a limit of Rs 100 per hospitalization)

are provided in cash for travelling to the hospital (deducted from the benefit package of Rs

30000/-)

o All pre existing diseases are covered from day 1

o There is no age limit for enrollment into the scheme

o 75 percent of the premium is borne by the Central Government while 25 percent is the State’s

responsibility (90 percent in case of Jammu & Kashmir as well as North Eastern States)

o There is a provision for the State Governments to top up the coverage amount beyond Rs.

30000/-

Basic design of the scheme

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Although other government-run public health insurance schemes existed in India, RSBY is a

pioneering scheme in many aspects. Some of its key design features are:

1. Public-Private Partnership (PPP): Public and private medical facilities, Third Party

Administrators (TPA) and insurers partner with the State Nodal Agencies (SNAs) that set the

guidelines, quality standards, and monitors programme implementation.

2. Central-State Government Collaborative Model: While the programme was designed by a

department of the central government, the implementation and management is undertaken in

collaboration with respective state governments. The premium subsidies are co-financed by

the centre and the states, thus ensuring mutual ownership and control.

3. Leveraging of Technology: Since the scheme targeted Below Poverty Line1 (BPL) families

with low literacy levels, paperwork was minimized by using biometric identification that

enabled instant enrolment, and control over fraud.

4. Demand-side Financing: The scheme financially empowers the patient through the provision

of a value-loaded smartcard that offers cashless access to medical facilities covering almost all

procedures. The smartcard can be used at any empanelled hospital in the national network,

allowing the convenience of flexibility to the considerable migratory population in the country.

5. Premium Subsidy: The premium is subsidised 100% from government funds, with only a

nominal enrolment cost paid by the beneficiary.

6. Collection, Storage and Maintenance of Data: Data collected from the administration of the

scheme is stored and maintained by the Government agency, thereby facilitating future

actuarial calculations and market development.

Different actors and their role in the RSBY

Beneficiaries: Initially the scheme targeted BPL population alone. Now it has started

expanding its coverage to include other occupational groups. Beneficiaries of the MGNREGA

scheme, domestic workers, auto-rickshaw drivers, etc. Beneficiaries are expected to enrol in the

scheme by paying Rs.30 (approx. US$ 0.5) per family (for five members) for a year, receive a

smart card, and then use the benefits when hospitalized in empanelled hospitals.

Non-governmental organisations (NGO): NGOs are expected to create awareness among

the community esp. the eligible groups about RSBY and mobilize them for enrolment.

Insurance Companies (both private and public sector companies): The companies

compete with each other for covering the eligible families in each State. The company with the

lowest bid gets the contract for implementing the scheme in that specific State. Once selected, the

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company has to appoint smart card agencies, work closely with the State government’s Nodal

Agency to identify the eligible households, empanel hospitals and contract NGOs to create

awareness in the community.

Third Party administrators (TPA): These are private agencies that help the Insurance

Company in implementing the scheme in the field level.

Smart Card Providers: They provide the technology for this scheme.

Empanelled hospitals (both public and private): Once empanelled by the Insurance

Company, they provide the necessary services to the RSBY beneficiaries. Their services are

reimbursed by the Insurance Company via TPAs or directly.

State government Nodal Agency (SNA): It is an independent body formed by the

Government which acts as the focal point for governing the programme. In most States, it is led

by the Department of Labour while in some it is the Department of Health & Family Welfare. It

initiates the process of introducing the scheme in the State, negotiates with the insurance company

and monitors the enrolment and the utilization. The State contributes 25% of the premium through

this agency.

Central government: The Ministry of Labour and Employment launched the scheme and

its main responsibility is to develop technical and administrative guidelines and market the scheme

to the State governments. The Central government contributes 75% of the premium to the

Insurance Company through the Ministry.

1.2 Aims and Objectives

Poorest Area Civil Society Programme (PACS) intends to conduct an impact evaluation

study to assess the impact of various strategies it pursues along with the partner civil society

organizations (CSOs), aiming to improve access to health services and utilization of hospitalization

insurance facilities under the Rashtriya Swasthya Bima Yojana (RSBY), with an emphasis on

social and economically disadvantaged population groups. Institute of Human Development

(IHD), New Delhi has been entrusted with the assignment of conducting the impact assessment of

different strategies and interventions being pursued in certain districts in two states, Jharkhand and

West Bengal.

The main objective this assessment study is to:

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i. Assess the effectiveness of various interventions and activities being undertaken by

PACS/CSO partners, in improving the awareness of communities regarding enrolment

and utilization processes under RSBY, such as access to and use of Smart Cards.

ii. Understand the impact on capacities of the partner CSOs towards building community

awareness and improved uptake of RSBY provisions, and also in sensitizing other

stakeholders such as community leaders, local self-government institutions, health

officials and local administrations to ensure smooth, better functioning of the scheme.

iii. Identify best practices in each of the study states and communities, that can help

benchmark PACS’ future initiatives and generate learning points for replication and

scaling-up.

1.3 Review of literature

Although, the RSBY scheme is now its sixth year of progress only a few studies have been

conducted across /different settings in India. The existing studies broadly covered awareness,

coverage, and enrolment aspects of the scheme. Some others have attempted to cover the effect of

scheme on health expenditure, hospitalization experiences and other aspects of service utilization.

Enrolment

As per the RSBY website, around 37.7 million BPL families are currently enrolled on the

RSBY scheme nationwide (www.rsby.gov.in). The scheme is being implemented in 512 districts

across 28 states and union territories. There are many evidences across different settings that have

highlighted substantial gaps in the scheme accessibility. For instance, Sun (2011) has studied

enrolment patterns at village, household and individual levels using administrative data. The

findings indicate that there are wide variations in enrolment rates across villages, districts, regions

and demographic groups. About 3% of the selected villages have witnessed that all BPL

households have been enrolled while none eligible families have enrolled in 10% of the villages.

This study also points out that variation in the performance of awareness raising is the main factor

causing the discrepancy of enrolment rates. Furthermore, Sun asserts that there may exist

“geographic discrimination based on the cost of enrolment” or the deliberate enrolment of

“healthier” villages in insurers’ behavior. Study further asserts that these variations may be linked

to various factors such as discrepancies in BPL data which has not taken into account factors of

birth; death; migration or marriage in the subsequent years after the BPL survey was conducted;

poor power back up in the villages; low awareness among the people about the scheme and

enrollment schedule in their respective villages etc. (Sun 2011).

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Similarly, Rathi (2011) in his evaluation of RSBY in Amravati, Maharashtra, found that

the lack of information and late enrolment led to only 39% enrolment in the district. The tribal

blocks of the district which have the maximum number of poor householdswitnessed least

enrolment levels. The study further suggests that beneficiaries were concentrated in certain areas

and villages. Similarly, Narayana’s (2010) study shows huge enrolment variation within the states,

evidencing low enrolment in poorer districts.

It has been argued that any scheme which targets only BPL families risks leaving out a

large number of actual poor communities due to exclusion errors in the BPL list. In Chhattisgarh,

the government recognizes 74% of its population as poor and provides subsidized grain

accordingly (Wadhwa 2010). However, central government has fixed the percentage of BPL in the

State at 46%. Hence, there is a huge population of poor people who have not been even considered

eligible for the RSBY scheme, this being an entirely centrally – sponsored scheme.

Using a larger sample of 145 districts during the first year of RSBY, Swarup (2011) finds

district-wise imbalances in enrolment rates. The descriptive analysis by the author largely

attributes these variations in enrolment rates to ‘‘defective and outdated’’ BPL lists provided by

the state governments to insurance companies, and concludes that the errors in the lists also

produce a gender bias, since they include only the names of male heads of household. However,

this could also be attributed to skewed incentives for insurance companies because payment is

provided on enrolment per household instead of enrolment per individual (Das &Leino, 2011).

Dror and Vellakkal (2012) evaluate the financial burden of RSBY, and its implications for

enrolment. The authors argue that finance plays an important role in undertaking enrolment drives.

In order to scale up from the existing levels of enrolment, and to maintain the financial viability

of the scheme, the central budget allocation for RSBY should be increased and the scheme will

have to attract a large above-poverty-line enrolment (i.e., those who pay a non-subsidized

premium).

A recent study conducted in Maharashtra found that the ever-enrollment rate of RSBY

amongst BPL households (22%) was even lower than the proportion of households that reported

to be aware about the scheme. Further, the present found that only 12% of the eligible households

reported that they were currently enrolled under the RSBY programme, though a small proportion

of them were not having valid RSBY card during the period of data collection (Thakur &Ghosh,

2013).

Utilization of RSBY scheme

According to the study by Hou& Palacios (2011), utilization rates vary largely across

villages and districts. Their research reveals that districts served by three of the six insurance

companies have higher utilization rates than areas where two of the three are private insurers.

Page | 18

Study also found that the likelihood of RSBY scheme access depends on the number of people in

the same village who have already utilized the benefits and the number of hospitals empaneled

under the scheme in the area. The utilization rate is also found to be concentrated to a select few

empaneled hospitals in the district (Hou& Palacios 2011).

Narayana’s (2010) findings show that the average hospitalization rate per 1000 persons

over a scope of 365 days varies from 4 in Punjab to 25 in Gujarat. The study also reports the highest

hospitalization rate of 196.41 in the Dangs district of Gujarat and the lowest in 1 in the Jalandhar

district of Punjab. Study suggested that the low density of empaneled hospitals and the lower

empanelment of the private hospitals in total as the probable factor for variation in district

hospitalization rates.

In a study assessing existing health insurance schemes, Reddy et. al., (2011) find that the

nationwide hospitalization rate per 1000 persons for 2009-10 stands at 20, taking into

consideration those districts which have completed one year of the RSBY scheme. Assam, Goa,

Chandigarh report the lowest hospitalization rates of a mere 1while Gujarat reports the highest at

42. The hospitalization rate per 1000 beneficiaries in other state based insurance schemes is

reported to be five in the Rajiv Aarogyashri scheme; four in the Vajpayee Aarogyashri and

Kalaignar schemes and 22 in the Yesaswini scheme. This number is high (64) for private health

insurance. As per the study, the average nationwide hospital expenditure for RSBY is

approximately Rs. 4262. The lowest expenses are reported in Tamil Nadu (Rs. 886) and highest in

the state of Punjab (Rs.6554). The claims ratio in this study is found to be 7%, with Gujarat having

the highest claims ratio of 15% and Goa the lowest of 0.20% (Reddy et. al., 2011).

Kumar (2010) explores the implementation of RSBY in Puri district, Odisha state and finds

out that the reasons of low utilization of inpatient healthcare were due to the high proportion of

illiteracy and the poor performance of awareness raising, the BPL households lack enough

awareness of their RSBY benefits. Further, study suggest that the number of empaneled hospitals

in that area is far from enough along with few of them refuse or delay treatment to the BPL

households, which ultimately negatively associated with the scheme utilization. Similarly, a study

conducted in the Durg district of Chhattisgarh found that the in 99% of studied cases, the RSBY

brochure was not given when the BPL households are being enrolled. Consequently, the

respondents don’t have the list of empaneled hospitals at the time of enrolment (Nandi et al., 2012).

Based on a large scale survey of a randomly selected sample of 3,647 eligible households

and 39 interviews of empaneled hospitals, Rajasekhar et al. (2011) assessed the current

implementation of RSBY in India’s Karnataka state observed some serious problems that

significantly determine the utilization of the benefits, such as “delays of several months to issue

the smart cards; poor knowledge of how and where to utilise the scheme; hospitals not trained to

Page | 19

use card-reading technology; and month-long delays and arbitrary caps in the reimbursement of

treatment expenses to hospitals.”

Page | 20

Section – I1:

Data & Methodology

2.1 Evaluation Research Design

2.1.1 Evaluation Methodology

The evaluation methodology, in the absence of appropriate baseline data in the intervention

districts/communities, relies upon a treatment-control design, with a partially randomised

approach. This is done by separately sampling households from districts which are covered under

the PACS programmes (‘intervention’ group) and which are not (‘non-intervension’ group), in

both the states. Sample-level matching is followed to ensure that the study communities/villages

selected from both the groups are broadly similar in terms of socioeconomic characteristics.

The evaluation approach will follow a mixed-method design, involving a household survey

using semi-structured interview schedules, with the data being subject to quantitative analyses,

and qualitative interviews from other stakeholders. While the quantitative approach will allow

assessing the impacts on a set of output or outcome indicators such as levels of awareness about

Page | 21

the programme and its benefits, enrolment in RSBY and/or renewal of Smart Cards (program

participation), actual usage of the during hospitalization events, and ultimately the extent of

financial risk-protection (program benefits) thus availed, the qualitative evidence will be useful to

assess the process dimensions of the interventions being conducted on the one hand, and

functioning of the RSBY programme at large on the other.

For the quantitative analyses, the evaluation approach will primarily rely on standardized3

comparisons of the output/outcome indicators between the PACS (treatment) and non-PACS

(control) samples. Additionally, we also focus on examining the relative impacts on the specific

disadvantaged population, by incorporating appropriate socioeconomic profiling and stratums

during the sample design. In other words, this approach will allow both between-group (treatment-

control) as well as within-group (between disadvantaged vis-à-vis non-disadvantaged groups)

comparisons in terms of the output indicators.

The qualitative approach – evaluating the processes rather than specific outputs/outcomes

– will rely on the perspectives of the key stakeholders regarding specific interventions being in

place, or on the key aspects of RSBY such as the enrolment process, renewal of Smart Cards,

information on hospitals and use of cards etc. As elaborated in the next section, a few interviews

will be conducted in both the states, and the results helping to understand the important features

relating to the functioning of RSBY, covering the vulnerable groups, and the role of PACS/CSO

partners’ interventions and initiatives in impacting on the above.

2.1.2 Sample Selection

Details of the sample selection approach, for household survey, have been earlier described

in the Study Proposal. To briefly recapitulate, all districts in both the states were ranked according

to the proportion of BPL (or ‘target’) population, calculated on the basis of figures provided in the

RSBY website. From the list4, two districts from the PACS intervention districts were selected,

additionally keeping in view the geographical spread of the states. Districts of comparable ‘target’

population proportion, while at the same time, not being physically contagious is selected as the

3 Standardizing or statistical adjustments in the output/outcome indicators lie at the core of the analytical rigour of

the evaluation, and helps to prevent any biases or potentially faulty inferences. This will be primarily achieved in the

analysis through ‘need-standardizations’ i.e. controlling for need factors such as disease prevalence, and average

hospitalization rates, and standard demographic adjustments such as age-sex composition of the two sample-groups.

Such adjustments, based on observable characteristics, are rather straightforward but more tricky is to adequately

control for ‘unobserved’ effects such as similar interventions being in place in the ‘control’ communities, or risks of

spillover to these communities due to physical contagiousness to the ‘intervention’ communities. Entire elimination

of such unobserved effects is more data-demanding, but the evaluation design being adopted does this partly through

selecting geographically distant sampling units, and collecting data through screening questions on exposure to

similar interventions by the control sample as being given to the treatment sample. 4 See Annexure 1 of this Report

Page | 22

districts. Accordingly, West Singhbhum and Deogarh in Jharkhand, and Jalpaiguri and

Murshidabad in West Bengal were selected as the PACS sample (‘treatment’) districts; the

control districts respectively are Khunti and Godda (Jharkhand), and Birbhum and Coochbehar5

(West Bengal). The selection of blocks follow a slightly different logic: all blocks in the 8 districts

identified above are listed on the basis of two indicators: combined proportion of scheduled castes

and tribes (as an indicator of vulnerable socioeconomic groups) and female literacy rate, as per

the latest Census of India 2011 data (Primary Census Abstract). Detailed lists and tabulations are

included as Annexure 2. To select the blocks from the PACS-sub sample, decisions are made based

on discussions/feedback from respective state teams and CSO partners6. Once the ‘treatment’

blocks are identified, blocks of similar socioeconomic standing in terms of the two indicators

considered are identified from the ‘control’ or non-PACS sub-sample. Two Gram Panchayats, are

then randomly chosen from each of these blocks, followed by random selection of sample

households.

The target size of the sample households, as discussed at length in the proposal, have

been worked out to be 1300 households, including 575 (500 beneficiaries or RSBY card-

holders, 75 non-beneficiaries) from Jharkhand and 725 (625 beneficiaries, 100 non-

beneficiaries) from West Bengal (For the interested reader, the details of the sample size

determination methodology is included as Annexure 3).

The list of sampling units (finalized for Jharkhand, to be finalized based on state inputs for

West Bengal) is as follows:

Category State Districts Blocks Villages (PSU)

PACS-district

West Bengal

Jalpaiguri

1 Kumargram 1 Khurdanga 1

2 Khurdanga 2

2 Malbazar 3 Chengmari

4 Rangamati

Murshidabad

1 Jiaganj 1 Mukundabag

2 Prasadpur

2 Sagardighi 3 Barala

4 Gobardhandanga

Jharkhand West Singbhum

1 Chakradhapur 1 Asantaliya

2 Jamid

2 Majhgaon 3 Nayagaon

4 Ghodabandha

Devghar 1 Madhupur 1 Suggapahari

5Coochbehar although neighbouringJalpaiguri, is selected as a control, as all other districts (except Darjeeling) of

Northern West Bengal, a distinctive geographic and socioeconomic region of the state, are in the PACS intervention

sample. 6 At the time of submitting the Inception Report the blocks of the two Jharkhand districts could be decided based on

interaction meetings.

Page | 23

2 Gadiya

2 Mohanpur 3 Bichgarha

4 Jamuniya

Non-PACS-district

West Bengal

Coochbehar

1 Tufanganj-II 1 Salbari I

2 Mahishkuchi I

2 Mekhliganj 3 Niztarof

4 Changrabandha

Birbhum

1 Rajnagar 1 Lauberia/Aligarh

2 Balarampur/Chandrapur

2 Sainthia 3 Derpur/Hatora

4 Paharpur/Ikra

Jharkhand

Godda

1 Basantray 1 Jamnikola

2 Bodra

2 Meherma 3 Gajhanda

4 Dhodra

Khunti

1 Khunti 1 Siladon

2 Dadiguttu/Gutjora

2 Erki (Tamar II) 3 Erki/Arki

4 Sindri

In the preliminary sampling approach specified in the Project Proposal, it was envisaged

to conduct a rapid houselisting exercise from the twin objective of (a) identifying RSBY Smart-

Card holders (beneficiaries) and non-beneficiaries, and (b) stratifying the sample on the basis of

key socioeconomic parameters, namely social/religious group affiliations and education levels.

However, during subsequent interactions it was felt that such screening exercise would lead to

higher costs both in financial and time resources terms, given the project’s timeframes. As an

alternative, it was proposed that updated lists of beneficiary households (‘RSBY rolls’), as

available from the respective State Nodal Agencies and/or other agencies (including the state

PACS teams/CSO partners) be used as the sampling frame for selecting the beneficiary sample

(1125 households). In this approach, stratification will be left random, i.e. without any separate

screening, but using other a-priori information sources (e.g. social mapping, feedback from local

key informants), and non-beneficiary households will be selected randomly from neighbouring

households (not possessing RSBY cards) of the beneficiaries. However, during the household

selection it will be ensured to have a balanced mix of all socioeconomic stratums, and particularly

adequate representation of the vulnerable or priority groups. A systematic circular sampling

allowing common intervals will be followed to identify beneficiary households to be interviewed

from the ‘RSBY rolls’; it was also agreed that the state PACS teams and CSO partners will

facilitate procuring the RSBY rolls/cardholder’s lists for the selected GPs and making these

available to the evaluation team, for both PACS as well as non-PACS areas under the study.

As stated earlier, the household survey will be supplemented by qualitative data collected

through alternative techniques such as in-depth and key-informant interviews, focus group

discussions and interactions with key programme personnel, from both the providers (government)

and the community organizations. While the exact numbers of each tools/techniques and targeted

interviewees will be finalized at the time of data collection, a broad indication is provided by the

two schemas below:

Page | 24

2.2 Study Tools and Techniques

The tools and techniques that will be applied in this study is divided into two segments:

Quantitative research tools:

Section 1: This section includes questions related to the household member’s

demographics and socioeconomics characteristics, which will be used for stratification, and group-

based analysis (2 pages)

Section 2: Information related to the household living condition, household assets, income

and livelihoods, and social networks will be asked. This section will help in distinguishing between

treatment-seeking behaviour, and allow observing financial risk-protection impacts, based on a

household’s economic ability to pay, arising out of insurance coverage (2 pages, including poverty

profile and consumption expenditure module).

Section 3: This is the core health module. In this section, detailed information related to

health including short-term and chronic morbidities and health care utilization will be asked.

Further information on hospitalization will also be covered with special focus on type of

hospitalization, number of days spend, cost of hospitalization etc. A separate block will collect

information on health care financing, or health expenditure patterns, sources of financing the

expenses, coping mechanism adopted in response to the financial implications arising out of the

health shocks, and any adverse welfare consequences (3-4 pages).

Section 4: This section deals with the RSBY users’ experience that essentially includes

flow of information, their perception & satisfaction. More specifically, we will ask about the

source of information, experience of the enrolment process, utilization of smart card, whether they

have explained about the process/how to use your RSBY card, information of nearest hospitals to

seek treatment and be able to use the Card etc. In addition, questions will also cover the reasons

for not utilizing the health card and their suggestions to improve the overall efficiency of RSBY

programme. Developing this section which can help in assessing the relative outreach, coverage,

impacts and people’s perception on the different interventions and initiatives being supported by

PACS/CSO partners’ activities in the intervention communities, is of much importance for the

evaluation’s approach, and currently interactions between the research and programme teams are

being held to fine-tune the dimensions to be included in the interview schedules, and make them

suitable for precise, objective assessments. This section is expected to be about 5 pages including

all the domains stated above. A draft matrix, which is being updated and fine-tuned during the

state-level briefings, is appended (Annexe 4).

Page | 25

Qualitative research tools:

The study has applied following qualitative techniques to understand the different

dimensions related to RSBY from different stakeholders. Detailed descriptions of the number of

qualitative surveys are graphically presented below.

FGDs: The study has conducted six FGDs from individual users and different stakeholders

as illustrated in the table earlier, to understand the flow of information related to RSBY scheme,

enrolment process etc. The domain included covered problems or constrains related to enrolment

in RSBY scheme, time taken to complete the entire process and staff behaviour. The FGD also

covered processes and steps adopted by different stakeholders for mobilizing people for enrolling

in this scheme with special emphasis on socially excluded groups in the community. We also tried

to examine the challenges in encouraging people for enrolling in the RSBY scheme. The FGDs

was based on stratified groups or stakeholders, which was finalized in consultation with PACS and

its other partners.

IDIs: This study has also performed about 20 IDIs, across all eight selected districts. The

IDIs included those individuals who were directly associated with the RSBY scheme at state,

district, block and local/community level along with beneficiaries. For instance, detailed in depth

interviews was conducted to the district programme managers (DPM) in charge of RSBY

programme unit. The issues that were covered in IDIs strategies related to the management

information system (MIS), smart card distribution and key steps towards expanding the

beneficiaries under RSBY. Further at village level members of Panchayat interviewed to

understand the village or community specific knowledge and perceptions of RSBY, constraints

that restricts the coverage of the scheme. What are the steps so far taken to encourage the scheme

among socially deprived groups at village or community level and their progresses? Further,

detailed interview related to nearest hospital travel arrangements; overall facility and experiences

was also examined by RSBY beneficiaries. Study also captured suggestions, recommendations

and key issues that need to be focused towards universal coverage of RSBY scheme among

marginalised sections of the society. One of the key drivers of any scheme at community level is

the NGOs and CSOs. The study also covered their views on RSBY scheme and what they have

the strategies to strengthen the overall impact of scheme, particularly among poorer sections of the

society.

Qualitative approach of the study

FGDs (6)

(8)

IDIs (20)

(25)

Case study (2)

(4)

West Bengal

(3)

PACS(2)

Non-PACS(1)

Jharkhand

West Bengal

(10)

PACS(5)

Non-PACS(5)

Jharkhand

West Bengal

(1)

Page | 26

Page | 27

Part III

Page | 28

Major Findings

3. Description of the study population

3.1 Primary survey: Sample distribution

This section presents the description of the study population in intervention and non-

intervention districts in two states. It briefly covered demographic, socioeconomic and some

household level sample characteristics.

The age wise distribution of the sample population shows that the majority of the sample

(over 50 percent) belonged to the age group 15-49 in both intervention and non-intervention

districts in two selected states. Population aged 6-14 years contributes nearly one in five across all

eight selected districts. The sex wise sample distribution shows higher proportion of males across

all eight districts. However, in Jharkhand, the proportion of female population in non-intervention

district is higher (46 percent) than to intervention district (48 percent).

Page | 29

The distribution of sample size by social group (caste) shows that the majority of

population belonged to the General/OBC categories in all eight selected districts, followed by

Scheduled Tribes (STs) except in non-intervention district of West Bengal. The sample distribution

in West Bengal shows higher proportion of ST population in intervention district (26 percent), as

compare with non-intervention district (5 percent). As far as the religious composition is concern,

majority were Hindus (71 percent). A considerable proportion of the sample was belonged to the

Muslim community (29 percent).

The distribution of sample population by education categories shows contrast picture

across two study states. For instance, in both intervention and non-intervention areas over three in

every five did not have any formal level of education. However, the corresponding figure in

Jharkhand is less than 10 percent. Moreover, about 15 percent in intervention and 26 percent in

non-intervention areas of Jharkhand had completed higher secondary and above years of

schooling. On the other side, less than 5 percent of the sample individuals had completed higher

58 53 6244

17 21 12 52

25 26 265

0

20

40

60

80

100

Intervention district Non-intervention district Intervention district Non-intervention district

Jharkhand West Bengal

Figure: Caste wise population distributaion

General/OBC Scheduled Castes Scheduled Tribes

7284

30

83

79

58

17217 12

0

0

20

40

60

80

100



Figure: Religions composition

Hindu Muslims Sarna/Christians/Others

Page | 30

secondary and above years of schooling in West Bengal. As far as the household’s monthly per

capita expenditure (MPCE) is concern, distribution shows comparatively higher proportion of

household belonged to the lowest category among intervention areas (22 percent) for both states

than non-intervention areas (18 percent).

Employment and occupational pattern is one the primary factors influencing the economic

status of the household. Thus, the nature of employment in a household determines the economic

condition of a household to a great extent. Finding shows that, the overall unemployment rate is

higher in West Bengal (27 percent) as compare with Jharkhand (17 percent). Furthermore, over

one-fourth of the total sample individuals in Jharkhand are engaged as a daily wage labourer –

with slightly higher proportion in intervention (24 percent) than to non-intervention district (21

percent). In case of West Bengal, in both intervention and non-intervention districts about 30

percent individuals worked as daily wage labouers.

Overall, mass media exposure is lower in both states (43 percent). However, in case of non-

intervention district of Jharkhand over half of the sample population had some form of mass media

awareness, whereas in intervention district it was about 36 percent. As far as the drinking water

and sanitation facility is concerned, result shows widespread open defecation practices particularly

in Jharkhand across both intervention (98 percent) and non-intervention (91 percent) areas.

However, in West Bengal open defecation is comparatively lower and about 30 percent of the

households have toilet facility within premises, apart from those 6 percent uses public toilets.

6 10

66 64

13 13

19 22

40 32

9 8

2520

4 41526

2 3

0

20

40

60

80

100



Figure: Educational levels

Illiterate Primary completed (upto 4)

Secondary completed (upto 9) Higher secondary (upto 10)

Higher secondary & above (11 & above)

Page | 31

3.2 Health status and healthcare services utilization

3.2.1 Morbidity and healthcare utilization

This section presents the morbidity prevalence, hospitalization and utilization of health

facility across intervention and non-intervention districts in two states. The survey asked number

of questions related with the different morbidities, illness, injuries, accidents etc. Survey further

asked type of healthcare use for each morbidity/illness. To understand the health needs of the

population including health insurance coverage, a glimpse of morbidity and hospitalization is

useful.

64

4955 59

36

5145 41

0

20

40

60

80

100



Figure: Mass media exposure

No exposure Any exposure

16

9

12 11



Figure: Overall Morbidity Prevalence (in%)

Page | 32

Results suggest higher morbidity prevalence (minor aliment during last 30 days) in

intervention areas of both states –Jharkhand (16 percent) and West Bengal (12 percent). This

clearly suggests that the healthcare needs and coverage of health insurance is comparatively higher

in intervention districts than to non-intervention. Further, finding shows considerable variations

by key socioeconomic characteristics in both intervention and non-intervention areas. For instance,

among all five educational categories, morbidity prevalence is considerably higher in intervention

area of Jharkhand, than to non-intervention. Respondents belong to the SC group has reported

higher morbidity rates in intervention areas (Jharkhand 24 percent; West Bengal 15 percent) as

compare with non-intervention areas (Jharkhand 9 percent; West Bengal 10 percent).

Except Muslims of the intervention area in West Bengal, morbidity prevalence is higher

across all religious categories in intervention areas of Jharkhand and West Bengal as compare with

intervention areas. Similarly, when comparing the household’s monthly per capita expenditure

(MPCE), finding shows higher morbidity prevalence in intervention districts than to non-

intervention, particularly in case of Jharkhand.

Table. Morbidity prevalence: Differentials across socioeconomic characteristics


Socioeconomic characteristics Intervention

District

Non-

Intervention

District

Intervention

District

Non-

Intervention

District

Sex Male 19.9 12.2 6.1 4.0

Female 12.0 5.6 4.6 3.3

Highest Education Level Illiterate 29.8 13.5 11.6 11.5

Primary completed (upto 4) 10.4 4.8 11.7 8.0

Secondary completed (upto 9) 11.0 9.9 9.4 18.6

Higher secondary (upto 10) 12.7 8.1 20.6 11.4

Higher secondary & above (11 & above) 3.2 7.6 3.9 4.0

Caste

General/OBC 16.7 10.1 9.2 12.7

Scheduled Castes 23.5 9.3 15.4 10.1

Page | 33

Scheduled Tribes 9.8 7.0 15.4 7.3

Religion Hindu 18.2 9.2 15.8 11.1

Muslims 16.3 11.5 8.5 11.4

Sarna/Christians/Others 9.2 4.5 15.7 0.0

MPCE

MPCE quintile 1 (Lowest) 7.9 3.6 8.7 6.5

MPCE quintile 2 12.3 7.0 8.8 8.1

MPCE quintile 3 16.1 8.0 11.6 11.1

MPCE quintile 4 22.4 9.4 15.1 15.4

MPCE quintile 5 (Higher) 24.2 18.1 14.6 17.0

As far as the type of healthcare visits for morbidity is concern, about half of the individuals

gone to informal providers (51 percent) in intervention area, followed by private facility (38

percent) in Jharkhand. However, in case of West Bengal over two-third had visited private

healthcare providers in intervention areas. It is important to note that considerably lower

proportion utilized public health facility across both intervention and non-intervention areas of

Jharkhand and West Bengal. This pattern further strengthens the evidence of heavily reliance of

majority of population in these areas on private and informal healthcare providers. In such

circumstances, household expenditure on healthcare could be higher.

3.2.2 Hospitalization

The hospitalization rate in the sample population is another key indicator that essentially

provides overall impression about the health insurance requirements. Survey asked in every

household whether any of the members hospitalized in last 365 (one year) days due to any illness

or accident. Results indicate that overall hospitalization rate is higher in Jharkhand (5.8 percent)

than West Bengal (4.4 percent). However, result did not fine considerable variations across

intervention and non-intervention areas in Jharkhand. But in West Bengal, hospitalization is

comparatively higher in intervention (5.3 percent) than non-intervention area (3.6 percent).

Page | 34

According to the different background characteristics, results show higher hospitalization

among STs in intervention districts across both states (Jharkhand 8 percent and West Bengal 5

percent). Similarly, in both study states and across all education categories, higher hospitalization

is reported among intervention than non-intervention districts. As expected, considerable

variations in hospitalization is evident by individuals age group. For instance, in case of Jharkhand

about 28 percent sample in intervention district aged 50-64 years were admitted in the hospital in

last one year, much higher than the non-intervention district (21 percent). Overall, irrespective of

the type of districts hospitalization is higher among male than female in both states.

Finding suggests that in Jharkhand about three-fifth of the hospitalization utilized private

health facility, followed by trust/others (19 percent) in intervention district. Whereas, in case of

non-intervention district about half of the hospitalization cased utilized private health facility,

followed by trust/others providers (33 percent). Similarly, in case of West Bengal across both

intervention and non-intervention districts over half of the total hospitalization cases utilized

private health, followed by government health facility. Thus, the pattern empirically confirms

much lower use of public health facility for hospitalization in both states and elevated use of private

health facility. Furthermore, type of health facility use for the hospitalization by selected

socioeconomic characteristics does not show much variation. Like, in Jharkhand about 72 percent

lowest MPCE household gone for private health facility for hospitalization as compared with 85

percent among highest MPCE household in intervention area. Similarly, in the intervention area

of West Bengal, about half of the households belonged to the both top and bottom MPCE

categories opted private health facility for hospitalization.

5.56.0

5.3

3.6



Figure: Hospitalization (in %)

Page | 35

3.2.3 Out-of-pocket expenditure (OOP)

The current requirements of health insurance coverage and its future policy decisions

heavily based on the household expenditure on healthcare – popularly known as out-of-pocket

(OOP) expenditure – and its distribution across various socioeconomic groups. To this end, finding

shows high mean monthly expenditure in case of West Bengal in both intervention (Rs. 2373) and

non-intervention (Rs. 3540) as compare with Jharkhand (intervention Rs. 1578 and non-

intervention Rs. 1261). Further, it is imperative to note that in case of Jharkhand, mean expenditure

for in-patient care is considerably higher in intervention district (Rs. 1728) than to non-intervention

districts (Rs. 1079).

It has been argued that the healthcare expenditures are largely unpredictable and any

significant fraction of a household’s expenditure on payments made towards financing health care

services out-of-pocket (OOP), to the total MPCE of the household can have a disruptive impact on

household MPCE and ultimately an impoverishing effect on household living standard. Because

of this, a higher share of OOP expenditure is considered as a major concern in the health financing

system. Earlier studies in India have estimated the share of OOP expenditure to the total MPCE of

the households in the range of 7-10 percent. We have calculated the share of OOP payments as a

percentage of total household MPCE as well as household capacity to pay, defined earlier as the

average non-food (non-subsistence) expenditure of the household. The results are presented in

table 5.2.

6

17

37

27

75

5054

51

19

33

9

22

Intervention District Non-Intervention District Intervention District Non-Intervention District


Figure: Health facility type for hospitalization

Public facility Private facility Trust/others

Page | 36

The socioeconomic disparity in household OOP is also evident. For instance, in Jharkhand

mean monthly OOP expenditure on health is equal among General/OBCs and household belonged

to the SCs categories. However, it is well known fact that the income gap between these two social

groups has been enormous, particularly in northern and eastern states of India, including

Jharkhand.

The extent of the absolute financial burden on the households on account of the out-of-

pocket expenses on healthcare can be examined by studying the proportional share of these

expenses to the total MPCE expenditure of the households. For the study population as a whole,

we find that on average about 25 percent of the total MPCE expenditure, is spent for

healthcare services in intervention districts across both the states. The figures indicate a

considerable share almost one-fourth of the total non-food expenditure of households is committed

towards the treatment of ailing members, exerting substantial financial burden on the households.

Moreover, the impact is not uniform; it rather differs according to the socioeconomic status of the

households. There are striking differences in the percentage share, when the population is viewed

in terms of socioeconomic status.

As seen from the table below, households belonged to the ST social group in intervention

district of Jharkhand spent 34 percent, in terms of the percentage share of mean out-of-pocket

expenditure to household MPCE expenditure. Further, in both intervention and non-intervention

districts of Jharkhand and West Bengal, he percentage share of mean out-of-pocket expenditure to

household MPCE expenditure is substantially higher among illiterate as compare with those who

had completed higher level of schooling.

Table: : Mean Out of Pocket Expenditure (OOPE) and percentage share of OOPE of total Household

expenditure, according to selected Household Attributes

1512 1453

2642

4120

1728

1079

19072317

15781261

2373

3540



Figure: Mean monthly health expenditure (in Rs.)

Out-patient In-patient Total

Page | 37


Socioeconomic characteristics Intervention

District

Non-

Intervention

District

Intervention

District

Non-

Intervention

District

Highest Education Level

Illiterate 26.4 28.1 29.0 31.7

Primary completed (upto 4) 29.0 16.6 25.2 22.1

Secondary completed (upto 9) 27.1 21.3 27.3 16.5

Higher secondary (upto 10) 20.9 21.4 18.1 30.7

Higher secondary & above (11 & above) 22.4 21.4 23.0 28.1

Caste

General/OBC 23.2 22.9 25.3 26.3



Religion

Hindu 26.3 22.1 24.1 23.2

Muslims 25.9 22.8 25.8 34.0

Sarna/Christians/Others 18.5 12.0 28.4

MPCE


MPCE quintile 2 21.0 20.2 22.4 22.2

MPCE quintile 3 19.2 23.0 26.3 23.5

MPCE quintile 4 28.5 19.7 25.6 26.4


Total 24.9 21.5 25.6 24.9

4. RSBY: Awareness, Coverage and Utilization

4.1 PACS interventions in two selected states: A brief

Page | 38

Prior to study results, it would be important to briefly describe the key strategies or

interventions conducted by PACS in two selected states for this study – Jharkhand and West

Bengal. It has been acknowledge by many experts that boosting awareness, increasing enrolment

and encouraging people to use schemes like RSBY require multi-sectoral approach. Moreover,

ensuring proper coordination and synergies across different actors both government and non-

government involved directly or indirectly is indispensable towards achieving the desirable goals

for any programmes. A detailed description of the intervention types along with its description and

target population is mentioned below. It is worth to note the few interventions could be conducted

in both states.

Intervention Types Description of interventions Target group/audience

JHARKHAND

Stakeholder

sensitization

To create a buy in among community level

stakeholders for RSBY and activate

community level channels of communication

1. Panchayat members and urban

functionaries

2. Hospital authorities

3. Representatives from insurance

companies, district administration and

civil society organisation

Exposure visits More than 1900 members from community

based organisations (CBOs) are taken for

exposure visit to RSBY empanelled hospitals

which are conducted across Jharkhand

Community Based Organisations

(CBOs)

Jharkhand Mahila

Samakhya Society

The objective to expand the outreach of the

scheme to more women from socially

excluded groups

Monthly meetings of JMSS

District

Consultations

District level meetings with insurance

companies are being conducted for getting

information on enrollment and extending

support during enrollment

Insurance companies

IEC activities 1. Rallies, street plays, wall writings,

community radio shows, home visits, health

camps and mass level religious ceremonies;

2. Jingles are being used to raise the

awareness

Community

Special RSBY

enrolment stations

CSO have supported enrollment teams during

enrollment in naxal affected areas

Naxal affected areas

District Review

Committees (DRC)

It has been mandated that these committees

would monitor the RSBY progress in terms

of enrolment, hospital empanelment and IEC

through regular weekly meetings

PACS, insurance companies and

empanelled hospitals in presence of

DKM

Page | 39

RSBY Impact

Assessment study

Teams during enrollment in naxal affected

areas

PACS & Partner organisations

RSBY Mitra

initiative

A community cadre on RSBY has been

initiated.

Community

WEST BENGAL

Capacity building District level capacity building programme

for community mobilisers were organised in

West Bengal in which 100 community

mobilisers were given training on RSBY.

Awareness

meetings

Making communities aware about scheme

through them and inculcating positive health

seeking behaviour

School teachers and students

RSBY Enrolment

stations

Advocacy for setting up of enrolment stations

at places which can be accessed easily by

communities

Village level

IEC activities 1. Local folk shows, tableau, wall writing and

awareness camps during religious ceremonies

to raise the motivation of communities;

2. Four booklets on FAQs on RSBY

3. Poster depicting steps of hospitalisation;

4. Leaflet and poster on RSBY enrolment;

5. Home visits and community level radio

shows;

6. Mass level religious ceremonies;

7. Distribution of pamphlets and leaflets

Community facilitators and CBO

members

District

Consultations

Key issues related to RSBY implementation

at field level have been shared with district

administration by CBO and CSO members

CBO's and CSO's

RSBY Impact

Assessment study

The aim to assess the initiatives of PACS and

its partbers on RSBY in better uptake of

services and in creating space for civil society

in RSBY scheme

PACS & Partner organisations

RSBY Technical

assistance manual

and Policy Brief

Technical assistance manual on RSBY which

would provide road map to state government

as well as CSO's to implement RSBY in

partnership mode

State level and CSO's

Hospital

Sensitization

meetings

Conducted with hospital staff and authorities

to sensitize them on providing discrimination

free access to health facilities to socially

excluded communities

Hospital staff and authorizes

4.2 RSBY in Jharkhand & West Bengal: An overview

Page | 40

This section provides key features of RSBY scheme in two study states, that main includes

district wise enrolment under scheme, hospitalization and overall expenditure. The performance

of the scheme is being considered from the perspective of the government as an implementing

authority, and the BPL households as beneficiaries. Enrolment and conversion ratios7 are used to

analyse the performance of RSBY from the point of view of the government, and the conversion

ratio is the ratio of targeted to enrolled beneficiaries. This measures how effectively RSBY scheme

was able to identify and enroll targeted beneficiaries. Below mentioned estimates and figures are

not based on the present study, rather obtained from the RSBY MIS data collected from respective

states health society websites (Statistical Appendix 1 & 2).

In case of Jharkhand, the overall conversion ratio of the state is 51%. However, district

wise pattern suggests considerable disparity – from lowest in Deoghar (29%) to highest in Giridih

(68%). Out of 24 districts, about 8 districts had a conversion ratio below 50%. On the other hand

nearly 8 districts in Jharkhand observed conversion ratio above 60%. The conversion ratio for

West Bengal is 55%, with Bankura toppled (85%) across all 19 districts. The lowest conversion

ratio was observed in Darjiling (24%), followed by Howrah (36%).

The hospitalization ratio8 is used to measures the percentage of policy holders who claim

benefits under RSBY. It reveals the actual use of the scheme. It is important to note that while

considering hospitalization cases, multiple claims are not included. Estimates from Jharkhand

shows overall hospitalization ratio at 0.6%, much lower than the West Bengal (5.5%). Further, out

of 24 districts of Jharkhand, only four districts namely Dhanbad (3.8%), Lohardaga (2.7%),

Bokaro (1.4%) and Deoghar (1.1%) have a hospitalization ratio above 1%. Moreover, in nearly 13

districts in Jharkhand have a hospitalization ratio below 0.5%. The district wise pattern in

hospitalization ratio across 19 districts of West Bengal suggests vast disparity. For instance,

hospitalization ratio in Jalpaigudi and Birbhum is over 10%, whereas the ratio is as low at 0.1%

and 0.6% in Dakshin Dinajpur and Kolkata respectively.

4.3 Awareness

4.3.1 Overall awareness of RSBY scheme

7 𝐶𝑜𝑛𝑣𝑒𝑟𝑠𝑖𝑜𝑛 𝑅𝑎𝑡𝑖𝑜 =Enrolled

Targetedx100

8 𝐻𝑜𝑠𝑝𝑖𝑡𝑎𝑙𝑖𝑧𝑎𝑡𝑖𝑜𝑛 𝑅𝑎𝑡𝑖𝑜 =

Hospitalized cases

Enrolledx100

Page | 41

Awareness about a scheme is vital for its effectiveness. RSBY incorporates in its

procedural definition the spreading of information with the purpose of increasing awareness and

knowledge about the same. Awareness about RSBY includes information about one’s eligibility,

process of enrolment, and benefits of the scheme. The survey asked range of questions related to

RSBY awareness including whether respondent heard about the scheme, specific information

related with benefits available under the RSBY scheme, source of awareness etc.

Finding of this study reveals huge inter-state variations in overall awareness of the RSBY

scheme. For instance, in West Bengal less between 24-27 percent were aware about the RSBY

scheme in both intervention and non-interventions areas. On the other hand, over 90 percent

respondents in intervention districts of Jharkhand had said that they knew about the scheme.

However, the proportion in case of non-intervention district is low at 82 percent, but still it is one

and half times higher to the West Bengal.

Awareness about RSBY scheme does not vary uniformly across key socioeconomic

characteristics of the population within districts and across intervention and non-intervention

areas. In both states, finding shows higher level of awareness about RSBY scheme in intervention

districts as compare with the non-intervention. For example, in case of West Bengal about 40

percent of illiterate respondents in intervention district told that they were aware of the RSBY

scheme. However the corresponding figure among illiterate in non-intervention district of West

Bengal is less than 25 percent. The different in RSBY awareness does not restrict to the illiterate.

Moreover, in non-intervention area of West Bengal, about 26 percent of the higher educated

respondents aware of RSBY scheme – much below than the intervention areas, where about half

of the respondents completed higher education were aware about the scheme.

94

82

24 27



Figure: Overall awareness of RSBY scheme (in%)

Page | 42

The difference in awareness about RSBY scheme between intervention and non-

intervention areas is quite apparent even across different social and economic groups. For instance,

in Jharkhand about 86 percent of the respondents in intervention district belonging to the Muslim

community were aware about the RSBY scheme, much higher than the non-intervention district

(59 percent). Similarly, about 27 percent STs from the non-intervention district of West Bengal

said that they are aware about the RSBY scheme, whereas the corresponding proportion is 50% in

intervention district. Results further show higher awareness of RSBY scheme across all five

household consumption groups in intervention district than to non-intervention district of West

Bengal.

8983

39

24

95

74

30 33

9383

39

21

97

80

50

26

91 87

32 27



Figure: Overall awareness of RSBY by education (in%)

Illiterate Primary completed Secondary completed

Higher secondary Higher secondary & above

29

50 51

37 34 3240 43

28 2720

29 29 31

2025

General/OBC SCs STs Quintile 1

(Lowest)

Quintile 2 Quintile 3 Quintile 4 Quintile 5

(Higher)

Caste MPCE

Figure: Awareness of RSBY scheme across social and economic groups in West Bengal

(in%)

Intervention district Non-intervention district

Page | 43

4.3.2 Depth of awareness

It is important to note that for the schemes like RSBY, its awareness could not be judged

alone based on the basic awareness or if anyone just heard about the name. Since, the entire

enrolment process and its proper utilization require in-depth knowledge including eligibility, date

and venue of enrolment, knowledge about empanelled health facility and type of care covered

under the scheme. Thus, considering this aspect, the survey asked range of questions related with

the specifics of schemes.

Overall, finding of this study shows higher awareness regarding different specific

components of RSBY in intervention district as compare with non-intervention district,

particularly in case of Jharkhand. For instance, about 88 percent respondents are aware about the

eligibility criteria of RSBY scheme, while the corresponding figure is 76 percent in case of non-

intervention district. Results further shows nearly 55 percent respondents in non-intervention

district knew that Rs. 30,000/- could be spend in a year for hospitalization. On the other hand about

73 percent respondents from intervention district had the knowledge of maximum amount that can

be spend on hospitalization per year. In case of West Bengal, finding does not show any promising

difference in awareness about specific components of RSBY scheme between intervention and

non-intervention districts.

Difference in awareness about the specific components of the RSBY scheme by key

socioeconomic groups across intervention and non-intervention districts is quite apparent in

Jharkhand. Results shows across castes and religious groups, awareness of the maximum amount

one can spend per year on hospitalization is higher in intervention district as compare with non-

intervention. For example, in non-intervention district about 57 percent respondents belonged to

70 6585

72

43

87

56 58 49 57

30

59

Gen

eral

/OB

C

SC

s

ST

s

Hin

du

Mu

slim

s

Sar

na/

Chri

stia

ns/

Oth

ers

Caste Religion

Figure: Awareness of maxmium amount per year paid under RSBY scheme in

Jharkhand (in%)


Page | 44

the STs knew about the maximum amount that can be utilized for hospitalization in a year under

RSBY scheme, whereas the corresponding proportion is 72 percent in intervention district.

Similarly, respondents from the Muslim and others religion have much higher level of awareness

of the maximum amount per year available under RSBY scheme in intervention area than to

respondents from the non-intervention district.

4.3.3 Sources of awareness

In terms of main sources of awareness, finding shows that in intervention districts of both

selected states, substantial proportion of respondents got to know about the RSBY scheme from

the PACS initiated activities. For instance, about 38 percent of the respondents reported RSBY

Mitra as the main source in Jharkhand. Apart from RSBY Mitra, respondents from intervention

districts also got to know about the RSBY scheme either through local teachers/ASHA or

Anganwadi workers. Fewer respondents also reported that they came to know about the RSBY

scheme from friends (19 percent) or through TV/radios (6 percent). On the other hand, in non-

intervention district over half of the respondents reported local teachers/ASHA/Anganwadi

workers (64 percent) and family/friends (31 percent) as the main sources from whom they got to

know about the RSBY scheme.

Results further suggest high reach of RSBY Mitras among marginalized sections of society

including STs and poor. For example, in Jharkhand over 60 percent of respondents belonging to

the STs and poorest MPCE quintile in intervention district reported RSBY Mitra as the main

source of information related to the RSBY scheme.

19

52

38

6

36

64

8 5

24 26

55

917

42

4 7

Friends/

Relatives/

Neighbours

Teacher/

Panchayat/

ANM/ AWW

PACS Mitra/

Mobilizer

TV/ Radio/

Others

Friends/

Relatives/

Neighbours

Teacher/

Panchayat/

ANM/ AWW

SHG/ NGO TV/ Radio/

Others


Figure: Sources of awareness about RSBY scheme (in %)


Page | 45

In West Bengal, the most sited source of RSBY awareness is from the different means of

campaigns conducted by PACS, in case of intervention. However, the main point the need to

highlight in case of West Bengal is higher reach of PACS supported mass-media campaign in

intervention district (55 percent) than the mass-media campaign conducted by other organizations

in non-intervention district

(43 percent). Further, it is also interesting to note that the mass-media campaign led by PACS in

intervention district have a higher reach across all social and economic groups as compare with

mass-media campaign conducted by other organizations in non-intervention district.

4.4 Enrolment

4.4.1 Coverage of RSBY scheme

Enrolment is the first step towards the utilization of the scheme. It is at this stage that the

beneficiary enters the periphery of RSBY scheme. We have found earlier considerable inter-state

and intra-state disparity in overall awareness of the RSBY scheme along with disparity in specific

components of the scheme. However, in case of enrolment results do not show many variations in

enrolment of the RSBY scheme across all eight selected districts in both states. For instance, in

both states across intervention and non-intervention districts over 80 percent of the households

enrolled in RSBY scheme. The high coverage of RSBY scheme in all eight selected districts could

be explained in terms of overall study design of the entire study. Since, this study design heavily

depends up on households enrolled under RSBY scheme to examine the entire process of RSBY

scheme including experiences during enrolment, utilization etc. In addition, for both states the

conversion ratio (mentioned earlier) of the RSBY scheme is over 50 percent, with many districts

48 52

77

59 5766

44

64

4045

52 5243 43

39 40

General/OBC SCs STs Quintile 1

(Lowest)

Quintile 2 Quintile 3 Quintile 4 Quintile 5

(Higher)

Caste MPCE

Figure: Reach of mass media compagin in West Bengal (in%)


Page | 46

lies between 60-80 percent. Thus, it is not surprising to have enrolment rates in eight selected

districts is considerably higher.

Table: Enrolment of households under RSBY scheme by selected socioeconomic characteristics


Background Characteristics Intervention

District

Non-Intervention

District

Intervention

District

Non-Intervention

District

Highest education level in HH

Illiterate 84.2 86.2 80.7 90.7

Primary completed 87.2 86.8 89.1 84.7

Secondary completed 83.3 87.2 81.9 85.2

Higher secondary 89.0 79.7 83.3 84.5

Higher secondary & above 84.8 83.3 70.0 84.4

Caste (HH)

General/OBC 83.2 86.8 82.3 82.1



Religion (HH)

Hindu 86.0 85.5 84.9 87.9

Muslims 76.2 81.5 82.2 78.9


MPCE


MPCE quintile 2 91.5 83.3 85.7 88.4

MPCE quintile 3 82.5 89.3 82.0 82.4

MPCE quintile 4 80.0 84.1 86.4 87.1


Total 85.5 84.6 83.2 86.2

4.4.2 Source of motivation

Present study also attempted to assess the possible sources that encourage enrolment under

the RSBY scheme. Finding suggests higher motivation from the local teachers/ASHA or panchayat

members towards enrolment of the scheme across both intervention and non-intervention districts

in both states. In case of non-intervention districts, followed by local teachers/ASHA or panchayat,

friends and relatives played key role towards enrolment. However, in case of intervention districts,

PACS interventions such as RSBY Mitra in Jharkhand and other PACS supported community

mobilizes in West Bengal encouraged households to enroll under this scheme. Here, once again as

reflected in case of awareness, substantial higher percentage (66) of STs in intervention district of

Jharkhand reported RSBY Mitra as the main source of motivation behind enrolment under RSBY

scheme.

Page | 47

4.4.3 Help during enrolment processes

The entire enrolment process of RSBY scheme is very complicated and requires all

documents ready for the enrolment day. Since, in majority of cases the entire enrolment process

for a village or group of villages takes place in single day, prior information including venue of

enrolment, require documents, presence of desire number of family members along with head of

the households quite vital. In many cases, the refusal rates are very high due to lack of proper

guidance prior and during enrolment process. Thus, in that case appropriate and timely guidance

is one of the key dimensions of entire RSBY scheme to ensure high enrolment rates.

Finding shows that in non-intervention districts majority of respondents said nobody

helped them during the enrolment process – Jharkhand (92 percent) and West Bengal (59 percent).

However, in case of intervention districts about 63 percent of the respondents in Jharkhand and 38

percent in West Bengal informed that nobody extended any kind of support during the enrolment

process. It is important to note that in case of West Bengal across both intervention and non-

intervention districts, local political leaders or workers quite often extended their support in these

kind of schemes design for marginalized sections of society. However, such kind of political

awareness or initiatives lacking in other eastern Indian states, including Jharkhand. Moreover,

results clearly revealed that in intervention districts, about 31 percent respondents in Jharkhand

and 23 percent in West Bengal reported PACS initiatives interventions such as Mitra (in

Jharkhand) and other community mobilizers (particularly in West Bengal) helped they during

RSBY enrolment process. It is also important to note that across all eight intervention and non-

intervention districts, respondents unanimously said they did not get any help during the enrolment

process from the smart card providers.

7

34

51

37

2 412

4757

7 3 228 9 8 4 4 2 5

16

211

1

Sel

f

Fri

end

s/ r

elat

ives

Tea

cher

/ A

SH

A/

Pan

chay

at

RS

BY

-Mit

ra/

Mo

bil

izer

s

Po

liti

cal

lead

er

Oth

ers

Sel

f

Fri

end

s/ r

elat

ives

Tea

cher

/ A

SH

A/

Pan

chay

at

NG

Os/

SH

Gs

Po

liti

cal

lead

er

Oth

ers

Intervention District Non-Intervention District

Figure: Source of motivation (in%)


Page | 48

The comparison between interventions districts in both states in terms of help

provided during the enrolment process by selected socioeconomic characteristics of sample

population, suggest considerable variations. Overall, PACS led initiatives have higher reach in

Jharkhand than to West Bengal by major background characteristics. However, across religious

groups, finding identified one exception in Jharkhand where none of the Muslim respondent

reported PACS led initiatives helped them during the entire enrolment process. Nevertheless, in

many cases Jharkhand figure shows much promising results than in West Bengal. For example,

only 6 percent illiterate respondents said they received help from PACS led community mobilizers

during enrolment process in West Bengal, as against 38 percent reported support from PACS led

initiatives (mainly RSBY Mitra) in Jharkhand.

Finding further shows respondents belonged to the STs group in Jharkhand reported

considerably higher support received from the PACS supported initiatives during enrolment

process (59 percent), than to West Bengal (33 percent). It appears from the results that the PACS

led initiatives have a higher reach among poor during enrolment process in Jharkhand than to West

Bengal. For example, about 40 percent respondents from the poorest MPCE quintile said that they

received some kind of support from the PACS led initiatives during the enrolment process.

However, the corresponding figure in case of West Bengal is about 30 percent among poorest

MPCE quintile who reported support extended from the PACS led interventions during enrolment.

1

31

63

5 0 1

92

75

23

3844

5 2

59

35

Smart card

provider

PACS

Interventions

Nobody Others Smart card

provider

NGOs/SHGs Nobody Others


Figure: Helped during enrolment process (in%)


Page | 49

Table: Helped during RSBY enrolment process in intervention districts according to key background

characteristics


Background Characteristics PACS

Interventions

Nobody Others PACS

Interventions

Nobody Others


Illiterate 37.5 56.3 6.3 5.6 44.4 55.6

Primary completed 31.4 65.7 2.9 24.0 40.0 40.0

Secondary completed 21.0 73.3 4.8 25.0 37.5 50.0

Higher secondary 42.4 54.6 0.0 50.0 25.0 25.0

Higher secondary & above 36.6 51.2 12.2 33.3 33.3 33.3

Caste

General/OBC 21.7 73.7 4.0 13.2 42.1 50.0

Scheduled Castes 20.9 79.1 0.0 40.0 40.0 40.0

Scheduled Tribes 58.8 29.4 8.8 33.3 33.3 36.7

Religion

Hindu 22.4 71.9 5.2 40.0 30.0 43.3

Muslims 0.0 100.0 0.0 11.4 45.7 42.9

Others 70.9 21.8 3.6 12.5 37.5 50.0

MPCE

MPCE quintile 1 (Lowest) 39.3 44.3 11.5 0.0 30.0 55.0

MPCE quintile 2 45.5 50.9 3.6 7.7 53.9 30.8

MPCE quintile 3 29.1 69.1 1.8 21.4 35.7 42.9

MPCE quintile 4 14.6 82.9 2.4 30.0 25.0 40.0

MPCE quintile 5 (Higher) 21.6 76.5 2.0 43.8 43.8 43.8

4.4.4 Post enrolment visit for detailed information

Apart from the detailed information prior to and during enrolment process, in-depth and

accurate information is needed to every household about the benefits of the scheme including,

amount available per year for hospitalization, name and location of the empanelled hospitals,

process at health facility and other benefits like transportation allowances etc. In many cases it has

been observed that households enroll in the schemes but inadequately informed about the benefits

of the scheme which ultimately led to the underutilization of schemes. Thus, the present study

asked household whether anyone visited your home after the RSBY enrolment completed to

inform you about the benefits of the scheme.

Finding of this survey clearly suggest absence of any kind of post enrolment household

visits in all four non-intervention districts in both states. For instance, nearly all sample household

(98 percent) in two non-intervention districts of Jharkhand reported no visit by anyone after the

enrolment procedure of RSBY scheme. However, in case of West Bengal about 35 percent of the

Page | 50

household visited by someone after the enrolment process, most possibly either by some panchayat

member or by ASHA worker in non-intervention areas. On the other hand, across all four

intervention districts in both states, nearly 30 percent of the household were visited by PACS

related community mobilizes in Jharkhand, compared to 23 percent in case of West Bengal.

Further, results suggest higher percentage of households belonging to STs were visited by

PACS led community mobilizes in Jharkhand (63 percent). Even, 46 percent of the respondents

who are illiterate in intervention districts of Jharkhand said that PACS supported community

mobilizes visited their household after the enrolment to inform about the different benefits that

one could receive from the RSBY scheme. However, the overall pattern suggest that PACS led

community mobilizes have a higher reach to the households in Jharkhand than to West Bengal,

particularly among marginalized sections including STs, illiterate and poor.

4.5 Utilization

One of the most essential indicators of assessing real coverage of any scheme, apart from

knowledge and enrolment is the utilization. Thus, in case of RSBY scheme, utilization of benefits

during hospitalization remains vital to gauge the real progress of the scheme, particularly among

marginalized sections of the population including STs, SCs, minorities and the poor. It is important

to mention here that the utilization rates of RSBY scheme is based on those household reported

hospitalization cases in last one year.

The use of RSBY scheme during hospitalization significantly varies across both the states.

Moreover, considerable variations are evident between intervention and non-intervention districts

in Jharkhand but not in West Bengal. To illustrate, in case of West Bengal higher use of RSBY

67

30

3

98

2 0

58

2328

61

5

35

Nobody PACS initiatives Others Nobody NGOs/SHGs Others


Figure: Post enrolment household visit (in%)


Page | 51

scheme is observed in non-intervention districts (26 percent) than the intervention districts (20

percent). However, on the other hand in Jharkhand over half of the households reporting

hospitalization in the sample has utilized RSBY scheme benefits in intervention areas, whereas the

use of RSBY scheme during hospitalization is 21 percent in non-intervention districts.

Finding suggests progressive utilization of RSBY benefits among

vulnerable/marginalized communities in Jharkhand. As far as the socioeconomic disparity

between intervention and non-intervention districts in uptake of RSBY scheme is concern,

finding suggests comparatively higher utilization in intervention districts of Jharkhand than

to non-intervention districts. For example, the use of RSBY scheme during hospitalization

among illiterates in intervention districts of Jharkhand is about 67 percent, whereas the

corresponding figure in non-intervention districts is 33 percent. Similarly just one in five

respondents from the ST group utilized scheme in non-intervention districts, much lower

than the STs of intervention districts (83 percent). The highest gap between intervention and

non-intervention districts in terms of use of RSBY scheme observed in case household

MPCE. For instance, just 6 percent households from the lowest MPCE category in non-

intervention areas utilized RSBY scheme during hospitalization, which is considerably lower

as compare with the intervention districts of 81 percent.

Results however, do not show similar promising comparative utilization pattern between

intervention and non-intervention districts of West Bengal. Except few, the RSBY utilization

pattern remains equal in majority of socioeconomic categories across intervention and non-

intervention districts. Like, in case of ST groups, the utilization of RSBY scheme during

hospitalization is higher in intervention districts (38 percent) than to non intervention districts (20

percent).

52.3%

20.9% 20.0%

25.6%



Figure: Utilization of RSBY for hospitalization (in%)

Page | 52

Table: Utilization of RSBY scheme during hospitalization by selected socioeconomic characteristics


Background Characteristics Intervention

district

Non-

intervention

district

Intervention

district

Non-

intervention

district


Illiterate 66.7 33.3 22.2 21.4





Caste

General/OBC 45.2 16.7 15.1 27.0



Religion

Hindu 44.3 17.1 30.8 23.9

Muslims 20.0 57.1 14.6 36.4


MPCE


MPCE quintile 2 78.6 26.7 30.8 40.0

MPCE quintile 3 37.5 10.5 25.0 18.2

MPCE quintile 4 31.6 30.4 11.5 17.6


4.6 Effect of PACS interventions on awareness, enrolment and utilization of RSBY scheme:

Multivariate regression analysis

Page | 53

The net effect of PACS led interventions programmers in selected districts of Jharkhand

and West Bengal with aim of enhancing overall and specific awareness about the RSBY scheme,

along with increasing the utilization rates of the scheme during hospitalization requires application

to multivariate logistic regression analysis. The main purpose of logistic regression analysis

applied here to examine the net effect of awareness, and utilization in intervention districts, after

adjusting the effect of other key independent variables in the model.

4.6.1 Effect on overall and specific awareness of RSBY Scheme

In case of overall awareness about RSBY scheme is concern, result clearly shows higher

odds of awareness in intervention districts than to non-intervention districts in both the states.

However, the strength of association across two states differs but the direction remains positive.

To illustrate, in Jharkhand the likelihood of overall awareness about the RSBY scheme in

intervention districts is over three and half times higher as compare with non-intervention districts,

with statistical significant at 1%. On the other hand, in case of West Bengal, although the odds of

overall awareness of RSBY scheme is little more than twice higher in intervention districts

compare with non-intervention districts, this association statistically significant at 10%.

Table. Estimated odds ratio to examine the effect of PACS interventions on overall awareness of RSBY

scheme in Jharkhand and West Bengal

Independent variables Jharkhand West Bengal

Odds Ratio p-value Odds Ratio p-value

Education

Illiterate (ref.) 1.00 1.00





Castes

General/OBC (ref.) 1.00 1.00



Religion

Hindu (ref.) 1.00 1.00

Muslims 0.31** 0.002 0.45 0.126

Christians/Others 1.37 0.570 0.56 0.230

MPCE

MPCE quintile 1 (ref.) 1.00 1.00

MPCE quintile 2 1.37 0.484 0.99 0.252

Page | 54

MPCE quintile 3 1.15 0.753 0.88 0.225

MPCE quintile 4 0.83 0.650 0.79 0.206


Mass media exposure

No exposure (ref.) 1.00 1.00

Any exposure 1.62 0.113 1.46 0.249

District

Non-Intervention (ref.) 1.00 1.00

Intervention 3.40*** 0.000 2.16* 0.071

Ref.: Reference Category; Level of significance: * p<0.10, ** p<0.05, *** p<0.001

As far as the awareness of specific components of RSBY scheme is concern, out of six

different dimensions, regression results shows higher awareness of four components in

intervention districts than to non-intervention districts of Jharkhand. For instance, regression

analysis after adjusting other independent variables in the model shows over two time higher level

of awareness about amount available for one year under RSBY scheme for hospitalization in

intervention districts as compare with non-intervention districts of Jharkhand. Similarly, the odds

of awareness about the transportation allowance provided under RSBY scheme is nearly twice

higher in intervention districts than to non-intervention districts.

In case of West Bengal, none of the models show any statistical significant difference

between level of specific components of RSBY scheme between intervention and non-intervention

districts. Although, the direction of odds rations in case of all six specific domains remains positive

in case of intervention districts, but difficult to conclude due to lack of statistical power.

There are other independent variables which are significantly associated with the specific

knowledge about different domains. In particular, many specific awareness indicators significantly

influences by level of education and consumption expenditure of the household.

Page | 55

Table. Estimated odds ratio to examine the effect of PACS interventions on specific awareness of different components about RSBY scheme in Jharkhand

and West Bengal

Independent variables Awareness about

eligibility

No. of enrollment

member

Awareness

about

enrollment

expenses

How much

amount,

RSBY/year

Type of

treatment

provided under

RSBY

Awareness about

transportation

allowance

JH WB JH WB JH WB JH WB JH WB JH WB

Education

Illiterate (ref.) 1.00 1.00 1.00 1.00 1.00 1.00 1.00 1.00 1.00 1.00 1.00 1.00

Primary completed 1.27*** 1.05*** 2.63** 0.83* 3.08* 0.47*** 1.00 0.58** 1.44 0.78*** 1.57 0.73***

Secondary completed 1.22 1.29 2.83** 0.84 2.17 1.04 1.16 0.72 1.89* 1.14 1.11 0.86

Higher secondary 2.41** 1.29 3.06** 0.87 1.77 1.82 2.43** 0.99 2.71** 0.88 1.39 1.15

Higher secondary & above 2.35** 1.15 3.64** 0.84 2.31 0.25** 2.65** 0.56 3.34** 0.40** 1.99 0.55

Castes

General/OBC (ref.) 1.00 1.00 1.00 1.00 1.00 1.00 1.00 1.00 1.00 1.00 1.00 1.00

Scheduled Castes 1.03 1.41 1.49 0.84 0.55 2.07 1.04 0.90 1.05 0.97 0.69 0.70

Scheduled Tribes 0.65 0.62 0.54** 0.53** 0.67 0.73 0.69 0.67 0.72 1.04 1.02 1.42

Religion

Hindu (ref.) 1.00 1.00 1.00 1.00 1.00 1.00 1.00 1.00 1.00 1.00 1.00 1.00

Muslims 2.04** 1.81** 1.20 1.17 0.59 1.17 0.39** 1.64 0.57* 1.16 0.64 0.68

Christians/Others 0.71 1.31 1.04 1.45 0.78 2.52 1.96* 1.04 1.77 0.60 2.10** 0.28

MPCE

MPCE quintile 1 (ref.) 1.00 1.00 1.00 1.00 1.00 1.00 1.00 1.00 1.00 1.00 1.00 1.00

MPCE quintile 2 0.58 1.06 0.95 0.74 0.42* 0.13** 0.71 0.68 0.62 1.22 0.64 1.27

MPCE quintile 3 0.29*** 0.97 0.57 0.80 0.29* 0.11** 0.52 0.76 0.51** 1.19 0.46** 0.66

MPCE quintile 4 0.39** 1.15 0.64 0.94 0.22** 0.15* 0.46 0.92 0.46** 1.27 0.44** 0.20*

MPCE quintile 5 0.39** 1.37 0.47** 0.76 0.34* 0.08** 0.33 0.81 0.48** 0.85 0.39** 0.63

Mass media exposure

No exposure (ref.) 1.00 1.00 1.00 1.00 1.00 1.00 1.00 1.00 1.00 1.00 1.00 1.00

Page | 56

Any exposure 0.99 0.82 0.94 1.18 0.49** 0.66 1.06 1.267 0.83 1.55** 0.96 4.00***

District

Non-Intervention (ref.) 1.00 1.00 1.00 1.00 1.00 1.00 1.00 1.00 1.00 1.00 1.00 1.00

Intervention 1.29 0.71 2.07*** 1.06 1.39 1.58 2.26*** 1.047 1.53** 0.81 1.92*** 1.93


Page | 57

4.6.2 Effect on utilization of RSBY scheme during hospitalization

As mention previously, utilization of scheme remains one of the key indicators that show

actual performance in any area or population. Thus, to examine whether districts covered under

PACS intervention programmes have higher utilization rates than the non-intervention districts,

we performed multivariate regression analysis by including other independent variables in the

model.

In Jharkhand, finding shows that the likelihood of RSBY scheme utilization for

hospitalization is nearly five times higher in intervention districts as compare with non-

intervention districts, with high statistical power at 1%. This pattern is quite expected since in

previous results including basic cross tabulation pattern with regard to awareness, enrolment, and

utilization has been fairly encouraging across intervention districts in Jharkhand.

However, in case of West Bengal the likelihood of RSBY scheme in intervention district

is lower than the non-intervention districts, but the association is very week. This association is in

continuation what the entire pattern suggested in previous sections about low level of performance

in various dimensions that the study covered, particularly in intervention districts of West Bengal.

Table. Estimated odds ratio to examine the effect of PACS interventions on utilization of RSBY scheme in

Jharkhand and West Bengal

Independent variables Jharkhand West Bengal

Odds Ratio p-value Odds Ratio p-value

Education

Illiterate (ref.) 1.00 1.00





Castes

General/OBC (ref.) 1.00 1.00


Scheduled Tribes 2.30 0.124 4.75* 0.062

Religion

Hindu (ref.) 1.00 1.00

Muslims 2.56 0.192 1.30 0.699

Christians/Others 1.40 0.584 0.40 0.466

MPCE

MPCE quintile 1 (ref.) 1.00 1.00

MPCE quintile 2 1.11 0.861 1.03 0.961

Page | 58

MPCE quintile 3 0.29* 0.044 0.43 0.216

MPCE quintile 4 0.56 0.282 0.27* 0.065


Mass media exposure

No exposure (ref.) 1.00 1.00

Any exposure 0.79 0.573 3.26** 0.009

District

Non-Intervention (ref.) 1.00 1.00

Intervention 4.73*** 0.000 0.32* 0.074


Page | 59

4.7 Findings from Qualitative Methods

The statistical analysis performed in previous sections may help us to understand the

current pattern, socioeconomic differences across districts in terms of overall awareness about

RSBY scheme, enrolment, and utilization for hospitalization care. Moreover, it also helps to

examine the net effect of difference in RSBY awareness, enrolment and utilization between

intervention and non-intervention districts in both states. However, when it comes to in-depth

understanding about the different process involved, functional constrains and dimensions that

difficult to capture in quantitative surveys, qualitative approach is needed. Thus, this study has

performed some focus group discussion along with in-depth interviews in intervention districts

across both states.

4.7.1 Finding from Focus Group Discussions (FGDs)

Key domains Jharkhand West Bengal

Effect of

PACS

interventions

on

Awareness

Overall awareness about the RSBY

scheme has increased over last few

months. Participants were anonymously

agreed that after RSBY Mitra infinitives

awareness about RSBY scheme has gone

up manifold. One participant from ST

community told that prior to the RSBY

Mitra, he did not know about the actual

benefit of the RSBY scheme.

In general participants told continuous

visit of RSBY Mitra in the village and

always try to search whether anyone in

case suffer for any illness in the

household must visit health facility along

with card.

It was also observed during the discussion

that majority of villagers did not know

previously about the empanelled hospitals

and transportation allowance covered

under the RSBY scheme.

Majority of respondents came to know

about the RSBY scheme during mother’s

day meeting held in Sahayata Kendra.

After the mother’s day meeting local

PACS community mobilizes took a

session on RSBY scheme.

During the meeting respondents were told

about the details benefits of the RSBY

scheme, along with the enrolment process.

Effect of

PACS

interventions

on

enrolment

During FGDs, the team member felt that

the enrolment under RSBY schemes

remain higher, since majority of

participants enrolled under the scheme

either in 2010 or 2011.

The overall enrolment rate is moderate, as

mentioned by majority of participants.

Although, in many cases participants

enrolled in the scheme in 2011, but never

used for any hospitalization.

Page | 60

and

enrolment

processes

It was also noticed that one of the main

huddle towards enrolment under the

RSBY scheme is older BPL list.

However, few two of the participants

from the ST community elaborated that

although her family name is not included

in the BPL lists but RSBY Mitra told

them to use their MNREGA job card for

the enrolment under the RSBY scheme.

Many respondents told that during last

enrolment in the village RSBY Mitra

contacted majority of family in the village

and told about the entire process including

essential documents needed, number of

family members that needs to be present,

enrolment timing and venue.

A major constraint towards enrolment in

the RSBY scheme that was highlighted

during FGDs is timing. As majority of

family works as a tea garden worker in

villages where normal timing is from

morning 8AM to evening 4-5 PM, they do

not find enough time to enroll.

Being asked, they replied that they were

denied leave grants for the day of

enrolment, even after the PACS local

community mobilizes discussed issue with

the employers regarding importance of the

scheme.

One of the participant recalled that the

enrolment process last time lasted up to 9

PM in the night, but due to huge rush she

could not enrolled.

Effect of

PACS

interventions

on

Utilization

One of the key observations that the study

team noticed during the FGDs is the high

level of RSBY scheme use during

hospitalization in recent months in the

community. Although, there are many

issues that remain significant for

restricting total utilization of scheme

which we will discussed in subsequent

sections.

Participants were unanimous about the

fact that in spite of high enrolment rates

for over three to four years they did not

see anyone from the community who used

this scheme during hospitalization.

Earlier they used to enroll in the scheme

as they were enrolling in other schemes

but nobody informed about its benefits.

However, two of the participants who

used this scheme recently for

hospitalization praise the help and kind of

support extended by RSBY Mitra in

obtaining this benefit.

They shared with us that since they never

visited any hospital facility, it was

impossible if RSBY Mitra did not

It was felt that the actual use of RSBY

scheme for hospitalization visits started

very recently in the village. Earlier people

used to visit health facility provided by tea

gardens to their employees. However,

limited health facility is available and

hospitalization facility in many cases not

available in these health facilities.

However, after the launch of RSBY

Sahaya Kendra majority of participants

came to know about the lists of

empanelled hospitals.

Moreover, one of the participants who

knew about the scheme earlier was

refused by the empanelled hospital. But

once he came to know through the

Sahayata Kendara that the same hospital

cannot refuse, since it is one of the

empanelled hospitals he went again and

utilized RSBY scheme for in-patient care.

Page | 61

accompany them to the health facility. It

was due to the RSBY Mitras continues

visits to the family and motivations that

helped them to use hospital facility.

Overall

Impact

Overall, participants who themselves

utilized RSBY scheme for in-patient care

and those who interacted with their

friends and neighborhood benefited from

the scheme categorically registered many

benefits that are mentioned below:

- Better health facility in hospitals

- No economic burden on family

- Early cure due to proper check-ups

and continuous monitoring during

hospitalization

- Many used to sell their animals and

land for high cost of hospitalization

which stopped completely

- High level of Malaria presence each

year cause heavy burden in terms of

financial loss of household, which

has reduced substantially this year.

The participants were not very firm to

comment on the impact of RSBY scheme.

This could be due to the fact that very

little hospitalization rate observed in

villages. One respondent that used RSBY

scheme for eye operation however told

that in absence of RSBY scheme it was

impossible for him to undergone this

operation due to low income.

Constraints There are many issues that was raised

during the discussion ranging from need

of up gradation of BPL lists, distance to

nearest empanelled hospital, loss of

income for additional member who

accompany to the patient, poor quality of

food served in hospitals etc.

One major issue that was raised during

the discussion is the unavailability of

costly medicine in the hospitals for which

people bound to buy from outside.

One of the main constrains that was

highlighted during the discussion was lack

of timing and non-cooperation from the

tea garden authorities during enrolment.

The other main issue was the old BPL

lists that do not include many households.

Poor quality of food in hospitals remains

of the key problems from the users point

of view

Page | 62

4.7.2 Finding from In-Depth Interviews (IDIs)

Present study, apart from FDGs had also conducted few IDIs from different

stokeholds/actors that are directly and indirectly associated with the RSBY scheme in terms of

awareness, enrolment, utilization and monitoring related issues.

Type Jharkhand West Bengal

Gram

Pradhan

Earlier people did not know about the

RSBY scheme

Although, few people in the village

earlier enrolled in the scheme but nobody

know how to use it.

Moreover, she told that even she herself

did not aware about the scheme till very

recently.

Since PACS led prorammes (through

SHARE) launched in the village, people

came to know about the RSBY scheme

and its benefits

She told that RSBY Mitra visits each

family in the village prior to the

enrolment day and inform about the

detailed information related with

enrolment process and documents that are

required.

Many families in the village used benefits

under this scheme recently with the help

of RSBY Mitra.

She further told that villagers are poor

and illiterate and have extensive believe

in traditional healers. But due to the

awareness about the benefits under

RSBY scheme, number of families

utilizing hospital care increased in recent

months.

In many cases, vehicles pooling by three

to four families for hospital visits is

common to reduce the expenses on travel,

idea initiated by RSBY Mitra.

Prior to CINI, no PRI member of this

village were aware about the RSBY

scheme.

Earlier people including many PRI

members believe that RSBY card is one

additional card like BPL

A three days meeting in Kolkata was

conducted by CINI and along with other

participants many PRI members were

invited to attend.

It was very intense meeting on RSBY

scheme and due to this meeting only

many PRI members came to know about

the benefit of the scheme.

While returning from the meeting, all

PRI members passed a resolution to

restrict agents from different private

hospitals who used to visit villages quite

often.

We extent every support to the RSBY

Sahayata Kendra established by PACS-

CINI in the village to support RSBY

related work.

PRI members always in active contact

with the Sahayata Kendra and prior to

every decision with related to RSBY

scheme we discussed with the local CINI

community mobilizes

Moreover, PRI members provide

information related to RSBY in almost

every meeting held in the village

Page | 63

However, she said that till now she never

invited by RSBY Mitra to attend any

community meeting

She further told that she will provide

every help in case she approached to raise

the awareness and utilization of RSBY

scheme in the village. She would be

happy to be part of any such programme

that is related with the RSBY scheme.

After the launch of Sahayata Kendra

many people able to utilize the benefits

provided by the scheme.

Overall hospitalization rates have

increased in recent years since people

aware that the cost will be covered by

this RSBY card.

He agreed that if proper awareness were

spread earlier, many deaths in the village

could easily be prevented due to lack of

financial support.

ASHA/

AWW

She first came to aware about the RSBY

scheme in 2011 through SHARE self

helped group meeting.

She was then aware about the eligibility

of the households in obtaining RSBY

scheme including BPL, MGNERA.

Earlier few people used to enroll in the

scheme, but the card only delivered to

those who used to pay Rs.15 per card

extra.

In many cases cards were delivered near

expiry date and none was able to use

them.

Till 2013, many families in the village

enrolled in the scheme but none of them

able to use since they did not know the

benefits.

However, after 2014 many people started

utilizing scheme for hospitalization.

But still majority of villages do not want

to go hospitals since they never gone out

of the village in their lifetime and they

feel very scare.

In this situation, people still prefer to take

care from traditional healers, whom they

feel more confident in interacting at the

doorsteps, and they charge less

However, few families started visiting

hospitals as they are now aware about the

benefits and hospitals that they know are

empanelled under RSBY scheme.

Prior to 2012, she did not know about

the RSBY scheme at all. Neither any

PRI members ever asked her about the

progress related to the scheme.

She first came to know about the scheme

in 2012 through CINI and realized how

important the scheme is for villagers.

Prior to interaction with CINI members,

she did not at all involve in the scheme.

However, after knowing the benefits she

attends every meeting conducted by

CINI to support the awareness and

enrolment.

In monthly meeting along with PRI

members and other local workers,

doctors are also invited and discuss

about the RSBY scheme and its

progress.

Previously villagers fears to go hospitals

due to high costs of treatment, but now

since they know about the scheme along

with details of empanelled hospitals,

they starts going hospitals frequently.

Page | 64

She further complained that the RSBY

Mitra does not visit households

frequently and at many occasions when

people are in need of her, no one could

find her.

Community

mobilizes

She joined as a RSBY Mitra in 2013 and

went for four days rigorous training in

Ranchi.

Prior to this training she did not know

about the RSBY scheme and the benefits

provider under the scheme.

When asked she told that she was

selected as a RSBY Mitra due to her

higher educational qualifications and well

known face in entire village.

Till 2012, very few families enrolled

under the RSBY scheme and none of

them ever used benefits for

hospitalization.

However, after completion of her training

in 2013 she started working and

contacted many families and provided

them knowledge about the scheme.

She recalled, in 2014 with her

commitment and motivation about 97

families in the village enrolled under

RSBY scheme.

In 2013 about 13 families utilized

benefits of RSBY scheme for

hospitalization care, which increased to

37 in 2014.

She told that in every weekly meeting,

she assess household where any of the

family member suffers from illness. She

than visit those household and provide

necessary counseling and if needed she

encourage family to visit empanelled

hospital for proper care.

In many cases she said family fears to

visit hospitals since nobody from the

family visited any hospital previously. In

that situation she accompanies family

The local community mobilize said that

his hobby is social work and due to this

he got interested to work closer in RSBY

scheme.

He joined as a PACS community

mobilize in 2013 and manage 9 villages.

His education qualification is

graduation.

Prior to joining as communities

mobilize, he did not aware about the

RSBY scheme at all.

When I joined this position in 2013, the

biggest challenge was lower coverage of

RSBY card, in many villages no RSBY

enrolment camps ever been conducted.

Of those who have RSBY scheme hardly

anybody knows its proper utilization.

There were several hospitals agents who

frequently visited villages and cheat

people in the name of health camps and

withdrawn entire money from their

cards.

In many cases I have seen, hospitals

scratch smart cards without any

hospitalization.

However, after joining this position, I

first make PRI members aware about the

wrongdoing that was going on in many

villages.

A resolution than passed by PRI

members and complete ban was imposed

on those private agents.

According to him, the biggest challenge

during enrolment of RSBY scheme is

bringing five family members to the

enrolment venue. Since majority of them

working on tea gardens on daily wages,

Page | 65

members to the hospitals and extent

every possible support in terms of

contacting RSBY help desk at hospitals,

talk to the doctors etc.

She further recalls that in many instances,

once she helped any family for

hospitalization from next time onwards

the family go alone, which she think is

the most important.

She further said that if any family in the

village benefited from the hospitalization,

it helps others to motivate and encourage

them to use the scheme.

However, she said that in spite of all

affords many families still prefer to

contact traditional healers for healthcare.

The most common problem is that if any

family which she encouraged to visit

hospitals does not get hospitalized, in that

condition family need to spend on

medical and transportation, that goes

negative to the family and others

neighborhoods.

it becomes very challenging to

convenience them.

At many occasions I personally, talked

to the tea garden administration to grant

leave from the jobs at least for half day

to enable families to enroll under the

SRBY scheme. But very few actually

follow what they promised to me.

I conducted many hospital exposure

visits to enable villagers to learn them

about the experience of hospitalization

which ultimately increases their

confidence.

Due to the lack of timing, families still

prefer to reach traditional healers who

are locally available.

Page | 66

References

Ahuja R and NarangA (2005) Emerging Trends in Health Insurance for Low-Income Groups. Economic

and Political Weekly, 40(38): 4151-4157.

Berki SE (1986) A Look at Catastrophic Medical Expenses and the Poor.Health Affairs5: 138 145.

Berman P, Ahuja R, and Bhandari L (2010) The Impoverishing Effect of Healthcare Payments in India:

New Methodology and Findings. Economic and Political Weekly, 45(16): 65-71.

Berman P, Ahuja R, Bhandari L (2010) The impoverishing effect of healthcare payments in India: new

methodology and findings. Economic & Political Weekly, 45:65-71

Carrin G and James C (2004). Reaching universal coverage via social health insurance: key design

features in the transition period. Health Financing Policy Issue Paper, WHO, Geneva. Available at:

http://www.who.int/health_financing/issues/en/reaching_universal_dp_04_2.pdf

Das J &Leino J (2011) Evaluating the RSBY: lessons from an experimental information campaign.

Economic & Political Weekly, 46(32): 85-93.

Dror DM &Vellakkal S (2012) Is RSBY India’s platform to implementing universal hospital insurance?

Indian Journal of Medical Research, 135, 56–63.

Ellis RP, Alam M and Gupta I (2000) Health Insurance in India: Prognosis and Prospectus. Economic and

Political Weekly, 35(4): 207-217

Eman B (2004) Community based health insurance in low-income countries: a systematic review of the

evidence. Helath Policy and Planning, 19(5): 249-70

Filmer D, and Pritchett L (1999) The Effect of Household Wealth on Educational Attainment: Evidence

from 35 Countries. Population and Development Review, 25: 85-120.

Garg C & Karan A (2005) Out-of-pocket Expenditure and Impoverishment: Policy Implications for

Targetted Populations in India.Paper presented at Forum 9, Mumbai, India, 12-16 September,

2005.

Grover, S & Palacios R (2011) The first two years of RSBY in Delhi. In Palacios, Robert, Das, Jishnu and

Sun. Changqing (eds) “India's Health Insurance Scheme for the Poor: Evidence from the Early

Experience of the RashtriyaSwasthyaBimaYojana” Centre for Policy Research, New Delhi

http://www.who.int/health_financing/issues/en/reaching_universal_dp_04_2.pdf

Page | 67

Gupta I (2009) Out-of-pocket Expenditures and Poverty: Estimates from NSS 61st Round, Institute of

Economic Growth, Delhi, 2009. Available at:

http://planningcommission.nic.in/reports/genrep/indrani.pdf

Gupta I and Trivedi M (2005) Social Health Insurance Redefined: Health for All through Coverage for

All. Economic and Political Weekly, 40(38): 4132-4140

Gupta I and Trivedi M (2006) Health Insurance: Beyond a Piecemeal Approach. Economic and Political

Weekly, 41(25): 2525-2528

Hou, X & Palacios R (2011) Hospitalization patterns in RSBY: preliminary evidence from the MIS. In

Palacios, Robert, Das, Jishnu and Sun. Changqing (eds) “India's Health Insurance Scheme for the

Poor: Evidence from the Early Experience of the RashtriyaSwasthyaBimaYojana” Centre for

Policy Research, New Delhi

Hsiao W and Shaw RP (2007) Social Health Insurance for Developing Nations. The World Bank

Washington, D.C.

Kumer S (2010) Awareness, Accessibility and barriers in utilization of RashtriyaSwathyaBimaYojana

among BPL households in Puri district, Ordisha. Available:

http://www.slideshare.net/SudheirYadav/awareness-accessibility-and-barriers-in-utilization-of-

rastriya-swasthya-bima-yozna-services-among-bpl-families-in-puri-district-odisha

Lagarde M, Haines A, Palmer N (2009) The impact of conditional cash transfers on health outcomes and

use of health services in low and middle income countries. Cochrane Database System

Review,7(4):CD008137.

Mazumdar S. &Mazumdar P.G. (2013). Health and Healthcare.Delhi Human Development Report- 2013.

Academic Foundation & Institute for Human Development, New Delhi

Montgomery M, Gragnolati M, Burke KA, Paredes E (2000) Measuring Living Standards with Proxy

Varables.Demography, 37(2): 155-74.

Nandi S, Nundy M, Prasad V, Kanungo K, Khan H, Haripriya S, Mishra T &Garg S (2012) The

Implementation of RSBY in Chhattisgarh, India: A study of the Durg district. Health, Culture and

Society, 2(1):

Narayana D (2010) Review of the RashtriyaSwasthyaBimaYojana.Economic and Political Weekly

45(29): 13-18.

Pannarunothai S & Mills A (1997) The Poor Pay More: Health-related Inequality in Thailand. Social

Science and Medicine, 44(12): 1781-1790.

Rajasekhar D, Berg E, Ghatak M & Roy S (2010) Implementing Health Insurance: The Rollout of

RashtriyaSwasthyaBimaYojana in Karnataka. Economic and Political Weekly, 46(20): 56-63.

Rathi P (2011) Evaluation of ´RashtriyaSwasthyaBimaYojana, a Health Insurance Scheme for below

poverty line people in Amravati. IIM Bangalore, India, 2011.

http://planningcommission.nic.in/reports/genrep/indrani.pdf

http://www.slideshare.net/SudheirYadav/awareness-accessibility-and-barriers-in-utilization-of-rastriya-swasthya-bima-yozna-services-among-bpl-families-in-puri-district-odisha

http://www.slideshare.net/SudheirYadav/awareness-accessibility-and-barriers-in-utilization-of-rastriya-swasthya-bima-yozna-services-among-bpl-families-in-puri-district-odisha

http://www.ncbi.nlm.nih.gov/pubmed?term=Lagarde%20M%5BAuthor%5D&cauthor=true&cauthor_uid=19821444

http://www.ncbi.nlm.nih.gov/pubmed?term=Haines%20A%5BAuthor%5D&cauthor=true&cauthor_uid=19821444

http://www.ncbi.nlm.nih.gov/pubmed?term=Palmer%20N%5BAuthor%5D&cauthor=true&cauthor_uid=19821444

http://www.ncbi.nlm.nih.gov/pubmed/19821444

http://www.ncbi.nlm.nih.gov/pubmed/19821444

Page | 68

Reddy KS &Selvaraj S (2011) A Critical Assessment of the Existing Health Insurance Models in India.

Public Health Foundation of India, New Delhi. Available:

http://planningcommission.nic.in/reports/sereport/ser/ser_heal1305.pdf

Seshadri T, Trivedi M, Saxena D, Nair R, Soors W, Criel B, Devadasan N (2011) Study of

RashtriyaSwasthyaBimaYojana Health Insurance in India. WHO Reference no. 2011/126289-0.

Available: http://www.iphindia.org/v2/wp-content/uploads/2013/01/RSBY-

report_2013_Jan_02.pdf

Su TT, Kouyate B &Flessa S (2006) Catastrophic Household expenditure for Health Care in a Low-

income Society: A Study from Nouna District, Burkina Faso”, Bulletin of the WorldHealth

Organization, 84(1): 21-27.

Sun C (2011) An analysis of RSBY enrolment patterns: Preliminary evidence and lessons from the early

experience. In Palacios, Robert, Das, Jishnu and Sun. Changqing (eds) “India's Health Insurance

Scheme for the Poor: Evidence from the Early Experience of the RashtriyaSwasthyaBimaYojana”,

Centre for Policy Research, New Delhi.

Swarup A (2011) RashtriyaSwasthyaBimaYojana (RSBY) … some initial trends. RSBY Working Paper,

New Delhi.

Thakur H &Ghosh S (2013) Social Exclusion and (RSBY) RashtriyaSwasthyaBimaYojana in

Maharashtra.Tata Institute of Social Sciences, Mumbai. Available:

http://www.healthinc.eu/PDF/TISS_Maharashtra_RSBY_Case_Study_report.pdf

Thuan NBT, Lofgren C, Chuc NKT, Janlert U &Lindholm L (2006) Household Out-of-pocket Payments

for Illness: Evidence from Vietnam. Public Health, 6: 283

Wadhwa JDP (2010) Central Vigilance Committee on Public Distribution System Report on the State Of

Chhattisgarh. New Delhi: Justice Wadhwa Committee.

WHO. Sustainable Health Financing, Universal Coverage, and Social Health Insurance. In: 58th World

Health Assembly. Agenda Item 13.16 Edition. Geneva, 2005.

World Bank, 2000. “Measuring Living Standards: Household Consumption and Wealth Indices”,

Quantitative Techniques for Health Equity Analysis—Technical Note #4, The World Bank: Poverty

and Health, health, Nutrition and Population Division, Washington D.C. Available at

http://siteresources.worldbank.org/INTPAH/Resources/Publications/Quantitative-

Techniques/health_eq_tn04.pdf.

World Health Organisation (2005) Sustainable Health Financing, Universal Coverage, and Social Health

Insurance. In: 58th World Health Assembly. Agenda Item 13.16 Edition. Geneva.

Xu K (2005) Distribution of Health Payments and Catastrophic Expenditures: Methodology”, WHO

Discussion Paper, Number 2-2005, Geneva: WHO.

Xu K, Evans DB, Kawabata K, Zeramdini R, Klavus J & Murray CJL (2003a) Household Catastrophic

Health Expenditure: A Multicountry Analysis. Lancet, 362:111-117.

Xu K, Klavus J, Kawabata K, Evans DB, Hanvoravongchai P, Ortiz JP, Zeramdini R & Murray CJL

(2003b) Household Health System Contributions and Capacity to Pay: Definitional, Empirical and

http://planningcommission.nic.in/reports/sereport/ser/ser_heal1305.pdf

http://www.iphindia.org/v2/wp-content/uploads/2013/01/RSBY-report_2013_Jan_02.pdf

http://www.iphindia.org/v2/wp-content/uploads/2013/01/RSBY-report_2013_Jan_02.pdf

http://www.healthinc.eu/PDF/TISS_Maharashtra_RSBY_Case_Study_report.pdf



Page | 69

Technical Challenges, in C.J.L. Murray & D.B. Evans (eds.), Health SystemPerformance

Assessment: Debates, Methods and Empiricism, Geneva: WHO, pp. 533-542.

Page | 70

Statistical Appendix

Page | 71

Page | 72

Appendix 1: RSBY in Jharkhand: A situational analysis

S.No. District Year of

Policy

Premium

(With

Service

tax)

Total Target Families Hospitals

Empanelled

Hospitalization

Total Enrolled

Conversion

ratio Private Public

Hospitalization

cases

Hospitalization

value (Rs)

Hospitalization-

ratio*

1 Bokaro 3 279 104886 55588 53.0 14 13 761 5,267,350 1.4

2 Chatra 3 279 133289 74867 56.2 8 6 49 145375 0.1

3 Deoghar 4 450 141175 41517 29.4 6 8 454 3358425 1.1

4 Dhanbad 4 450 157825 84546 53.6 24 9 3196 20912925 3.8

5 Dumka 3 376 125287 62276 49.7 4 10 208 712000 0.3

6 Garhwa 4 450 274843 86203 31.4 7 6 176 1408000 0.2

7 Giridih 3 376 188230 126996 67.5 11 12 1203 7957825 0.9

8 Godda 3 279 131196 68837 52.5 4 8 57 594,500 0.1

9 Gumla 3 376 87545 55410 63.3 3 11 244 825375 0.4

10 Hazaribag 2 279 167290 110102 65.8 15 12 623 2702000 0.6

11 Jamtara 3 450 109850 52024 47.4 3 6 149 808375 0.3

12 Khunti 4 450 62763 40332 64.3 4 6 65 180250 0.2

13 Kodarma 2 279 51638 32210 62.4 8 7 149 982750 0.5

14 Latehar 3 279 111744 67800 60.7 7 13 0 0 0.0

15 Lohardaga 3 376 45555 23646 51.9 5 7 645 1192500 2.7

16 Pakaur 3 279 129854 74095 57.1 7 6 132 799,250 0.2

17 Palamu 3 376 258719 93778 36.2 13 11 593 4667825 0.6

18

Pashchimi

Singhbhum 4 450 174506 79992 45.8 4 14 107 483283 0.1

19 Purbi Singhbhum 3 376 148810 79654 53.5 10 11 571 1821100 0.7

20 Ramgarh 2 279 95430 53385 55.9 15 4 42 230,250 0.1

21 Ranchi 4 450 226006 103400 45.8 34 16 1332 7450975 1.3

22 Sahibganj 3 279 137517 80018 58.2 2 7 0 0 0.0

23 Saraikela 3 450 184868 111153 60.1 7 10 38 180875 0.0

24 Simdega 3 376 71629 30267 42.3 2 7 103 248750 0.3

Total 3320455 1688096 50.8 217 220 10897 62,929,958 0.6

Source: RSBY website accessed on February 15, 2015 (http://jhr.nic.in/templates/rsbyproject/index.html)

http://jhr.nic.in/templates/rsbyproject/index.html

Page | 73

Appendix 2: RSBY in West Bengal: A situational analysis

S. No District Year

of

Policy

Premium

(With

Service

tax)

Total Target Families

Hospitals

Empanelled Hospitalization

Total Enrolled

Conversion

ratio Private Public

Hospitalization

cases

Hospitalization

value (Rs)

Hospitalization

ratio*

1 Bankura 3 460 418430 354436 84.7 30 2 23355 149954442 6.6

2 Birbhum 3 460 424717 335541 79.0 24 2 34718 264494407 10.3

3 Burdwan 5 232 972156 673953 69.3 70 5 44763 292761858 6.6

4 Coochbehar 3 460 472396 179391 38.0 3 5 9811 60441932 5.5

5 Dakshin Dinajpur 2 460 234732 137000 58.4 3 4 142 716450 0.1

6 Darjiling 2 460 144484 33987 23.5 8 3 633 3214357 1.9

7 Hoogly 3 460 547375 347485 63.5 32 3 14917 87089447 4.3

8 Howrah 3 460 238342 85626 35.9 29 1 5559 35551919 6.5

9 Jalpaiguri 3 460 619180 228123 36.8 10 3 24096 121580338 10.6

10 Kolkata 1 432 217846 112912 51.8 35 9 733 4962910 0.6

11 Maldah 5 185 654264 366123 56.0 15 2 13265 85698223 3.6

12 Murshidabad 4 205 1021376 558776 54.7 44 1 47037 342073927 8.4

13 Nadia 4 262 690852 370858 53.7 52 1 29048 215522881 7.8

14 North 24 Parganas 4 380 874840 444780 50.8 43 10 14303 94703415 3.2

15 Paschim Medinipur 4 212 813626 449362 55.2 26 2 14154 91804037 3.1

16 Purba Midnapore 4 380 461806 277280 60.0 63 1 10123 76494191 3.7

17 Purulia 3 460 394035 197619 50.2 8 2 4265 21894603 2.2

18 South 24 Parganas 2 460 706669 343831 48.7 45 5 17754 121191692 5.2

19 Uttar Dinajpur 3 460 293416 146000 49.8 4 1 40 274250 0.0

Total 10200542 5643083 55.3 544 62 308716 2070425279 5.5

Source: RSBY website accessed on February 15-*, 2015 (http://www.rsbywb.gov.in/home#)

http://www.rsbywb.gov.in/home

Page | 74

Appendix 3. Profile of the sample population by background characteristics


Background characteristics Intervention

District

Non-

intervention

district

Total Intervention

District

Non-

intervention

district

Total

Age group

0-5 11.3 9.7 10.5 7.2 7.9 7.6

6-14 21.5 22.8 22.1 17.3 16.4 16.8

15-49 50.7 51.4 51.0 59.4 59.2 59.3

50-64 12.7 12.0 12.3 12.3 12.3 12.3

65+ 3.9 4.1 4.0 3.8 4.2 4.1

Sex

Male 51.8 53.9 52.8 50.2 51.1 50.7

Female 48.2 46.1 47.2 49.8 48.9 49.3


Illiterate 6.4 9.7 8.1 66.3 63.5 64.7





Occupation

Daily wage labourer 24.4 21.6 23.1 29.7 30.4 30.1

Self employed/Salaried 16.0 16.7 16.3 7.1 5.5 6.2

Unemployed/Non-salary 17.1 16.4 16.7 26.9 27.7 27.4

Student 27.6 29.5 28.5 26.4 24.4 25.2

Elderly/Handicap/children 15.0 15.8 15.4 9.9 12.0 11.1

Caste

General/OBC 58.3 53.4 55.8 62.1 43.5 51.1



Religion

Hindu 72.1 83.6 77.8 30.1 82.8 61.3

Muslims 7.1 9.1 8.1 58.3 17.0 33.8

Sarna/Christians/Others 20.9 7.4 14.1 11.7 0.2 4.9

MPCE


MPCE quintile 2 19.9 20.1 20.0 18.1 21.2 20.0

MPCE quintile 3 21.2 18.8 20.0 19.7 20.3 20.1

MPCE quintile 4 16.8 23.2 20.0 21.4 19.0 20.0


Toilet facility

Page | 75

Open defecation 98.3 90.5 94.4 60.9 63.0 62.2

Public toilet 0.7 1.7 1.2 3.6 8.1 6.2

Toilet in premises 1.0 7.8 4.4 35.5 28.9 31.6

Source of water

Piped water 33.3 43.4 38.3 14.0 7.2 9.9

Tube well/hand pump 46.1 27.5 36.8 54.2 81.4 70.3

Others 19.9 28.8 24.3 31.8 11.4 19.7

Main source of cooking fuel

Kerosene oil 0.3 0.7 0.5 2.3 3.7 5.5

Coal 23.9 29.2 26.5 13.9 19.2 16.5

Wood 70.4 63.1 66.7 50.4 53.1 66.7

LPG 1.4 1.0 1.2 2.4 2.0 2.2

Electricity 4.0 6.1 5.1 7.0 5.1 9.1

Mass media exposure

No exposure 63.6 49.0 56.3 54.7 58.7 57.1

Any exposure 36.4 51.0 43.7 45.3 41.3 42.9

Main source of information

regarding govt.

programmers/schemes

Friends/family members 61.8 75.5 68.6 24.6 23.9 24.2

Media 5.2 14.5 9.8 2.3 1.8 2.0

Local govt. worker (ANM, AWW etc.) 53.8 50.4 52.1 25.4 29.7 28.0

Political party worker/leader etc. 37.2 34.8 36.0 55.4 62.2 59.5

Religious leaders 0.7 0.0 0.4 1.9 4.6 3.5

Local NGO/CBO members 26.7 0.7 13.9 19.2 11.2 14.4

Others 10.4 7.5 9.0 5.8 2.5 3.8

Total Households 297 298 595 309 448 757

Total Individuals 1,660 1,524 3,184 1,499 2,006 3,505

Page | 76

Appendix 4. Prevalence of short-term morbidity by background characteristics



District

Non-

intervention

district

Total Intervention

District

Non-

intervention

district

Total

Age group

0-5 0.0 0.7 0.3 2.8 3.8 3.4

6-14 1.1 0.0 0.6 3.5 2.4 2.9

15-49 15.7 9.7 12.8 12.8 12.4 12.5

50-64 47.6 25.7 37.4 20.9 16.3 18.2

65+ 47.7 24.2 36.2 15.5 26.4 22.1

Sex

Male 19.9 12.2 16.1 11.8 13.0 12.5

Female 12.0 5.6 9.0 11.4 9.3 10.2


Illiterate 29.8 13.5 21.9 11.6 11.5 11.5





Occupation

Daily wage labourer 24.2 16.4 20.7 16.0 15.8 15.9



Student 1.8 0.4 1.1 5.6 4.3 4.9


Caste

General/OBC 16.7 10.06 13.6 9.2 12.7 10.9



Religion

Hindu 18.2 9.2 13.6 15.8 11.1 12.1

Muslims 16.3 11.5 13.7 8.5 11.4 9.3


MPCE


MPCE quintile 2 12.3 7.0 9.7 8.8 8.1 8.3

MPCE quintile 3 16.1 8.0 12.6 11.6 11.1 11.3

MPCE quintile 4 22.4 9.4 15.5 15.1 15.4 15.3


Toilet facility

Page | 77

Open defecation 15.8 8.6 12.5 11.3 11.1 11.2

Public toilet 33.3 15.0 21.9 13.7 14.2 14.1


Source of water

Piped water 30.0 66.7 38.5 11.6 20.4 15.3


Others 13.0 8.4 11.9 16.2 12.0 14.9

Mass media exposure

No exposure 16.9 8.7 13.5 12.3 11.7 11.9

Any exposure 14.7 9.5 11.9 10.8 10.5 10.6

Total 16.1 9.1 12.8 11.6 11.2 11.4

Page | 78

Appendix 5. Hospitalization rates by selected background characteristics



District

Non-

intervention

district

Total Intervention

District

Non-

intervention

district

Total

Age group

0-5 0.0 0.0 0.0 1.9 0.0 0.8

6-14 0.0 0.0 0.0 1.2 1.5 1.4

15-49 4.4 6.4 5.4 5.3 3.0 3.9

50-64 17.6 15.3 16.5 9.7 8.9 9.3

65+ 27.7 21.0 24.4 17.5 12.9 14.8

Sex

Male 7.3 7.8 7.6 6.1 4.0 4.9

Female 3.6 3.8 3.7 4.6 3.3 3.8


Illiterate 7.7 9.0 8.3 5.3 3.9 4.5





Occupation

Daily wage laborer 7.7 10.9 9.1 8.3 4.9 6.3



Student 0.0 0.2 0.1 1.0 1.2 1.1


Caste

General/OBC 4.4 6.3 5.3 6.0 3.6 4.8



Religion

Hindu 5.3 6.0 5.6 5.6 3.9 4.3

Muslims 4.7 3.9 4.2 5.9 2.5 4.9


MPCE


MPCE quintile 2 5.4 4.2 4.8 5.1 3.0 3.8

MPCE quintile 3 5.0 6.0 5.5 3.3 4.8 4.2

MPCE quintile 4 6.8 8.4 7.7 8.6 4.2 6.3


Page | 79

Toilet facility

Open defecation 5.6 6.1 5.8 5.0 4.0 4.4

Public toilet 0.0 0.0 0.0 4.0 4.5 4.4


Source of water

Piped water 8.9 19.7 11.1 7.8 4.7 6.5


Others 3.0 5.2 3.2 3.9 3.0 3.6

Mass media exposure

No exposure 4.2 4.9 4.5 4.4 3.8 4.1

Any exposure 7.7 7.0 7.3 6.3 3.4 4.7

Total 5.5 6.0 5.8 5.3 3.6 4.4

Page | 80

Appendix 6. Type of health facility use for hospitalization by selected socioeconomic characteristics in Jharkhand

Intervention District Non-Intervention District Total

Background

Characteristic

Public

facility

Private

facility

Informal

providers

Public

facility

Private

facility

Informal

providers

Public

facility

Private

facility

Informal

providers

Age group

15-49 4.6 59.1 36.4 8.0 52.0 40.0 6.4 55.3 38.3

50-64 4.4 91.3 4.4 33.3 33.3 33.3 15.8 68.4 15.8

65+ 12.5 75.0 12.5 12.5 75.0 12.5 12.5 75.0 12.5

Sex

Male 5.3 73.7 21.1 17.7 47.1 35.3 11.1 61.1 27.8

Female 6.7 80.0 13.3 14.3 57.1 28.6 10.3 69.0 20.7

Highest education level

Illiterate 4.2 75.0 20.8 19.2 53.9 26.9 12.0 64.0 24.0

Primary completed 13.3 66.7 20.0 16.7 66.7 16.7 14.3 66.7 19.1

Secondary completed 0.0 83.3 16.7 8.3 33.3 58.3 5.6 50.0 44.4

Higher secondary 0.0 80.0 20.0 33.3 66.7 0.0 12.5 75.0 12.5

Higher secondary & above 0.0 100.0 0.0 0.0 0.0 100.0 0.0 75.0 25.0

Occupation

Daily wage laborer 0.0 85.0 15.0 26.3 47.4 26.3 12.8 66.7 20.5

Self employed/Salaried 8.7 60.9 30.4 17.7 41.2 41.2 12.5 52.5 35.0

Unemployed/Non-salary 0.0 100.0 0.0 0.0 75.0 25.0 0.0 85.7 14.3

Student 14.3 85.7 0.0 0.0 62.5 37.5 6.7 73.3 20.0

Caste

General/OBC 7.1 71.4 21.4 0.0 59.3 40.7 3.6 65.5 30.9

Scheduled Castes 12.5 75.0 12.5 66.7 22.2 11.1 41.2 47.1 11.8

Scheduled Tribes 0.0 82.4 17.7 16.7 50.0 33.3 6.9 69.0 24.1

Religion

Hindu 8.8 73.5 17.7 11.9 57.1 31.0 10.5 64.5 25.0

Muslims 0.0 80.0 20.0 0.0 0.0 100.0 0.0 66.7 33.3

Sarna/Christians/Others 0.0 78.6 21.4 60.0 0.0 40.0 15.8 57.9 26.3

MPCE

MPCE quintile 1 (Lowest) 9.1 72.7 18.2 9.1 54.6 36.4 9.1 63.6 27.3

MPCE quintile 2 0.0 66.7 33.3 28.6 28.6 42.9 12.5 50.0 37.5

MPCE quintile 3 10.0 80.0 10.0 16.7 58.3 25.0 13.6 68.2 18.2

MPCE quintile 4 0.0 70.0 30.0 14.3 57.1 28.6 8.3 62.5 29.2

MPCE quintile 5 (Higher) 7.7 84.6 7.7 25.0 25.0 50.0 11.8 70.6 17.7

Mass media exposure

No exposure 0.0 76.0 24.0 18.2 40.9 40.9 8.5 59.6 31.9

Any exposure 10.7 75.0 14.3 15.4 57.7 26.9 13.0 66.7 20.4

Total 5.7 75.5 18.9 16.7 50.0 33.3 10.9 63.4 25.7

Page | 81

Appendix 7. Type of health facility use for hospitalization by selected socioeconomic characteristics in West Bengal

Intervention District Non-Intervention District Total

Background

characteristic

Public

facility

Private

facility

Informal

providers

Public

facility

Private

facility

Informal

providers

Public

facility

Private

facility

Informal

providers

Age group

0-5 50.0 50.0 0.0 na na na 50.0 50.0 0.0

6-14 33.3 66.7 0.0 50.0 25.0 25.0 42.9 42.9 14.3

15-49 25.8 58.1 16.1 24.0 60.0 16.0 25.0 58.9 16.1

50-64 61.5 38.5 0.0 15.4 38.5 46.2 38.5 38.5 23.1

65+ 37.5 62.5 0.0 42.9 57.1 0.0 40.0 60.0 0.0

Sex

Male 35.3 64.7 0.0 29.6 48.2 22.2 32.8 57.4 9.8

Female 39.1 39.1 21.7 22.7 54.6 22.7 31.1 46.7 22.2


Illiterate 45.0 45.0 10.0 33.3 43.3 23.3 40.0 44.3 15.7

Primary completed 11.1 88.9 0.0 16.7 75.0 8.3 14.3 81.0 4.8

Secondary completed 16.7 66.7 16.7 25.0 25.0 50.0 20.0 50.0 30.0

Higher secondary 0.0 100.0 na 0.0 50.0 50.0 0.0 66.7 33.3

Higher secondary & above na na 0.0 0.0 100.0 0.0 0.0 100.0 0.0

Occupation

Daily wage labourer 44.0 48.0 8.0 26.3 47.4 26.3 36.4 47.7 15.9

Self employed/Salaried 25.0 75.0 0.0 75.0 0.0 25.0 50.0 37.5 12.5

Unemployed/Non-salaried 21.4 64.3 14.3 7.1 78.6 14.3 14.3 71.4 14.3

Student 33.3 66.7 0.0 20.0 40.0 40.0 25.0 50.0 25.0

Elderly/Handicap/children 40.0 50.0 10.0 42.9 42.9 14.3 41.2 47.1 11.8

Caste

General/OBC 37.2 51.2 11.6 13.6 63.6 22.7 29.2 55.4 15.4


Scheduled Tribes 50.0 50.0 0.0 na na na 50.0 50.0 0.0

Religion

Hindu 42.9 57.1 0.0 29.6 47.7 22.7 32.8 50.0 17.2

Muslims 35.7 52.4 11.9 0.0 80.0 20.0 31.9 55.3 12.8

Christians/Others 0.0 100.0 0.0 na na na 0.0 100.0 0.0

MPCE


MPCE quintile 2 66.7 33.3 0.0 12.5 75.0 12.5 41.2 52.9 5.9

MPCE quintile 3 11.1 88.9 0.0 33.3 33.3 33.3 23.8 57.1 19.1

MPCE quintile 4 33.3 55.6 11.1 23.1 61.5 15.4 29.0 58.1 12.9


Mass media exposure

No exposure 48.2 37.0 14.8 18.5 51.9 29.6 33.3 44.4 22.2

Page | 82

Any exposure 26.7 70.0 3.3 36.4 50.0 13.6 30.8 61.5 7.7

Total 36.8 54.4 8.8 26.5 51.0 22.5 32.1 52.8 15.1

Page | 83

Appendix 8. Mean monthly healthcare expenditure by background characteristics (in Rs.)


Background Characteristic Out-patient In-patient Total Out-patient In-patient Total


Illiterate 2026 665 1591 2453 2592 2495

Primary completed 1475 1296 1335 2540 1955 2351

Secondary completed 1527 1829 1618 3265 1203 2521

Higher secondary 1015 1246 1097 2041 1995 2027

Higher secondary & above 1677 1282 1463 15415 3309 9557

Caste

General/OBC 1604 1582 1577 4356 2340 3687

Scheduled Castes 1473 1737 1575 2586 2131 2389

Scheduled Tribes 1110 828 940 1997 1204 1777

Religion

Hindu 1511 1520 1503 3205 1841 2716

Muslims 1928 1986 1949 4189 2545 3619

Christians/Others 866 448 628 2286 2137 2255

MPCE

MPCE quintile 1 (Lowest) 889 955 899 2177 556 1672

MPCE quintile 2 871 1276 1029 4281 957 3173

MPCE quintile 3 918 1110 994 1842 2493 2070

MPCE quintile 4 1311 1563 1435 3101 1876 2633

MPCE quintile 5 (Higher) 2639 2056 2417 5469 3776 4915

Mass media exposure

No exposure 1584 1471 1525 2878 2825 2862

Any exposure 1344 1333 1325 4445 1310 3188

District Type

Intervention 1512 1728 1578 2642 1907 2373

Non-intervention 1453 1079 1261 4120 2317 3540

Total 1488 1396 1433 3469 2105 2,997

Page | 84

Appendix 9. Mean Out of Pocket Expenditure (OOPE) and percentage share of OOPE of total household expenditure according to selected

household attributes in Jharkhand (in %)

Background Characteristics Intervention District Non-Intervention District Total

Out-patient In-patient Total Out-patient In-patient Total Out-patient In-patient Total


Illiterate 17.6 52.9 26.4 39.8 10.6 28.1 30.9 21.2 27.5

Primary completed (upto 4) 26.6 35.1 29.0 15.1 18.1 16.6 20.5 27.1 23.1

Secondary completed (upto 9) 27.8 25.1 27.1 20.0 23.5 21.3 25.2 24.3 24.9

Higher secondary (upto 10) 18.0 24.8 20.9 19.8 25.0 21.4 18.7 24.9 21.1

Higher secondary & above (11 & above) 22.8 22.0 22.4 15.8 25.7 21.4 18.9 24.2 21.8

Caste

General/OBC 21.6 27.3 23.2 24.2 21.9 22.9 22.6 24.3 23.0



Religion

Hindu 25.2 28.8 26.3 19.7 25.3 22.1 22.8 26.9 24.3

Muslims 21.1 36.5 25.9 28.2 15.0 22.8 24.5 24.0 24.3

Christians/Others 21.9 15.3 18.5 15.2 12.0 12.0 21.0 14.2 16.8

MPCE


MPCE quintile 2 19.0 24.5 21.0 19.3 22.7 20.2 19.1 23.5 20.6

MPCE quintile 3 17.6 23.1 19.2 15.2 29.1 23.0 17.0 26.4 20.7

MPCE quintile 4 28.3 28.7 28.5 15.4 23.1 19.7 22.5 25.6 24.0


Mass media exposure

No exposure 26.2 24.0 25.1 23.5 27.9 25.3 25.2 25.8 25.2

Any exposure 21.0 28.9 24.5 17.3 19.9 18.3 19.1 23.7 21.2

Total 24.4 26.4 24.9 20.5 23.0 21.5 22.8 24.6 23.3

Page | 85

Appendix 10. Mean Out of Pocket Expenditure (OOPE) and percentage share of OOPE of total household expenditure according to selected

household attributes in West Bengal (in %)

Background Characteristics Intervention District Non-Intervention District All District

Out-patient In-patient Total Out-patient In-patient Total Out-patient In-patient Total


Illiterate 28.8 29.4 29.0 34.1 24.2 31.7 31.7 27.4 30.3

Primary completed (upto 4) 26.0 22.5 25.2 22.8 20.5 22.1 24.3 21.6 23.6

Secondary completed (upto 9) 35.1 15.9 27.3 19.7 11.3 16.5 26.5 13.7 21.5

Higher secondary (upto 10) 20.7 11.3 18.1 30.1 32.0 30.7 26.5 25.1 26.1

Higher secondary & above (11 & above) 24.7 22.4 23.0 25.7 31.3 28.1 25.4 26.2 25.8

Caste

General/OBC 29.1 20.4 25.3 25.2 29.2 26.3 26.9 23.8 25.8



Religion

Hindu 27.6 17.8 24.1 25.0 19.9 23.2 25.6 19.3 23.4

Muslims 28.6 22.2 25.8 32.4 39.0 34.0 29.7 24.9 27.9

Christians/Others 26.0 36.8 28.4 - - - 26.0 36.8 28.4

MPCE


MPCE quintile 2 24.8 19.1 22.4 23.5 19.2 22.2 24.0 19.1 22.3

MPCE quintile 3 28.5 22.2 26.3 24.0 22.5 23.5 26.0 22.3 24.8

MPCE quintile 4 27.6 22.0 25.6 29.7 19.5 26.4 28.7 21.1 26.0


Mass media exposure at HH level

No exposure 29.3 25.3 28.1 27.9 25.3 27.1 28.6 25.3 27.5

Any exposure 24.7 19.2 22.3 23.9 17.9 21.8 24.3 18.7 22.0

Total 27.8 21.9 25.6 26.3 22.3 24.9 26.9 22.1 25.2

Page | 86

Appendix 11. Awareness about schemes that covers hospitalization expenses by selected background characteristics (in %)


Intervention District Non-Intervention

District


District

Background characteristics Any scheme

that covers

Hospitalization

expenses

RSBY Any scheme

that covers

Hospitalization

expenses

RSBY Any scheme

that covers

Hospitalization

expenses

RSBY Any scheme

that covers

Hospitalization

expenses

RSBY


Illiterate 73.7 89.5 65.5 82.8 32.5 38.6 21.9 23.8

Primary completed 66.7 94.9 52.6 73.7 27.5 29.7 27.3 32.7

Secondary completed 70.8 93.3 60.6 83 34.7 38.9 19.5 20.7

Higher secondary 83.6 97.3 55.9 79.7 52.4 50 21.1 26.3

Higher secondary & above 89.1 91.3 70.5 87.2 31.6 31.6 28.9 26.7

Caste

General/OBC 75.7 95.4 55.3 80.5 26.7 28.8 24.6 27.7

Scheduled Castes 69.4 89.8 67.7 85.5 41.7 50 23.6 26.6

Scheduled Tribes 82.7 93.3 70.1 83.1 48.8 51.3 20 20

Religion

Hindu 76.6 95.3 63.9 83.5 54.9 60.4 24 26.4

Muslims 57.1 85.7 33.3 59.3 23.3 25 23.7 28.9

Christians/Others 82.3 91.9 72.7 95.5 36.1 38.9 0 0

MPCE

MPCE quintile 1 (Lowest) 89.4 95.5 62.3 81.1 30.9 36.8 25 28.6

MPCE quintile 2 76.3 94.9 68.3 86.7 30.4 33.9 23.7 29

MPCE quintile 3 73 98.4 64.3 78.6 25 31.7 29.7 30.8

MPCE quintile 4 76 86 59.4 82.6 36.9 40 17.6 20

MPCE quintile 5 (Higher) 66.1 93.2 55 81.7 48.3 43.1 23.1 25.3

Total 76.4 93.9 61.7 82.2 34.2 37.1 23.9 26.8

Page | 87

Appendix 12. Awareness about specific components of RSBY scheme by selected background characteristics in Jharkhand (in %)


Background

characteristics

Eligibili

ty

No. of

enrollme

nt

member

Enrollme

nt

expenses

Amou

nt

spent

per

year

Type of

treatme

nt

Awareness

about

transportati

on

allowance

Eligibili

ty

No. of

enrollme

nt

member

Enrollme

nt

expenses

Amou

nt

spent

per

year

Type of

treatme

nt

Awareness

about

transportati

on

allowance

Highest education

level

Illiterate 78.9 73.7 89.5 68.4 47.4 10.5 62.1 62.1 75.9 41.4 44.8 17.2

Primary completed 71.8 82.1 94.9 53.8 66.7 28.2 73.7 84.2 92.1 55.3 44.7 18.4

Secondary completed 73.3 90.8 91.7 69.2 67.5 18.3 71.3 77.7 89.4 47.9 55.3 18.1

Higher secondary 82.2 90.4 90.4 87.7 76.7 34.2 81.4 74.6 81.4 54.2 55.9 5.1

Higher secondary &

above

84.8 87 89.1 78.3 69.6 41.3 76.9 82.1 87.2 67.9 69.2 14.1

Caste

General/OBC 78.6 89 93.1 69.9 65.9 19.1 78 79.2 88.7 56 59.1 18.2


Scheduled Tribes 78.7 86.7 90.7 85.3 78.7 53.3 61 66.2 83.1 49.4 49.4 6.5

Religion

Hindu 77.1 87.9 92.5 72 66.8 21.5 75.1 78.3 86.3 57 58.6 14.5

Muslims 85.7 90.5 85.7 42.9 57.1 0 81.5 77.8 81.5 29.6 33.3 18.5

Christians/Others 75.8 87.1 88.7 87.1 79 53.2 54.5 68.2 90.9 59.1 63.6 9.1

MPCE

MPCE quintile 1

(Lowest)

86.4 86.4 98.5 90.9 80.3 47 81.1 86.8 92.5 58.5 67.9 17

MPCE quintile 2 81.4 93.2 91.5 79.7 69.5 28.8 73.3 78.3 88.3 58.3 60 18.3

MPCE quintile 3 68.3 88.9 90.5 66.7 65.1 19 67.9 73.2 83.9 57.1 53.6 14.3

MPCE quintile 4 78 88 86 64 64 16 71 75.4 79.7 53.6 49.3 13

MPCE quintile 5

(Higher)

72.9 83.1 88.1 61 62.7 18.6 78.3 75 88.3 46.7 55 10

Total 77.4 87.9 91.2 73.1 68.7 26.6 74.2 77.5 86.2 54.7 56.7 14.4

Page | 88

Appendix 13. Awareness about specific components of RSBY scheme by selected background characteristics in West Bengal (in %)


Background Characteristics Eligibility No. of

enrollment

member

Enrollment

expenses

How

much

amount

spent

per

year

Type of

treatment

Awareness

about

transportation

allowance

Eligibility No. of

enrollment

member

Enrollment

expenses

How

much

amount

spent

per

year

Type of

treatment

Awareness

about

transportation

allowance


Illiterate 60 80 99 87 41 5 73 74 96 86 39.3 2.8

Primary completed 59 72 97 80 27 3 70 73 92 76 40.7 3.3

Secondary completed 71 76 97 88 46 7 71 72 97 78 44.3 1.1

Higher secondary 71 74 100 86 45 5 69 76 97 88 36.2 6.9

Higher secondary & above 60 75 75 75 10 10 71 73 93 80 28.9 0

Caste

General/OBC 72 81 96 89 41 5 69 75 93 83 37.4 3.1

Scheduled Castes 61 69 100 78 22 0 73 72 96 80 40.1 3

Scheduled Tribes 46 65 95 77 32 9 62 67 91 71 47.6 0

Religion

Hindu 46 68 95 79 34 7 71 73 95 80 39.1 3.2

Muslims 75 80 97 89 41 5 67 76 93 87 39.5 1.3

Christians/Others 53 72 97 75 22 3 100 100 100 100 100 0

MPCE

MPCE quintile 1 (Lowest) 54 74 99 87 31 6 76 81 100 83 38.1 3.6

MPCE quintile 2 61 80 98 84 43 5 73 67 94 77 37.9 5.3

MPCE quintile 3 62 74 95 82 36 7 65 71 93 79 42.9 2.2

MPCE quintile 4 70 77 96 85 42 2 68 75 97 84 43.5 1.2

MPCE quintile 5 (Higher) 72 72 95 83 31 7 72 72 90 82 34.4 2.2

Total 64 75 96 84 37 5 71 73 95 81 39.3 2.9

Page | 89

Appendix 14. Source of awareness about s RSBY scheme by selected background Characteristics in

Jharkhand


Background

Characteristics

Friends/

Relative

s/

Neighbo

rs

Teacher/

Panchayat/

ANM/AW

W

RSB

Y

Mitra

TV/

Radio/

Other

Source

s

Friends/

Relative

s/

Neighbo

rs

Teacher/

Panchayat/

ANM/AW

W

SHG

/

NG

O

TV/

Radio/

Other

Source

s

Highest education

Illiterate 26.3 47.4 52.6 0.0 41.4 65.5 17.2 3.5

Primary completed 12.8 61.5 35.9 5.1 26.3 71.1 10.5 5.3

Secondary completed 23.3 58.3 25.8 7.5 40.4 58.5 7.5 2.1

Higher secondary 13.7 42.5 53.4 1.4 42.4 57.6 3.4 6.8

Higher secondary &

above

15.2 41.3 43.5 10.9 29.5 73.1 7.7 7.7

Caste

General/OBC 19.7 51.5 34.1 5.8 30.8 67.3 10.1 5.7

Scheduled Castes 20.4 61.2 20.4 8.2 61.3 53.2 6.5 3.2

Scheduled Tribes 14.7 45.3 60.0 4.0 27.3 67.5 5.2 5.2

Religion

Hindu 21.5 53.7 33.6 5.6 39.0 64.7 9.2 3.2

Muslim 14.3 71.4 9.5 4.8 18.5 51.9 3.7 25.9

Others 9.7 37.1 64.5 6.5 27.3 77.3 0.0 0.0

MPCE

MPCE quintile 1

(Lowest)

27.3 37.9 62.1 4.6 41.5 71.7 3.8 1.9

MPCE quintile 2 8.5 50.9 42.4 5.1 33.3 63.3 10.0 5.0

MPCE quintile 3 17.5 58.7 27.0 7.9 33.9 69.6 5.4 3.6

MPCE quintile 4 24.0 54.0 22.0 8.0 39.1 62.3 8.7 1.5

MPCE quintile 5 (Higher) 15.3 57.6 33.9 3.4 33.3 56.7 11.7 13.3

Total 18.5 51.5 38.4 5.7 36.2 64.4 8.1 5.0

Page | 90

Appendix 15. Source of awareness about s RSBY scheme by selected background characteristics in West

Bengal


Background

Characteristics

Frien

ds/

Relat

ives/

Neig

hbors

Teach

er/

Panch

ayat/

ANM

/

AW

W

PACS

interve

ntions

MLA/P

olitical

leader

TV/

Radio/

Other

Source

s

Friend

s/

Relati

ves/

Neigh

bours

Teach

er/

Panac

hayat/

ANM/

AWW

Mass

Medi

a

Cam

paign

SH

G/

N

G

O

ML

A/

Polit

ical

lead

er

TV/

Rad

io/

Oth

er

Sou

rces

Highest

education

Illiterate 27.7 10.8 51.8 16.9 7.2 12.2 9.4 51.4 9.4 30.8 7.5

Primary

completed

20.7 12.0 54.4 12.0 12.0 24.7 15.3 40.0 4.0 28.7 6.0

Secondary

completed

23.6 2.8 45.8 27.8 8.3 15.9 10.2 29.6 1.1 37.5 4.6

Higher

secondary

28.6 19.1 76.2 9.5 2.4 8.6 10.3 48.3 5.2 22.4 12.1

Higher

secondary &

above

20.0 5.0 65.0 5.0 15.0 15.6 6.7 55.6 0.0 28.9 4.4

Caste

General/OBC 24.0 8.3 48.4 20.8 8.9 16.9 7.2 40.0 2.6 38.0 7.7

Scheduled

Castes

33.3 8.3 52.0 16.7 8.3 15.1 12.9 45.3 6.5 25.0 6.5

Scheduled

Tribes

21.0 14.8 76.5 4.9 8.6 38.1 33.3 52.4 0.0 14.3 0.0

Religion

Hindu 24.7 8.6 64.5 10.8 7.5 15.9 11.9 42.1 4.9 31.0 6.5

Muslim 24.4 9.4 47.2 21.1 8.3 22.4 9.2 48.7 2.6 26.3 7.9

Others 22.2 16.7 72.2 5.6 13.9 0.0 0.0 100.0 0.0 0.0 0.0

MPCE

MPCE quintile 1 19.1 5.9 58.5 14.7 8.8 10.7 9.5 52.4 7.1 28.6 6.0

MPCE quintile 2 23.2 5.4 57.1 10.7 7.1 23.2 9.5 43.2 3.2 26.3 6.3

MPCE quintile 3 23.0 8.2 65.6 13.1 13.1 16.5 15.4 42.9 3.3 26.4 8.8

MPCE quintile 4 31.8 19.7 43.9 19.7 9.1 16.5 11.8 38.8 4.7 31.8 7.1

MPCE quintile 5 24.1 10.3 63.8 22.4 5.2 17.2 10.8 39.8 4.3 37.6 5.4

Total 24.3 10.0 55.3 16.2 8.7 17.0 11.4 43.3 4.5 30.1 6.7

Page | 91

Imact Assessement Study on RSBY

Page | 92

Appendix 16. Source of awareness about s RSBY scheme by selected background characteristics in Jharkhand


Backgroun

d

Characteris

tics

Mike

Anno

uncem

ent

Ralli

es/

Proc

essio

ns

Ta

ble

au

Vide

o/Fil

m

Sho

ws

Pu

pp

et

Sh

o

ws

Dra

ma/

Plays

/Stre

ets

Play

Fo

lk

so

ng

s/

Ar

t

W

all

wri

tin

g/

Po

ste

rs

Mike

Anno

uncem

ent

Ralli

es/

Proc

essio

ns

Ta

ble

au

Vide

o/Fil

m

Sho

ws

Pu

pp

et

Sh

o

ws

Dra

ma/

Plays

/Stre

ets

Play

Fo

lk

so

ng

s/

Ar

t

W

all

wri

tin

g/

Po

ste

rs

Highest

education

level

Illiterate 15.8 5.3 0.0 0.0 0.

0

10.5 5.

3

10.

5

6.9 0.0 0.0 0.0 0.

0

3.4 0.

0

0.0

Primary

completed

28.2 2.6 0.0 0.0 0.

0

10.3 2.

6

5.1 5.3 0.0 0.0 0.0 0.

0

2.6 0.

0

0.0

Secondary

completed

38.3 0.8 0.0 0.0 0.

0

5.8 0.

8

8.3 3.2 0.0 0.0 0.0 0.

0

0.0 0.

0

0.0

Higher

secondary

38.4 1.4 0.0 0.0 0.

0

12.3 4.

1

13.

7

5.1 0.0 0.0 0.0 0.

0

1.7 0.

0

3.4

Higher

secondary &

above

28.3 2.2 0.0 0.0 0.

0

6.5 2.

2

17.

4

6.4 1.3 0.0 0.0 0.

0

0.0 0.

0

1.3

Caste

General/OB

C

35.3 1.7 0.0 0.0 0.

0

6.9 2.

9

11.

0

3.8 0.6 0.0 0.0 0.

0

0.0 0.

0

0.6

Scheduled

Castes

55.1 4.1 0.0 0.0 0.

0

8.2 4.

1

20.

4

3.2 0.0 0.0 0.0 0.

0

1.6 0.

0

0.0

Scheduled

Tribes

17.3 0.0 0.0 0.0 0.

0

12.0 0.

0

4.0 9.1 0.0 0.0 0.0 0.

0

2.6 0.

0

2.6

Religion

Hindu 41.6 2.3 0.0 0.0 0.

0

8.4 3.

3

13.

6

5.2 0.4 0.0 0.0 0.

0

0.8 0.

0

1.2

Muslims 19.0 0.0 0.0 0.0 0.

0

0.0 0.

0

4.8 7.4 0.0 0.0 0.0 0.

0

3.7 0.

0

0.0

Others 12.9 0.0 0.0 0.0 0.

0

11.3 0.

0

3.2 0.0 0.0 0.0 0.0 0.

0

0.0 0.

0

0.0

MPCE

MPCE

quintile 1

(Lowest)

13.6 1.5 0.0 0.0 0.

0

18.2 1.

5

9.1 1.9 0.0 0.0 0.0 0.

0

0.0 0.

0

0.0

MPCE

quintile 2

30.5 0.0 0.0 0.0 0.

0

8.5 3.

4

5.1 6.7 0.0 0.0 0.0 0.

0

0.0 0.

0

0.0

MPCE

quintile 3

47.6 0.0 0.0 0.0 0.

0

1.6 0.

0

9.5 7.1 0.0 0.0 0.0 0.

0

1.8 0.

0

3.6

MPCE

quintile 4

44.0 4.0 0.0 0.0 0.

0

6.0 4.

0

18.

0

4.3 1.4 0.0 0.0 0.

0

1.4 0.

0

1.4

MPCE

quintile 5

(Higher)

37.3 3.4 0.0 0.0 0.

0

6.8 3.

4

13.

6

5.0 0.0 0.0 0.0 0.

0

1.7 0.

0

0.0

Media

Exposure


Page | 93

No exposure 34.9 2.1 0.0 0.0 0.

0

8.5 3.

2

8.5 4.1 0.0 0.0 0.0 0.

0

2.1 0.

0

0.7

Any

exposure

32.4 0.9 0.0 0.0 0.

0

8.3 0.

9

14.

8

5.9 0.7 0.0 0.0 0.

0

0.0 0.

0

1.3

Total 34.0 1.7 0.0 0.0 0.

0

8.4 2.

4

10.

8

5.0 0.3 0.0 0.0 0.

0

1.0 0.

0

1.0

Appendix 17. Source of awareness about s RSBY scheme by selected background characteristics in West Bengal


Background

Characterist

ics

Mike

Annou

nceme

nt

Ralli

es/

Proc

essio

ns

Ta

ble

au

Vide

o/Fil

m

Sho

ws

Pu

pp

et

Sh

ow

s

Dram

a/

Plays

/Stree

ts

Play

Fo

lk

so

ng

s/

Ar

t

Wa

ll

wri

tin

g/

Po

ste

rs

Mike

Annou

nceme

nt

Ralli

es/

Proc

essio

ns

Ta

ble

au

Vide

o/Fil

m

Sho

ws

Pu

pp

et

Sh

ow

s

Dram

a/

Plays

/Stree

ts

Play

Fo

lk

so

ng

s/

Ar

t

Wa

ll

wri

tin

g/

Po

ste

rs Highest

education

level

Illiterate 55.4 4.8 3.6 3.6 1.2 4.8 0.

0

14.

5

71.0 7.5 4.7 9.3 9.3 4.7 5.

6

13.

1 Primary

completed 59.8 3.3 1.1 2.2 1.1 2.2 1.

1

15.

2

72.7 3.3 2.7 5.3 4.7 3.3 4.

7

7.3

Secondary completed

50.0 2.8 2.8 2.8 1.4 2.8 1.

4

11.

1

62.5 2.3 2.3 3.4 9.1 9.1 3.

4

8.0


Page | 94

Higher secondary

57.1 11.9 9.5 9.5 2.4 9.5 2.

4

31.

0

65.5 0.0 0.0 1.7 1.7 1.7 0.

0

3.4

Higher secondary &

above

55.0 10.0 5.0 5.0 0.0 5.0 5.

0

35.

0

77.8 0.0 0.0 6.7 2.2 2.2 2.

2

4.4

Caste General/OB

C 52.6 3.6 2.6 4.7 1.0 3.1 0.

5

10.

9

68.7 0.5 1.0 2.6 2.6 2.1 1.

5

7.2

Scheduled

Castes 63.9 5.6 5.6 5.6 2.8 2.8 2.

8

19.

4

71.6 6.0 3.9 8.6 9.5 6.9 5.

6

9.5

Scheduled

Tribes 59.3 8.6 4.9 1.2 1.2 7.4 2.

5

32.

1

61.9 0.0 0.0 0.0 0.0 0.0 4.

8

0.0

Religion Hindu 57.0 8.6 3.2 2.2 2.2 5.4 2.

2

25.

8

68.5 4.0 2.7 6.5 7.0 5.1 4.

3

8.1

Muslims 52.8 2.8 2.8 5.6 1.1 3.9 0.

6

11.

7

76.3 0.0 1.3 1.3 1.3 1.3 1.

3

7.9

Others 66.7 8.3 8.3 0.0 0.0 2.8 2.

8

25.

0

100.0 0.0 0.0 0.0 0.0 0.0 0.

0

0.0

MPCE MPCE

quintile 1 (Lowest)

47.1 2.9 2.9 10.3 1.5 5.9 0.

0

16.

2

69.0 7.1 4.8 4.8 8.3 4.8 4.

8

9.5

MPCE

quintile 2 58.9 5.4 5.4 1.8 0.0 3.6 0.

0

10.

7

60.0 4.2 2.1 4.2 5.3 4.2 3.

2

12.

6 MPCE

quintile 3 55.7 3.3 1.6 3.3 3.3 8.2 3.

3

23.

0

70.3 4.4 4.4 11.0 4.4 3.3 3.

3

5.5

MPCE

quintile 4 48.5 4.5 3.0 1.5 1.5 1.5 1.

5

18.

2

76.5 0.0 0.0 0.0 3.5 2.4 3.

5

5.9

MPCE

quintile 5 (Higher)

70.7 10.3 5.2 1.7 0.0 1.7 1.

7

19.

0

74.2 1.1 1.1 7.5 8.6 7.5 4.

3

6.5

Media

Exposure

No

exposure 59.8 4.7 3.6 3.0 0.0 3.6 0.

0

13.

0

67.3 3.0 2.3 4.6 4.6 3.0 3.

8

6.5

Any

exposure 50.7 5.7 3.6 5.0 2.9 5.0 2.

9

22.

9

73.5 3.8 2.7 7.0 8.1 6.5 3.

8

10.

3 Total 55.7 5.2 3.6 3.9 1.3 4.2 1.

3

17.

5

69.9 3.3 2.5 5.6 6.0 4.5 3.

8

8.0


Page | 95

Appendix 18. Frequency of awareness programmers about RSBY scheme by selected background characteristics



District


District

Background

Characteristics

Tw

ice

or

mo

re

in

eve

ry

2

mo

nth

Mo

re

tha

n 2

mo

nth

s

On

ce/

twi

ce

in

a

ye

ar

Do

n't

Kn

ow

Tw

ice

or

mo

re

in

eve

ry

2

mo

nth

Mo

re

tha

n 2

mo

nth

s

On

ce/

twi

ce

in

a

ye

ar

Do

n't

Kn

ow

Tw

ice

or

mo

re

in

eve

ry

2

mo

nth

Mo

re

tha

n 2

mo

nth

s

Once/

twice

in a

year

Do

n't

Kn

ow

Tw

ice

or

mo

re

in

eve

ry

2

mo

nth

Mo

re

tha

n 2

mo

nth

s

Once/

twice

in a

year

Do

n't

Kn

ow

Highest

education level

Illiterate 16.

7

25.0 0.0 58.

3

0.0 17.7 0.0 82.

4

5.8 0.0 43.5 50.

7

2.2 0.0 35.5 62.

4

Primary

completed

5.3 26.3 10.

5

57.

9

0.0 15.4 15.

4

69.

2

7.4 1.5 38.2 52.

9

3.5 0.0 39.1 57.

4

Secondary

completed

10.

3

11.5 3.9 74.

4

8.0 16.0 12.

0

64.

0

5.0 3.3 31.7 60.

0

7.3 0.0 39.1 53.

6

Higher

secondary

9.8 17.7 5.9 66.

7

0.0 14.3 0.0 85.

7

5.6 16.7 55.6 22.

2

0.0 0.0 59.1 40.

9

Higher

secondary &

above

10.

7

25.0 0.0 64.

3

10.

0

20.0 10.

0

60.

0

11.

8

0.0 35.3 52.

9

4.9 2.4 41.5 51.

2

Caste

General/OBC 5.9 14.9 2.0 77.

2

5.1 35.9 12.

8

46.

2

5.2 1.3 36.0 57.

5

6.6 0.0 43.5 50.

0

Scheduled

Castes

2.9 11.8 0.0 85.

3

0.0 3.7 0.0 96.

3

10.

7

7.1 28.6 53.

6

1.1 0.6 39.9 58.

4

Scheduled

Tribes

22.

6

26.4 11.

3

39.

6

8.7 0.0 8.7 82.

6

7.3 7.3 55.1 30.

4

0.0 0.0 25.0 75.

0

Religion


Page | 96

Hindu 6.3 13.9 2.1 77.

8

5.2 19.5 9.1 66.

2

13.

3

5.3 49.3 32.

0

2.4 0.3 42.3 55.

0

Muslims 0.0 0.0 0.0 10

0.0

0.0 0.0 0.0 10

0.0

4.1 1.4 33.8 60.

7

9.5 0.0 34.9 55.

6

Others 25.

6

33.3 12.

8

28.

2

0.0 0.0 0.0 10

0.0

0.0 10.0 50.0 40.

0

0.0 0.0 0.0 10

0.0

MPCE

MPCE quintile

1 (Lowest)

18.

4

24.5 6.1 51.

0

0.0 26.3 5.3 68.

4

10.

6

6.4 36.2 46.

8

4.3 1.4 40.0 54.

3

MPCE quintile

2

11.

8

14.7 8.8 64.

7

7.1 35.7 14.

3

42.

9

11.

4

2.3 50.0 36.

4

2.9 0.0 38.6 58.

6

MPCE quintile

3

4.8 19.1 2.4 73.

8

5.9 5.9 17.

7

70.

6

3.6 1.8 32.7 61.

8

1.4 0.0 35.6 63.

0

MPCE quintile

4

6.9 3.5 0.0 89.

7

9.1 9.1 4.6 77.

3

0.0 3.8 39.6 56.

6

4.2 0.0 45.8 50.

0

MPCE quintile

5 (Higher)

5.9 20.6 2.9 70.

6

0.0 11.8 0.0 88.

2

7.8 3.9 45.1 43.

1

5.2 0.0 44.2 50.

7

Media

Exposure

No exposure 6.1 16.5 4.4 73.

0

4.0 18.0 6.0 72.

0

4.5 1.5 37.6 56.

4

4.3 0.5 40.0 55.

2

Any exposure 16.

4

19.2 4.1 60.

3

5.1 15.4 10.

3

69.

2

8.6 6.0 43.6 41.

9

2.6 0.0 42.1 55.

3

Total 10.

1

17.6 4.3 68.

1

4.5 16.9 7.9 70.

8

6.4 3.6 40.4 49.

6

3.6 0.3 40.9 55.

3


Page | 97

Appendix 19. Source of encouragement for enrolling in RSBY scheme by selected background characteristics in

Jharkhand

Background

Characteristics


Self

Motiv

ated

Friend

s/

Relativ

es/

Neigh

bors

Teach

er/

ASH

A/

AW

W/

Panca

yat

RSB

Y-

Mitr

a

MLA

/

Politi

cal

leade

r

Othe

r

Sour

ces

Self

Motiv

ated

Friend

s/

Relativ

es/

Neigh

bors

Teach

er/

ASH

A/

AW

W/

Panca

yat

NG

Os/

SH

Gs

MLA

/

Politi

cal

leade

r

Othe

r

Sour

ces

Highest education

level

Illiterate 5.3 26.3 36.8 52.6 0.0 0.0 6.9 48.3 51.7 10.4 3.5 0.0


Secondary

completed

8.3 39.2 57.5 25.8 3.3 6.7 13.8 46.8 52.1 5.3 5.3 1.1


Higher secondary &

above

6.5 32.6 47.8 45.7 0.0 4.4 11.5 48.7 64.1 7.7 2.6 2.6

Caste

General/OBC 8.7 35.3 51.5 28.3 2.3 4.6 12.6 42.8 61.6 10.7 3.1 1.3


Scheduled Tribes 6.7 26.7 42.7 66.7 1.3 4.0 10.4 42.9 62.3 0.0 3.9 5.2

Religion

Hindu 7.5 38.3 52.3 32.2 2.8 4.2 10.0 48.6 57.4 8.0 2.8 1.6

Muslims 4.8 28.6 66.7 0.0 0.0 29.6 11.1 55.6 0.0 0.0 3.7

Others 8.1 22.6 41.9 66.1 0.0 4.8 9.1 68.2 50.0 0.0 9.1 9.1

MPCE

MPCE quintile 1

(Lowest)

4.6 37.9 48.5 68.2 4.6 4.6 9.4 56.6 56.6 7.6 5.7 3.8

MPCE quintile 2 6.8 28.8 49.2 44.1 3.4 1.7 13.3 50.0 63.3 5.0 3.3 0.0

MPCE quintile 3 6.4 33.3 54.0 23.8 1.6 6.4 10.7 44.6 62.5 5.4 1.8 0.0

MPCE quintile 4 10.0 44.0 48.0 18.0 0.0 2.0 8.7 47.8 52.2 10.2 1.5 4.4

MPCE quintile 5

(Higher)

10.2 28.8 55.9 25.4 0.0 5.1 16.7 35.0 50.0 5.0 3.3 3.3

Media Exposure

No exposure 8.5 36.5 51.9 33.3 2.7 3.2 12.3 50.0 52.1 5.5 2.1 0.7

Any exposure 5.6 30.6 50.0 43.5 0.9 5.6 11.2 43.4 61.2 7.9 4.0 4.0

Total 7.4 34.3 51.2 37.0 2.0 4.0 11.7 46.6 56.7 6.7 3.0 2.4


Page | 98

Appendix 20. Source of encouragement for enrolling in RSBY scheme by selected background characteristics in

Jharkhand

Background

Characteristics


Self

Motiv

ated

Friend

s/

Relati

ves/

Neigh

bors

Teac

her/

ASH

A/

AW

W/

Panc

ayat

RSB

Y-

Mit

ra

ML

A/

Politi

cal

leade

r

Othe

r

Sour

ces

Self

Motiv

ated

Friend

s/

Relati

ves/

Neigh

bors

Teach

er/

ASH

A/

AW

W/

Panca

yat

RSB

Y-

Mit

ra

ML

A/

Politi

cal

leade

r

Othe

r

Sour

ces

Highest education

level

Illiterate 5.3 26.3 36.8 52.6 0.0 0.0 6.9 48.3 51.7 10.4 3.5 0.0


Secondary

completed

8.3 39.2 57.5 25.8 3.3 6.7 13.8 46.8 52.1 5.3 5.3 1.1


Higher secondary

& above

6.5 32.6 47.8 45.7 0.0 4.4 11.5 48.7 64.1 7.7 2.6 2.6

Caste

General/OBC 8.7 35.3 51.5 28.3 2.3 4.6 12.6 42.8 61.6 10.7 3.1 1.3



Religion

Hindu 7.5 38.3 52.3 32.2 2.8 4.2 10.0 48.6 57.4 8.0 2.8 1.6

Muslims 4.8 28.6 66.7 0.0 0.0 29.6 11.1 55.6 0.0 0.0 3.7


Page | 99

Others 8.1 22.6 41.9 66.1 0.0 4.8 9.1 68.2 50.0 0.0 9.1 9.1

MPCE

MPCE quintile 1

(Lowest)

4.6 37.9 48.5 68.2 4.6 4.6 9.4 56.6 56.6 7.6 5.7 3.8

MPCE quintile 2 6.8 28.8 49.2 44.1 3.4 1.7 13.3 50.0 63.3 5.0 3.3 0.0

MPCE quintile 3 6.4 33.3 54.0 23.8 1.6 6.4 10.7 44.6 62.5 5.4 1.8 0.0

MPCE quintile 4 10.0 44.0 48.0 18.0 0.0 2.0 8.7 47.8 52.2 10.2 1.5 4.4

MPCE quintile 5

(Higher)

10.2 28.8 55.9 25.4 0.0 5.1 16.7 35.0 50.0 5.0 3.3 3.3

Media Exposure

No exposure 8.5 36.5 51.9 33.3 2.7 3.2 12.3 50.0 52.1 5.5 2.1 0.7

Any exposure 5.6 30.6 50.0 43.5 0.9 5.6 11.2 43.4 61.2 7.9 4.0 4.0

Total 7.4 34.3 51.2 37.0 2.0 4.0 11.7 46.6 56.7 6.7 3.0 2.4

Appendix 21. Who informed about the entire enrolment process of RSBY scheme by selected background characteristics in

Jharkhand



Page | 100

Background

Characteristics

Self

Moti

vated

Frien

ds/

Relat

ives/

Neig

hbor

s

Teache

r/

ASHA/

AWW/

Pancha

yat

Mass

Medi

a

Cam

paign

SHG

/

PAC

S-

Mob

ilizer

ML

A/

Poli

tical

lead

er

Oth

er

Sou

rces

Self

Moti

vated

Frien

ds/

Relat

ives/

Neig

hbor

s

Teache

r/

ASHA/

AWW/

Pancha

yat

Mass

Medi

a

Cam

paign

SHG

/

PAC

S-

Mob

ilizer

ML

A/

Poli

tical

lead

er

Oth

er

Sou

rces

Highest

education level

Illiterate 0.0 21.1 31.6 0.0 52.6 0.0 0.0 3.5 51.7 51.7 3.5 6.9 0.0 0.0

Primary

completed

7.7 33.3 46.2 0.0 41.0 0.0 2.6 5.3 34.2 63.2 2.6 5.3 2.6 7.9

Secondary

completed

4.2 36.7 56.7 0.0 25.8 5.0 6.7 6.4 46.8 53.2 0.0 6.4 4.3 1.1

Higher

secondary

4.1 23.3 46.6 0.0 49.3 4.1 1.4 3.4 44.1 55.9 0.0 1.7 0.0 8.5

Higher

secondary &

above

2.2 28.3 45.7 0.0 50.0 4.4 6.5 2.6 47.4 65.4 3.9 6.4 2.6 2.6

Caste

General/OBC 4.1 31.2 49.1 0.0 30.6 2.9 5.2 5.7 41.5 61.6 2.5 8.8 1.9 4.4

Scheduled

Castes

2.0 38.8 61.2 0.0 22.5 6.1 2.0 6.5 59.7 38.7 1.6 3.2 3.2 3.2

Scheduled

Tribes

5.3 24.0 42.7 0.0 69.3 4.0 4.0 0.0 41.6 66.2 0.0 0.0 2.6 2.6

Religion

Hindu 4.2 34.6 50.5 0.0 34.1 4.7 4.7 4.4 47.4 58.6 2.0 6.4 2.4 1.6

Muslims 0.0 28.6 66.7 0.0 0.0 0.0 0.0 7.4 11.1 55.6 0.0 0.0 0.0 18.5

Others 4.8 17.7 40.3 0.0 69.4 1.6 4.8 0.0 63.6 54.6 0.0 0.0 4.6 9.1

MPCE

MPCE quintile

1 (Lowest)

3.0 28.8 42.4 0.0 68.2 10.6 4.6 1.9 56.6 58.5 1.9 3.8 3.8 3.8

MPCE quintile

2

3.4 22.0 49.2 0.0 47.5 5.1 1.7 6.7 45.0 68.3 1.7 3.3 1.7 0.0

MPCE quintile

3

1.6 33.3 54.0 0.0 25.4 1.6 7.9 5.4 44.6 62.5 0.0 3.6 0.0 1.8

MPCE quintile

4

4.0 42.0 46.0 0.0 20.0 0.0 2.0 2.9 44.9 53.6 2.9 10.1 2.9 2.9

MPCE quintile

5 (Higher)

8.5 28.8 55.9 0.0 28.8 0.0 5.1 5.0 36.7 48.3 1.7 5.0 3.3 10.0

Media

Exposure

No exposure 4.2 32.8 49.2 0.0 34.4 4.2 3.7 4.1 48.6 52.7 0.7 4.8 2.1 3.4

Any exposure 3.7 26.9 50.0 0.0 47.2 2.8 5.6 4.6 42.1 63.2 2.6 5.9 2.6 4.0

Total 4.0 30.6 49.5 0.0 39.1 3.7 4.4 4.4 45.3 58.1 1.7 5.4 2.4 3.7


Page | 101

Appendix 22. Who informed about the entire enrolment process of RSBY scheme by selected background

characteristics in West Bengal

Backgroun

d

Characteris

tics


Self

Mot

ivat

ed

Frie

nds/

Rel

ativ

es/

Nei

ghb

ors

Teacher/

ASHA/A

WW/Panc

hayat

Mas

s

Med

ia

Ca

mpa

ign

SH

G/

PA

CS-

Mo

bili

zer

M

LA

/

Pol

itic

al

lea

der

Ot

her

So

urc

es

Self

Mot

ivat

ed

Frie

nds/

Rel

ativ

es/

Nei

ghb

ors

Teacher/

ASHA/A

WW/Panc

hayat

Mas

s

Med

ia

Ca

mpa

ign

SH

G/

PA

CS-

Mo

bili

zer

M

LA

/

Pol

itic

al

lea

der

Ot

her

So

urc

es

Highest

education

level

Illiterate 1.2 2.4 9.6 0.0 4.8 3.6 2.4 0.9 12.2 17.8 0.0 2.8 11.

2

0.0

Primary

completed

3.3 9.8 8.7 0.0 6.5 5.4 3.3 4.0 5.3 9.3 0.0 1.3 8.0 0.7

Secondary

completed

1.4 5.6 5.6 0.0 8.3 2.8 6.9 2.3 3.4 10.2 1.1 1.1 14.

8

3.4

Higher

secondary

0.0 14.3 4.8 0.0 9.5 4.8 0.0 1.7 8.6 19.0 0.0 3.5 12.

1

1.7

Higher

secondary &

above

10.0 5.0 10.0 5.0 15.0 0.0 5.0 8.9 8.9 31.1 0.0 0.0 8.9 0.0

Caste

General/OB

C

1.0 4.7 6.3 0.0 3.1 2.1 5.2 2.6 7.2 16.4 0.5 1.5 13.

3

1.5

Scheduled

Castes

0.0 5.6 2.8 0.0 8.3 2.8 0.0 1.7 6.9 14.2 0.0 2.2 8.6 0.9

Scheduled

Tribes

6.2 13.6 13.6 1.2 17.3 8.6 1.2 23.8 14.3 9.5 0.0 0.0 9.5 0.0


Page | 102

Religion

Hindu 3.2 11.8 12.9 0.0 16.1 6.5 1.1 3.5 7.0 13.8 0.3 2.2 11.

9

1.4

Muslims 0.6 3.9 6.7 0.0 2.2 2.2 5.6 1.3 9.2 19.7 0.0 0.0 5.3 0.0

Others 8.3 11.1 0.0 2.8 11.1 5.6 0.0 0.0 0.0 100.0 0.0 0.0 0.0 0.0

MPCE

MPCE

quintile 1

(Lowest)

2.9 4.4 4.4 0.0 2.9 1.5 1.5 3.6 10.7 26.2 1.2 1.2 16.

7

0.0

MPCE

quintile 2

1.8 5.4 8.9 0.0 3.6 7.1 1.8 4.2 4.2 14.7 0.0 3.2 13.

7

2.1

MPCE

quintile 3

3.3 4.9 9.8 0.0 6.6 4.9 3.3 2.2 4.4 7.7 0.0 0.0 5.5 1.1

MPCE

quintile 4

1.5 9.1 6.1 0.0 12.1 1.5 9.1 3.5 9.4 12.9 0.0 1.2 7.1 2.4

MPCE

quintile 5

(Higher)

1.7 12.1 10.3 1.7 12.1 5.2 1.7 2.2 8.6 14.0 0.0 3.2 10.

8

0.0

Media

Exposure

No exposure 2.4 4.7 7.1 0.6 4.1 3.6 1.2 2.7 6.5 13.7 0.4 1.5 12.

2

0.0

Any

exposure

2.1 10.0 8.6 0.0 11.4 4.3 6.4 3.8 8.7 16.8 0.0 2.2 8.7 2.7

Total 2.3 7.1 7.8 0.3 7.4 3.9 3.6 3.1 7.4 15.0 0.2 1.8 10.

7

1.1


Page | 103

Appendix 23. Anyone helped during the RSBY enrolment process by selected background characteristics



District


Background

Characteristic

s

Sma

rt

car

d

pro

vide

r

PACS

Interv

ention

s

No

bod

y

Ot

her

s

Sma

rt

car

d

pro

vide

r

NG

Os/

SH

Gs

No

bod

y

Ot

her

s

Sma

rt

car

d

pro

vide

r

PACS

Interv

ention

s

No

bod

y

Ot

her

s

Sma

rt

car

d

pro

vide

r

NGOs

/SHGs

No

bod

y

Ot

her

s

Highest

education level

Illiterate 0.0 37.5 56.

3

6.3 4.0 0.0 96.

0

0.0 0.0 5.6 44.

4

55.

6

2.9 5.9 58.

8

38.

2

Primary

completed

0.0 31.4 65.

7

2.9 0.0 0.0 91.

7

8.3 12.0 24.0 40.

0

40.

0

5.6 0.0 58.

3

36.

1

Secondary

completed

1.0 21.0 73.

3

4.8 0.0 2.4 88.

1

9.5 0.0 25.0 37.

5

50.

0

4.0 0.0 64.

0

32.

0

Higher

secondary

3.0 42.4 54.

6

0.0 0.0 0.0 92.

2

7.8 12.5 50.0 25.

0

25.

0

11.8 0.0 52.

9

35.

3

Higher

secondary &

above

0.0 36.6 51.

2

12.

2

0.0 1.5 94.

1

4.4 0.0 33.3 33.

3

33.

3

5.6 0.0 61.

1

33.

3

Caste

General/OBC 0.7 21.7 73.

7

4.0 0.7 2.1 90.

2

7.0 2.6 13.2 42.

1

50.

0

8.8 0.0 50.

9

40.

4

Scheduled

Castes

0.0 20.9 79.

1

0.0 0.0 0.0 94.

6

5.5 0.0 40.0 40.

0

40.

0

3.1 3.1 67.

2

29.

7

Scheduled

Tribes

2.9 58.8 29.

4

8.8 0.0 0.0 92.

4

7.6 10.0 33.3 33.

3

36.

7

0.0 0.0 55.

6

44.

4

Religion

Hindu 0.5 22.4 71.

9

5.2 0.5 1.4 90.

5

7.7 10.0 40.0 30.

0

43.

3

5.5 1.8 64.

6

30.

0

Muslims 0.0 0.0 100

.0

0.0 0.0 0.0 100

.0

0.0 2.9 11.4 45.

7

42.

9

5.3 0.0 31.

6

63.

2

Others 3.6 70.9 21.

8

3.6 0.0 0.0 94.

7

5.3 0.0 12.5 37.

5

50.

0

0.0 0.0 0.0 100

.0

MPCE


Page | 104

MPCE quintile

1 (Lowest)

4.9 39.3 44.

3

11.

5

2.1 2.1 87.

2

8.5 0.0 0.0 40.

0

70.

0

9.1 0.0 8.0 6.7

MPCE quintile

2

0.0 45.5 50.

9

3.6 0.0 0.0 88.

5

11.

5

7.7 7.7 53.

9

30.

8

27.3 23.5 28.

0

25.

3

MPCE quintile

3

0.0 29.1 69.

1

1.8 0.0 0.0 90.

0

10.

0

7.1 21.4 35.

7

42.

9

0.0 0.0 0.0 6.7

MPCE quintile

4

0.0 14.6 82.

9

2.4 0.0 0.0 96.

8

3.2 10.0 30.0 25.

0

40.

0

45.5 70.6 56.

0

132

.0

MPCE quintile

5 (Higher)

0.0 21.6 76.

5

2.0 0.0 3.8 94.

3

1.9 0.0 43.8 43.

8

43.

8

18.2 5.9 8.0 36.

0

Media

Exposure

No exposure 0.6 27.8 67.

5

4.1 0.8 0.0 90.

1

9.2 6.5 9.7 51.

6

38.

7

5.6 1.4 60.

6

33.

8

Any exposure 2.1 37.2 55.

3

5.3 0.0 2.3 93.

2

4.5 4.8 33.3 28.

6

47.

6

5.1 1.7 57.

6

37.

3

Total 1.1 31.2 63.

1

4.6 0.4 1.1 91.

7

6.8 5.5 23.3 38.

4

43.

8

5.4 1.5 59.

2

35.

4

Appendix 24. Post RSBY enrolment visit by selected background characteristics


Intervention District Non-intervention

District


District


Page | 105

Background

Characteristics

Nobo

dy

PACS

initiati

ves

Oth

ers

Nobo

dy

NG

Os/

SH

Gs

Oth

ers

Nobo

dy

PACS

initiati

ves

Oth

ers

Nobo

dy

NGOs/S

HGs

Oth

ers

Highest education

level

Illiterate 53.3 46.7 0.0 95.2 4.8 0.0 66.7 20.0 40.0 67.9 0.0 32.1


Secondary

completed

80.9 18.1 1.1 97.0 3.0 0.0 69.2 23.1 7.7 52.2 4.4 43.5


Higher secondary &

above

60.0 36.7 3.3 98.2 1.9 0.0 33.3 33.3 33.3 43.8 6.3 50.0

Caste

General/OBC 75.5 22.3 2.2 95.6 3.5 0.9 75.6 7.3 26.8 51.9 1.9 46.2



Religion

Hindu 76.2 21.5 2.3 97.2 2.3 0.6 32.0 48.0 36.0 62.8 5.3 31.9

Muslims 100.0 0.0 0.0 100.0 0.0 0.0 79.0 5.3 21.1 46.7 0.0 53.3

Others 15.4 79.5 5.1 100.0 0.0 0.0 33.3 33.3 33.3 100.0 0.0 0.0

MPCE

MPCE quintile 1

(Lowest)

46.3 48.2 5.6 100.0 0.0 0.0 83.3 0.0 16.7 60.7 3.6 35.7

MPCE quintile 2 62.2 37.8 0.0 100.0 0.0 0.0 61.5 0.0 46.2 62.5 4.2 33.3

MPCE quintile 3 79.2 20.8 0.0 97.4 0.0 2.6 44.4 22.2 33.3 62.5 12.5 25.0

MPCE quintile 4 84.2 15.8 0.0 95.5 4.6 0.0 54.6 31.8 27.3 59.1 4.6 36.4

MPCE quintile 5

(Higher)

71.4 21.4 7.1 95.0 5.0 0.0 46.2 53.9 15.4 60.0 0.0 40.0

Media Exposure

No exposure 73.0 26.4 0.7 98.0 1.0 1.0 79.3 3.5 20.7 67.2 1.6 31.2

Any exposure 57.0 36.7 6.3 97.2 2.8 0.0 42.5 37.5 32.5 53.1 8.2 38.8

Total 67.4 30.0 2.6 97.6 1.9 0.5 58.0 23.2 27.5 60.9 4.6 34.6


Page | 106

Appendix 25.Satisfaction of entire RSBY enrolment process by selected background characteristics



Background Characteristics Unsatisfactory Somewhat

unsatisfactory

OK/

Satisfactory

Unsatisfactory Somewhat

unsatisfactory

OK/

Satisfactory


unsatisfactory

OK/

Satisfactory


unsatisfactory

OK/

Satisfactory


Illiterate 68.8 0.0 31.3 64.0 24.0 12.0 23.5 17.7 52.9 6.5 41.9 48.4


Secondary completed 64.8 20.0 15.2 70.2 27.4 2.4 15.4 30.8 46.2 29.6 25.9 44.4


Higher secondary & above 73.2 22.0 4.9 57.4 30.9 11.8 0.0 40.0 60.0 5.9 52.9 29.4

Caste

General/OBC 63.8 19.7 16.5 55.2 35.7 9.1 17.1 31.7 43.9 20.7 31.0 43.1



Religion

Hindu 68.8 18.8 12.5 60.6 32.1 7.2 29.2 12.5 41.7 19.8 37.8 37.8

Muslims 56.3 18.8 25.0 58.3 41.7 0.0 18.4 31.6 44.7 16.7 16.7 61.1

Others 69.1 29.1 1.8 79.0 21.1 0.0 0.0 33.3 66.7 0.0 0.0 0.0

MPCE

MPCE quintile 1 (Lowest) 77.1 19.7 3.3 68.1 27.7 4.3 36.4 9.1 45.5 15.6 28.1 50.0

MPCE quintile 2 70.9 23.6 5.5 67.3 23.1 9.6 16.7 33.3 41.7 12.9 35.5 48.4

MPCE quintile 3 58.2 27.3 14.6 54.0 42.0 4.0 18.2 36.4 45.5 15.8 42.1 36.8

MPCE quintile 4 63.4 22.0 14.6 59.7 35.5 4.8 14.3 23.8 57.1 32.0 24.0 40.0

MPCE quintile 5 (Higher) 68.6 11.8 19.6 60.4 32.1 7.6 23.1 23.1 30.8 21.7 47.8 21.7

Media Exposure

No exposure 62.7 21.3 16.0 67.2 28.2 4.6 25.0 28.6 39.3 23.2 34.8 37.7


Page | 107

Any exposure 77.7 20.2 2.1 56.4 36.1 7.5 17.5 22.5 50.0 14.8 34.4 44.3

Total 68.1 20.9 11.0 61.7 32.2 6.1 20.6 25.0 45.6 19.2 34.6 40.8


Page | 108

Annex 1

Sample Selection& Sampling Design

The study design will follow a multi-stage, stratified design in arriving at the required sample and its selection process.

In order to decide the required sample size, we will use the following formula:

n = [t2*p(1-p)]/m2 (1)

Where,

n = required sample size

t = confidence level at 95% (standard value of 1.96)

p = estimated prevalence of the variable of interest

m = margin of error at 5% (standard value of 0.05)

Generally, to this estimated ‘n’ an adjustment factor for the ‘design-effect’ arising due to the multistage, clustered

design of the sample – usually around 2 – is applied. Accordingly the final sample size is,

N = n*d (2)

As the main ‘variables of interest’, we use two indicators:

i. Average rate/proportion of BPL households enrolled under RSBY scheme – Coverage indicator

ii. Estimated rate of hospitalization among the target population, i.e. BPL households (assumed as double the

observed level for general population) – Need indicator

Based on the above formula, the required sample size for the two states is computed as shown below:

Criteria Jharkhand West Bengal

Hospitalization rate (general pop)# 0.06 0.12

Hospitalization rate (target pop) 0.12 0.24

RSBY coverage rate^ 0.49 0.56

p (Combined average (33% weightage for coverage indicator, 66%

for need indicator)) 0.231 0.336

1-p 0.769 0.664

t2 3.8416 3.8416

m2 0.0025 0.0025

n 273 343

Oversampling/non-response (allowing additional 15%) 314 394

d 1.6 1.6

Round-off 500 625

Non-beneficiary (add 15%) 575 719

PACS-n 288 300

Non-PACS-n 288 425

N 575 725

# Source: NSSO 60th Round (2004-05)

^ www.rsby.gov.in

Note: The split between PACS and non-PACS sample is based on a 50:50 ratio for Jharkhand and 40:60 for WB (using

roughly the district covered in each of these states by PACS)


Page | 109

Hence, we propose a total sample of 1300 households, including 575 (500 beneficiaries, 75 non-beneficiaries)

from Jharkhand and 725 (625 beneficiaries, 100 non-beneficiaries) from West Bengal.

Table 1

Ranking list of Districts

SN District

No. of

Household

(Census2011)

Total

(BPL)

Enrolled

(RSBY)

Proportion

of BPL to

HH

1 Jalpaiguri 868326 619180 222945 71.3

2 Koch Bihar 665720 474461 249920 71.3

3 Maldah 846991 601102 404418 71.0

4 Puruliya 567824 394035 197619 69.4

5 Paschim Medinipur 1301610 747304 450101 57.4

6 Murshidabad 1570759 887260 631003 56.5

7 Bankura 766902 418430 354436 54.6

8 Birbhum 817899 424717 335541 51.9

9 Dakshin Dinajpur 396406 204193 127011 51.5

10 Barddhaman 1730927 833882 619250 48.2

11 Uttar Dinajpur 605674 291349 125830 48.1

12 Nadia 1232282 551647 339750 44.8

13 Hugli 1287423 547375 338785 42.5

14 Purba Medinipur 1114170 461806 277280 41.4

15

South Twenty Four

Parganas 1781221 706669 138719 39.7

16

North Twenty Four

Parganas 2348683 874840 395606 37.2

17 Darjiling 391234 144484 33987 36.9

18 Haora 1061336 238342 85626 22.5

19 Kolkata 1024928 217846 96934 21.3

T WEST BENGAL 20380315 9638922 5424761 47.3

This Colour indicates the PACS Districts


Page | 110

SN District

No. of

Household

(Census2011)

Total

(BPL)

Enrolled

(RSBY)

Proportion

of BPL to

HH

1 Garhwa 254697 274843 86203 107.9

2 Latehar 133381 125653 51124 94.2

3 Saraikela-Kharsawan 221232 184868 86548 83.6

4 Chatra 182271 133289 74867 73.1

5 Palamu 358754 258719 93778 72.1

6 Pakur 182317 129854 74095 71.2

7 Jamtara 155275 109850 52024 70.7

8 Sahibganj 227023 137517 80018 60.6

9 Simdega 118288 71629 30267 60.6

10 Khunti 103700 62763 24795 60.5

11 Pashchimi Singhbhum 302046 174506 79992 57.8

12 Hazaribagh 304749 167290 110060 54.9

13 Deoghar 264347 141175 41517 53.4

14 Ramgarh 179375 95430 53385 53.2

15 Godda 253648 131196 68721 51.7

16 Lohardaga 88638 45555 23556 51.4

17 Giridih 396521 188230 126996 47.5

18 Gumla 188988 87545 55134 46.3

19 Dumka 275019 125287 62276 45.6

20 Kodarma 116155 51638 32210 44.5

21 Ranchi 569444 226006 103400 39.7

22 Purbi Singhbhum 476931 148810 79654 31.2

23 Dhanbad 507064 157825 84546 31.1

24 Bokaro 394918 104886 53973 26.6

T JHARKHAND 6254781 3334364 1629139 53.3


Page | 111

Annex 2 IMPACT ASSESSEMENT STUDY ON RASHTRIYA SWASTHYA BIMA YOJANA (RSBY)

MAIN QUESTIONNAIRE - JHARKHAND

Sponsored by Poorest Area Civil Society Programme [PACS]

INSTITUTE FOR HUMAN DEVELOPMENT NIDM Building, 3rd Floor, IIPA Campus, I.P Estate, Mahatma Gandhi Marg, New Delhi-110 002

Phones – 2335 8166, 2332 1610 / Fax : 23765410

Email: [email protected]

BLOCK 1: Interview Particulars

1. Interview ID 5. Supervisor Name and Signature

2. Supervisor ID 6. DEO Name and Signature

3. Data Entry Operator ID 7. Interview/Re-interview status

4. Interview er Name and Signature 8. Interview Date and Start-time

BLOCK 2: Household Identification Particulars

1 District 7 Gram Panchayat

2 PSU No. (Unique code) 8 Village Name

3 Block 9

Caste Category

(SC=1, ST=2, OBC=3, General=4)

4 Unique Household Identification

No. (UHID) 10

Religion

(Hindu=1, Muslim=2, Christian=3,

Others=4)

5 Name of Household Head 11 Highest educational attainment in

the household

1. SEGMENT 2. SUB-GROUP

A. RSBY Beneficiary Sample A. Minority

B. RSBY Non-Beneficiary sample B. ST

C. SC/OBC

Informed Consent Statement

INTERVIEWER – (Read out): Namaskar. My name is (please say your name here) and I work for Institute for Human Development, a

research institute in New Delhi. Your household has been selected to collect some detailed information on health and health care aspects

and the amount you have spent on health care for your family member, and your use and experience of the national health insurance scheme,

RSBY. It will take about 45 minutes for you to answer the questions. You can choose not to answer any questions or refuse participating in

the interview at any point of time throughout the interview. The information you provide will be confidential and used for research purposes

only. If you can spare the time now, and with your permission, can I start the interview now?

mailto:[email protected]


Page | 112

BLOCK 3: HOUSEHOLD MEMBER ROSTER

A. Demographics and Socioeconomics

Details of all family members: In order to determine whom to interview, I need to know who lives at this address. Let me

assure you that any information you provide is strictly confidential. I would like the age, sex, education, marital status and

relationship to you of each of the members of this household who live here. Please include people who may presently be in

an institution due to their health (hospital, nursing home etc.) for a short or long period. All the members in the household

should be entered first, from oldest to youngest.Don’t forget to include yourself in the appropriate order.

1.1

Lin

e No

.

1.2

Name

1.3

Sex

1.4

Relatio

nsh

ip w

ith h

ouseh

old

head

1.5

Age

1.6

Marital statu

s

1.7

Hig

hest ed

ucatio

nal lev

el

1.8

Usu

al activity

status

1.9

Wh

ether su

ffered fro

m an

y

min

or illn

esses durin

g la

st 1 m

on

th

1.1

0 W

heth

er suffers fro

m an

y

chro

nic d

iseases since la

st 12

mo

nth

s?

1.1

1 W

heth

er hosp

italized ev

er

durin

g la

st 12

mon

ths

1.1

2 H

ealth In

suran

ce Coverag

e

1

2

3

4

5

6

7

8

9

CODES

For 1.3: Sex male=1, female=2

For 1.4: Relation to head self=1, spouse of head=2, married child=3, spouse of married child=4, unmarried chiId=5, grand child=6, father/mother/father-in-law/mother-in-law=7, brother/sister/brother-in-law/sister-in-law/other relative=8, servant/employees/other non-relatives=9


Page | 113

For 1.6: Marital status never married=1, currently married=2, widowed=3, divorced/separated=4

For 1.7: Educational level Illiterate=01; literate but never gone to school=02, Upto class 4=03, Upto class=04, Completed class 10=05, completed class 12= 06, completed Graduation= 07, Any higher education above graduation=08

For 1.8: Usual activity status Casual/daily wage laborer=01, Self-employed (including small business & trade)=02, Regular salaried employment=03, Unemployed/seeking work=04, Student=05, Home-maker/household work/domestic duties (unpaid)=06, Disabled/Old/Young=07, Household

entrepreneur (tailoring/weaning/hand wash)=08, Others=99 (Specify)

For Q.1.9 to 1.11: Yes=1, No=0, don’t know/can’t say=99.

For Q. 1.12: RSBY=1, Private insurance=2, Covered by employer=3, Not covered with any scheme=4, DK/CS=99

Note: Q1.9: When suffered from any common/minor/short-term illness in last 30 days (such as – fever/cold & cough/loose motion…….etc.) Q 1.10: Diabetes/cancer/hypertension/heart alignments/heart alignment/respiratory problems/tuberculosis/arthritis/long standing pain in bone/joints)

B. Social Networks

Is anyone in the family presently a member of any of the followings :

10 Self Help Group (SHG)/Credit Cooperatives Yes (1) No (0) DK/CS (99)

11 NGO/MFI (Micro Finance Institution) client Yes (1) No (0) DK/CS (99)

12 Trade unions Yes (1) No (0) DK/CS (99)

13 Political party Yes (1) No (0) DK/CS (99)

14 Religious organization Yes (1) No (0) DK/CS (99)

15 Local CBO’s (Community Based Organizations) Yes (1) No (0) DK/CS (99)

16 Other membership-based organization Yes (1) No (0) DK/CS (99)

17 Do you or your family members personally know the Gram Panchayat/Local MLA/MP/any other elected member of your AREA?

Yes (1) No (0) DK/CS (99)

Number of times you did the following during last 7 days/in last week?

18 Watch TV Never (1) Rarely (2) Daily (3)

19 Listen Radio Never (1) Rarely (2) Daily (3)

20 Read Newspaper/magazines Never (1) Rarely (2) Daily (3)

21

What are your main sources of your information regarding government programmes/schemes?

(Multiple Answers)

[Friends and family-members =1,

Media (A-V/Print)=2,

Local government workers (ANM, AWW =3,

Political party, workers/leaders/elected reps =4,

Religious leaders/places of worship-=5,

Local NGO/CBO members =6,

Others(specify)=98, Don’t Know/CS=99]


Page | 114

BLOCK 4: HEALTH STATUS AND HEALTH CARE UTILIZATION

A. Particulars of non-hospitalized/short-term aliments of household members during the last 30 days

22 Srl. no. of ailment 1 2 3 4 5

23 Srl. no. of member reporting ailment

Number of days within the reference period

24 Nature of ailment (code on page no…)

25 Total duration of ailment (days)

26 Ill

27 On restricted activity

28 Confined to bed

29 Did you/[member] receive any medical treatment for this

ailment? (Yes-1, No-2)

30 If not (Q 43=2), reasons for not seeking/receiving any medical

treatment?

No medical facility available in the neighbourhood - 1,

Facilities available but no treatment sought owing to: lack of

faith - 2,

Long waiting - 3,

Financial reasons - 4,

Ailment not considered serious - 5,

Others - 98

31 If yes (Q 43=1), Type of health service provider/health facility

from where treatment was sought?

Govt. clinic/dispensary-1


Page | 115

Govt hospital-2

Private physician/clinic-3

Private hospital/nursing home (including NGO/trust

hospitals)-4

Quacks/informal providers-5

Medicine shops/pharmacy/old prescriptions-6

Hakim/vaids-7

Other (specify)

32 Please provide reasons for seeking treatment from this

provider/health facility?

Nearest health facility/convenient (including convenient

operational hours)-1

Low cost/financial reasons-2

Usual choice for treatment/past experience of effective

treatment-3

Neighbours/friends advised-4

Others (specify)-98

Not sure/DK/CS) =99

if 1 in item 1

33 If Q___=1 (Ask treatment was sought from any sources,

except govt. health facility) [If Q.61≠1 or Q.61≠2]

Reason for not using services of government

physicians/health facilities

Govt. doctor/facility too far-1,

Not satisfied with medical treatment by Govt. doctor/facility -2

Long waiting -3,

Required specific services not available - 4,

Others – 98

Now, I would like to collect some information on the expenses incurred for your treatment

From the illness you have been describing, I will require expenses incurred on different purposes, and also from where/which sources did

you manage to pay. (In case of multiple episodes, information from the most recent)


Page | 116

Please provide amount spent on

(I)

Total cost

(II)

Amount paid out-of

pocket (own

income/savings)

III

Amount from

other sources

IV

Source

V

34 Doctor’s fee

35 Diagnostic tests

36 Medicine/injections

37 Bed charges

38 Surgery charges

39 Any special diet/other food

40 Follow-up costs

41 Transportation (including ambulance)

42 Any other indirect costs (wage loss of

attendants etc.)

43 Total expenses

Instructions: funsZ”k

For III: Ask respondent whether entire amount was met with self-income/salary/from other household member. If so, copy the

total costs from Col.2 to Col. 3 and skip col.4 & col.5

For IV: Entre the amount that was with supported from other sources:

If Partial support=include amount

If total (entire amount supported by external sources)=copy col. 3.

For V: Other/External sources:

1=Borrow from friend/neighbor/relatives;

2=Loans from office;

3=Paid by the employee

4=Loan (with interest) from money lender

9=Others (specific)

44

How were the expenses met? (Multiple responses

possible)

Note: These questions are to be asked if the respondent

is unable to give break-up of the expenses incurred

(and its financing sources)

Self savings =1

Employer paid =2

Friends/family =3

Health insurance (others)=5

Borrowings from money lenders with interest

Selling of assets =7

Others (specify) =98

DK/CS=99

45

Was it of any difficulty for your family/yourself to

meet the costs associated with your (child’s) treatment,

and spending the amount you mentioned?

1=Extremely difficult

2=Somewhat difficult

3=Not at all

46 Number of days confined to bed/absent in work

CODES FOR AILMENT:


Page | 117

ailment code ailment code Gastro-intestinal Diabetes mellitus 22 Diarrhoea/ dysentery 01 Under-nutrition 23 Gastritis/gastric or peptic ulcer 02 Anaemia 24 Worm infestation 03 Sexually transmitted diseases 25 Amoebiosis 04 Febrile illnesses

Hepatitis/Jaundice 05 Malaria 26 Cardiovascular Diseases Eruptive 27 Heart disease 06 Mumps 28 Hypertension 07 Diphtheria 29 Whooping cough 30 Respiratory including ear/nose/throat ailments 08 Fever of unknown origin 31 Tuberculosis 09

Bronchial asthma 10 Tetanus 32 Disorders of joints and bones 11 Filariasis/Elephantiasis 33 Diseases of kidney/urinary system 12

Prostatic disorders 13 Disabilities Gynaecological disorders 14 Locomotor 34 Neurological disorders 15 Visual including blindness (excluding 35 cataract)

Psychiatric disorders 16 Speech 36 Hearing 37 Eye ailments Diseases of Mouth/Teeth/Gum 38 Conjunctivitis 17 Accidents/Injuries/Burns/

Glaucoma 18 Fractures/Poisoning 39 Cataract 19 Cancer and other tumours 40

Diseases of skin 20 Other diagnosed ailments 41 Goitre 21 Other undiagnosed ailments 99

B. Particulars of medical treatment received as inpatient of a hospital during the last 365 days

47 Sr1. no. of the hospitalisation case 1 2 3 4 5

48 Srl. no. of member (as in HH roster) hospitalized

49 Age (years)

50 Type of hospital (code)

Govt hospital=1

Private hospital/nursing home (including NGO/trust hospitals)=2

Other (specify)=98

51 Nature of ailment (code on page no…)

Disease Code will be added

52 Type of ward (free - 1, paying general - 2, paying special - 3)

53 Duration of stay in hospital (days)


Page | 118

Details of medical services received (not received - 1; received: free - 2, partly free - 3, on payment - 4)

54 Bed charges

55 Attendant/Nursing

56 Food

57 Surgery charges

58 medicine

59 X-ray/ECG/EEG/Scan

60 other diagnostic tests

61 Did [member] receive any treatment before hospitalisation for

the ailment mentioned in Q 5 (yes - 1, no - 2)

62

If 1 in

item 15

Source of treatment

Govt. clinic/dispensary=1; Govt hospital =2; Private

physician/clinic=3; Private hospital/nursing home

(including NGO/trust hospitals)=4; Quacks/informal

providers=5; Medicine shops/pharmacy/old

prescriptions=6; Other (specify)=98

63 Duration of treatment (days)

64 whether treatment continued after discharge from hospital (yes -

1, no - 2)

65

If 1 in

item 18

Source of treatment (code)

Govt. clinic/dispensary=1; Govt hospital =2; Private

physician/clinic=3; Private hospital/nursing home

(including NGO/trust hospitals)=4; Quacks/informal

providers=5; Medicine shops/pharmacy/old

prescriptions=6; Other (specify)=98

66 Duration of treatment (days)

Now, I would like to collect some information on the expenses incurred for all episodes/events of Hospitalization for all members of this

household, on all diseases DURING LAST 12 MONTHS

From the illnesses and hospitalizations you have been describing, I will require expenses incurred on different purposes, and also from

where/which sources did you manage to pay. (In case of multiple episodes, information from the most recent)


(I)

Total cost

(II)

Amount paid out-

of pocket (own

income/savings)

III

Amount from

other sources

IV

Source

V

Amount provided

under RSBY

VI

67 Doctor’s fee

68 Diagnostic tests


70 Bed charges

71 Surgery charges


73 Follow-up costs

74 Transportation (including

ambulance)


Page | 119

75 Any other indirect costs (wage loss

of attendants etc.)

76 Total expenses

Instructions: For III: Ask respondent whether entire amount was met with self-income/salary/from other household member. If

so, copy the total costs from Col.2 to Col. 3 and skip col.4 & col.5

For IV: Enter the amount that was with supported from other sources:

If Partial support=include amount ;


For V: Other/External sources: 1=Borrow from friend/neighbor/relatives; 2=Loans from office/ place of work; 3=Paid by the

employee; 4=Loan (with interest) from money lender; 5=Sold household assets/jewelry; 9=Others (specific)

77

Ask only if respondent cannot provide break-up of the

expenses incurred (and its financing sources

How were the expenses met? (Multiple responses

possible)

Self savings =1

Employer paid =2

Friends/family =3

Health ins-RSBY - =4

Health insurance (others)=5

Borrowings from money lenders with interest =6

Selling of assets =7

Others (specify) =98

DK/CS=99

78

Loss of household income, if any, due to

hospitalization of [member] (Rs)

Instruction: Include loss of wage for the hospitalized member

(if working)

79


meet the costs associated with the hospitalizations of

your household members, and spending the amount you

mentioned?



3=Not at all

C. Accidental Injury, Treatment and Financing

80 Did you/any household member suffer from any accidents or an injury in the

past 12 months that required medical treatment?

(Ignore minor cuts/bruises; include those that required medical treatment)

Yes

(1)

No

(0)

If no, Skip to next

Section

81

82

Indicate which members suffered such injuries

(Only include currently surviving members; for dead members record in

Block___): [ADD ADDITIONAL SHEET IN CASE OF MORE THAN TWO]

(Instruction – copy Member Line Number from Block-___)

ID-1 ID-2

83 Type of accident/Mechanism of Injury

(1=motor vehicle, 2=pedestrian-vehicle crash, 3=motorcycle, 4=bicycle,

5=fall , 6=gunshot/firearms, 7=stab/cuts, 8=fire/burn s, 9=poisoning,

10=drowning , 11=others , 98=Others (specify); 99=DK/CS)

84 Where did the injury occur?


Page | 120

(1=home , 2=school, 3=streets/highways/railways, 4=trade & service areas

(shops, offices), 5=water bodies, 6=industrial/construction, 98=others

(specify); ; 99=DK/CS)

85 When (in the last 12 months) did the accident happen?

(1=within last 30 days, 2=last 3 months , 3=3-6 months , 4=6-12 months f,

98=Others (specify); 99=DK/CS)

86 Which body parts/organs were injured/affected by the accident? (Head flj =1;

Limb =2; Chest =3; Shoulder/neck/back =4; Internal organ =5)

87 Did any other family members/friends accompany you/member at the time of

the accident/injury?

(0=No, 1=Yes, 99=DK/CS)

88 How you /your family did come to know about the accident/injury of the

member?

(1=police, 2=hospital authorities, 3=friends/neighbors, 4=unknown

strangers; 98=Others (specify)

89

Did you/member receive any medical attention/treatment at the

accident/injury site?

(0=No, 1=Yes, 99=DK/CS)

90 Were you/member taken/went to any hospital/clinic to receive treatment after

the injury/accident? (0=No, 1=Yes, 99=DK/CS)

91 Name of the hospital

92

Type of the facility

Govt. clinic/dispensary =01;

Govt hospital =02;

Private physician/clinic =03;

Private hospital/nursing home (including NGO/trust hospitals) =04;

Quacks/informal providers =05;

Hakim/vaids=07;

Other (specify) =98)

93 How were you/member taken/went to the hospital/clinic/physician mentioned

in Q 198?

(1=Govt ambulance, 2=pvt. Ambulance, 3=pvt vehicles 4=police vehicles

5=rickshaw/vans, 98= Others (specify); 99=DK/CS)

94 Are you aware of the ambulance service OR the helpline number xxxxxx for

emergency medical transportation service of the Delhi Government?

(0=No, 1=Yes, 98= Others (specify); 99=DK/CS)

95 Reasons for seeking care/treatment from the particular facility?

Nearest health facility/convenientworking hours =01;

Low cost/financial reasons =02;

Usual choice for treatment/past experience of effective treatment=03;

neighbours/friends advised=04

taken by police/other

persons/ambulance=05

98=Others

(specify);

99=Not

sure/DK/CS)))


Page | 121

96 Did you/member receive immediate treatment (including examination,

dressing of the wound, applying bandages/casts) after arriving at the health

facility?

(0=No, 1=Yes, 99=DK/CS)

97 Were any diagnostic tests/scans conducted

(0=No, 1=Yes, 99=DK/CS)

98 How satisfied were you by the overall quality of treatment/care received

while being treated for the accident/injury at the health facility?

Rate in a scale of 1-5, with 1=Extremely dissatisfied and 5=Very Satisfied

99 Did the accident/injury require any hospitalization/in-patient stay of the

member?

(0=No, 1=Yes, 99=DK/CS)

100 Days of stay

101 Total duration of treatment (include hospitalizations and any follow-up visits)

Total expenditure incurred on account of treatment and related expenses due to the accident/injury of the member in last 12

months?

Please provide amount spent for

(i)

Total cost

(II)

Amount paid

out-of pocket

(own

income/savings)

III

Amount from

other sources

IV

Source

V

Amount

provided under

RSBY scheme

VI

102 Doctor’s fee

103 Diagnostic tests


105 Bed charges

106 Surgery charges


108 Follow-up costs

109 Transportation (including

ambulance)

110 Any other indirect costs (wage loss

of attendants etc.)

111 Total expenses

Instructions:

For III: Ask respondent whether entire amount was met with self-income/salary/from other household member. If so, copy the

total costs from Col.2 to Col. 3 and skip col.4 & col.5

For IV: Entre the amount that was with supported from other sources:

If Partial support=include amount


For V: Other/External sources: 1=Borrow from friend/neighbor/relatives; 2=Loans from office; 3=Paid by the employee; 4=Loan

(with interest) from money lender; 9=Others (specific)

112 What has been the major source of finance for the treatment? [Note: These

questions are to be asked if the respondent is unable to give break-up of the

expenses incurred (and its financing sources]

Self savings =1,

Employer paid=2,

Friends/family =3,


Page | 122

Health ins-RSBY =4,

Health insurance (others vU;)=5,

Borrowings from money lenders with interest =6,

Selling of assets =7,

Others =8, Others (specify)=98;

DK/CS=99

113 Was it of any difficulty for your family/yourself to meet the costs associated

with your (child’s) treatment, and spending the amount you mentioned?



3=Not at all

114 Are you/hh member restricted in any of the following areas as a result of this

accident / injury?

(a) Attending work on a full-time/pre-accident/injury leaves

(b) Attending school regularly

(c) Attend daily living activities (bathing/driving/walking/using toilets)

(d) Attend daily household chores (outing/shopping/managing

household finance etc.)

Yes

(1)

A

B

C

d

No

(2)

A

B

C

d

DK/CS

(99)

A

B

C

d

115 Have you/hh member missed work due to this accident / injury?

(0=No, 1=Yes, 99=DK/CS)

116 Number of days lost/confined to bed:

117 Did the accident/injury cause any permanent/semi-permanent disability?

(loss of limb, eyesight, hearing. Cognition etc)

(0=No, 1=Yes, 98= Others (specify); 99=DK/CS)

118 How difficult you found to adjust with the loss of work / financial hardships,

following the accident?

Rate in a scale of 1-3, with 1=Extremely difficult;2=Somewhat difficult; Not

difficult at all=3

119 How would you rate the current health status/condition of the member, with

respect to the accident/injury

Rate in a scale of 1-5, with Very poor=1; Poor=2; Somewhat

OK/moderate=3; Good=4 and 5=Excellent

D. Welfare Impacts Of Health Shocks & Coping Mechanisms


Page | 123

120 Considering all events of diseases/illnesses, hospitalizations, accidents,

injury experienced by your family members in last 1 year, how would

you rate the impact of all these events taken together, on the economic

status/capacity of your household?

Very severe impact 1

Sever impact 2

Moderate impact 3

Partial impact 4

No effect 5

121 Do you consider that your family has fully recovered, partially

recovered, or not at all recovered from the financial impacts of the

health shocks - taking all of these adverse health events together?

Completely recovered 1

Partially recovered 2

Not at all recovered 3

122 For some families, health shocks/adverse health events have been seen

to be responsible for making families poorer, and impoverished in

some cases.

Now, considering the economic status of your household during same

time of last year (March, 2013/ Last Holi) and the health

shocks/adverse health events your family has faced since then, do you

think that the economic status/capacity of your household have:

Deteriorated considerably 1

Deteriorate somewhat 2

More or less remained the same 3

Improved somewhat 4

Substantially improved 5

Do you think that your household/any family member had to do any of the following to cope with/manage the financial impacts

arising out of all these ill-health/diseases events taken together?

(1=Severe impact, 2=High, but not severe impact, 3=Somewhat/little impact, 4=No impact)

122 Postpone marriages in the family 1 2 3 4

123 Withdraw children from schools 1 2 3 4

124 Children required to work 1 2 3 4

125 Elderly members required to work 1 2 3 4

126 Adults forced to take up additional working hours 1 2 3 4

127 Reduce food consumption (e.g. adults skipping meals, buy cheaper/less quality

food) 1 2 3 4

128 Reduce other non-food consumption expenditure (on clothing, festival-spending,

travel to native places, entertainment etc) 1 2 3 4

129 Postpone/defer purchase of assets 1 2 3 4

130 Delay/Ignore/Avoid non-critical health care needs of household members 1 2 3 4

131 Would you be able to raise Rs. 10,000 in one week if you needed it for some

emergency?

Yes

(1)

No

(0)

DK/CS

(99)

132 How would you raise Rs. 10,000?

Mention top 3 sources in the order you would follow

(Selling durable goods/equipment =1, Selling land/house =2 , From

savings=3, From relatives/friends =4, From employer=5, From

moneylender=6, Taking extra work=7, From any

MFI/cooperative/NBFI=8; Others (specify) =98; DK/CS=99 )

1st 1 2 3 4 5 6 7 8 9 99

2nd 1 2 3 4 5 6 7 8 9 99

3rd 1 2 3 4 5 6 7 8 9 99

E. Quality Of Medical Services/Quality Of Care


Page | 124

133 (a) Have you visited/accompanied patient to

any health provider/ hospital/clinic for out-

patient care (OPD) in last 12 months

(b)Have you been hospitalized/spent time

with other family members during

hospitalization in- patient care in last 12

months

Yes (1)

If yes, complete the full

column

No (0)

If no, move to

(b)

Yes (1)

If yes, complete the

full column

No (0)

If no, Skip to

next section

134 Type of health facility used Government hospital (1)

Private hospital/nursing/clinics (2)

Private practitioner (3)

Informal providers/Jhola chap etc.(4)

Government hospital (1)



Informal providers/Jhola chap etc. (4)

Rank the top three services, which you liked/found best during your last visit to a hospital/ nursing home/clinic

Rank (1,2,3)

OPD IPD

135 Skill and Competency of the staff/physician

136 Overall Cleanliness

137 Friendliness and courtesy of the staff

138 Effectiveness of the treatment and medicine prescribed

139 Cost of the treatment

140 Ease of communicating treatment/ therapy

141 Any other aspects (Specify)

Rank the top three services, which you disliked/found worst during your last visit to a hospital/ nursing home/clinic

Rank (1,2,3)

142 OPD IPD

143 Distance

144 Waiting Time

145 Cleanliness/ Environment

146 Lack of Privacy during consultation/ overcrowding

147 Behaviour of staff/ physician

148 Cost of treatment

149 Effectiveness of the treatment and medicine prescribed

150 Any other aspects (Specify)

Now, I am going to ask you a few questions on the health services

You have received/experienced while you were at the hospital clinic and your overall experience.

Domains

For outpatient care

(OPD)

For in- patient

care/hospitalization

151 How approachable/friendly was the doctor?

1=Very much; 2=somewhat; 3=not at all

152 How approachable/friendly was the other staff

(nurses/technicians/clerks)? 1=Very much; 2=somewhat; 3=not at

all

153 Did you find the working hours convenient to you, given your

normal daily tasks/duties?

1=Very convenient; 2=Somewhat convenient; 3=Inconvenient;

4=Very inconvenient

154 How convenient/accessible was the location of the facility/clinic

from your residence?


4=Very inconvenient


Page | 125

155 Would you consider the time taken by the doctor/nurses/assistants

properly explained to you the diagnosis and the treatment required?

1=Adequate; 2= Somewhat Adequate; 3= Inadequate

156 Do you think that the doctor/nurses/assistants properly explained to

you the diagnosis and the treatment required?

1=Yes, very much; 2=Somewhat normally explained; 3=

157 In case you have had any queries regarding your/patient’s

problems/treatment how were it responded? Would you the

response were:

1=Polite & adequate; 2=Polite but inadequate; 3=Rude &

inadequate

158 How would you rate the privacy available, when the doctor was

examining you/the patient?

1=Satisfied /good; 2=Somewhat satisfied; 3=Poor/not satisfied

159 How would you rate the facilities available for emergency care?


160 How would you rate the – availability of drugs and medicines? \


161 How would you rate the – hygiene, sanitation, and cleanness at the

facility 1=Satisfied /good; 2=Somewhat satisfied; 3=Poor/not

satisfied

162 How confident were you in the treatment that was being provided?

1=Very confident; 2=Somewhat confident; 3=Not at all confident

163 How would you rate the effectiveness of the treatment provided?

1=Very effective; 2=Somewhat effective; 3=Ineffective

164 In case you had to wait for your turn, while seeking care (being

treated at the facility (for consultation, tests or obtaining drugs

etc.), how proper would you consider the waiting time was?

1=Proper/OK; 2=Somewhat proper/manageable; 3=Very

long/frustrating

165 Do you feel that you/patient were kept in the hospital longer than

required? 1=Yes; 2=No

166 During the stay, how convenient would you consider was the

facilities for having your friend/relatives etc.

visit/interact/accompany you?


4=Very inconvenient

167 How would you rate the safety/security at the hospital?


168 Were there only pressure/expectations/request for making any

unofficial payment/bribes?

1=Yes; 2=No


Page | 126

BLOCK 5: RSBY-INTERVENTION: WEST BENGAL

Section A: Screening and Non-beneficiaries

Now, I would like to ask you a few questions regarding your Knowledge with the RSBY scheme.

169 Are you aware of a government scheme/programme that covers hospitalization expenses for

families such as yours?

Yes

(1)

No

(2)

170 Have you ever heard of a scheme called Rashtriya Swasthya Bima Yojana (RSBY)?

Yes

(1)

No

(2)

171 Have you ever seen any of your neighbours/relatives/friend having a card such as this? [SHOW

RSBY CARD]

Yes

(1)

No

(2)

IF ANSWER “NO” to all of the 3 questions above, Skip to next BLOCK 6

IF ANSWER “YES” to any of the 3 questions above go to next question

172 Do you/hh posses a RSBY smart card? Yes No


Page | 127

(1)

Skip to Q. 176

(2)

173 Why have you/your family not enrolled in the programme/RSBY?

Unsure about enrolment process; =1

Do not have required documents; =2

Lack of time to visit enrolment centre/get enrolled =3

Was refused enrolment; =4

Was told that the scheme is no longer operational;-=5

Unaware about the actual benefit; =6

Considers that the benefit will be too little -=7

Unsatisfactory experience of friends/neighbours =8

98=Others (Specify)

99=Can’t say/DK

174

Do you consider that it will be useful/helpful for your family if you are enrolled under

RSBY/and can avail of the facilities/financial support it provided? Would you say it will

be:

Very useful 1

Somewhat useful 2

Not useful at all 3

175

For families such as yours, what kind of help/support do you think the government should provide, with regards to

healthcare/medical treatment needs of your family and the financial implications associated with it?

(OPEN ENDED QUESTION/Note down)

Section B: Awareness and Knowledge about RSBY – Relevant Intervention Assessments

176 Have you heard about the RSBY scheme?

Yes

(1)

No

(2)

177 Did anyone come to your house to inform you about the RSBY scheme?

Yes

(1)

No

(2)

Others

(98)

178 Do you know the organisation name of the person who visited you regarding RSBY

scheme? --------------------------------

179

Where did you first come to know about the RSBY scheme?

Neighbours/friends=1

Relatives=2

Local school teacher=3

Employer=4

Govt. workers=5

Local health worker=6


Page | 128

Local NGO=7

MLAs/other political workers=8

Newspaper/magazines=9

TV/films=10

Others (specify)=98

180

Do you know who is eligible for the scheme?

Everyone in the family=1

BPL families=2

Antyoday Anna Yojana families=3

NREGA card holders=4

Others(specify)=5

Don’t know=99

181

How many family members can be enrolled?

At most 5 members=1

All household members=2

Others (specify)=98

Don’t know=99

182

Which members of the family are compulsory to enroll in RSBY scheme?

183 How much does it cost to enroll in this scheme? (in Rs.)

184 What is the maximum amount per year that can be spent under RSBY scheme?

185

What kind of treatment is provided free of cost under RSBY/Smart Card? (Prompt)

Hospitalized treatment=1

Home based treatment=2

Both=3

Don’t know=98

186 Are transportation allowances provided to the patient under RSBY scheme?

Yes

(1)

No

(2)

DK

(99)

187

Do you have to pay for the diagnostic tests (Examples: X-ray/ECG/EEG/Scan)during

hospitalisation if you enroll in this scheme?

Yes=1

No=2

Don’t know=99

188

Do you have to pay for medicines and drugs in case of hospitalisation if you enrol in this

scheme?

Yes=1

No=2

Don’t know=99

189

Have you noticed/observed any of the following activities related with awareness

generation/information on RSBY taking place in your village/community?

(Read all options one-by-one)

Mike announcements in the community/village=1

Rallies=2

Tableau=3

Video shows=4

Puppet shows=5

Street plays=6

Wall writing=7

Others (specify)=98

190

How often have you noticed such awareness related activities on RSBY scheme in your

community?

Twice or more in a month=1

Monthly=2

Every two months=3


Page | 129

More than two months=4

Others (specify)=98

Don’t know=99

Show IEC materials and Test Familiarity

191

Have you seen?

Exhibit 1

Exhibit 2

Exhibit 3

Exhibit 4

Exhibit 5

192

How useful do you think these materials are?

Exhibit 1

Exhibit 2

Exhibit 3

Exhibit 4

Exhibit 5

Section C: Enrolment and Orientation

193

Do you have a RSBY smart card?

Yes=1

No=2

Don’t know=99

194 In which year did enrolment take place?

195

Please show your RSBY/Smart card.

Showed=1

Did not want to show=2

Other (specify)=98

196

Who encouraged you to apply for the RSBY scheme?

Self=1


Relatives=3


Employer=5

Govt. workers=6


Local NGO=8


Others (specify)=98

197

Who informed you about the RSBY enrolment process?


Relatives=2


Employer=4

Govt. workers=5


Local NGO=7


Others (specify)=98

198 Where did you apply for RSBY scheme?


Page | 130

In the village=1

Outside the village=2

Others (specify)=98

199 How far was the enrolment centre from your house? (in kms)

200

How did you come to know about RSBY enrolment venue?

Self=1


Relatives=3


Employer=5

Govt. workers=6


Local NGO=8

Announcements=9


Others (specify)=98

201

What documents did you produce for the enrolment?

BPL Card=1

MNEREGA ID Proof=2

Others (Specify)=98

202

Did anyone told you about the essential documents that are required to enrol under

RSBY?


Relatives=2


Employer=4

Govt. workers=5


Local NGO=7

Corporators/MLAs/other political workers=8

Others (specify)=98

203 Did anyone help you during the enrolment process apart from the RSBY enrolment team

members?

204

Did you face any problem in obtaining the card?

Yes

(1)

No

(2)

205

What problems did you face in obtaining the card?

206

Did you get the RSBY smart card instantly?

Yes

(1)

No

(2)

207 If no, when did you receive your smart card? (in days)

208 Did you make any payments to receive the RSBY smart card? (in Rs)

209 Did you receive any documents with the card?

Yes

(1)

No

(2)

210

What information was provided on the documents?

List of hospitals =1

How to use the card=2

Whom to contact in case of any query=3

Information about district kiosk=4


Page | 131

Other (specify)=98

Don’t remember=99

211 Did you receive any information on RSBY/Smart Card verbally?

Yes

(1)

No

(2)

212 Who provided you the information?

213

What information was conveyed to you? (Read out options)

List of hospitals=1


Who to contact in case of any query=3


No information was conveyed=5

Other (Specify)=98

Don’t remember=99

214 Did you ask any for any doubts/clarifications related to RSBY scheme during enrolment?

Yes

(1)

No

(2)

215 Did anyone respond to your doubts/clarifications?

Yes

(1)

No

(2)

216 Who was the person/organization that responded to your doubts/clarifications?

217 Did anyone visit your home after acquiring RSBY smart card for detail description related to its usage and others?

218

Were you told about the date when you could start using the smart card?

Yes

(1)

No

(2)

219

How long did it take you to complete the whole enrolment process?

Less than one hour=1

One or more than one hour=2

If more than one hour, please specify=3

220

What was your experience of the enrolment process (How satisfactory….)?

Complicated/difficult/long-waiting/v. unsatisfactory=1

Somewhat unsatisfactory=2

OK/satisfactory/no problem=3

Others (specify)=98

DK/CS=99

201 Are you aware of the three nearest RSBY empanelled hospital nearby your locality?

Yes

(1)

No

(2)

202 If yes, please name the hospitals?

1……………………..

2………………………

3………………………

203 Have you ever be a part of any hospital exposure visits conducted by any organisation?

Yes

(1)

No

(2)

204

Who approached you prior to hospital exposure visits?

Friends/relatives=1

Any PRI member=2



Page | 132

Local NGO/CBO=4

Others (Specify)=98

205 Did anyone tell you about the purpose of hospital exposure visits?

206 How many people from you community were accompanying you during hospital

exposure visit?

207

Which hospital did you visit?

208 How much time did you spent on exposure visit? (in hrs.)

209

To whom did you interact during hospital exposure visit?

Doctors=1

Nurses=2

Hospital administrative staff=3

RSBY help desk=4

Others (Specify)=98

210

Did you visit different departments/locations inside the hospitals?

Registration desk=1

Patient waiting hall=2

Doctors room=3

X-ray room=4

Drug distribution centre=5

Toilets/Wash room=6

Others (Specify)=98

211 What was the major issue that was raised during the hospital exposure visits?

212 Did your confident improve after the hospital exposure visit?

Yes

(1)

No

(2)

Can’t

say

(99)

213

Did hospital exposure visit change your perception towards?

Doctors=1

Nurses=2

Staff=3

Others (Specify)=98

214 Did you share you hospital exposure visit to anyone in the community?

Yes

(1)

No

(2)

Section D: Utilization and Satisfaction

215 Screener Check: Did you use your RSBY Smart Card for medical treatment-

related payments for any of your ill family members during last 12 months:

Yes

(1)

No

(2)

216 Type of aliment/disease for which hospitalization was required?

217 Which RSBY-empanelled hospital did you visit?

218 How far is the hospital from your house/village? (in kms)

218

How did you reach the RSBY empanelled hospital?

Ambulance=1

Public transport=2

Private transport=3

Others (Specify)=98


Page | 133

219 Was there a RSBY helpdesk/counter at the hospital

Yes

(1)

No

(2)

220

Whether the RSBY help desk was Separate=1

Shared=2 Don’t know=98

201 Did you find any staff member at the RSBY help desk?

Yes

(1)

No

(2)

202 Did anybody help you/informed you about how to use your RSBY card regarding the

admission/treatment processes?

Yes

(1)

No

(2)

203

How long did you/the patient have to wait before being attended by the Help-Desk staff?

(In hrs.)

204

Was fingerprint verification done through a fingerprint scanner?

Yes

(1)

No

(2)

Don’t

know

(99)

205 Were you informed about the costs of treatment or given an estimate in advance/at the

time of admission?

Yes

(1)

No

(2)

206 Were you informed about the amount that can be charged/paid from your RSBY Card?

Yes

(1)

No

(2)

207

How was the behavior of staff at RSBY help-desk?

Polite=1

Rude=2

No separate helpdesk available=3

208

Did you face any type of discrimination on RSBY help desk based on?

Caste/social group=1

Religion=2

Place=3

Others (Specify)=98

209 What was the total expenditure (Kharcha) on the hospitalization? (in Rs.)

210 What was the amount paid/cost of treatment supported by the RSBY Card? (in Rs.)

211 On discharge was discharge summary provided to the family?

Yes

(1)

No

(2)

Don’t

know

(99)

212 Was the fingerprint verification done at the time of discharge?

Yes

(1)

No

(2)

Don’t

know

(99)

213

When did you get the RSBY/Smart card back?

After swiping at the time of admission=1

On discharge=2

Next day=3

Two days later=4

Others (specify)=98

214 Were you told about the amount of money left in the card at the time of discharge?

Yes

(1)

No

(2)

Don’t

know

(99)


Page | 134

215

How would you rate the behaviour and overall help/support of the staff dealing with

your admission/use of your RSBY Card.

(Please provide your response in a scale of 1-5 where 1=most dissatisfied/very poor and

5=Very satisfied/excellent)

216 Were you told the amount of money available in your Card at the time of discharge?

217

Was any other post-hospitalization expenses covered under RSBY?

No=0

Some medicines provided from hospital=1

Free ambulance/transport to return home=2

Free tests/scan etc on follow-up visits=3

Dressing of wounds etc.=4

Others (specify)=98

218

How would you rate your overall experience in using the RSBY Card at the hospital?

(Please provide your response in a scale of 1-5 where 1=most dissatisfied/very poor

and 5=Very satisfied/excellent)

219

Did you have any complaint/problems during hospital visit?

Use of RSBY card=1

Lack of adequate cost of treatment/amount covered under RSBY=2

For that you were by cheated/mislead in somewhat or the other=3

Others (specify)=98

220 Did you lodge any complaint regarding your grievances?

Yes

(1)

No

(2)

DK/CS

(99)

221

If yes, place of lodging grivabces?

Hospital authorities=1

CSO=2

Others (specify)=3

222 Are you aware about any measures/action taken on the basis of your graviances/

Yes

(1)

No

(2)

DK/CS

(99)

223

Is there any post hospitalization expenses covered under RSBY?

224 Was the patient prescribed any medicines after the discharge?

Yes

(1)

No

(2)

Don’t

know

(99)

225

For how many days the medicines needed to be taken after discharge?(based on discharge summary)

Days=1

Weeks=2

Months=3

Don’t know=98

226 Were these medicines provided by the hospital?

Yes

(1)

No

(2)

Don’t

know

(99)

227 Was the patient prescribed any tests after discharge?

Yes

(1)

No

(2)

Don’t

know

(99)

228 Were facilities for those tests organized by hospital free of cost?

Yes

(1)

No

(2)

Don’t

know

(99)

229

How is health of patient now comparing when he was admitted to the hospital?

Has died=1


Page | 135

No improvement=2

Partially recovered=3

Has recovered completely=4

230

How significant would you consider the financial support you have received under

RSBY, by being a card-holder?

Insignificant/little help/support=1

Somewhat useful/helpful=2

Very useful/helpful=3

BLOCK 6: A. INCOME & LIVELIHOOD

231 What is the major income-earning activity of this household? (Formal sector employment/salaried service=1, Business/petty-trade=2, Self-employment=3, Manual/Wage-labour=4, Traditional

semi-skilled trade=5, Remittance/Doles=6, Others (specify)=98)

Do the household/any members of the household own the following?

232 Mobile phone Yes (1) No (0) DK/CS (99)

233 Motorcycles/scooters Yes (1) No (0) DK/CS (99)

234 Cycle Yes (1) No (0) DK/CS (99)

235 Coolers Yes (1) No (0) DK/CS (99)

236 Television Yes (1) No (0) DK/CS (99)

237 Television with cable/satellite TV connection Yes (1) No (0) DK/CS (99)

238 Any land (in Delhi/native place) Yes (1) No (0) DK/CS (99)

239

Thinking of all the income-earning individuals in this household,

which category would you say the household falls, taking the total

MONTHLY household income/earning?

>5000 1

5000-7500 2

7500-10000 3

10000-15000 4

15000-30000 5

30000-50000 6

50000 & above 7

DK/CS 99

B. Consumption Expenditure

How much money was spent by your household – on

240 (a) Food – during last 7 days

241 (b) Electricity/Water Supply – during last 30 days

242 (c) Transportation (to school/works) – during last 30 days

243 (d) Education of children (including tuition) – during last 30 days

244 (e) Medical care/treatment (all diseases/injuries/by staying illness etc.) during last 30

days

245 (f) Rent/Taxes (for housing) – during last 30 days

(g) Clothing/entertainment (movies/cable rent)/communications(mobile)/travels – during

last 30 days

(h) Domestic durables (TV/bicycle/furniture) – during last 1year

(i) Home repair/constructions – during last 1year


Page | 136

(j) Clothing/footwear – during last 1year

(k) Any other expenses – during last 1year

(l) TOTAL

C. Living Conditions

Location of the house/quarters

(Near Garbage dumps =1, On pavements =2, Street-side =3, Near/beside railway-lines =4, JJ Colonies =5,

Unauthorized colonies =6, Resettlement colonies=7, Regularized colonies =8, Others(specify) =98)

Whether household members sleep in the same room where food is cooked (Yes gk¡ =1, No ugha =0)

Type of toilet used by household members (Open defecation =1; Public toilet=2; WC – in premises=3; Flush; Other (specify) =98)

Main source of drinking water

(Piped water=1; Tubewell/handpump=2; Public Tap =3; Tanker=4; Wells=5; Other(specify) =98)

If public tap water/tanker: Hours of availability ______Hours (Public tab)

_________No. of times (Tanker)

Type of cooking fuel used (Kerosene =1; Coal/Cow-dung/other wastes =2; LPG=3; Electricity=4; Other (specify) =98)


Page | 137

Annex 3 IMPACT ASSESSEMENT STUDY ON RASHTRIYA SWASTHYA BIMA YOJANA (RSBY)

MAIN QUESTIONNAIRE – WEST BENGAL

Sponsored by Poorest Area Civil Society Programme [PACS]

INSTITUTE FOR HUMAN DEVELOPMENT NIDM Building, 3rd Floor, IIPA Campus, I.P Estate, Mahatma Gandhi Marg, New Delhi-110 002

Phones – 2335 8166, 2332 1610 / Fax : 23765410

Email: [email protected]

BLOCK 1: INTERVIEW PARTICULARS

1. Interview ID 5. Supervisor Name and Signature

2. Supervisor ID 6. DEO Name and Signature

3. Data Entry Operator ID 7. Interview/Re-interview status

4. Interview er Name and Signature 8. Interview Date and Start-time

BLOCK 2: HOUSEHOLD IDENTIFICATION PARTICULARS

1 District 7 Gram Panchayat

2 PSU No. (Unique code) 8 Village Name

3 Block 9

Caste Category

(SC=1, ST=2, OBC=3, General=4)

4 Unique Household Identification

No. (UHID) 10

Religion

(Hindu=1, Muslim=2, Christian=3,

Others=4)

5 Name of Household Head 11 Highest educational attainment in

the household

1. SEGMENT 2. SUB-GROUP

A. RSBY Beneficiary Sample A. Minority

B. RSBY Non-Beneficiary sample B. ST

C. SC/OBC

Informed Consent Statement

INTERVIEWER – (Read out): Namaskar. My name is (please say your name here) and I work for Institute for Human Development, a

research institute in New Delhi. Your household has been selected to collect some detailed information on health and health care aspects

and the amount you have spent on health care for your family member, and your use and experience of the national health insurance scheme,

RSBY. It will take about 45 minutes for you to answer the questions. You can choose not to answer any questions or refuse participating in

the interview at any point of time throughout the interview. The information you provide will be confidential and used for research purposes only. If you can spare the time now, and with your permission, can I start the interview now?

mailto:[email protected]


Page | 138

BLOCK 3: HOUSEHOLD MEMBER ROSTER

C. Demographics and Socioeconomics

Details of all family members: In order to determine whom to interview, I need to know who lives at this address. Let me

assure you that any information you provide is strictly confidential. I would like the age, sex, education, marital status and

relationship to you of each of the members of this household who live here. All the members in the household should be

entered first, from oldest to youngest.

1.1 1.2 1.3 1.4 1.5 1.6 1.7 1.8 1.9 1.10 1.11 1.12

1.1

Lin

e No

.

1.2

Name

1.3

Sex

1.4

Relatio

nsh

ip

with

hou

seho

ld

head

1.5

Age

1.6

Marital

status

1.7

Hig

hest

edu

cation

al

level

1.8

Usu

al

activity

status

1.9

Wh

ether

suffered

from

any

min

or

illnesses

durin

g la

st 1

mo

nth

1.1

0

Wh

ether

suffers fro

m

any

chro

nic

diseases

since la

st 12

mo

nth

s?

1.1

1

Wh

ether

hosp

italized

ever d

urin

g

last 1

2

mo

nth

s

1.1

2 A

ny

health

schem

e/insu

r

ance

1

2

3

4

5

6

7

8

9

CODES

For 1.3: Sex male=1, female=2

For 1.4: Relation to head self=1, spouse of head=2, married child=3, spouse of married child=4, unmarried chiId=5, grand child=6, father/mother/father-in-

law/mother-in-law=7, brother/sister/brother-in-law/sister-in-law/other relative=8, servant/employees/other non-relatives=9

For 1.6: Marital status never married=1, currently married=2, widowed=3, divorced/separated=4

For 1.7: Educational level Illiterate=01; literate but never gone to school=02, Upto class 4=03, Upto class=04, Completed class 10=05, completed class 12=

06, completed Graduation= 07, Any higher education above graduation=08


Page | 139

For 1.8: Usual activity status Casual/daily wage laborer=01, Self-employed (including small business & trade)=02, Regular salaried employment=03,

Unemployed/seeking work=04, Student=05, Home-maker/household work/domestic duties (unpaid)=06, Disabled/Old/Young=07, Household

entrepreneur (tailoring/weaning/hand wash)=08, Others=99 (Specify)

For Q.1.9 to 1.12: Yes=1, No=0, don’t know/can’t say=99.

Note: Q1.9: When suffered from any common/minor/short-term illness in last 30 days (such as – fever/cold & cough/loose motion…….etc.) Q 1.10: Diabetes/cancer/hypertension/heart alignments/heart alignment/respiratory problems/tuberculosis/arthritis/long standing pain in bone/joints)

D. Social Networks

Is anyone in the family presently a member of any of the followings :

B1 Self Help Group (SHG)/Credit Cooperatives Yes (1) No (0) DK/CS (99)

B2 NGO/MFI (Micro Finance Institution) client Yes (1) No (0) DK/CS (99)

B3 Trade unions Yes (1) No (0) DK/CS (99)

B4 Political party Yes (1) No (0) DK/CS (99)

B5 Religious organization Yes (1) No (0) DK/CS (99)

B6 Local CBO’s (Community Based Organizations) Yes (1) No (0) DK/CS (99)

Do you or your family members personally know the Gram Panchayat/Local MLA/MP/any other elected member of your AREA?

Yes (1) No (0) DK/CS (99)

Number of times you did the following during last 7 days/in last week?

B7 Watch TV Never (1) Rarely (2) Daily (3)

B8 Listen Radio Never (1) Rarely (2) Daily (3)

B9 Read Newspaper/magazines Never (1) Rarely (2) Daily (3)

B10

What are your main sources of your information regarding government programmes/schemes?

(Multiple Answers)

Friends and family-members =1,

Media (Audio-Visual/Print)=2,

Local government workers (ANM, AWW) =3,

Political party, workers/leaders/elected representatives =4,

Religious leaders/places of worship-=5,

Local NGO/CBO members =6,

Others(specify)=98, Don’t Know/CS=99


Page | 140

BLOCK 4: HEALTH STATUS AND HEALTH CARE UTILIZATION

Minor Ailments during last 30 days (Non-Hospitalized)

4.1 Srl. no. of ailment 1 2 3 4 5

4.2 Srl. no. of member reporting ailment (COPY LINE NUM. – Q

1.1)

4.3 Nature of ailment (code on page no 4)

4.4 Total duration of ailment (days): Days Ill

4.5 Total duration of ailment (days): Days of restricted activity

4.6 Total duration of ailment (days): Days confined to bed

4.7 Did you/[member] receive any medical treatment for this ailment?

(Yes-1, No-2)

4.8 If not (Q 4.7=2)

Reasons for not seeking/receiving any medical treatment:

No medical facility available in the neighbourhood - 1

Lack of faith - 2

Long waiting - 3

Financial reasons - 4

Ailment not considered serious – 5

Others – 98

4.9 If yes (Q 4.7=1)

Type of health service provider/health facility from where

treatment was sought?


Govt hospital-2


Page | 141


Private hospital/nursing home -4



Hakim/vaids-7

Other (specify):-------------------------------------------------------------

--

4.10 Why was treatment sought from this provider/health facility?

(Allow multiple responses)

Nearest health facility/Easily accessible-1

Convenient operational hours)-2

Low cost/financial reasons-3

Usual choice for treatment/past experience of effective treatment-4

Neighbours/friends advised-5

Others (specify)-98

---------------------------------------------------------------------------------

-

4.11 Ask ONLY IF treatment was sought from any sources, except

govt. health facility - [If Q.61≠1 or Q.61≠2]

Reason for not using services of government physicians/health

facilities:

Govt. doctor/facility too far-1

Not satisfied with medical treatment by Govt. doctor/facility -2

Long waiting -3

Required specific services not available – 4

Others – 98

--------------------------------------------------------------------------------

---


Page | 142

Now, I would like to collect some information on the expenses incurred for treatment of the illnesses of all your family members you

have just described, during the last 30 days.

I will require expenses incurred on different purposes and also from where/which sources did you manage to pay.


(Column 1)

Total cost

(Column 2)

Amount paid

out-of pocket

(own income and

savings)

(Column 3)

Amount from

other sources

(Column 4)

Source

(Column 5)

4.12 Doctor’s fee

4.13 Diagnostic tests

4.14 Medicine/injections

4.15 Bed charges

4.16 Surgery charges

4.17 Any special diet/other food

4.18 Follow-up costs

4.19 Transportation (including

ambulance)

4.20 Any other indirect costs (wage loss

of attendants etc.)

4.21 Total expenses

Instructions:

For Column 2: Ask respondent whether entire amount was met with self-income/salary/from other household member. If so,

copy the total costs from Col.2 to Col. 3 and skip col.4 & col.5

For Column 4: Include amount that was supported/financed by other sources

For Column 5: Include the source for the amount included in (IV).

Codes:

1=Borrow from friend/neighbor/relatives (without interest)

2=Loans from office/employer (without interest)

3=Paid by the employer, not t be paid back

4=Loan (with interest) from money lenders or others

5=Selling any assets

98=Others (specific)

----------------------------------------------------------------------------------------------------------------------------- ---------------------------

4.22

If the respondent is unable to give break-up of the

expenses incurred (and its financing sources), ASK

THE FOLLOWING QUESTION:

How were the expenses met?

(Multiple responses possible)

Self savings 1

Employer paid 2

Friends/family 3

Health insurance (others) 4

Borrowings from money lenders with

interest 5

Selling of assets 6

Others (specify):

4.23


meet the costs associated with the treatment, and

spending the amount you mentioned, for the

diseases during last 30 days?

Extremely difficult 1

Somewhat difficult 2

Not at all 3

4.24 Number of days confined to bed/absent in work


Page | 143

CODES FOR DISEASES:

Disease code Disease code

Diarrhoea/ dysentery 01 Diphtheria 21

Gastritis/gastric or peptic ulcer 02 Whooping cough 22

Hepatitis/Jaundice 03 Fever of unknown origin/Other fevers 23

Heart disease 04 Cough and cold 24

Hypertension 05 Filariasis/Elephantiasis 25

Respiratory including ear/nose/throat ailments 06 Diseases of Mouth/Teeth/Gum 26

Tuberculosis 07 Accidents/Injuries/Burns/ 27

Bronchial asthma 08 Fractures/Poisoning 28

Disorders of joints and bones 09 Cancer and other tumours 29

Diseases of kidney/urinary system 10 Disabilities

Prostatic disorders 11 Locomotor 30

Gynaecological disorders 12 Visual including blindness (excluding 31

Psychiatric disorders 13 cataract) 32

Eye ailments (Conjunctivitis/Cataract) 14 Speech 33

Diabetes mellitus 15 Hearing 34

Anaemia 16 Other diagnosed ailments 100

Sexually transmitted diseases 17

Malaria 18

Typhoid 19

Encephalitis 20

BLOCK 5: HEALTH STATUS AND HEALTH CARE UTILIZATION Hospitalized Illnesses During Last 365 Days

5.1 Sr1. no. of the hospitalisation case 1 2 3 4 5

5.2 Srl. no. of member hospitalized (COPY LINE NO.- Q 1.10)

5.3 Type of hospital

Any Govt hospital=1


Page | 144

Private hospital/nursing home (including NGO/trust hospitals)=2

Other (specify)=98

5.4 Nature of ailment (code above)

5.5 Type of ward (free - 1, paying general - 2, paying special - 3)

5.6 Duration of stay in hospital (days)

5.7 Did [member] receive any treatment before hospitalisation for the

ailment mentioned in Q 5.4 (Yes - 1, No - 2)

5.8

If 1

in

item

5.7

Source of treatment:


Govt hospital-2


Private hospital/nursing home -4



Hakim/vaids-7

Other (specify):---------------------------------------------

5.9 Duration of treatment (days)

5.10 Current status of the member:

(Fully cured-1, Partially cured, under treatment-2, Partially

cured, but no treatment ongoing-3 )


Page | 145

Now, I would like to collect some information on the expenses incurred for all episodes/events of Hospitalization for all members of this household, on all diseases

DURING LAST 12 MONTHS

From the illnesses and hospitalizations you have been describing, I will require expenses incurred on different purposes, and also from where/which sources did you manage to

pay. (In case of multiple episodes, information from the most recent)


(Column 1)

Total cost

(Column 2)

Amount paid

out-of pocket

(own income and

savings)

(Column 3)

Amount from

other sources

(Column 4)

Source

(Column 5)

Amount

provided under

RSBY

(Column 6)

5.11 Doctor’s fee



5.14 Bed charges




5.18 Transportation (including ambulance)

5.19 Any other indirect costs (wage loss of

attendants etc.)

5.20 Total expenses

Instructions:

For Column 2: Ask respondent whether entire amount was met with self-income/salary/from other household member. If so, copy the total costs from Col.2

to Col. 3 and skip col.4 & col.5


For Column 5: Include the source for the amount included in (IV). If answers ‘6’ (RSBY) complete the entries for Q 5.20 for Column 6

Codes:






Page | 146


6=RSBY


----------------------------------------------------------------------------------------------------------------------------- ---------------------------

5.23

If the respondent is unable to give break-up of the expenses incurred

(and its financing sources), ASK THE FOLLOWING QUESTION:

How were the expenses met?

(Multiple responses possible)

Self savings 1

Employer paid 2

Friends/family 3

RSBY 4

Health insurance (others) 5

Borrowings from money lenders with

interest 6

Selling of assets 7

Others (specify)

5.24

Loss of household income, if any, due to hospitalization of [member]

(Rs)

Instruction: Include loss of wage for the hospitalized member (if working)

5.25

Was it of any difficulty for your family/yourself to meet the costs

associated with the hospitalizations of your household members, and

spending the amount you mentioned?

Extremely difficult 1

Somewhat difficult 2

Not at all 3

BLOCK 6: Accidental Injury, Treatment and Financing During Last 365 Days

6.1

Did you/any household member suffer from any accidents or an injury in the

past 12 months that required medical treatment?

(Ignore minor cuts/bruises; include those that required medical treatment)

Yes

(1)

No

(0)

If no, Skip to next

Section

6.2 Indicate which members suffered such injuries: ID-1 ID-2


Page | 147

(Instruction – Copy Member Line Number from Block- 3, Q 1.1)

6.3

Type of accident/Mechanism of Injury

Codes:

1=motor vehicle, 2=pedestrian-vehicle crash, 3=motorcycle, 4=bicycle,

5=fall, 6=gunshot/firearms, 7=stab/cuts, 8=fire/burns, 9=poisoning,

10=drowning , 11=others , 98=Others (specify); 99=DK/CS)

6.4

Where did the injury occur?

Codes:

1=home , 2=school, 3=streets/highways/railways, 4=trade & service areas

(shops, offices), 5=water bodies, 6=industrial/construction

6.5

Which body parts/organs were injured/affected by the accident?

Codes:

Head =1; Limb =2; Chest =3; Shoulder/neck/back =4; Internal organ =5

6.6

How you /your family did come to know about the accident/injury of the

member?

(1=police, 2=hospital authorities, 3=friends/neighbors, 4=unknown

strangers; 98=Others (specify)

6.7

Did you/member receive any medical attention/treatment at the

accident/injury site?

(0=No, 1=Yes, 99=DK/CS)


Page | 148

6.8 Were you/member taken/went to any hospital/clinic to receive treatment after

the injury/accident? (0=No, 1=Yes, 99=DK/CS)

6.9

Type of the facility

Govt. clinic/dispensary =01;

Govt hospital =02;

Private physician/clinic =03;

Private hospital/nursing home (including NGO/trust hospitals) =04;

Quacks/informal providers =05;

Hakim/vaids=07;

Other (specify) =98)

6.10

How were you/member taken/went to the hospital/clinic/physician mentioned

in Q 198?

Codes:

1=Govt ambulance, 2=pvt. Ambulance, 3=pvt vehicles 4=police vehicles

5=rickshaw/vans, 98= Others (specify); 99=DK/CS

6.11

Reasons for seeking care/treatment from the particular facility?

Nearest health facility/convenientworking hours =01

Low cost/financial reasons =02

Usual choice for treatment/past experience of effective treatment=03

Neighbours/friends advised=04

Taken by police/other persons/ambulance=05

98=Others

6.12

Did you/member receive immediate treatment (including examination,

dressing of the wound, applying bandages/casts, diagnostic tests/scans) after

arriving at the health facility?

(1=Yes,2=No, 99=DK/CS)


Page | 149

6.13

How satisfied were you by the overall quality of treatment/care received

while being treated for the accident/injury at the health facility?

Rate in a scale of 1-5, with 1=Extremely dissatisfied and 5=Very Satisfied

6.14

Did the accident/injury require any hospitalization/in-patient stay of the

member?

(0=No, 1=Yes, 99=DK/CS)

6.15 Days of stay

6.16 Total duration of treatment (include hospitalizations and any follow-up visits)

Total expenditure incurred on account of treatment and related expenses due to the accident/injury of the member in last 12

months?


(Column 1)

Total cost

(Column 2)

Amount paid

out-of pocket

(own income and

savings)

(Column 3)

Amount from

other sources

(Column 4)

Source

(Column

5)

Amount

provided under

RSBY

(Column 6)

6.17 Doctor’s fee



6.20 Bed charges




6.24 Transportation (including

ambulance)

6.25 Any other indirect costs (wage loss

of attendants etc.)

6.26 Total expenses

Instructions:

For Column 2: Ask respondent whether entire amount was met with self-income/salary/from other household member. If so, copy

the total costs from Col.2 to Col. 3 and skip col.4 & col.5


For Column 5: Include the source for the amount included in (IV). If answers ‘6’ (RSBY) complete the entries for Q 5.20 for

Column 6

Codes:



Page | 150





6=RSBY


----------------------------------------------------------------------------------------------------------------------------- ---------------------------

6.27

What has been the major source of finance for the treatment?

[Note: These questions are to be asked if the respondent is unable to give

break-up of the expenses incurred (and its financing sources]

Self savings =1, Employer paid=2, Friends/family =3, Health ins-RSBY =4,

Health insurance (others;)=5, Borrowings from money lenders with interest

=6, Selling of assets =7, Others =8, Others (specify)=98; DK/CS=99

6.28

Was it of any difficulty for your family/yourself to meet the costs associated

with member’s treatment, and spending the amount you mentioned?

1=Extremely difficult , 2=Somewhat difficult, 3=Not at all

6.29

Are you/hh member restricted in any of the following areas as a result of this accident / injury?

Codes: Completely=1, Partially/somewhat=2, Not at all=3


Page | 151

a) Attending work on a full-time/pre-accident/injury leaves

b) Attending school regularly

c) Attend daily living activities (bathing/driving/walking/using toilets)

d) Attend daily household chores (outing/shopping/managing

household finance etc.)

e) Any disability

1 2 3

1 2 3

1 2 3

1 2 3

1 2 3

6.30

Total number of days missed at work due to this accident / injury?

(Include number of days. If not lost any days include ‘0’)

6.31

How difficult you found to adjust with the loss of work / financial hardships, following the accident?

Rate in a scale of 1-3, with 1=Extremely difficult;2=Somewhat difficult; Not difficult at all=3

6.32

How would you rate the current health status/condition of the member, with respect to the

accident/injury

Rate in a scale of 1-5, with

Very poor=1; Poor=2; Somewhat OK/moderate=3; Good=4 and 5=Excellent

BLOCK 7: Welfare Impacts Of Health Shocks & Coping Mechanisms

7.1

Considering all events of diseases/illnesses, hospitalizations,

accidents, injury experienced by your family members in last 1

year, how would you rate the impact of all these events taken

together, on the economic status/capacity of your household?

Instruction to Investigator: If answers ‘No effect’=5, SKIP TO

Q 7.13

Very severe impact 1

Severe impact 2

Moderate impact 3

Partial impact 4

No effect 5

7.2

Do you consider that your family has fully recovered, partially

recovered, or not at all recovered from the financial impacts of

the health shocks - taking all of these adverse health events

together?

Completely recovered 1

Partially recovered 2

Not at all recovered 3


Page | 152

7.3

Considering the economic status of your household during same

time of last year (March, 2013/ Last Holi) and the health

shocks/adverse health events your family has faced since then,

do you think that the economic status/capacity of your household

have:

Deteriorated considerably 1

Deteriorate somewhat 2

More or less remained the same 3

Improved somewhat 4

Substantially improved 5

Do you think that your household/any family member had to do any of the following to cope with/manage the financial impacts

arising out of all these ill-health/diseases events taken together?

Codes:

1=Severe impact, 2=High, but not severe impact, 3=Somewhat/little impact, 4=No impact

7.4 Postpone marriages in the family 1 2 3 4

7.5 Withdraw children from schools 1 2 3 4

7.6 Children required to work 1 2 3 4

7.7 Elderly members required to work 1 2 3 4

7.8 Adults forced to take up additional working hours 1 2 3 4

7.9 Reduce food consumption (e.g. adults skipping meals, buy cheaper/less quality food) 1 2 3 4

7.10 Reduce expenditure on clothing, festival-spending, travel to native places, entertainment

etc 1 2 3 4

7.11 Postpone/defer purchase of assets 1 2 3 4

7.12 Delay/Ignore/Avoid non-critical health care needs of household members 1 2 3 4


Page | 153

7.13 Would you be able to raise Rs. 10,000 in one week if you needed it for some

emergency?

Yes

(1)

No

(0)

DK/CS

(99)

7.14

How would you raise Rs. 10,000?

Mention top 3 sources in the order you would follow

(Selling durable goods/equipment =1, Selling land/house =2 , From

savings=3, From relatives/friends =4, From employer=5, From

moneylender=6, Taking extra work=7, From any

MFI/cooperative/NBFI=8; Others (specify) =98; DK/CS=99 )

1st 1 2 3 4 5 6 7 8 9 99

2nd 1 2 3 4 5 6 7 8 9 99

3rd 1 2 3 4 5 6 7 8 9 99


Page | 154

BLOCK 8: Quality Of Medical Services/Quality Of Care

8.1

Have you PERSONALLYvisited/accompanied any

patient to any health provider/ hospital/clinic for

outpatient care (OPD) in last 12 months?

(A) (B)

Yes

(1)

No

(2)

If - Yes (1), type of provider/health facility





8.2

Have you been hospitalized/spent time with other

family members during hospitalization in- patient

care in last 12 months? Yes

(1)

No

(2)

If - Yes (1), type of provider/health facility





INSTRUCTION TO THE INVESTIGATOR:

In the space provided below, write the type of provider/health facility for both OPD and In-patient care.

Copy the codes for OPD from Q 8.1 (B) and for In-patient care from Q 8.2 (B).

Then continue asking the questions in Column 2, and insert the answers in Column 3 (OPD) and Column 4 (IPD). First

complete all Column 3 (OPD) entries before starting asking the responses for Column 4 (IPD)

For each of the following aspects of treatment, and your experience at the health facility, or about the physician, please rank the provider or health

facility in Column 3/Column 4 in a scale of 1 to 5, where

1=Very good or Very satisfactory, and 5=Very Poor or Very unsatisfactory

Column 2

Column 3 Column 4

OPD Code:

IPD Code:


Page | 155

8.3 Skill and Competency of the staff/physician 1 2 3 4 5 1 2 3 4 5

8.4 Overall Cleanliness 1 2 3 4 5 1 2 3 4 5

8.5 Friendliness and courtesy of the staff 1 2 3 4 5 1 2 3 4 5

8.6 Effectiveness of the treatment and medicine prescribed 1 2 3 4 5 1 2 3 4 5

8.7 Cost of the treatment 1 2 3 4 5 1 2 3 4 5

8.8 Ease of communicating treatment/ therapy 1 2 3 4 5 1 2 3 4 5

8.9 Distance/Accessibility 1 2 3 4 5 1 2 3 4 5

8.10 Waiting Time 1 2 3 4 5 1 2 3 4 5

8.11 Cleanliness/ Environment 1 2 3 4 5 1 2 3 4 5

8.12 Lack of Privacy during consultation/ overcrowding 1 2 3 4 5 1 2 3 4 5

8.13 Behaviour of staff/ physician 1 2 3 4 5 1 2 3 4 5

8.14 Cost of treatment 1 2 3 4 5 1 2 3 4 5

8.15 Effectiveness of the treatment and medicine prescribed 1 2 3 4 5 1 2 3 4 5

8.16 Friendliness of the doctor 1 2 3 4 5 1 2 3 4 5

8.17 Friendliness of nurses/other staff 1 2 3 4 5 1 2 3 4 5

8.18 Convenience of working hours 1 2 3 4 5 1 2 3 4 5

8.19 Explanation of diagnosis and treatment 1 2 3 4 5 1 2 3 4 5

8.20 Facilities for emergency treatment 1 2 3 4 5 1 2 3 4 5

8.21 Availability of drugs and medicines 1 2 3 4 5 1 2 3 4 5

8.22 Confidence in the treatment provided 1 2 3 4 5 1 2 3 4 5

8.23 Effetiveness of of the treatment provided 1 2 3 4 5 1 2 3 4 5

BLOCK 9: RSBY-INTERVENTION: WEST BENGAL

Section A: Screening and Non-beneficiaries

ASK TO ALL HOUSEHOLDS

Now, I would like to ask you a few questions regarding your Knowledge with the RSBY scheme.

9A.1 Are you aware of a government scheme/programme that covers hospitalization expenses for

families such as yours?

Yes

(1)

No

(2)


Page | 156

9A.2 Have you ever heard of a scheme called Rashtriya Swasthya Bima Yojana (RSBY)/‘Smart

Card’?

Yes

(1)

No

(2)

9A.3

Have you ever seen any of your neighbours/relatives/friend having a card such as this?

[SHOW RSBY SMART CARD]

Yes

(1)

No

(2)

IF ANSWER “NO” to all of the 3 questions above, Skip to next BLOCK 10

IF ANSWER “YES” to any of the 3 questions above go to next question

9A.4 Did you/household ever possess a Smart-Card/enrolled under RSBY?

Yes (1)

No (2)

FOR ‘YES (1)’ SKIP TO

Q 9A.6

9A.5 Why have you/your family never enrolled under RSBY?

[MULTIPLE RESPONSES POSSIBLE]

Codes:

Unsure about enrolment process =1

Do not have required documents =2

Lack of time to visit enrolment centre/get enrolled=3

Was refused enrolment=4

Was told that the scheme is no longer operational-=5

Go to Q

9A.8


Page | 157

Unaware about the actual benefit =6

Considers that the benefit will be too little=7

Unsatisfactory experience of friends/neighbours =8

Name not included in the BPL lists= 9

98=Others (Specify)

99=Can’t say/DK

9A.6

Is your RSBY Smart Card currently valid (enrolled during the last

phase)?

Instruction: If respondent is not sure, check Smart Card to confirm

Yes

(1)

No

(2)

For ‘Yes (1)’ skip to

Q 9A.8

Reasons for not renewing the Smart-Card for current year?


Codes:

Considered RSBY of little/no use = 1

Lack of time to visit enrolment centre/get enrolled=3

Was refused enrolment=4

Was told that the scheme is no longer operational-=5

Did not receive any information on renewal/enrolment =6

Unsatisfactory experience of using Card by self/friends/neighbours =7


Page | 158

98=Others (Specify)

99=Can’t say/DK

9A.7 How useful/helpful would it be if your family is enrolled under RSBY?

Very useful 1

Somewhat useful 2

Not useful at all 3

Section B: Awareness and Knowledge about RSBY – Relevant Intervention Assessments

9B-1

Where did you first come to know about the RSBY scheme?

Codes:

Neighbours/friends /Relatives=1


Employer=3

Group meeting organized by Panchayat=4

Through Folk team members=5

Announcement/posters at religious places (Mosque/Jalsas/Durga Pandals

etc.)=6

Self Help Groups (SHGs)=7

Chit distributions=8

Govt. workers=9


Local NGO=11



TV/films=14

RSBY-PACS Community Mobilizer (Note respondent can use Name)=15

Others (specify)=98

9B-2 Did anyone come to your house to inform you about the RSBY scheme? Yes (1) No (2) DK/CS

(99)

9B-3

If Q 9B-2=Yes (1)

From which organization/department did the person belong?


Page | 159

9B-4

Who is eligible for this scheme?

Everyone=1

BPL families=2

Antyoday Anna Yojana families=3

NREGA card holders with 15 days of work=4

Others(specify)=5

Don’t know=98

9B-5

How many family members can be enrolled?

At most 5 members=1

All household members=2

Others (specify)=98

Don’t know=99

9B-6 Which members of the family are compulsory to enroll in RSBY scheme?

9B-7 How much does it cost to enroll in this scheme? (in Rs.)

9B-8 What is the maximum amount per year that can be spent under RSBY scheme?

9B-9

What kind of treatment is provided free of cost under RSBY/Smart Card? (Prompt)

Hospitalized treatment=1

Home based treatment=2

Outdoor/Clinic visits=3

Others (specify)=98

Don’t know=99

9B-10 Are transportation allowances provided to the patient under RSBY scheme? Yes

(1)

No

(2)

Don’t know

(99)

9B-11 Do you pay for the diagnostic tests (Examples: X-ray/ECG/EEG/Scan) during

hospitalisation if you enroll in this scheme?

Yes

(1)

No

(2)

Don’t know

(99)

9B-12 Do you pay for medicines and drugs in case of hospitalisation if you enrol in this

scheme?

Yes

(1)

No

(2)

Don’t know

(99)

9B-13

From where did you get the information related to the different provisions of the

RSBY scheme?

Codes:

Neighbours/friends /Relatives=1


Employer=3

Group meeting organized by Panchayat=4

Through Folk team members=5


Page | 160

Announcement/posters at religious places (Mosque/Jalsas/Durga Pandals

etc.)=6



Govt. workers=9


Local NGO=11



TV/films=14

RSBY-PACS Community Mobilizer (Note respondent can use Name)=15

Others (specify)=98

Have you noticed/observed any of the following activities in your village/community that had provided any

information on RSBY (such as, enrolment process, how to use the card etc)?

Codes: Yes=1, No=2, Can’t say/Not sure=3

9B-14 Mike announcements in the community/village 1 2 99

9B-15 Rallies/Processions 1 2 99

9B-16 Tableau 1 2 99

9B-17 Video shows/Film shows 1 2 99

9B-18 Puppet shows 1 2 99

9B-19 Drama/Plays/Street plays 1 2 99

9B-20 Folk-song (Bhawaiya)/Folk-art (Patachitra) Teams 1 2 99

9B-21 Wall writing/Posters 1 2 99

9B-22

How often have you noticed such awareness related activities on RSBY scheme in

your community?


Monthly=2

Every two months=3


Once/twice in the last 1 year=5

Others (specify)=98

Don’t know=99

Show IEC materials and test familiarity.

Show the exhibits provided according to the number, and ask the questions:

9B-23 Have you seen the following?

Exhibit 1

Yes (1), No (2), Not sure (99)

1 2 99


Page | 161

Exhibit 2

Exhibit 3

Exhibit 4

Exhibit 5

1 2 99

1 2 99

1 2 99

1 2 99

9B-24

How useful do you think these materials are in providing required information

about enrolment and using different facilities and provisions under RSBY?

Exhibit 1

Exhibit 2

Exhibit 3

Exhibit 4

Exhibit 5

Very useful (1), Somewhat

useful (2), Not at all useful (3),

DK/CS (99)

1 2 3 99

1 2 3 99

1 2 3 99

1 2 3 99

1 2 3 99

9B-25

Have you seen or heard any mike announcements/posters and banners at/from any

of the following places related to information on RSBY?

Mosque/Dargaah/Temple/etc.=1

Durga puja pandals=2

Kirtans=3

Jalsas/Cultural functions=4

Not seen any announcements in any of the above palces =5

Put the codes for which

answers ‘Yes’

9B-26

If Q 9B-25=1,2,3,or 4 (Seen/Heard the announcements)

What information did you get on RSBY scheme from these announcements/mass-

media? (Read out each)

Eligibility criteria=1

Benefits of the scheme=2

No. of person in a family to get the benefit=3

Amount needed for registration=4

Hospitalization criteria=5

Process of transaction=6


answers ‘Yes’

9B-27 Did you find it useful? Yes

(1)

No

(2)

9B-28

Were any of the following initiatives taken

by the local Panchayat or Govt.

Departments to raise the awareness on

RSBY scheme?

Yes(1) No(2) DK/CS (99)

Community gatherings

Gram Sabha/VHND meetings

Workshops


Page | 162

Home visits by ANM/AWW

Public announcements

Distributing leaflets

If at least for one of the options of 9B-28, answer is ‘Yes (1)’ continue with next question, otherwise SKIP TO Q

9B-29

How often have you noticed such activities by Panchayat/Govt departments?


Monthly=2

Every two months=3


9B-30

What information did you get on RSBY scheme from the initiatives taken by the

Panchayat/govt departments?

Codes:

Eligibility criteria=1

Benefits of the scheme=2

No. of person in a family to get the benefit=3

Amount needed for registration=4

Hospitalization criteria=5

How to use the Card=6

What to do in case of any problems/complaints=7

Put the codes for which answers

‘Yes’

9B-31 Have you heard about RSBY Sahayata Kendra? Yes

(1)

No

(2)

If ‘No (2)’ SKIP TO

Section C

9B-32

How did you come to know about RSBY Sahayata Kendra?

Self=1

Neighbours/Friends/Relatives=2


Employer=5

Govt. workers=6


Local NGO=8


RSBY-PACS Community mobilize=10

Others (specify)=98


Page | 163

Section C: Enrolment and Orientation

Instruction for Investigators: Please collect the information for first enrolment only, and make it clear that we are not looking for information related to

renewal.

9C-1

Who encouraged you to apply for the RSBY scheme?


Codes:

Self-motivated/nobody in particular=1

Relatives/ Neighbours/Friends/Interpersonal communication = 2

Group meeting organized by Panchayat/Gram Sabha/Govt Departments=3

Local folk-art/IEC team members=4

Announcement at religious places (Mosque/Temple etc.)=5



ANM/ASHA/AWW durng Home visits=8


Employer=10

Govt. workers=11


RSBY-PACS Community mobilizer=13

Others (specify)=98

9C-2

Who informed you about the RSBY enrolment process?


Codes: Self-motivated/nobody in particular=1









Employer=10

Govt. workers=11




Page | 164

Others (specify)=98

9C-3 How far was the enrolment centre from your house? (in kms)

Were you provided/did you have the following information before you went for enrolment?

(Yes=1, No-2, DK/CS/Not sure=99)

9C-5 Venue/timings for enrolment/photography & biometrics 1 2 99

9C-6 Carry BPL Card/ Carry MNEREGA ID Proof 1 2 99

9C-7 Registration fee (Rs. 30) 1 2 99

9C-8 All five members present during enrolement 1 2 99

9C-9

From where did you get these informations on RSBY enrolment venue and other

details?

Codes:

Self =1









Employer=10

Govt. workers=11



Others (specify)=98

9C-10

What documents did you produce for the enrolment?

BPL Card=1

MNEREGA ID Proof=2

Others (Specify)=98


Page | 165

9C-11

Did anyone help you during the enrolment process apart from the RSBY

enrolment team members?

Smart card service providers=1 FKO from Panchayat=2 Members from CSO=3

Self Help Groups (SHG)=4

RSBY-PACS Community Mobilizer=5

Nobody helped=6

Others (specify)=98

9C-12 Did you face any problem during the enrolment OR in obtaining the card? Yes (1) No (2)

9C-13

What problems did you face? [OPEN-ENDED, RECORD VERBATIM]

9C-14

How were these problems resolved? [OPEN-ENDED, RECORD VERBATIM]

9C-15 Did you get the RSBY smart card instantly? Yes (1) No (2)

9C-16 If no, when did you receive your smart card? (in days)

9C-17 Did you make any payments to receive the RSBY smart card? (in Rs)

9C-18 Did you receive any documents with the card? Yes (1) No (2)

Did you receive following items with the card?

9C-19 Cash receipt 1 2 99

9C-20 Hospital list 1 2 99

9C-21

What information was provided on the documents?

(Multiple responses to be allowed)

List of hospitals=1


Page | 166


Whom to contact in case of any query=3


Other (specify) =98. _____________________________________

Don’t remember=99

9C-22 Did you receive any information on RSBY/Smart Card verbally?

Yes (1) No (2)

9C-23

Who provided you the information?

9C-24

What information was conveyed to you? (Read out options)

List of hospitals=1


Who to contact in case of any query=3


No information was conveyed=5

Other (Specify)=98

Don’t remember=99

9C-25

Did you ask any for any doubts/clarifications related to RSBY scheme during enrolment?

Yes

(1)

No

(2)

9C-26

Did anyone respond to your doubts/clarifications?

Yes

(1)

No

(2)

9C-27

Who was the person/organization that responded to your doubts/clarifications?

9C-28

Did anyone visit your home after acquiring RSBY smart card for detail description related to its usage and others?



Page | 167



Nobody helped=6

Others (specify)=98

9C-29

Were you told about the date when you could start using the smart card?

Yes

(1)

No

(2)

9C-30

How long did it take you to complete the whole enrolment process?

Less than one hour =1

One or more than one hour=2

If more than one hour, please specify=3

9C-31

What was your experience of the enrolment process (How satisfactory….)?

Complicated/difficult/long-waiting/v. unsatisfactory=1

Somewhat unsatisfactory=2

OK/satisfactory/no problem=3

Others (specify)=98

DK/CS=99

9C-32

Are you aware of the three nearest RSBY empanelled hospital nearby your

locality?

Yes

(1)

No

(2)

9C-33

If yes, please name the hospitals?

1.

2.

3.

9C-34

Have you ever be a part of any hospital exposure visits conducted

by any organisation?

Yes (1) No (2) If ‘No (2)’

SKIP TO

Section D


Page | 168

9C-35

Who approached you prior to hospital exposure visits?




Nobody helped=6

Others (specify)=98

9C-36 Did anyone tell you about the purpose of hospital exposure visits?

Yes (1) No (2)

9C-37

How many people from you community were accompanying you during hospital

exposure visit?

9C-38 Which hospital did you visit?

9C-39 How much time did you spent on exposure visit? (in hrs.)

9C-40

With whom did you interact during hospital exposure visit?

Doctors=1

Nurses=2

Hospital administrative staff=3

RSBY help desk=4

Others (Specify)=98

9C-41

Did you visit different departments/locations inside the hospitals?

Registration desk=1

Patient waiting hall=2

Doctors room=3

X-ray room=4

Drug distribution centre=5

Toilets/Wash room=6


answers ‘Yes’

Were you informed about the following during hospital exposure visits?

9C-42 RSBY Help Desk and its role 1 2 99

9C-43 Package rates 1 2 99

9C-44 Facilities available and entitled during hospital stay 1 2 99


Page | 169

9C-45 Provisions for receiving transportation expenses 1 2 99

9C-46 Did your confidence improve after the hospital exposure visit?

Yes

(1)

No

(2)

DK/CS

(98)

9C-47 Did hospital exposure visit change your perception towards doctors, nurses and

other health workers/staff?

Yes

(1)

No

(2)

9C-48

Did you share your experiences during the hospital exposure visit to anyone in the

community?

Yes

(1)

No

(2)

Section D: Utilization and Satisfaction

9D-1 Screener Check: Did you use your RSBY Smart Card for

medical treatment-related payments for any of your ill and

hospitalized family members during last 12 months:

Yes

(1)

No

(2)

If ‘Yes (1)’ continue with

next questions

If ‘No (2)’ SKIP TO

BLOCK 6

9D-2 Type of aliment/disease for which hospitalization was required?

9D-3 Which RSBY-empanelled hospital did you visit?

9D-4

Why did you go to this particular health facility/hospital?

Codes:

Advised/referred during health camps=1

Advised by Community mobilize/SHG members=2

Self-decided after consulting with community mobilize or other CBO members=3

Suggested by district kiosks=4

Nearest hospital/habitual choice=5

Advised by others in the community/past experience=6

Other reasons:_______________________________________________________

9D-5 How far is the hospital from your house/village? (in kms)

9D-6

How did you reach the RSBY empanelled hospital?

Ambulance=1

Public transport=2

Private transport=3

Other arrangements=4

Others (Specify)=98


Page | 170

9D-7

Was there a RSBY helpdesk/counter/Enquiry at

the hospital?

Yes

(1)

No

(2)

DK/CS

(99) If ‘No (2) or ‘99’ SKIP TO

Q 9D-16

9D-8 Did you find any staff member at the RSBY help desk?

Yes

(1)

No

(2)

9D-9

At the Help-desk, did anybody help you/informed you about how to use your

RSBY card regarding the admission/treatment processes?

Yes

(1)

No

(2)

9D-10

How long did you/the patient have to wait before being attended by the Help-Desk

staff? (In hrs.)

9D-11

Was fingerprint verification done through a fingerprint scanner?

Yes

(1)

No

(2)

DK/CS

(99)

9D-12

Were you informed about the costs of treatment or given an estimate in advance/at

the time of admission?

Yes

(1)

No

(2)

9D-13

Were you informed about the amount that can be charged/paid from your RSBY

Card?

Yes

(1)

No

(2)

9D-14 How was the behavior of staff at RSBY help-desk? Codes: Polite=1, Rude=2

9D-15

Did you face any type of discrimination on RSBY help desk?

Yes

(1)

No

(2)

9D-16 What was the total expenditure (Kharcha) on the hospitalization? (in Rs.)

9D-17

What was the amount paid/cost of treatment supported by the RSBY Card? (in Rs.)

9D-18

On discharge was discharge summary provided to the family?

Yes

(1)

No

(2)

DK/CS

(99)

9D-19

Was the fingerprint verification done at the time of discharge?

Yes

(1)

No

(2)

DK/CS

(99)


Page | 171

9D-20

When did you get the RSBY/Smart card back? Codes:

After swiping at the time of admission=1, On discharge=2 , Next day=3, Two days

later=4, Others (specify)=98

9D-21

Were you told about the amount of money left in the card at the time of discharge?

Yes

(1)

No

(2)

DK/CS

(99)

9D-22

How would you rate the behaviour and overall help/support of the staff dealing

with your admission/use of your RSBY Card

(Please provide your response in a scale of 1-5 where 1=most dissatisfied/very

poor and 5=Very satisfied/excellent)

1 2 3 4 5

9D-23 Were you told the amount of money available in your Card at the time of

discharge?

Yes

(1)

No

(2)

DK/CS

(99)

9D-24

Was any other post-hospitalization expenses covered under RSBY?

No=0

Some medicines provided from hospital=1

Free ambulance/transport to return home=2

Free tests/scan etc on follow-up visits=3

Dressing of wounds etc.=4

Others (specify)=98

9D-25

How would you rate your overall experience in using the RSBY Card at the

hospital?

(Please provide your response in a scale of 1-5 where 1=most dissatisfied/very

poor and 5=Very satisfied/excellent)

1 2 3 4 5

Did you have any complaint/problems regarding the hospitalization and use of RSBY Card?

Instruction: Read out the options

9D-26 Proper use of RSBY card Yes (1) No (2)

9D-27 Lack of adequate cost of treatment/amount covered under RSBY Yes (1) No (2)

9D-28 For that you were by cheated/mislead in somewhat or the other Yes (1) No (2)

SKIP TO Q 287 IF all answers are ‘No (2)’

9D-29 Did you lodge any complaint regarding your grievances?

Yes

(1)

No

(2)

DK/CS

(99)


Page | 172

9D-30

If yes, place of lodging grievances?

Hospital authorities=1

CSO representatives=2

District kiosks=3

Others (specify)=98

9D-31 Are you aware about any measures/action taken on the basis of your grievances?

Yes

(1)

No

(2)

DK/CS

(99)

9D-32

Is there any post hospitalization expenses covered under RSBY?

9D-33

Was the patient prescribed any medicines after the discharge?

Yes

(1)

No

(2)

DK/CS

(99)

9D-34

Were these medicines provided by the hospital?

Yes

(1)

No

(2)

DK/CS

(99)

9D-35 Was the patient prescribed any tests after discharge?

Yes

(1)

No

(2)

DK/CS

(99)

9D-36

Were facilities for those tests organized by hospital free of cost?

Yes

(1)

No

(2)

DK/CS

(99)

9D-37

How significant would you consider the financial support you have received under

RSBY, by being a card-holder?

Codes:

Insignificant/little help/support=1

Somewhat useful/helpful=2

Very useful/helpful=3


Page | 173

BLOCK 10: A. INCOME & LIVELIHOOD

10.1 What is the major income-earning activity of this household? (Formal sector employment/salaried service=1, Business/petty-trade=2, Self-employment=3, Manual/Wage-labour=4, Traditional semi-

skilled trade=5, Remittance/Doles=6, Others (specify)=98)

Do the household/any members of the household own the following?

10.2 Mobile phone Yes (1) No (0) DK/CS (99)

10.3 Motorcycles/scooters Yes (1) No (0) DK/CS (99)

10.4 Cycle Yes (1) No (0) DK/CS (99)

10.5 Radio/transistors/stereo Yes (1) No (0) DK/CS (99)

10.6 Television Yes (1) No (0) DK/CS (99)

10.7 Television with cable/satellite TV connection Yes (1) No (0) DK/CS (99)

10.8 Agricultural land (more than 1 bigha) Yes (1) No (0) DK/CS (99)

10.9

Thinking of all the income-earning individuals in this household,

which category would you say the household falls, taking the total

MONTHLY household income/earning?

>5000 1

5000-7500 2

7500-10000 3

10000-15000 4

15000-30000 5

30000-50000 6

50000 & above 7

DK/CS 99

D. Consumption Expenditure

How much money was spent by your household – on

10.10 Food – during last 7 days

10.11 Electricity/Water Supply – during last 30 days

10.12 Transportation (to school/works) – during last 30 days

10.13 Education of children (including tuition) – during last 30 days

10.14 Medical care/treatment (all diseases/injuries/by staying illness etc.) during last 30 days

10.15 Entertainment (movies/cable rent)/communications(mobile)/travels – during last 30 days

10.16 Domestic durables (TV/bicycle/furniture) – during last 1year


Page | 174

10.17 Home repair/constructions – during last 1year

10.18 Clothing/footwear – during last 1year

10.19 Any other expenses – during last 1year

10.20 TOTAL

E. Living Conditions

10.21 Whether household members sleep in the same room where food is cooked (Yes =1, No =2)

10.22 Type of toilet used by household members (Open defecation =1; Public toilet=2; WC – in premises=3; Flush; Other (specify) =98)

10.23 Main source of drinking water (Piped water=1; Tubewell/handpump=2; Public Tap =3; Tanker=4; Wells=5; Other(specify) =98)

10.24 Type of cooking fuel used (Kerosene =1; Coal/Cow-dung/other wastes =2; LPG=3; Electricity=4; Other (specify) =98)


Page | 175

Annex 4 Qualitative Tools – FGD Guidelines and In-Depth/Key Informant Interviews Outlines

Guidelines for Focus Group Discussion (FGD)

Group Category

Adult Women Group Tribal Male Group Minority Male Group

DISCUSSANT NAME

Date of FGD Signature Start time End time

Locality Details:

Village/Gram Panchayat Block District

Group Members’ Details:

Name

Sex (M/F)

Age

Completed level (class) of education

Occupation

Knows about RSBY (Y/N)


Page | 176

Has RSBY Smart Card (Y/N) 1 2 3 4 5 6 7 8

Consent Statement:

Signatures of Participating Group Members:

1. 2. 3. 4.

5. 6. 7. 8.

1. What do you know about the RSBY Programme?

2. How did you get to know about the programme?

3. How can a family benefit from this programme?

4. Do you consider that RSBY can be helpful for poor families?

5. Have you noticed something different regarding your experience with the health system after RSBY has started?

6. From where did you know about the different features of the RSBY program?

7. Have you or anyone you know in your locality, ever used the RSBY Smart Card for any hospitalization needs? How was the experience?

8. For what type of diseases/illnesses were the RSBY smart Cards used? Did anybody advised you in this regard?

9. Were any problems faced? If yes, how were the problems resolved?

10. Are any SHGs/CBOs/NGOs active in your village/community? If yes, what are the different activities and interventions these organizations support?


Page | 177

11. Are you aware about any activities undertaken by [PARTNER NGO NAME/NAME OF COMMUNITY MOBILIZER] regarding RSBY? If yes, can you describe the different activities which you have seen?

12. Have these activities/programs in any way helped you to know better about RSBY program? In what ways?

13. Did anybody other than [PARTNER NGO NAME/NAME OF COMMUNITY MOBILIZER] such as panchayat members, doctors, ANM/ASHA/anganwadi worker, political leaders ever told you anything about RSBY, or have helped in getting hospitalizations under RSBY? Please describe.

14. What would you expect from a scheme such as RSBY, so that it is most beneficial/useful to a family such as yours?

Thank you for your time and kind cooperation

Guidelines and Discussion Points for In-Depth/Key-Informant Interviews

CATEGORY ‘A’: RSBY FUNCTIONARIES - GOVERNMENT

Interviewer’s Name

Date of Interview Signature Start time End time

Respondent Characteristics: 1 Name 2 Sex Male Female 3 Age 4 Designation/Role 5 Full contact details (with mobile number and email) 6 Educational Qualifications 7 Professional Training (if any) 8 Years in present position

1. What are the main activities that you/your office/department are engaged in the context of promoting better awareness and utilization of RSBY?

2. Who are the other key associates/partners/stakeholders whom you involve in these activities? How do you identify your potential stakeholders?


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3. How important, in your view, is to involve communities and other non-governmental stakeholders such as CBOs/NGOs to improve the functionings and desired impacts of the RSBY programme?

4. Are you aware of any activities or interventions undertaken by PACS in the state/district on RSBY? If so, can you please briefly state them? Which of these activities/interventions you consider to be most appropriate and why? Which of the activities do you consider not effective enough and needs to be modified? Are there any specific areas or issues where you would have liked PACS to concentrate its activities and interventions, in view of any local issues or challenges that you may have faced?

5. How would you describe your interactions with the program personnel of PACS and its partnering organizations regarding different operational and functional aspects of the RSBY program? Do you think that the existing processes of the interactions needs to be revised, or modified? If so, how do you think such changes should happen?

6. Do you have any suggestions, regarding how the overall RSBY program can be strengthened or modified, when you think of the most disadvantaged or vulnerable beneficiary who is in need of the support? Please explain your reasons.



CATEGORY ‘B’: PACS/PARTNER CBO’s FUNCTIONARIES

Interviewer’s Name

Date of Interview Signature Start time End time

Respondent Characteristics: 1 Name 2 Sex Male Female 3 Age 4 Affiliation/Organization 5 Designation/Role 6 Full contact details (with mobile number and email) 7 Educational Qualifications 8 Professional Training 9 Years in present Organization

1. What are the main activities that your organization (PACS/partner CSO, e.g. CINI, SHS) is engaged in the context of promoting better awareness and utilization of RSBY?


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2. How would you describe your role in these activities? How are you involved?

3. Who are the other key associates/partners/stakeholders whom you involve in these activities? How do you identify your potential stakeholders?

4. How would you describe your interactions with the government (including the respective nodal agency/officer, and other key government officials in the state/district) functionaries/institutions related to the operation of RSBY? Do you think that the existing processes of the interactions needs to be revised, or modified? If so, how do you think such changes should happen?

5. How would you describe your interactions with or experience about other supporting institutions/individuals related to the operation of RSBY (TPA, insurance agency, district kiosks/helplines etc.)? Do you think that the existing processes of the interactions, or the current system of operations needs to be revised, or modified? If so, how do you think such changes should happen?

6. ONLY FOR NON-PACS RESPONDENTS (CSO PARTNERS): How do you consider the help and support you have received from PACS and its representatives? Please also consider how useful were the different orientations, capacity-building events (e.g. training, workshops) that were organized, in helping you to conduct your regular activities in a better way. Do you have any suggestions how these interactions with PACS can be further strengthened?

7. Do you have practical experience of working among the communities where the PACS interventions are in place? If so, how would you describe the communities’ acceptance of or reaction to the major intervention strategies or components that were introduced?

8. What do you think were/are the most successful strategies/interventions that were introduced? Why do you think so?

9. Which strategies/interventions/program components do you think were not as successful as it was initially thought of? What were the barriers that you think were responsible for such outcomes/results?

10. Thinking of a time when the PACS programme no longer continues, do you think that the existing interventions/activities/strategies ongoing in the community are sustainable in the long-run? If yes, who or what processes or institutions do you think are critical to make the interventions self-sustaining? If not, which are the main challenges that you can think of?

11. Do you have any suggestions, regarding how the overall RSBY program can be strengthened or modified, when you think of the most disadvantaged or vulnerable beneficiary who is in need of the support? Please explain your reasons.


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CATEGORY ‘C’: COMMUNITY-LEVEL STAKEHOLDERS

Interviewer’s Name Date of Interview Signature Start time End time

Respondent Characteristics: 1 Name 2 Sex Male Female 3 Age 4 Affiliation/Organization/GP 5 Designation/Role 6 Full contact details (with mobile number and email) 7 Educational Qualifications 8 Professional Training (if any) 9 Years in present Organization OR Years in office (for PRI members)

COMMON SECTION 15. How would you describe the progress and achievements in improving enrolment under the RSBY programme in your village/community? Do you consider that the achievements or performance in terms of enrolment, have improved recently? If yes, what do you think were the main reasons for such positive improvements? If not, what were the challenges that prevented better achievement or performances?

16. What is your opinion regarding the functioning of the RSBY programme, in general, in your village/community? Are there any major issues which you think requires to be addressed in this regard? ASK ONLY TO PRI MEMBERS

1. Are you aware of any organizations/individuals/groups working on improving the functioning and impacts of the RSBY programme in your village/community? If yes, please name them. IF PACS/PARTNER CBOs ARE NOT MENTIONED, TRY TO PROBE WITH SPECIFIC NAMES (Are you aware of any activities by [PACS/PARTNER CBOs NAME])

2. Can you please tell me something more about your opinion about the different activities undertaken by the organization(s)? How important or effective do you think are the different activities to improve performance of RSBY program, in view of the local needs and problems? Do you have any suggestions on how the activities and/or interventions being provided by the organization could be modified?

3. Did you ever participate in any programmes/events that involved elected people’s representatives or other government functionaries, where issues related to RSBY were discussed? If yes, can you please describe some of the issues that were discussed? Who provided/organized


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the programmes? How useful do you consider were the events/programmes in improving your own understanding about the RSBY programme and your roles and responsibilities in improving its performance?

ASK OTHER RESPONDENTS

1. Are you involved in any activities (awareness generation, counselling, facilitating enrolment etc) in your village/community regarding RSBY programme? If yes, what are the main activities in which you are involved in?

2. Who are the other key associates/partners/stakeholders whom you involve in these activities? Is there any way through which you prioritize your activities (for e.g. focusing more on local challenges, identifying more vulnerable families etc)? Please describe.

3. How would you describe your interactions with the local government officials and the PRI members related to the operation of RSBY? How would you describe your interactions with the [NAME OF PACS PARTNERING NGO/CBO] and its representatives?

4. ONLY FOR NON-PACS RESPONDENTS (CSO PARTNERS): How do you consider the help and support you have received from PACS and its representatives? Please also consider how useful were the different orientations, capacity-building events (e.g. training, workshops) that were organized, in helping you to conduct your regular activities in a better way. Do you have any suggestions how these interactions with PACS can be further strengthened?

5. How would you describe the communities’ acceptance of or reaction to the major intervention strategies or activities that you are involved in regarding the RSBY programme? Do you have any suggestions on how these activities could be modified according to the local needs and challenges?

6. What do you think were/are the most successful strategies/interventions that were introduced? Why do you think so? Which strategies/interventions/program components do you think were not successful? What were the barriers that you think were responsible for such outcomes/results?


Documents

Impact Assessment Study on Rasthtriya Swasthya Bima …...Impact Assessment Study on Rasthtriya Swasthya Bima Yojana (RSBY) Study Report Submitted to Poorest Area Civil Society (PACS),