Course Guide Training Course on RSBY for Civil Society Organisations

Training Course on

For Civil Society OrganizationsRashtRiya swasthya Bima yojana

Course Guide

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As we hear raving reviews of the Rashtriya Swasthya Bima Yojana (RSBY) for its innovative design, and technology-powered seamless interface, symbolized by the smart card, we continue to remind ourselves of the massive challenge of reaching out to the beneficiaries and empowering them with an awareness on how to use it.

This is what has formed a vibrant and flourishing partnership with civil society and development organizations – united by a collective

ambition of making the scheme work for some of the poorest and socially excluded communities.

I have said this before and wish to reiterate that RSBY is the first business model for social sector in our country. It is a scheme that engages private sector with a promise that business can also be done by working on a scheme meant for communities at the bottom of the pyramid.

This is also an important moment in our journey, where we realize the need for a vigilant and informed civil society that is informed about the technical aspects and process of the scheme. This they would then blend with their intensive experience of working with communities, while addressing numerous barriers and risks that can impact access and usage.

The Poorest Areas Civil Society (PACS) works with some of the most socially excluded groups – Dalits, Tribals, Muslims, Women and Persons with Disability – through two hundred civil society organizations. As a community driven program that works with state schemes, PACS has been working on communications and community engagements under RSBY to enhance the access and utilization of the scheme by the marginalized communities.

I would like to place on record how valuable our partnership with PACS has been.

One of it’s key strength being a large network of civil society organization, PACS has embarked on a campaign for building capacity of these organization and their frontline staff. This is intended to be an exhaustive process of trainings that is being rolled out as we speak and would be followed up with refreshers.

The training manual and handbook forms fundamental tools for building organizational and individual capacities for better and effective implementation of RSBY.

I am happy that these resources will be available publically for wider civil society and institutions that wish to translate this scheme into a living experience that supports millions of poor families.

Anil Swarup, Director General Labor Welfare,

Ministry of Labor & Employment, Government of India

Foreword

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Contents

Foreword iiiAcknowledgement vii

Module/Session Guide 1

Schedule & Content flow for RSBY training The schedule and flow of contents covered in the course 3

Day One 9Session # 1 Introduction to Course 9

Session # 2 PACS and RSBY 13

Session # 3 Genesis and History of RSBY 16

Session # 4 The RSBY Scheme: Key Features and Provisions of RSBY 19

Session # 5 Pre Enrollment Phase of RSBY 28

Session # 6 Reflections 34

Day Two 37Session # 1 Recap 37

Session # 2 Enrollment Phase 38

Session # 3 Post Enrollment Phase – Hospitalization 44

Session # 4 Linkage Building and Stakeholder Management 50

Session # 5 Reflections 53

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Day Three 55Session # 1 Recap 55

Session # 2 Grievance Redressal Mechanisms 57

Session # 3 Role of CSOs in Grievance Redressal 62

Session # 4 Transparency and Accountability: Role of CSOs 66

Session # 5 Action Planning and Validation 70

Annexure 85Case Study for Day One: Session # 3 75

Day One: Session # 4 Statement for Card Matching Game - Mix and Match Jumbled up Card Game on RSBY 76

Optional Case Study for Day 3 Session # 2 78

Pre and Post Evaluation Test 80

Some illustrations from the field 86

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Acknowledgement

Sources:wRSBY, Website (www.rsby.gov.in)

wRSBY Connect, issue no.6, July, Produced jointly by Ministry of Labor and Employment (MoLE), Government of India and Deutsche Gesellschaft für Internationale Zusammenarbeit (GIZ) GmbH as part of Indo-German Social Security Program (IGSSP).

wTraining Module on “Financial Procedures related to Key Schemes/Areas under NRHM”, June, 2011, Ministry of Health and Family Welfare, Government of India Hospital Manual for RSBY (Ref – July 2012)

wHospital Manual for RSBY (Ref – July 2012)

Session Guide 1

Overview This training course on Rashtriya Swasthya Bima Yojana (RSBY) is designed for participants from Civil Society Organizations (CSOs).

The key objectives of this training course are:

wDeveloping shared understanding and sensitization of the participants on RSBY perspective, processes and steps involved in the scheme implementation of the scheme and role of CSOs in RSBY.

wEnhancing participant’s knowledge and skills to orient cadre of facilitators at local level, both in rural and urban context.

wBuilding a cadre of facilitators who will facilitate effective implementation of RSBY at community level.

Course Structure: The course content has been organized in eight broad sections, each helping participants to develop their understanding, sensitization and skills in implementation of RSBY. These sections include:

1. PACS and RSBY - provides an opportunity to understand about PACS programme objectives, perspective and strategy and role of PACS programme and partners in RSBY,

2. RSBY as a Scheme - highlights the genesis and history of RSBY, major provisions of scheme, key features, phases of implementation - pre, during and post, operational mechanism of RSBY and role of CSOs in effective implementation of RSBY,

3. Pre-enrollment phase - enumerates the key activities in pre-enrollment phase, particularly beneficiary identification and role of CSO in pre enrollment phase.

4. Enrollment phase - discusses the process of enrollment, documents required for enrollment, responsible authorities for enrollment, addressing issues related to enrollment, mechanism of enrollment for left out families and role of CSO.

Session Guide

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Course Guide on Rashtriya Swasthya Bima Yojana for Civil Society Organizations2

5. Post enrollment identifies - listing of issues, identification of good practices and challenges in post enrollment phase and role of CSOs,

6. Linkage building focuses on implementation structure, stakeholder mapping and developing stakeholder participation strategy for effective implementation of RSBY at various levels.

7. Grievance Redressal explains existing structure, mechanisms for grievances redressal, role of CSOs and identification of issues for grievance redressal,

8. Transparency and Accountability identifies existing monitoring and evaluation process in RSBY and building up community based monitoring system.

These content areas have been organized into sessions for maintaining day strcture & flow and pace of learning. The sessions plan below have been organized into a three day structure and session. The day and session wise flow of content is as under:

Schedule & Content flow for RSBY training 3

Schedule & Content flow for RSBY training

The schedule and flow of contents covered in the course

Day 0ne

Time Session title and key contents Method/activities

60 mins Session 1

Introduction to course

w Introduction & ice breaking

w Pre test, expectations levelling and objective setting

w Sharing of course structure/schedule

w Large group plenary

w Exercises (moving the clock)

w Pre-training test

w Presentation by power point or charts

45 mins Session 2

PACS and RSBY

w About PACS project and RSBY in PACS Frame work

w Need for CSOs in RSBY

w Presentation

w Mind mapping exercise- using card writing and sorting

90 mins Session 3

Genesis and History of RSBY

w Need for RSBY in development context

w Genesis and history

w Overview of the schemes

w Current status of RSBY in India

w Case analysis/situation analysis exercise

w Presentation on overview

w Presentation on RSBY Factsheet

30 mins Session 4

60 mins RSBY – as a Scheme Key features and provisions of RSBY

w Major provisions of Scheme/Key features

w Phases of implementation- Pre, During and Post

w Operational mechanism of RSBY

w Implementation Structure

w Film show and discussions (RSBY film)

w Presentation on RSBY provisions and features

w Card matching game/Mix & Match (jumbled up card game)

w Flow diagram/Flex

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60 mins Session 5

Pre enrollment Phase

w Activities in Pre enrollment Phase

w Issues, Challenges and Role of CSO in Pre enrollment

w Film show and discussions (RSBY film on pre preparation)

w Small group discussion and presentation on role of CSOs

w Presentation on pre enrollment preparations

Day Two

Time Session title and key contents Method

Session 1 Open session

10.00-11.00 w Process of Enrollment

w Essentials for Enrollment:

• Documents required for enrollment

• Responsible authority for enrollment

• Addressing issues related to enrollment

• Mechanism to enroll left out families

w Film show and discussions (RSBY film on enrollment)

w Flow diagram/Flex

w Presentation on enrollment process

11.00-11.15 Tea break

11.15-12.00 w Role of CSO in enrollment phase

w Group discussion

w Presentation

12.00-1.30 w Hospitalization: steps and processes

w Identification of issues and Gaps„ identification in post enrolment phase and role of CSOs in addressing those gaps and issues (strategy development)

w Film show

w Small group discussions (card writing and sorting)

w Small group discussion and presentation on strategy development

1.30-2.30 Lunch break

2.30-5.30 Linkage building and Stakeholder management:

w Implementation structure of RSBY

w Stakeholder mapping and stakeholder participation strategy

w Presentation

w Small group discussions and presentation stakeholder mapping Strategy development

w Worksheet and Open house

4.00-4.15 Tea break

5.30-6.00 Reflections and question answers on the days sessions and learning

w Open session

Schedule & Content flow for RSBY training 5

Day Three

Time Session title and key contents Method

9.30-10.00 Recap and reflections on day one’s proceedings

w Open session

10.00-11.00 Grievance Redressal

w Types and nature of grievances

w Existing structure, mechanisms and parties

w Case analysis

w Mind mapping exercise in buzz group and presentation on grievance redressal

11.00-11.15 Tea break

11.15-1.30 Role of CSOs:

w Role of CSOs in identification of issues for grievance dedressal

w Strategy development

w Small group discussions and presentation

w Presentation on strategy development

1.30-2.30 Lunch break

2.30-4.00 Transparency and Accountability: Role of CSOs

w Existing monitoring and evaluation process in RSBY

w Tools for social accountability- SA, RTI, citizen report card etc.,

w Building up community based monitoring system

w Presentation

w Films on tools

w Small group discussions and presentation

4.00-4.15 Tea break

4.15-5.30 w Action planning

w Post training test and evaluation

w Wrap-up and vote of thanks

w Worksheets for action planning

w Questionnaire

w Large group plenary

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How to Use the Guide

This session guide is organized into days and sessions, which build upon each other in terms of content flow and is sequenced in a logical presentation order for maintaining pace and flow of learning. Each session is designed and explained in the following components:

Title:

Identifies the main topic of the session

Learner’s Objectives:

Describes what the participant will be able to do by the end of the session to demonstrate increased knowledge, improved skills, or attitudinal change.

Time:

Indicates the approximate amount of time the session will take.

Key contents and sub topics:

Main topic and sub topic - provides a breakdown of the session into sub topics, including the time allocation for each sub-topic.

Methods:

Identifies the key methods for the sessions and elaborates the key activities to be facilitated during the session.

Process - steps and activities:

Provide specific instructions to the trainer about how to conduct the session and flow of the content, activities and processes.

7How to use the Guide

Materials Required

List all the materials that will be required for facilitation of the session.

Reading and reference material:

Indicate all the handouts that will be required for the sessions. Handouts are compiled separately as course material.

Trainer’s notes for facilitation:

Identifies the key points to remember during the facilitation of the session and tips for facilitator of the session.

Notes:

They may include expected or possible responses to a question, definitions, or other key points that the trainer should try to elicit during the session.

Course material:

A separate document is produced which contains session handouts for each session. At the end, a set of questions have been produced, which is segregated into different sections.

Illustrations:

A few cases and examples have been provided in the annexure and the trainer can use these examples during the different sessions.

Day One: Session # 1Introduction to Course 9

Learner’s objectiveAt the end of the session participants will be able to:

wRelate to the different content areas that will be covered during the course

wArticulate the course objectives, processes and methodologies

wFollow training norms agreed upon collectively

wGet introduced to other participants of the course

Time 60 min

Key contents and sub topics w Introductions of participants

wPre test, expectations mapping, levelling and objective setting

wSharing of course structure/schedule and setting ground rules

Method(s) wLarge group plenary

wExercises (moving the clock)

w Ice breaking excercises

wPre-training test

wExpectations mapping

Material required wHandout 1 training form handout book on course objectives, structure

and ground rules

wExpectation chart/cards, program schedule

wRSBY, meta cards, charts, paper and markers

Session Plans for RSBY training

Introduction to Course

Day One: Session # 1

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10 Course Guide on Rashtriya Swasthya Bima Yojana for Civil Society Organizations

Process-steps and activitiesw Introduction to the training and setting the context.

wTo make the introduction session more interactive, facilitate introduction process using ice breaker/games as provided at the end of the session.

Introduction process-Option 1: Moving the clock wAsk participants to divide into two groups and stand in two circles - inner

circle and outer circle.

wMembers of inner circle and outer circle should face each other.

wAsk participants to introduce themselves to the person they are facing.

wAllocate two to three minutes for introduction. Once introduction with that person is over, ask participants to move clock-wise and interact with the next person. This process will continue until one participant has introduced himself/herself to a minimum of five other participants.

wDepending on the time, the whole cycle of introduction can be finished.

wOnce the introduction session is over, conduct pre-training test of the participants.

Option 2: Introduction in Dyads wForm dyads, ask to choose new person from the group.

wGive key questions like name, experience etc., to discuss with each other.

wGive some time for interaction.

wAsk the dyad to introduce one - another to large group or two dyads can share with each other. Further, this process can be replicated until the all dyads interact with each other.

wOnce the introduction session is over, conduct pre-training test of the participants.

Option 3: Paint your picture exercisew Introduce the exercise by explaining that all participants will make their

symbolic pictures depicting their strengths and likings i.e., something about themselves that they would like to be recognized by others.

wAsk participants not to write their names but create a symbol or picture by which others can identify their picture.

wDistribute card sheet or A 4 size plain paper and sketch pen or crayon for making picture.

wAsk participants to share their pictures with large groups highlighting their strengths and likings.

wPaste pictures on the walls.

wConsolidate introduction session.

wOnce introduction session is over, conduct pre-training test of the participants.

Day One: Session # 1Introduction to Course 11

Expectations levelling and sharing of course structure and objectives

wAsk participants to write one or two key expectations on the card.

wOrganize the expectations around the perspective of RSBY, key features of the scheme, pre, during and post enrollment phase, grievances, stakeholder participation and others.

wShare the consolidated expectations collected before training and from expectation mapping.

wAfter expectation mapping and consolidation, establish course objectives and present course structure using power point presentation or flip chart, referring to the groups of expectation cards.

w Formulate and validate ground rules.

wConstitute learning/monitoring/steering groups based on the purpose of this group. One of the purposes can be to facilitate the reflection/recap session in the evening and morning.

Reading and reference materialwHandouts 1 & 2 of the Handout Manual.

wCourse structure, objectives and schedule.

wBackground note on PACS RSBY training strategy.

Trainer’s note-tips for facilitationwEnsure timely registration of participants.

wSet the stage by introducing the need & context of the training and expectation levelling to course contents.

wUse ice breakers for introduction of the group. For introduction process, brief participants to mention following details when they introduce themselves to fellow participants:

lName –

l Place of residence –

l About the organization & designation

lWork experience and their key achievements/contribution which they feel proud of

lOne thing that people say is a quality in them

wTo grow a habit of collection of good practices from the community, we may also introduce an envelope with details about each participant on a display board below their picture and give instructions to each participant to write good things about other participants and put chits in their envelopes at the end of the training program. This activity helps a lot in encouragement and confidence building of partcipants.

w While establishing training objectives, refer to the key points given below.

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Points for summing up1.The course content has been broadly organized in eight sections, which

are further divided into sessions and each aims at helping participants to develop their understanding and skills in order to further improve the implementation of RSBY. These sections include:

wPACS and RSBY

wRSBY – as a scheme

wPre enrollment phase

wEnrollment phase

wPost enrollment phase

wLinkage building

2. The course objective is to build a cadre of facilitators who will facilitate effective implementation of RSBY at community level.

3. Developing shared understanding and sensitization of course participants on RSBY perspective, processes and steps involved in scheme implementation and role of CSOs in effective implementation of RSBY

Ice breaker excercises- (trainer to choose any one)

wMoving the clock

w Introduction in Dyads

wPaint your picture

Day One: Session # 2PACS and RSBY 13

Learner’s objective(s) At the end of the session, participants will be able to:

wRelate to the need for intervention towards effective implementation of RSBY in PACS project areas

wArticulate key processes of RSBY in program framework of PACS

Time45 minutes

Key contents and sub topics wAbout PACS programme

wRSBY in PACS programme frame work

Method(s)wMind mapping exercise - using card writing and sorting

wPresentation

Material requiredwHandout 2 from the Handout Manual, that briefs on RSBY in PACS

framework and role of CSOs in RSBY

wSmall cards, charts, papers and markers

Process- steps and activitiesActivity 1: Introduce the context

wGive an overview of the PACS program and situate the need for intervening in RSBY in PACS context using chart-papers or a white board presentation.

Activity 2: Mind mapping

Ask each participant to write the following on two separate cards.

1.Key features of RSBY

2.Possible interventions

PACS and RSBY


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wStick the cards on wall/panel board and work with participants to cluster the issues into common themes/categories for further discussion. The clustering can be done on the basis of scheme implementation cycle of RSBY or intervention strategies (mobilization, capacity building, advocacy, transparency and accountability etc.).

wAfter clustering of cards, consolidate the key points emerging from the group and supplement the points by input on the possibilities of working on RSBY as part of PACS project using power point presentation.

wShare the journey of PACS partnership with RSBY so far.

wSummarize the session and provide space for question answers and observations of the participants.

w Distribute handout # 2 for the session.

Reading and reference materialwDetails of PACS program.

wSuggested intervention under PACS program towards effective implementation of RSBY.

wRefer to session handout # 2 and points for summing up and power point presentations.

Trainer’s note: tips for facilitation wPrior to session, build strong understanding on PACS program and its

mandate.

wDiscuss on how RSBY is linked with rights and entitlements of the marginalized and fits in broader framework of PACS project.

wWhile clustering of cards, there might be some issues which do not fit in the consolidation framework. Stick these cards separately and brief the participants that these are somehow different issues which do not fit in with the given framework of training. Especially mention that these issues are important and can be discussed individually during the break or informal interactions.

Day One: Session # 2PACS and RSBY 15

Points for summing up

About PACS Project

wPACS is an initiative of UK Government’s Department for International Development (DFID) in partnership with CSOs.

w It enables socially excluded communities to claim their rights and entitlements more effectively and thus, aims at reducing the welfare gap between the socially excluded population and the general population.

wPACS program (2009-2016) in India focuses on areas of education, health, nutrition and livelihoods and aims to support CSOs in promoting inclusive local, district and state policies, programs and institutions.

w It is being implemented in 90 districts across seven states.

RSBY in PACS Framework

wAccessibility to quality health services by socially excluded groups is one of the key thematic focuses of PACS.

wRSBY program presents a unique opportunity to exhibit demonstrable ways of improving the uptake of entitlements.

w Interventions for RSBY in PACS are focused around:

l Awareness and knowledge dissemination about the scheme.

l Insuring the success of the scheme by collaborating with government authorities and stake holders.

l Identifying relevant implementation gaps in the scheme and taking them up with the concerned authority for its resolution.

l Involving and training CSOs.

Need for CSOs’ Participation in RSBY

wKnowledge about the scheme at community level is very low.

wLow Knowledge has affected the reach, implementation and success of the scheme in local communities.

w Improving the knowledge and understanding of CSOs on the RSBY will help them to build awareness and action at the community level.

w Involvement of CSOs will strengthen the implementation and success at the local level.



wRelate to the need of RSBY in the context of health security of the poor and marginalized population.

wArticulate the history and emergence process of RSBY as a successful health insurance scheme.

wDescribe the need and importance of RSBY.

Time90 minutes

Key contents and sub topics wNeed for RSBY in development context.

wGenesis and history.

wOverview of the schemes.

wCurrent status of RSBY in India and in the respective state.

Method(s)wCase and situation analysis.

wSmall group discussion.

wPresentation.

Material requiredwSession handout 3 on genesis, history and overview of RSBY.

wCase studies as mentioned in illustraion on pg 90.

wFlip charts, markers etc.

Process- steps and activities

Activity 1: Case study & genesis of RSBY

w Introduce the key contents and sub topic.

wDivide the large group into four or five small groups (four-seven members in each small group) for group discussion.

wPresent the case of Ram Bhargawa’s story from Annexure pg 90.

Genesis and History of RSBY


Day One: Session # 3Genesis and History of RSBY 17

wDistribute the copy of the case to all participants.

wAsk all groups to discuss the following questions:

Q1. Identify the factors responsible for the present condition of Ram Bhargawa?

Q2. How can Ram Bhargawa come out of this situation?

wAllocate 20 minutes time for group work.

wAsk participants to record key points on the flip chart or cards and present their findings to a large group by flip chart or cards.

wStick the flip chart or cards on wall/panel board and work with participants to cluster issues into common themes for further discussion on hindering factors and possible solutions linking with access to benefits of RSBY.

wBuild on the points emerging from the group and supplement by input on the need, genesis and overview of RSBY using Session Handout 3.

Activity 2: Current Status of RSBY

wPresent status chart of RSBY in India and state specific data on RSBY. Facilitator should prepare this information in advance.

wSummarize the session and provide space for question answers and observations of the participants

wDistribute Session Handout 3.

Reading and reference materialwGenesis and history of RSBY-session handout 3.

wRefer to points for summing up and statistical details of RSBY that should be available online.

Trainer’s note-tips for facilitation wFor small group discussions divide the group into five sub groups. For

group formation, the trainer can use energizer or counting exercises. Group formation ensures that groups are adequately distributed with regard to experience, number of group members and gender balance.

wAfter group discussion, ask groups to make a presentation and after presentation, encourage other group members to seek clarification. After group presentation, acknowledge participants efforts.

wAfter all presentations, consolidate key learnings. While consolidating, focus on the points mentioned below:

lNeed of RSBY

lHow RSBY ensures right to healthy leaving for poor and marginalized.

lOpportunity for accessing medical facilities not only from Government set up but also from private institutions.

wSince this session focuses on technical inputs and statistical presentation, so trainer needs to be adequately prepared with their notes. For this, refer session handout # 3, course guide and RSBY website for state specific data.

wDistribute session handout prior to consolidation as this will enable participants to refer to the facts and link consolidation points with the given information.

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Points for summing up and power point presentations

Need for RSBY in developmental context

wVulnerability of poor to health shocks through frequent illnesses and occupational health hazards.

wDeprivation from availing timely hospitalization benefits due to poverty coupled with inadequate savings, apprehension of high attendance cost, loss of wages and inaccessibility of health facilities.

Genesis and history

wThe scheme was launched by Ministry of Labor and Employment, Government of India from 1st April 2008.

wRSBY model has been built upon strengthening weak areas of other models of insurance scheme.

wPrevious schemes, funded by Central and State Government, have been handicapped due to lack of sustained efforts in implementation and poor policy design.

wTo counter this, RSBY uses an innovative model that involves multi stakeholders’ participation eliminating all the above bottlenecks.

An overview

wRSBY is a government-run health insurance scheme for the Indian poor.

w It provides cashless insurance for hospitalization in public as well private hospitals.

w It covers up to Rs.30,000 of medical expenses per family per year.

wPre-existing illnesses are covered from day one, for head of the household, spouse and up to three dependent children or parents

Current status of RSBY in India (as on 15 March 2013)

The scheme has been implemented in 458 districts across 30 States and Union Territories in India; the present status of RSBY is as follows:

l 32 million BPL families are currently enrolled in RSBY.

l An estimated 152 million persons are a part of BPL-families-with-a-RSBY-card.

l Around 3.7 million hospitalization cases from BPL families have benefited since the inception of the scheme in 2008.

Day One: Session # 4The RSBY Scheme: Key Features and Provisions of RSBY 19

Learner’s objective(s) At the end of the session participants will be able to:

w Identify key provisions of RSBY.

wArticulate implementation phases and operational mechanisms.

wDescribe the implementation structure of RSBY.

Time90 minutes

Key contents and sub topics wMajor provisions of scheme and key features.

wPhases of implementation- pre, during and post enrollment.

wOperational mechanism of RSBY.

w Implementation structure.

Method(s)wFilm show and discussions (RSBY film- Haro Jan Ki Peer).

wPresentation on RSBY provisions and features.

wCard matching game/mix & match (jumbled up card game).

wFlow chart diagram presentation (power-point).

wLearning game.

Material requiredwFilm and mix and match cards.

wPower point presentation on provisions and operational mechanisms of RSBY.

wFlex/flow chart diagram of implementation structure.

wFlip charts, markers, television, CD/DVD player.

wA packet of wrapped sweets.

The RSBY Scheme: Key Features and Provisions of RSBY


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Process- steps and activitiesActivity 1: Learning game

wDivide the participants in three small groups. Ask each group to elect or select their leaders and deputy leader.

wPlace an adequate number (equivalent or more than the total number of participants) of chocolates/toffees in the front of the room. The task that each leader and deputy team leader will have is to collect the maximum number of chocolates for their team. The team who gets the maximum number of chocolates will be declared the winner.

wNow place one team closer to the chocolates, the second team in the middle and the third team at the far end (far away from the chocolates). Explain that when the facilitator says “run”, only then they should run and collect the chocolates.

wFacilitate the first round of the game and declare the result. It is most likely the team that was the nearest the chocolates will get more and the team that was the farthest from the chocolates will get less, or no chocolates/toffees.

wNow facilitate round two, explaining the changes in the rules. For this round, anybody can go and collect the chocolates but no team can pick more than eight chocolates. If they pick up extra, they will have to put it back. Facilitate the round and declare the results.

wNow ask the participants to share their experiences and reflections on the game by asking the following questions:

lWhat happened in the game in round one and two?

lWho grappled the maximum resources?

lHow was the behavior of the different teams?

lWhat was the difference between the first and the second round?

wRecord the key points emerging from the discussion on the white board or charts. Explain the concept of equality and equity relating with access and control over resources. Relate with government schemes, rights and entitlements of the poor as given by the government, but ask the question - do poor people have access?

wSituate these experiences with implementation of RSBY and set the pace for understanding RSBY in detail.

Activity 2: Film Screening

wPlay the RSBY film (Haro Jan Ki peer)

wVideo film of 20 minutes duration after introducing the theme.

wAsk participants to observe the key aspects of RSBY in the film and how it is useful for the people living below poverty line (BPL).

wEncourage players to record key points on their cards or in their note pads. Stick the cards on wall/panel board or write key observations/reflections of the participants on the board or chart.

wRelate the cases discussed in the film with Rambhuan’s story.

wSummarize the key points using the pre, during and post enrollment phases of the RSBY.

wBuild on the points emerging from the group and supplement by input on the key provisions and phase of implementation of RSBY.


Activity 3: Card matching game

wExplain to the participants that the group will now play a mix and match jumbled up card game. Each participant will get a card. On each card, a part of some message will be written, while the other part of the message will be written on some other card. The participants will have to find out who in the group has the matching pair of message. If both cards match then the statement is complete.

wDistribute the cards among the participants and ask the group to match the cards. Ask the group to be in circles with their cards and share their statement with the large group.

l Each participant will have a card on which an incomplete sentence is written.

l Ask participants to search for their co partner who has a similar incomplete sentence.

lOnce participants have completed their search, ask them to stand in pairs with their partner.

lNow ask each pair to read their sentence aloud one by one and also explain the same.

l If there is any missing information, ask other participants to add it. If still there is a gap, the trainer should explain the provision.

l Repeat this process with each pair.

Once this is completed, ask participants to cluster their statements related to pre enrollment, during enrollment, hospitalization, grievances redressal etc.

wAsk each cluster to present or share their statements with the large group. Help participants if there is a mismatch in the statement. While presenting the statements, follow the implementation cycle of the scheme.

wSupplement the discussion on operational mechanisms of RSBY with the use of Session Handout.

Activity 4: Presentation

wPresent flex or flow chart on the implementation structure of RSBY, both at the national and at the state level, district level and village level. For this, refer to the flow diagrams given in page 25, 26, 27.

wSummarize the session by highlighting key provisions, phases and implementation mechanism.

wDistribute handouts of the implementation structure after the session.

Reading and reference materialwKey features and operational mechanism of RSBY- session handout # 4

wRefer to flow charts on implementation structure of RSBY on page 25, 26, 27 and points for summing up.

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Trainer’s note-tips for facilitation wFor the learning game, while forming teams develop competitive feelings

among the groups/teams. Explain the rules of the game properly. Placement of the teams is crucial, therefore, place one team close to the chocolates, the second team in the middle and the third team at the far end (i.e., far away from the chocolates). There should be more hurdles on the way of the team placed far from the chocolates.

wThe debriefing of the game should focus on the behaviors of the teams and access to resources by different teams. Relate these experiences with the concept of equality and equity and with access and control over resources. Relate with government schemes, rights and entitlements given by the government to the poor But do poor people have access? Situate these experiences with implementation of RSBY and set the pace for understanding RSBY in detail.

wThe film screening session “Haro Jan Ki Peer” is used for discussion and facilitation. This film provides exclusive technical information on key features and provisions of the RSBY scheme. It is basically used to sensitize participants and make them aware of the subject. This will provide an opportunity for the participants to understand the process related to the use of RSBY biometric enabled smart card to access health benefits.

wTrainer needs to follow points given below while using the film as a teaching aid:

l Brief the participants regarding the objective behind screening the film.

lGive brief introduction of the film. Share with participants that after film screening there would be a detailed discussion on the issues highlighted in the film.

l After film screening is complete, put up the following points for discussion:

(a) First reaction to/observation on the film.

(b) How RSBY was helpful to the beneficiaries.

(c) What process and benefits were explained to rickshaw pullers, RSBY card holders from a different state?

(d) What processes was adopted for getting benefits of RSBY card?

(e) How is it different from Rambhuwan’s case?

wRegarding the jumbled up card game, trainer will brief participants that this activity would be helpful in consolidating the learning derived from the film.

wFor a list of jumbled sentences and for card preparation, see Annexures section page 91 attached at the end of the module.


Points for summing upThe RSBY is an excellent attempt at providing social protection in health for the vulnerable and poor in India. Key features of the scheme are:

Empowering the Beneficiary – RSBY provides the participating BPL household with freedom of choice between public and private hospitals.

Business Model for all Stakeholders – The scheme has been designed as a business model for a social sector scheme with incentives built for each stakeholder.

Insurers

wThe insurer is paid premium for each household enrolled for RSBY.

Hospitals

wHospitals have the incentive to provide treatment to a large number of beneficiaries, as it is paid per beneficiary treated.

Intermediaries

wThe included intermediaries such as NGOs and MFIs are paid for the services they render in reaching out to the beneficiaries.

Government

wBy paying only a maximum sum up to Rs. 750 per family per year, the Government is able to provide access to quality healthcare to the BPL population.

Information Technology (IT) Intensive- Every beneficiary family is issued a biometric enabled smart card containing their fingerprints and photographs

Safe and Foolproof – The use of the smart card and a key management system makes this scheme safe and foolproof.

Portability – Even though enrolled in a particular district, the beneficiary will be able to use his/her smart card in any RSBY empanelled hospital across India.

Cashless and Paperless Transactions – A beneficiary gets cashless benefit in any of the empanelled hospitals.

Robust Monitoring and Evaluation- An elaborate backend data management system is being put in place which can track any transaction across India and provide periodic analytical reports.

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Phases of Implementation:

wPre enrollment- BPL card holders are identified.

wEnrollment-family detail authentication and preparation of smart card.

wPost enrollment (hospitalization)- smart card verification and cost deduction for hospitalization.

Operational mechanism of RSBY

The majority of the financing, about 75 percent, is provided by the Government of India, while the remainder is paid by the respective state government.

wSelection of Insurance Company- through competitive public bidding.

wPreparation of BPL Data- State Government prepares the BPL data.

wEnrollment of Beneficiaries- list of eligible BPL households is provided to the insurer and an enrollment schedule for each village, along with dates, is prepared by the insurance company for enrollment.

wEmpanellment of Healthcare Providers-both public and private healthcare providers are empanelled in the project.

wUtilization of Services by Beneficiaries-after reaching the hospital, the beneficiary visits the RSBY help desk at the hospital where his identity is verified by his photograph and fingerprints after which he is provided with the benefits.

wClaim Settlement-after rendering the service to the patient, the hospitals need to send an electronic report to the insurer/Third Party Administrator.

wPortability of Smart Card- the beneficiary shall be able to use health service facilities in any RSBY empanelled hospital across India.

wMonitoring and Evaluation-information relating to transactions that take place each day at each hospital is sent through a phone line to a district server.

Implementation Structure National Level Central Government (Ministry of Labor and

Employment)

State Level State Nodal Agency (Dept of Labor)

District Level DM/CMO

Village/Panchayat Level FKO(Field Key officer)


Government of India

2. Send for

verification1. P

repare

in

given fo

rmat

www.rsby.gov.in

4. Selection through tendering

10. Payment to Insurer

12. Claim Process

Insurance Company

State Nodal Agency

5. Empanellment

5. Setting-up

Health Care

Providers

9. Submission of data and bill

Beneficiary

Data

District Kiosk

Setting-u

p

Call Center

Awareness Health Camps

BPL

Beneficiaries

7. E

nro

llmen

t of B

enefi

ciar

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FKO

DKM

8. D

own

load

of F

KO

D

ata

at D

KM

ser

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11. Utilization of Services

6. Is

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Implementation Structure

Training Schedule/RSBY/PACS/SSK/2012

7. V

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of Sm

art C

ard

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State Government

District Administration prepares the BPL and other beneficiary list and shares with SNA

Select Insurance Company

Set up Mobile Enrollment Station

Prepare Enrollment Schedule

Declare Enrollment Schedule

Empanel Hospital

w Provide Treatment

w Send Reports to Insurance Company

Central Government-GoI


Hospital Code issued

Issues personalized Beneficiary Smart Card

Issue District Kiosk Card

Personalize and issue FKO Cards Post issuance issues

Issues personalized HAC CardAuthentication

of smart card at the time of enrollment

Hospitalization

Central Key Generating Authority

Hospital

District Kiosk

District Key Manager

Field Key Officer

Beneficiaries

Insurance Company



wExplain key activities and steps involved in pre enrollment phase of RSBY.

wArticulate key issues and challenges in pre enrollment phase of RSBY.

w Identify the role of CSOs in pre enrollment phase of RSBY.

Time75 minutes

Key contents and sub topics wActivities in pre enrollment phase.

w Issues and challenges.

wRole of CSO in pre enrollment phase.

Method(s)wFilm show and discussions (RSBY film on pre enrollment preparation-part

1 of enrollment film).

wPresentation on pre enrollment preparations.

wBuzz group discussion and presentation on role of CSOs.

Material requiredwRSBY film on pre enrollment preparation - part 1 of enrollment film (to be

downloaded online)

wPresentation on pre enrollment steps and activities and role of CSOs.

wFlip charts, markers, television, CD/DVD player.


Activity 1: Film Screening

w Introduce the topic of the film.

wScreen the video film of 30 minutes duration (RSBY film on pre enrollment preparation - part of enrollment film)

wFollow it up with a brain storming session.

Pre Enrollment Phase of RSBY


Day One: Session # 5Pre Enrollment Phase of RSBY 29

wAsk participants to observe key preparatory activities and steps in pre enrollment phase in film and how it is done.

wEncourage participants to record key points on their cards or note pads. Stick the cards on wall/panel board or write key observations/reflections of the participants on the board or chart.

l After film screening is complete, the following points may be put up for discussion:

(a) First reaction/observation on the film

(b) Key criteria for identification of beneficiary

(c) Process of listing

(d) Requirements for organizing enrollment camps

(e) Necessary preparation for enrollment team.

wSummarize the key points by using the observations of the participants on pre enrollment phase of RSBY. Explain the role of insurance agencies and state government in pre enrollment phase. Refer to flow chart at the end for this session (pg 33). The role of the insurance agency will also be derived from the film. The CSO’s role will be discussed at the end.

wSome new features have been added from this year to the 64 kb Smart card. Previously it was exclusively used to store information required for RSBY scheme like, fingerprint and photograph.

wRecently the RSBY Card has been upgraded and now it stores additional socio-economic and health related data and has a better security system.This new card has been envisaged to serve as a multi-purpose card providing different social security benefits. It is now used for three years, though the renewal of the card has to be on yearly basis.

wBuild on the points emerging from the group and supplement by input on key activities and preparatory steps using power point presentation.

Activity 2: Role of CSOs

wDivide the large group into eight or ten buzz groups of two to three for discussion.

wAsk the group member to be discuss on the question: Identify key role and possible intervention of CSOs in this phase.

wAllocate 10 minutes for group work.

wEach group will write four cards - two on roles and two on possible interventions.

wStick cards on wall/panel board and work with the participants to cluster issues into common themes for further discussion, i.e., issues, strategies and possible interventions.

wBuild on the points emerging from the group and supplement by input on the role of CSOs in pre enrollment phase using power point presentation.

wSummarize the session by highlighting key provisions, phases and implementation mechanism.

wKey processes of pre enrollment

wWho the beneficiary is

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wDos and don’ts of pre enrollment

wRole of CSOs

wDistribute session handout 5 for the session

Reading and reference materialwRefer pre enrollment phase- session handout # 5

wRefer points for summing up.

Trainer’s note-tips for facilitationwTrainer needs to follow points given below while using the film as a

learning aid:

l Brief participants regarding objective behind screening of film.

lGive a brief introduction of the film. Share with participants that after film screening, there would be a detailed discussion on the issues highlighted in the film. Ask participants to make notes while watching the film so that if they have any queries and questions, the same can be discussed after film screening.

wTrainer will have to emphasize on the concept of the enrollment kit which each enrollment team is required to carry on the day of enrollment at the village level. Trainer will have to mention key features of enrollment kit which consists of following hardware:

lWeb camera for photograph

lOptical biometric scanner- for fingerprints

lData Masters- based on state’s BPL data

l Battery Power Back-Up

lDye Sublimation Printer.



Pre Enrollment Phase

wThe pre enrollment phase is a very critical phase of the scheme because if the beneficiary is not listed then he/she is not entitled to any benefits designed in the scheme. Hence, it becomes very necessary that this phase is implemented well and it is ensured that all entitled families are listed and can move ahead in further process of registration and access to smart card.

w Identification of target families.

wPreparation of list of authenticated BPL card holders.

wData management.

wCommunity education/mobilization - campaign to disseminate information related to enrollment camps for enrolling and issuing smart cards.

Issues and Challenges in Pre Enrollment Phase

wAddressing complaints regarding the BPL List.

wDiscrepancies related with the name or other details of the members in BPL List.

wLack of information about enrollment camps venue among beneficiaries.

Role of CSO in Pre Enrollment

wTo collect information about the village where the camp will be organized.

wTo collect details of insurance company/field agency representative.

wTo take the date of camp to be organized.

wTo ensure that the needy person is enrolling.

wTo mobilize BPL families to participate in enrollment camp.

wTo monitor and support the process of enrollment.

wTo ensure transparency in enrollment camps.

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Empanellment of Hospitals

Set Up of District Kiosk

Set Up of Toll Free Call Center

Installation of Machines, Devices Software etc

Ensuring District Kiosk Card

Ensuring Hospital Card

Training of Person

Training of Person Maintain Records

Training of Hospital Staff

Maintaining Records

Pre Enrollment

Print these three details in the Enrollment Brochure

Role of Insurance Company in Pre Enrollment Phase


Have the state server in place as per requirement with requisite manpower and software

Ensure minimum no. of empanelled hospitals in each district

Set up the DKM computer in each district & have appropriate manpower to man it

Inspect brochure prior to final printing by the insurer and ensure essentials are available

Pre-Enrollment

Ensure incentive of FKOs (if approved by state)

Provide space for District Kiosk to the Insurer prominent Govt location

Equip Public hospitals with required infrastructure and manpower

Ensure Training of FKOs

Ensure its distribution to beneficiaries

Ensure setting up to District Kiosk by Insurance co and Toll free no. (common for the state, if possible)

Monitor availability and deployment of transaction software etc. at hospitals

Issue FLO Cards and ensure they are returned and data downloaded from them after completion of activity

Role of State Government in Pre-Enrollment Phase



wExplain the key contents discussed during the day.

wShare key learning and reflections on the day’s proceedings.

Time30 minutes

Key contents and sub topics wReflections on the day’s learning and proceedings

wQuestion - answers on the day’s session and learning

Method(s)w Individual sharing

wQuiz

wOpen house

Material requiredwCharts, flip charts, markers.

Process- steps and activitiesw In the large group recap the day’s proceedings.

wAsk participants to take five minutes to articulate their key learning of the day and questions/or clarification if any.

wPrepare chits on which questions will be written.

wAsk all participants to stand in a circle. Put all the chits in a box and rotate the box in a circle from any direction. Each participant picks up a chit and answers the question on it.

w If the person is unable to do so, co-participants can also attempt to answer the question. If any information is missing, the trainer will add to it or complete it if required.

Reflections


Day One: Session # 6Reflections 35

Reading and reference materialwKeep a set of FAQs (given in the annexure) ready, particularly regarding

this section for reference.

Trainer’s note-tips for facilitationwThis is a summing up session, in which trainer will consolidate the

topics and learning of the day.

wFor summing up process, facilitate a quiz using FAQs section from the Handout, page 47-55.

Day Two: Session # 1Recap 37


wExplain the key contents discussed during the previous day.

wShare the key learning and reflections on the previous day’s proceedings.

Time30 minutes

Key contents and sub topics wRecap on day one’s learning and proceedings.

wQuestion - answers on the day’s sessions and learning


wOpen house

Material requiredwCharts, flip charts, markers.

Process- steps and activitieswAsk participants to share the contents discussed the previous day and key

learning of the day.

wAsk them to share the key learning first and then the questions.

wEncourage participants to respond to the questions raised by the participants at first and if they are not able to do then the facilitator should help.

wClarify doubts about contents and session handouts.

wSet the stage for today’s opening session.

Session plans for training

Recap

Day Two: Session # 1



wExplain key activities, essentials and steps involved in enrollment phase/process.

wArticulate key issues and challenges in enrollment process.

w Identify the role of CSOs in enrollment phase of RSBY.

Time105 minutes

Key contents and sub topics wProcess of enrollment.

wEssentials for enrollment: documents required for enrollment; responsible authority for enrollment; addressing issues related to enrollment; mechanism to enroll left out families.

wRole of CSO in enrollment phase.

Method(s)wFilm show and discussions (RSBY film on enrollment).

wPresentation on enrollment process.

Material requiredwRSBY Film Part 2 on enrollment.

wPower point presentation on enrollment steps and activities and role of CSOs.

wCharts, markers, television, CD/DVD players.


Activity 1: Film screening on enrollment

w Introduce the topic of the video film.

wA video film of 30 minutes duration (RSBY film Part 2 on enrollment process) followed by a brain storming session.

Enrollment Phase


Day Two: Session # 2Enrollment Phase 39

wAsk participants to observe key activities and steps in enrollment phase in the film and how it is done. Ask them questions on:

lWhat are responsibilities and preparation needed for effective enrollment?

lWhat are processes that a beneficiary should follow during the enrollment process?

lWhen the card is issued what other information is given to the beneficiary?

wEncourage participants to record key points on their cards or their note pads. Stick the cards on wall/panel board or write key observations/reflections of the participants on the board or chart.

wSummarize the key points by using the observations of the participants on the enrollment phase of the RSBY. Highlight key steps and activities.

wUse flow chart and picture of enrollment station given on pg 44.

wBuild on the points emerging from the group and supplement by input on the key activities and steps in the enrollment process and essentials for enrollment.

Activity 2: Role of CSOs in this phase

wDivide the large group into three or four small groups for discussions.

wExplain to the group member to answer the question: Identify the key role and possible intervention of CSOs in this phase.

wAllocate 20 minutes for group work. Each group will write four to six cards- two/three on roles and two on possible interventions in the enrollment phase.

wStick the cards on wall/panel board and work with the participants to cluster the issues into common themes for further discussion, issues, strategies and possible interventions of CSOs in enrollment.

wBuild on the points emerging from the group and supplement by input on the role of CSOs in enrollment phase using points in session handout # 6.

wSummarize the session by highlighting roles and intervention strategies for CSOs in enrollment phase

wDistribute handouts at the end the session

Reading and reference materialwRefer enrollment phase- session handout # 6.

wRefer to points for summing up given below.

Trainer’s note-tips for facilitation wThis film provides exclusive technical information on process related to

enrollment phase of RSBY scheme. Points which are not available in the film, like the verification step and getting the card then and there will also have to be mentioned by the trainer.

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wThe film has some technical software information which may not be directly useful to CSOs but it is important to understand the processes that take place during the enrollment phase.

wTrainer needs to follow the points given below while using film as a teaching aid:

l Brief participants regarding objective behind screening of film.

lGive brief introduction of the film. Share with participants that after film screening a detailed discussion will be held on the issues highlighted in the film. Ask participants to make notes while watching the film and if they have any queries and questions, the same can be discussed after the film screening.

l After the film screening is complete, put the following points up for discussion:

(a) First reaction/observation on the film

(b) Enrollment camps

(c) Process of verification

(d) Issuing of smart card

wTrainer will brief the participants that based upon the information derived from the film, buzz group discussions would be held.

wTrainer will have to explain that the enrollment phase is where the actual process of registration, verification, collection of biometric data and smart card is issued.

wTrainer will brief participants that through the buzz group discussion role/responsibilities of CSOs towards effective implementation of pre enrollment phase will be listed.

wAfter discussion trainer will summarize the session and focus on the points mentioned in the summing up section below


Process of Enrollment

wProcurement of List

An electronic list of eligible BPL households is provided to the insurer.

wDeclaring Enrollment Schedule

An enrollment schedule for each village, along with dates, is prepared by the insurance company.

wSetting up of Enrollment Stations

Mobile enrollment stations are set up at local centers (e.g., public schools) at each village.


wEnrollment Procedure issuing of Smart Card

The smart card, along with an information pamphlet describing the scheme and the list of hospitals, is provided on the spot once the beneficiary has paid the Rs.30 fee.

wData Management

At the end of each day of enrollment, the list of households which have been issued smart cards is sent to the state nodal agency.

w Involvement of CSOs

Insurer has to hire intermediaries (e.g., NGOs, MFIs, etc.) to provide grassroots outreach.

Essentials for Enrollment

wDocuments Required for Enrollment

An enrollment schedule for each village, along with dates, prepared by the insurance company.

wResponsible Authority for Enrollment

Each enrollment team in the village is accompanied by a Field Key Officer (FKO) who identifies the beneficiaries at the time of enrollment.

Responsibilities of Enrollment Teams:

wAddressing and dealing with complaints regarding the BPL list.

wDealing with discrepancies in names or other details of the members in BPL list.

wDealing with migrants’ issues and their access to the smart card.

Mechanism to Enroll Left out Families

In case of death of an existing member on the card, another member, provided his/,her name is there in the data base, can be enrolled in his/her place.

Role of CSO in Enrollment Phase

wMotivate/sensitize community to be present in the enrollment camp.

wMake sure that all members of BPL households are enrolled.

wMake sure that the enrollment team is issuing the smart card on the spot to the beneficiary.

wMake sure that the enrollment team takes only Rs. 30 as registration fees.

wEnsure that details of all eligible family members as per BPL list are entered.

wEducate migrant families to demand for split cards for enhanced benefits at both ends.

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Process of Enrollment

District Level BPL List

BPL Data introduced in Enrollment Station

Personalization of Data

Data capture throughwPhotographwFingerprintswGenderwAge

Send card specific data and enrolled

data to district office

Card Personalization

Activate Card

Insurer Authority

Card issued and delivered

on spot


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wExplain the key steps and essentials for hospitalization.

w Identify key issues and challenges in hospitalization.

wDescribe the role of CSOs in post enrollment phase of RSBY/hospitalization process.

Time90 minutes

Key contents and sub topics wHospitalization process.

w Identification of issues and challenges in post enrollment phase and role of CSOs in addressing those issues (strategy development).

Method(s)wFilm Show

wSmall group discussions (card writing and sorting)

wPresentation

Material requiredwRSBY Film on Hospitalization

wPower point presentation on post enrollment steps, hospitalization and role of CSOs

wSmall cards, charts, markers, television and CD/LCD players.


Activity 1: Film screening on RSBY hospitalization

w Introduce the topic of the video film.

wRSBY video film of 30 minutes duration on hospitalization. Introducing the theme may be useful.

wAsk participants to observe key activities and steps in hospitalization process explained in the film.

Post Enrollment Phase – Hospitalization


Day Two: Session # 3Post Enrollment Phase – Hospitalization 45

wEncourage participants to record key points on their cards or note pads. Stick cards on wall/panel board or write key observations/reflections of the participants on the board or chart.

wDiscuss the following points:

lHow is it done? What are responsibilities and preparation needed at the hospital level?

lWhat steps need to be followed by the beneficiary during hospitalization?

lHow is the payment process settled?

wBuild on the points emerging from the group and supplement by inputs on the key steps and processes of hospitalization using power point presentation and flow diagram given at the end of the session.

wSummarize key points by using observations of participants on the post enrollment phase of the RSBY Hospitalization process.

Activity 2: Group discussion

wDivide the participants into three or four small groups for discussion.

wFacilitate the group member to discuss on the question: Identify key issues and challenges in hospitalization and role and possible intervention of CSOs in this phase.

wAllocate 20 minutes for group work. Each group will write four to six cards - two/three on roles and two on possible interventions.

wStick the cards on wall/panel board and work with participants to cluster the issues into common themes for further discussion, key issues and challenges and possible interventions of CSOs.

wBuild on the points emerging from the group and supplement by inputs on the role of CSOs in post enrollment phase using power point presentation.

wSummarize the session by highlighting key provisions and steps in the hospitalization process as well as responsibilities of hospitals.

wDistribute session handouts on the hospitalization process at the end of the session.

Reading and reference materialwRefer post enrollment phase-session handout # 7

wRefer to the points given below for summing up.

Trainer’s note-tips for facilitation wThis film provides exclusive technical information on process related to

the post enrollment phase of RSBY scheme. This film is basically used to make participants aware and enable them to develop understanding on the subject. This will provide an opportunity to the participants to understand the process related to post enrollment i.e., identification and listing of beneficiaries.

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wTrainer needs to follow the points given below while using the film as a teaching aid:

lGive brief introduction of the film. Share with participants that after film screening a detailed discussion will be held on the issues highlighted in the film.

l Ask participants to make notes while watching the film and if they have any queries and questions, the same can be discussed after the film screening.

wTrainer will need to explain that the post enrollment phase is a very critical phase of the scheme because if beneficiary is not using his/her smart card appropriately then the right to healthy living is denied.

wTrainer will need to brief participants that through this group discussion the roles & responsibilities of CSOs towards effective implementation of the post enrollment phase will be listed.

wThe film has some technical software information which may not be directly useful to CSOs, but it is important to understand the processes that take place in the hospitalization phase.

wAfter discussion, trainer will need to summarize the session and will focus on the following points of summing.



Hospitalization Process

wHospitalization means admission to hospital for 24 hours or more. RSBY applies to such hospitalization. However, it also includes such day care treatments entailing less than 24 hours as are listed out.

wThere will be an RSBY counter in the hospital to guide the beneficiary.

wThe beneficiary needs to take only the smart card when he/she goes to the hospital. The smart card is essential to get the service.

w If the disease is not in the package rate, the nodal person will take consent from the insurance company before blocking the amount

Information about hospitals

Based on the qualifying criteria, both public and private hospitals will be empanelled by the insurance company

Payment Procedures-Pre and Post Hospitalization

RSBY provides cashless service, which means that the patient will not have to spend any amount for availing of treatment and hospitalization. It is the job of the hospital to claim the amount from the insurer.

Types of Treatment Covered under RSBY

What is Covered wMaternity benefits are covered.

wAll surgical cases.

wConsultation and medicine leading to hospitalization covered.

wPre-existing diseases are covered under RSBY from day one itself.

What is not covered

wRSBY does not cover OPD expenses, or expenses in hospitals which do not lead to hospitalization.

w In case there is no hospitalization, beneficiary will have to bear the cost.

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Role of State Government in Post

Post Enrollment

Download the enrollment data from FKO cards, encrypted data from SCSP and ensure report from FKO

Set up a State Level Server to store data

Awareness Campaign for the Beneficiaries

Prepare the schedule of the health camps

Consolidate district wise data at State level

Closely monitor Utilization

Organize the health camps

Upload this data to Central Govt.

Get the encrypted enrollment date from Insurer and import in State server

During enrollment, monitor village wise enrollment to ensure no location is ignored or left out

Post Enrollment

Receive Paperless Claim Send conslidated data the Government

Settle Claim within 15 daysSend Back end data to Central Govt.

Provide Age wise Claim data to Nodal Agency

Role of Insurance Agency in Post Enrollment-Hospitalization Phase


Flow Chart of Post Enrollment Process

Beneficiary visits RSBY Help Desk at Empanelled Hospital

Verification of Card Registration of Beneficiary and generate slip

After diagnosis, prescribed for treatment

If OPD, informed not covered

Patient advised for treatment

Package block as per Prescribed list

Get Treatment

Collect Receipt and Transportation Cost at the Time of Discharge

Exit

Enrollment-Hospitalization Phase



w Identify key stakeholders in RSBY implementation.

wDescribe the role of SHs in effective implementation of RSBY and SHs’ participation strategy.

Time2 hours 30 minutes

Key contents and sub topics w Implementation structure of RSBY.

wStakeholder mapping.

wStakeholder participation strategy.

wCSOs strategy for linkage building.

Method(s)wSmall group discussions and presentations on stakeholder mapping.

wStrategy development Worksheet.

Material requiredwWorksheets at the end of session

wPresentation on implementation structure and stakeholder. mapping and participation strategy.

wLCD, meta cards, flip charts, markers etc.


Activity 1

w Introduce the topic and sub topic of the session.

wMake a presentation by recapitulating the flow chart used in implementation structure session of the RSBY for identifying the possible stakeholders in RSBY.

Linkage Building and Stakeholder Management


Day Two: Session # 4Linkage building and Stakeholder management 51

wExplain the concept of stakeholders and their participation using power point presentation with an illustration of RSBY.

wFocus on primary, secondary and tertiary stakeholders, possible stakes and the kind of resources, both positive and negative, for the success of the program. Give examples like: beneficiaries are always primary stakeholders, those who are directly linked are secondary stakeholders and those who are distant are tertiary stakeholders. Stakeholders can be analyzed based on their importance and influence. This analysis will be helpful in analyzing the stake of stakeholders and develop their participation strategy for the success of the program.

Activity 2

wDivide the large group into four or five small groups (four-six members in each small group) for discussion.

wFacilitate the group members to answer the questions: Identify the key stakeholders of RSBY, analyze stakeholders and develop stakeholder participation strategy in different phases of RSBY implementation - pre enrollment, during enrollment, hospitalization, grievance redressal.

wAllocate four/five minutes for group work.

wAsk participants to record key points on chart and present their findings to the larger group.

wStick the flip chart on wall/panel board and work with participants to cluster the common stakeholders and recommended participation strategy at state level, district level, village level and with a different set of stake holders, i.e., community, government, insurance agency.

wBuild on the points emerging from the group and supplement by input on the need for linkage building and stakeholder participation.


wDistribute session handouts at the end of the session.

Reading and reference materialwRefer linkage building and stakeholder analysis session handout # 8.

wRefer to the points for summing up given below.

Trainer’s note-tips for facilitation wPrepare presentation points prior to session. For this, refer to session

handout and summing up points.

wBrief participants that RSBY is a multi layered program involving various stakeholders at each level.

wAs CSOs we need to understand role of each stakeholder.

wFor group formation ensure that groups are adequately distributed with regard to experience, number of group members and gender balance and a mix from different organizations.

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wAfter a presentation from all groups, consolidate key learnings. While consolidating, focus on points mentioned below:

l Role of stakeholder in RSBY

l Strategy for linkage building and participation.

wSince this session focuses on stakeholder mapping, trainer needs to be adequately prepared with their notes. For this, refer session handout # 8.

wDistribute session handouts prior to consolidation. This will enable participants to refer to the facts and link consolidation points with the given information.

Worksheet

Stakeholder Mapping

Phases Key Stakeholders

Proposal Development Central Government/State Government

Setting up of State Level Organization State Nodal Agency

Pre enrollment FKO

Enrollment FKO and Insurance Company

Post Enrollment Insurance Company and Empanelled Hospital

Day Two: Session # 5Reflections 53


wExplain the key contents discussed during the day.

wShare the key learning and reflections on the day’s proceedings.

Time30 minutes

Key contents and sub topics wReflections on the day’s learning and proceedings.

wQuestion - answers on the day’s sessions and learning.


wQuiz

wOpen house

Material requiredwSmall cards, flip charts, markers etc.

Process- steps and activitiesw In the large group recap the day’s proceedings.

wAsk participants to take five minutes to articulate their key learning of the day and questions/or clarifications if any.

wAsk participant s to first share their key learning and then ask questions. Encourage participants to first respond to the questions and if they are not able to do so, then the facilitator should help.

Reading and reference materialwKeep a set of FAQs given in the Handout Booklet annexure relating

particularly to this section, ready for reference.

Reflections


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Trainer’s note-tips for facilitation wThis is a summing up session in which the trainer will consolidate the

topics and learning of day.

wFor summing up process, facilitate quiz using FAQs.

wTrainer will prepare chits on which questions will be written.

wAsk all participants to stand in a circle. Put all the chits in a box and rotate the box in a circle from any direction.

wPlay some music or a beat on the table. To the sound beat, participants will rotate the box in the circle. When the beat stops, the person who is holding the box will pick one chit read the question aloud.

w If the person is unable to do so, co-participants can also attempt to answer the question. If any information is missing, the trainer will add to it or complete it if required.

Day Three: Session # 1Recap 55


wExplain the key contents discussed during day one.

wShare key learning and reflections on previous day’s proceedings.

Time30 minutes

Key contents and sub topics wRecap on day one’s learning and proceedings.

wQuestion - answers on the day’s sessions and learning.


wOpen house

Material requiredwCharts and markers

Process- steps and activitieswAsk participants to share contents discussed the previous day and key

learning of the day.

wAsk participants to first share their key learning and then answer questions.

wEncourage participants to first respond to the questions, and if they are not able to do so then the facilitator should help.

wClarify doubts about the contents and session handouts.

Session Guide for RSBY Training for CSOs

Recap

Day Three: Session # 1

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Reading and reference materialwKeep a set of session hand outs of the previous day and presentations for

sharing and clarifications if any.

Trainer’s note-tips for facilitation wFacilitate the individual learnings of the participants and its application

in the context of their work.

wEnsure that the majority of the participants share their reflections and not only a few articulate ones.

Day Three: Session # 2Grievance Redressal Mechanisms 57


w Identify the existing structure, mechanisms and parties in RSBY Grievance Redressal Mechanism.

wDescribe the types and nature of grievances in RSBY.

Time60 minutes

Key contents and sub topics wTypes and nature of grievances.

wExisting structure, mechanisms and parties.

Method(s)wSmall group discussion.

wCase analysis

wMind mapping exercise

wPresentation on grievance redressal.

Material requiredwCase material, power point presentation on grievances redressal structure

and mechanisms.

w LCD, meta cards, flip charts, markers etc.


Activity 1: Group discussion

There are two options that are listed below for the session. Trainer needs to select any one of the activities listed below

wDivide the participants into four or five small groups for discussion.

wFacilitator the group member to discuss the question: based on your experiences and understanding, identify key grievances, parties involved and redressal mechanism.

Grievance Redressal Mechanisms


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wAllocate 20 minutes for group work. Each group will write cards or charts on - types of grievances, parties involved and mechanisms for redressal.

wStick the cards on wall/panel board and work with the participants to cluster the issues into common themes for further discussion on nature of grievances, parties and redressal mechanism.

wBuild on points emerging from the group and supplement by input on grievances redressal structure and mechanisms using power point presentation.

wSummarize the session by highlighting grievances redressal structure and mechanisms established in RSBY.

wDistribute handouts at the end of the session.

Activity 2: Case study discussion

wDivide the participants into four or five small groups for discussion.

Give each group the following situation: A beneficiary went to an empanelled hospital twice but she was denied the treatment because the machine was not working properly. They are not repairing the machines as their last payment was not cleared by the insurance agency. The insurance agency claims that they have not received payments yet from the SNA. The insurance agency also blames FKO and DKM for not providing adequate support.

wFacilitate the group member to discuss the following question: based on your experiences and understanding, identify key grievances, parties’ involved and redressal mechanism.

wAllocate 20 minutes for group work. Each group will write cards or charts on- Types of grievances, parties involved and mechanisms for redressal.

wStick the cards on wall/panel board and work with the participants to cluster the issues into common themes for further discussion on nature of grievances, parties and redressal mechanism.

wBuild on the points emerging from the group and supplement by input on the Grievances Redressal structure and mechanisms using power point presentation.

wSummarize the session by highlighting Grievances Redressal structure and mechanisms established in RSBY.


(Note: on this situation, facilitator team can also conduct a role play by giving this situation to a few participants to perform different roles and others can be observers about the processes and mechanism sought for grievance redressal)

Reading and reference materialwGrievance redressal mechanism- session handout # 9.

wRefer to the points for summing up given below.


Trainer’s note-tips for facilitation wFor group formation, ensure that groups are adequately distributed with

regard to experience, number of group members and gender balance.

wAfter all presentations, consolidate the key learnings. While consolidating focus on points mentioned below:

l Process of Grievance Redressal under RSBY

lMechanism and given structure

l Types of grievances

lHow to make a complaint

lNew mechanism of web based grievance redressal.

wSince this session focuses on technical inputs, trainer needs to be adequately prepared with their notes. For this, refer to session handout 9.

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Types and Nature of Grievances

wDispute between beneficiary and healthcare provider.

wDispute between healthcare provider and insurance company.

wDispute between insurance company and state government.

wGrievance of beneficiary.

wGrievance of insurance company.

wGrievance of a hospital.

wGrievance against state nodal agency/state government.

wGrievance Against FKO.

wGrievance Against DKM or other district authorities.

Existing Structure and Mechanisms for Grievance Redressal

Level Structure

District District Grievance Redressal Committee (DGRC)

State State Grievance Redressal Committee (SGRC)

National National Grievance Redressal Committee (NGRC)

Role of CSOs in Grievance RedressalNature of Grievance Level of Intervention

Between Beneficiary and Healthcare Provider DGRC/SGRC

Between Healthcare Provider and Insurance Company

DGRC

Dispute between Insurance Company and State Government

Grievance of Beneficiary DGRC

Grievance of Hospital DGRC/SGRC

Grievance Against FKO DGRC

Grievance against DKM or other District Authorities SGRC/NGRC

Grievance against State Nodal Agency/State Government

NGRC/DGLW & DGLW, Ministry of Labor & Employment, Government of India


New Grievance Redressal System:

wAll the complaints and grievances shall flow through a web based format.

wAll complaints and grievances will be updated on the web page by the receiving agency/designated person.

wA unique number will be generated for each grievance.

wFor all complaints and grievances, timelines have been defined clearly for redressal.

wHierarchy of Grievance Committee – District >> State >> Central.

wA day and time every month will be fixed for meeting of Grievance Redressal Committee at district and state levels.



wDescribe the nature of grievances and role of CSOs.

w Identify the possibilities and scope of CSO’s participation in grievance redressal.

Time75 minutes

Key contents and sub topics wRole of CSOs in identification of issues for grievance redressal.

wStrategy development.

Method(s)wSmall group discussions and presentation

wPresentation on strategy development

wOpen house

Material requiredwPresentation on CSO’s role in grievance redressal.

wCharts and markers.


Activity 1

wDivide the participants into four or five small groups (4-6 members in each small group) for discussion.

wFacilitate the group members to discuss the questions: identify key grievances, parties involved and possible intervention strategies of CSOs.

wAllocate 30 minutes for group work.

wAsk participants to record key points on flip chart or cards and present their findings to large group by flip chart or cards.

Role of CSOs in Grievance Redressal


Day Three: Session # 3Role of CSOs in Grievance Redressal 63

wStick the flip chart or cards on wall/panel board and work with participants to cluster issues into common themes for further discussion on types of grievances structure and possible CSO intervention.

wBuild on points emerging from the group and supplement by input on the role of CSOs in grievance redressal mechanisms.

wSummarize the session and provide space for question answers and observations of participants.


Reading and reference materialwRefer role of CSOs in Grievance Redressal- session handout # 9.

wRefer to the points given below for summing up.

Trainer’s note-tips for facilitation wFor group formation ensure that groups are adequately distributed with

regard to experience, number of group members and gender balance.

wAfter group discussion, ask groups to make presentation and after presentation, encourage other group members to seek clarifications. After group presentation, acknowledge participants’ efforts.

wAfter all presentations, consolidate key learnings. While consolidating, focus on points mentioned below:

l Types of grievances and role of CSOs to deal with these grievances.

lOrganization capacity building to deal with these grievances.

l Identification of platforms for putting up grievances for discussion.

wSince this session focuses on technical inputs, trainer needs to be adequately prepared with their notes; for this, refer session handout.

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Nature of Grievance Level of Intervention

Possible Role and Intervention of CSOs

Between Beneficiary and Healthcare Provider

DGRC/SGRC wCSO shall refer such dispute to the redressal committee constituted at the district level.

wCSO should sensitize beneficiary about this committee or facilitate the process.

wCSO should educate community on the process of addressing the grievances and building capacities on filling applications.

Between Healthcare Provider and Insurance Company

DGRC wFacilitate interface for resolving grievance so that community does not suffer.

wPromote community based organizations and local governance system to be engaged, if needed.

Dispute between Insurance Company and State Government

DGRC wFacilitate interface for resolving grievance so that community does not suffer.

Grievance of a Beneficiary

DGRC wCSO shall refer such dispute to the redressal committee constituted at the district level.


wCSO should educate community on the process of addressing grievances and building capacity on filling applications.

Grievance of a Hospital

DGRC/SGRC wCSO shall refer such dispute to the redressal committee constituted at the district level.


wCSO should educate community on the process of addressing grievances and building capacity on filling applications.

Day Three: Session # 3Role of CSOs in Grievance Redressal 65

Grievance against FKO

DGRC wFacilitate interface for resolving the grievance so that community does not suffer


Grievance against DKM or other District Authorities

SGRC/NGRC wFacilitate interface for resolving grievance so that the community does not suffer


Grievance against State Nodal Agency/State Government

NGRC/DGLW & DGLW, Ministry of Labor & Employment, Government of India

wFacilitate interface for resolving grievance so that community does not suffer

wPromote community based organizations and local governance system to be engaged, if needed

w If needed, CBOs can go for legal advocacy.



wExplain the existing monitoring and evaluation process in RSBY.

w Identify tools for social accountability in RSBY.

wArticulate strategies for community participation in community level M&E of RSBY.

Time90 minutes

Key contents and sub topics wExisting monitoring and evaluation process in RSBY.

wTools for social accountability- social audit, RTI.etc.

wBuilding up community based monitoring system.

Method(s)wPresentation

wFilms

wSmall group discussions and

Material requiredwFilm on tools.

wPresentation on transparency and accountability.

wCharts, markers, television and CD/DVD player


Activity 1

wStart with a brainstorming process in large group and make a presentation on monitoring and evaluation processes in RSBY, focusing on the role of

Transparency and Accountability: Role of CSOs


Day Three: Session # 4Transparency and Accountability: Role of CSOs 67

SNS, DKM, FKO and insurance agency in concurrent monitoring and periodic evaluations.

wConsolidate the presentation by giving space for question answers.

Activity 2

wShow a film on social audit (15-20 minutes).

wAsk participants’ observations about the film and steps involved in social audit.

wPresent other tools of social accountability and transparency using power point presentation.

wEncourage discussions on tools and convergence mechanisms like provision of social audit in MNREGA, discussion on RSBY issues in gram sabha meetings etc.

wGive an overview of RTI provisions and possibilities of RTI applications in RSBY by beneficiaries.

wConsolidate by highlighting the need for community participation in RSBY monitoring and evaluation.

Activity 3

wDivide the large group into four or five small groups (four-six members in each small group) for discussion.

wExplain the task to group members (question: Identify the key areas for M&E in RSBY implementation and strategy for community based monitoring and evaluation).

wAllocate space and time (20 minutes for group work).

wAsk participants to record key points on flip chart or cards and present their findings to the large group by flip chart or cards.

wStick the flip chart or cards on wall/panel board and work with participants to cluster issues into common themes for further discussions on community M&E area and community participation strategy (M+E areas can be clustered according to the implementation phase of RSBY).


wDistribute session handouts.

Reading and reference materialwRefer transparency and accountability: role of CSOs- session handout

#11.

wRefer to the points for summing up and power point presentation given below.

Trainer’s note-tips for facilitation wThis film provides exclusive technical information on social audit as

transparency and accountability tools. This film is basically used to

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make participants aware and enables them to develop understanding of the tools for establishing transparency and accountability towards the community. This will provide an opportunity to participants to understand the process of how to use these tools at the community level. However, the facilitator needs to build its linkage in applying in context of RSBY.

wTrainer needs to follow the points given below while using the film as a teaching aid:

l Brief participants regarding the objective behind screening of the film.

lGive a brief introduction of the film. Share with participants that after the film screening there would be a detailed discussion on the issues highlighted in the film. Ask the participants to make notes while watching the film so that if they have any queries and questions, the same can be discussed after the film screening.

l After the film screening is complete, the following points may be considered for discussion:

(a) First reaction to/observation on the film

(b) Understanding on the tool

(c) Application of the tool in context of RSBY.

wTrainer will explain that for effective implementation of schemes and programs, it is very essential that community led transparency and accountability systems are established,so that the community can play a vital role in monitoring of the implementation process.

wTrainer will brief participants that through this buzz group discussion, the role/responsibilities of CSOs towards establishing effective community monitoring system will be listed.

wAfter discussion, the trainer will ask each group to make a presentation and also encourage other participants to add inputs or ask questions.

wAfter presentation, trainer will summarize the session and focus on the following points:

l Key processes related to community monitoring system.

l Tools for community monitoring.

lDos and don’ts related to community led monitoring system.

l Role of CSOs in promoting accountability and transparency in effective implementation of RSBY.

Day Three: Session # 4Transparency and Accountability: Role of CSOs 69


Existing Monitoring and Evaluation process in RSBY

Periodicity – Evaluation studies for analyzing the performance of RSBY is to be carried out at least one evaluation every year.

Types of Evaluation – Though concurrent evaluation of the progress of implementation shall be done on a regular basis, t h e following types of periodic evaluation studies may be carried out by the state:

wFacility Survey – This will provide a good idea about the type and quality of healthcare facilities which are becoming available under RSBY

wPost-Utilization Survey – This type of survey will give information about beneficiary response to facilities in hospitals.

Methodology for Evaluations – Each survey will have a different methodology for evaluations. For the facility survey both empanelled and non-empanelled public and private hospitals should be studied.

Role of Intermediaries

wTo provide awareness and knowledge about the scheme.

wEnsure the success of scheme by collaborating with government authorities and stake holders.

wMobilize and sensitize community.

wTo enhance enrollment and hospitalization and also to conduct intensive mass awareness of the scheme.

wFacilitate periodic village level meetings of beneficiaries and inform them well in advance about the enrollment program.

Tools for Social Accountability-SA, RTI, Citizen Report CardTools Key Features Application in Context of

RSBY

Social Audit wMulti‐Perspective

wComprehensive

wParticipatory

wMulti directional

wRegular

wVerification

Panchayats are entitled to take up social audit for RSBY programs.

Right To Information

RTI covers inspection of work, document, record and its certified copy and information.

Every public authority is under obligation to provide information on written request or request by electronic means.

RTI provides an opportunity for proactive disclosure about the scheme as well as give right to community to seek information ranging from provisions of the scheme to grievance redressal.



w Identify good practices for replications and issues to be addressed.

wPrepare action plan for their organization.

w Identify tools for social accountability in RSBY.

wValidate the learning, processes and outcomes of the training course.

Time75 minutes

Key contents and sub topics wAction planning

wPost training test and evaluation (optional)

Method(s)wWorksheets for action planning

wLarge group plenary

Material requiredwWorksheets for action planning

w Charts and markers.


Activity 1

w Introduce the topic and sub topic

wAsk participants to identify good practices for replications and cases of discrimination or issues of concerns that needs to be addressed or incorporated in the action plan.

wGive an overview of the action planning, highlighting possible areas of implementation. Refer to session handout # 12 for action planning framework.

Action Planning and Validation


Day Three: Session # 5Action Planning and Validation 71

wAsk participants preferably organization-wise/ district wise/ block wise/ village wise to prepare the action plans that they will implement after training in their project areas.

wParticipant can select priority areas based on the phases of RSBY implementation in their state, mapping of good practices, issues of concerns and the need of their areas in RSBY implementation.

wAsk each participant to write their action plan on charts.

wPaste all the charts on wall/board for wall exhibition and present the plan to the larger group.

wAsk all the participants to go through each plan one by one and give comments and suggestions on each plan.

Activity 2: Optional

wConduct post training test as per the questionaire attached in annexure in Annexure on page

Activity 3

wConsolidate the training processes and do a quick recap of all the three days.

Reading and reference materialwAction planning worksheets

Trainer’s note-tips for facilitation wThis is the last session of the training, so trainer needs to consolidate the

key topics of training and establish the learning effectively.

wTrainer should facilitate the action planning exercise and see that practical and applicable action plan is prepared.

wShare the format for preparation of action plan and brief participants about the process.

wAsk participants to break their action plan at two levels- 1. long term interventions and 2. immediate actions.

wEncourage other participants to seek queries and discuss on activities of action plan.

wPrepare a presentation to consolidate the learning and key topics of three days.

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Worksheets for the sessionAction Planning Worksheet-1

Sl. No

1 Coverage

2 Target Community

3 Intervention Strategy

wMobilization

wAccess to benefits

wNetwork and Advocacy

wGrievance Redressal

wMonitoring

wCapacity Building

Action planning worksheet- 2Sl. No Proposed Activities/

InterventionDuration/Dates

Responsible person

Support Need from PACS

Organization Level

Community Level

Stakeholder Partnership build and influences

Documentation sharing and CB support/Follow up

ANNExURE

Annexure 75

Mr. Ram Bhargava’s StoryMr. Ram Bhargava, lives with his family (70 year old mother, wife Parwati and five small kids) in Vishunpurwa of Palki Gram Panchayat in Narayanpur block of Narayanpur district. Ram Bhargava is a landless daily wages laborer and earns bread and butter for his family by seeking everyday jobs. He goes to nearby cities for daily work and travels up to 20-25 km everyday by bicycle. His 70 year old mother is healthy but her eye sight is very poor. She is almost blind. Last year Ram Bhargava took his mother to a hospital for an eye operation but as the cost was very high, they had to postpone the operation.

One day Ram Bhargava was coming back after his day-long work by bicycle and he was hit by a jeep passing through and the driver ran away. Ram Bhargava was seriously injured and admitted by local people to a private hospital nearby and his family was informed about the accident. After examining him, the doctor diagnosed that there were serious injuries in his head and fractures in his leg, in addition to other wounds on his body. He was immediately referred for a small operation and at least five days hospitalization. The total cost would be around Rs. 12,000. The hospital asked his wife Parwati to deposit at least Rs. 5000 in advance and the remaining amount at the time of discharge. Parwati had no other option than going to a moneylender for a loan for which she would have to pay Rs. 15 per Rs. 100 as interest and deposited the money. Ram Bhargava was hospitalized and operated on; Parwati had to bear the expenses of hospital including food and other services. She was worried about the remaining amount. She went to a few relatives for help but they all refused to help her. Finally, she had no option but to sell her ancestral silver jewellery. for Rs. 8,000 and deposit the remaining Rs. 7,500 to the hospital. Ram had a plaster on his leg. The plaster would be removed after 20 days. Parwati was worried as to how she would survive now, as Ram would not be able to work for at least for another 25 days. The whole family was really concerned. This accident had put their life in turmoil.

Question 1. Which factors are responsible for Ram Bhargava’s current situation?

2. How can Ram Bhargava’s family come out from this situation?

Case Study for Day One: Session # 3


1. Rashtriya Swasthya Bima Yojna (RSBY) is a health insurance scheme - launched by Ministry of Labor and Employment, Government of India from 1st April 2008, for people living below poverty line.

2. Beneficiaries under RSBY are entitled to - hospitalization coverage up to Rs.30,000 for most of the diseases.

3. RSBY is a- paperless and cashless scheme for BPL families.

4. Government has fixed package rates- for hospitals for a large number of interventions.

5. Coverage extends to five members of the family- which includes the head of the household, spouse and up to three dependents.

6. Beneficiaries need to pay only- Rs.30 as registration fee, while the Central and the State Government pays the premium to the insurer.

7. The eligible family needs to come to the enrollment station- where the identity of the household head is confirmed by the authorized official.

8. An electronic list of eligible BPL households is provided to- the insurer, using a pre-specified data format.

9. The district level officials prepare- an enrollment schedule for each village, along with dates by the insurance company.

10. The BPL list is posted in- each village at the enrollment station and other prominent places.

11. The date and location of the enrollment in the village- is publicized in advance.

12. Mobile enrollment stations are set up- at local centers (e.g., public schools) in each village.

13. These stations are equipped with the hardware required to- print smart cards with a photo and to collect biometric information (fingerprints) of the members of the household covered.

14. Each enrollment team in the village is accompanied by- a Field Key Officer (FKO) who identifies the beneficiaries at the time of enrollment.

15. FKO is also provided with a smart card and he identifies- the beneficiaries and authenticates their smart card by his FKO card and finger print.

16. After reaching the hospital, the beneficiary will- visit the RSBY help desk at hospital where his identity will be verified by his/her photograph and fingerprints.

Statement for Card Matching Game - Mix and Match Jumbled up Card Game on RSBY


Annexure 77

17. If a diagnosis leads to hospitalization- the assistant at the help desk checks whether the procedure is in the list of pre-specified packages and then a package is selected from the menu.

18. At the time of discharge from the hospital- the beneficiary is paid Rs. 100 as transportation expense.

19. The pre-specified cost of the procedure is- deducted from the amount available on the card.

20. State governments through a competitive public bidding process- select a public or private insurance company licensed to provide health insurance.

21. After the insurance company is selected- they need to empanel both public and private healthcare providers in the project and nearby districts.

22. Enough hospitals should to be empanelled in the district- so that beneficiaries do not have to travel very far to get heathcare services.

23. Selected hospitals should set up a special RSBY desk- and install necessary hardware and software so that smart card transactions can be processed.

24. On receipt of the smart card, the beneficiary shall be able to- use health service facilities in any of the RSBY empanelled hospitals across India.

25. Any hospital which is empanelled under RSBY by any insurance company- will provide cashless and paperless treatment to the beneficiary.

26. Information relating to transactions that take place each day at each hospital- is sent through a phone line to a district server.

27. Government of India has added the following new categories of beneficiaries under this scheme, these include- 1) MNREGA beneficiaries, 2) Street vendors 3) Domestic workers 4) Bidi workers 5) Building and construction workers 6) Postmen 7) Railway porters 8) SC & ST households 9) Naxal affected families.

28. The authenticated smart card shall be handed over- to the beneficiary at the enrollment station itself.

29. Although the head of the family’s photograph is printed on the card, the photograph- of all family members is stored in the chip so that in case of need it can be used for verification.

30. FKOs are representative of the Government- they can be different entities in different districts/states, e.g., health workers, gram vikas adhikaris, patwaris, etc. RSBY does not cover- OPD expenses or expenses in hospitals which do not lead to hospitalization.

31. From 1st April 2009, maternity benefits- are also covered, including all the expenses related to the delivery.

32. A hospital will be paid- Rs. 2,500 for normal and 4,500 for caesarean delivery.

33. There shall be following set of Grievance Committees to attend to the grievances of various stakeholders at different levels- District Grievance Redressal Committee (DGRC) at the district level, State Grievance Redressal Committee (SGRC) at the state level and National Grievance Redressal Committee (NGRC) at the national level.

34. CSOs can play an important role in- promoting transparency and accountability in implementation of RSBY.

35. Now the grievances- can be placed on line using the web site of RSBY.


Sobharam Rathor’s story Mr. Sobharam Rathor, (BPL No. 540204025405 and RSBY Card–00248511220567503), 63 year old landless laborer of Shibni village in Shibni gram panchayat of Janjgir Champa district, had suffered from serious fractures in his hip. He had no money for treatment at a hospital. He was encouraged and motivated by satisfied card users of his village to opt for hospitalization at a private hospital through use of his smart card. He was advised by t h e FKO and t h e sarpanch to avail services of specialists in private hospitals. On the strength of the RSBY card, he was hospitalized at Aurodhara Private Hospital, Champa. He preferred this hospital as it was near his village. He was motivated by other smart card users of the village and doctors of the hospital to avail cashless service in the hospital by use of this smart card. The RSBY Help Desk of the hospital prominently displayed the RSBY board and benefits awarded to smart card holders.

One of the doctors of the hospital was a villager and provided him enough motivation for to avail the services of this private hospital through the use of his smart card. He was admitted after submission of his card and screening of his finger prints. The hospital arranged for a clinical examination of his blood and urine samples. He was admitted for one night and medicine was provided by the concerned medicine store on presentation of the prescription of the doctor. At the time of admission, the waiting period was less than 15 minutes. He was neither intimated about the expenses of his treatment at the time of admission nor about the expenses deducted from his card at the time of discharge.

As per provision of the card, all benefits have not been provided to him at the private hospital. The hospital staff could not inform much about the smart card. He felt that the hospital staff was not properly educated to answer his queries. He was not provided food during hospitalization. No transportation expense was reimbursed to him at the time of discharge. Sobharam Rathor is very disappointed with the services of the hospital. He wants to take up this issue with the higher authorities of RSBY.

The ward of the hospital was hygienic, neat and clean and well maintained.The behavior of the medical staff as well as the doctor is friendly and encouraging. He was highly satisfied with the service of the hospital. The smart card has been used by him again and by his daughter-in-law for delivery of her child. He came to know about the balance and expenses deducted in the card when his daughter-in-law got hospitalized for child birth at Mekahara Government Hospital, Raipur.

Optional Case Study for Day 3 Session # 2

Annexure 79

His daughter in law was provided transportation through Sanjeevani Express 108 for hospitalization at Government Hospital. She was also awarded Rs.1500 as incentive from Janani Sishu Suraksha Yojana. He was intimated that a sum of Rs. 10,900 had been deducted for one day hospitalization charges at Ausodhara Private Hospital, Janjgir.

This is a very shocking and exploitive deal given by the private hospital. He has no complaint about the services of the hospital except the heavy hospitalization expenses deducted from the card. At the time of discharge, the card was returned soon after finger print verification along with a discharge certificate and medicines for five days. He strongly feels that the scheme is a poor-friendly program of the Government through which cash less hospitalization and treatment is provided to hundreds of poor families and protection is provided against risk of health shock.

He is planning to take up these issues and problems faced in amount deduction and incomplete benefits with the higher authorities of RSBY.

Question 1. What are the issues being faced by Sobharam Rathor?

2. Where and which authority Sobharam Rathor should approach?

3. What is the solution to address this kind of grievance?

4. What are the other kinds of grievances and their redressal mechanisms and solutions?


Name:

Pre and post evaluation test for participants:

(Please write your answers in the appropriate box)

Question Before training

After training

1. What is RSBY?

2. Who is eligible for RSBY?

a) Any citizen of India

b) Any BPL card holder

c) Any BPL card holder and some other approved categories

d) Only SC/ST

3. 1. What is the insurance coverage in RSBY?

a) Rs. 15,000

b) Rs. 25,000

c) Rs. 40,000

d) Rs. 30,000

4. 2. What is the standard premium for RSBY?

a) Rs. 750 per year

b) Rs. 1000 per year

c) Is different in different set of districts

Pre and Post Evaluation Test

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After training

5. 3. Who pays the premium for RSBY?

a) State government

b) Central government

c) Central govt. pays 75% (90% for J&K and North-eastern states) while the state govt pays the remaining

d) Central Govt. Pays 25% while the state govt. pays the remaining amount

6. 4. Will beneficiaries have to pay anything to get the policy?

a) No

b) Only Rs. 30

c) Only Rs. 100

d) Rs. 30,000

7.

What are the time periods for the enrollment and the policy period for the beneficiaries?

8. What is the purpose of the smart card?

9. When will the smart card be given to the beneficiary after the enrollment?

a) On the spot at enrollment station

b) At the time of hospitalization

c) When printed by the insurer after enrollment

10. Why is the photograph of all family members taken when there is the photograph of only the head of household on the card?

11. Who are FKOs?

12. Whom do they need to pay Rs. 30 and when?

a) To the insurer at the time of enrollment

b) To the hospital at the time of hospitalization

c) To FKO

d) To the sarpanch of the village.

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After training

13. How many persons can be enrolled in one family?

a) 5

b) 6

c) 7

d) 4

14. What is meant by dependents?

a) Children, parents or any other family member who is in the Beneficiary list.

b) Only children

c) Only parents

d) Any relative

15. In case of children, till what age can they be insured?

a) Any age group if listed as dependent

b) Up to 10 years of age

c) Up to 18 years of age

d) Children cannot be insured

16. What happens if there are more than three children?

17. Is there any age limit in RSBY?

a) Yes

b) No

18. How many dependents can be enrolled if one of the spouses is no more?

a) 2

b) 3

c) 4

d) 6

19. Can only five children be enrolled without enrolling the head of the household?

20. What happens if there are complaints regarding the BPL list?

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After training

21. What happens if there is some problem with the name or other details of the members in BPL List?

22. What happens if the head of the household is travelling to a different district? Who will keep the card?

23. How many splits are allowed of one card?

a) 2

b) 4

c) 5

d) 3

24. What happens if the beneficiary loses the smart card or it gets damaged?

25. If other family members are not present at the time of enrollment, will the card be issued?

26. What happens if the beneficiary loses the smart card?

27. Will the beneficiary have to pay for the reissuance of the smart card in case they lose the first one?

28. What is this concept of hospitalization?

29. What is meant by day care surgeries?

30. Are pre-existing diseases covered under RSBY?

31. What is not covered?

32. How are day care surgeries different from hospitalization of less than 24 hours?

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After training

33. Are maternity benefits covered?

a) Yes

b) No

34. What is covered under maternity expenses?

35. Is there any provision to take care of the new-born?

36. If there are five members already covered in a family under RSBY, will the new-born be covered?

37. Is there any provision for payment of transportation charges?

38. Is there any proof, like tickets etc., required to claim transportation charges?

a) Yes, it is required

b) No, it is not required

39. When will the beneficiary get the transportation charge, at the time of hospitalization or discharge?

a) At the time of hospitalization

b) At the time of discharge

40. If there are less than five persons, will the coverage amount be reduced?

41. What is meant by on “floater basis”?

42. After the issuance of smart cards when will the benefits start accruing?

43. Which hospitals can the beneficiaries visit for treatment under RSBY?

44. How will the beneficiary know which hospitals they can go to for treatment under RSBY?

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After training

45. Has any amount to be paid at the hospital for treatment?

46. What is meant by cashless service?

47. What is meant by package charges?

48. Where will the beneficiary need to go once they reach a RSBY empanelled hospital?

49. Does the beneficiary need to take any document to the hospital other than the smart card?

50. What happens in case of any dispute?

51. How will the publicity for RSBY be done and who will do it?

52. What is District Kiosk and what are its functions?

53. How should the existing smart cards be modified?

54. How should the existing smart cards be split?

55. How should new smart cards be issued?

56. Who are intermediaries and what is their role in RSBY?

57. What is meant by Project Office and District Office of RSBY and what are their functions?

58. What is Call Center Service and what does it do?

59. Who is responsible for monitoring and evaluation of RSBY implementation?

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Some illustrations from the field(Note: Trainers can use these illustrations/examples during different sessions. These illustrations are based on a study conducted in select villages of Sitapur District in Uttar Pradesh)

Paragpur village No one is fully aware of the scheme, its benefits and processes. The villagers were informed of the enrollment process by the anganwadi worker (AWW) and the panchayat mitra (gram rozgar sewak). The AWW was herself informed one day before the enrollment process and was given slips to distribute. Many families missed the enrollment because they were not informed in advance and were out of station on the day of the enrollment. The village has its BPL list displayed in the primary school at all times. However, the BPL list put up on the day of the enrollment was taken down subsequently. All newborns are missing from the list. It has not been revised since 2002. The revision of this list has now started and is ongoing. There were no publicity campaigns organized by the panchayat or the insurance company. The families were not informed about the benefits of RSBY at the time of enrollment. They were told that the card was for three years. Nothing was said about the policy cover or whether the enrollment process would take place again the following year. The cards were given at once after the enrollment (in groups of 3 or 5). People were asked to pay Rs.30 for the card. The toll free number printed on the back of the card is 1800-180-4444 while the number printed on the back of the empanelled hospital list is 1800-1800-4444. No one in the village has any idea what the district kiosk is and what services can be availed there. The contact number of the district kiosk was not given at the time of enrollment and neither were the beneficiaries informed about its location or importance.

Mubarakpur village In Mubarakpur, the BPL list is not clear. A list has been put up at the school (not for RSBY. Indeed, the list did not exactly match the RSBY BPL list which had changed from previous year’s list) but many names that appear in this list do not have a BPL ration card and vice versa. There were many families who had been enrolled on one or more previous occasion but were not enrolled this time because their names were missing from the list at the enrollment center. There were many whose names were missing during previous enrollments but were enrolled this time. Most families with RSBY card had all or five members listed on the card. The helpline number given on the back of the card was different from the one printed on the back of the empanelled hospital list, as in the case of Paragpur. Some people from the company had come to spread awareness in a pre enrollment drive. However, this was done only two days before the enrollment. The AWW was told about the scheme two days before the enrollment. She did not distribute the slips herself. She was busy in a meeting when the people came to hand over the slips. The slips were distributed by these people one day before enrollment. Because of the sudden nature of the announcement, many people missed the enrollment this year. However, the awareness drive did work to a great extent. The gram panchayat has not met for over a year. In the previous year, the news of the enrollment and the scheme had been announced in the gram panchayat. In Mubarakpur too, all those who had utilized the scheme had done so in the same

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hospital and none of them had been paid Rs. 100 for transportation at the time of discharge. People knew very little about the scheme. They were not even aware that they should get Rs 100 for transportation and a slip at the time of discharge or that medicines for five days after discharge were also covered. The AWW was also unaware of this.

Pakariya villageThe slips for enrollment were distributed by the Pradhan two or three days before enrollment. No awareness campaign was launched by the insurance company. The BPL list was put up but only during the enrollment. Many people who have Antyoday and BPL ration cards had their names missing from the BPL list. A large number of poor families have been overlooked in the list. The people were not told that all five members whose names need to be on the card have to be present during enrollment. Because of this, some families had only the head of the family present at the time of the enrollment. For these families, details like photographs and fingerprints of all members of the family will hence be missing from the card. People had very little idea of the scheme. One person spent Rs 20,000 to undergo an operation even though he was a card holder. He knew that the scheme covers major operations but did not know where to go. He was illiterate and knew nothing about the empanelled hospitals. Nobody in the village was informed about the split card, form to revise family details, district kiosk or the helpline number. People have little confidence in the scheme and don’t believe they can get cashless service at private and government hospitals.

Rahimabad villageThe people had little idea of benefits under the scheme, the empanelled hospitals, district kiosk, availability of split cards, forms to revise family details or the helpline number. Slips had been distributed two to three days before enrollment by the panchayat mitra. In one case, a child’s name was missing from the list and this child was not enrolled. The child has some problems and has been advised to undergo an operation. The family was not informed about the form to correct family details. In this village too many BPL ration cards and BPL card holders had their names missing from the list. However, most people living in the village who had their names on the list were not enrolled. As with the previous village, confidence in the scheme is very low.

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Beneficiaries IllustrationsRajinder, PARAGPURRajinder has enrolled in RSBY for the second time. His family missed one enrollment because they were not present in the village at the time of the enrollment. The family has five members, Rajinder, his wife and three boys. The entire family is enrolled under the scheme. Rajinder is illiterate (can only sign his name). Only one member in the family, the eldest son, can read and write. Rajinder has some idea of the scheme but it is not thorough. He knows the card is for hospitalization but has no idea what “empanelled hospitals” are. He doesn’t know that expenditure on medicine is covered only for five days after discharge. Rajinder is 45 years old. His previous card showed his name as Rajinder and age 30. The new card shows his name as Sajinder and his year of birth as 1976 (36 years old).

Rajinder has utilized the scheme only once. This was two and a half years ago. He was unable to describe the ailment properly but said his son was unable to use his legs. He took his son to a hospital in Sitapur. He was told about this empanelled hospital from a shopkeeper who had heard it from someone else. He was referred to Lucknow for an X-ray and paid Rs. 5000 from his own pocket. After that he came back to Sitapur. The doctors performed an operation. His son was discharged in three days. No bill was given nor was he given Rs 100 for transportation. He then went back to the hospital for medicines one week later. His fingerprints were taken and he was given medicines for free. The same thing happened two weeks after discharge. His son has shown no improvement and still cannot use his legs properly. However, Rajinder was happy with the personal behavior of the hospital staff.

Ramesh, MUBARAKPURRamesh’s wife is an AWW. The questions were posed to his wife who has a fair idea of the scheme. However, she is not aware of the district kiosk and the services available at it. She is also unaware of the option of splitting the card. The family has four members, all of whom were enrolled. We were unable to locate the family in the BPL family list. The family has not utilized the scheme till now. Ramesh is a driver and usually comes home once every fortnight. The family missed the previous enrollments because Ramesh was not present in the village at the time of enrollment.

Kamlesh, PARAGPURKamlesh is a migrant. He lives and works in Lucknow while his family lives in the village. Kamlesh had a RSBY card till last year but missed the enrollment this time. He was away in Lucknow. The family was given a short notice of one day. The AWW was herself informed one day before the enrollment. The family has five members, Kamlesh, his wife and his three sons. Kamlesh has no idea about the benefits the scheme brings. For him it is an identity card. His family has never utilized the scheme. They have no information about the district Kiosk and the fact that his family can get enrolled by going there.

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Ramsen#, MUBARAKPURRamsen has a son who has a RSBY card. We could not meet him because he had gone to work in the field. Since Ramsen was present at the time when the card was made and also at the time when it was utilized, we decided to question Ramsen himself. This is the second time that his son has been enrolled. In the first year his daughter in law was pregnant but they did not utilize the scheme. He said it was raining and it would have been too much trouble to get her to the hospital. The second time a medical emergency arose in the family, his other son utilized the scheme for his child who had fallen down the stairs and broken his arm. This child (male) was not covered under RSBY since only one of Ramsen’s sons has his name in the BPL list. They first took the child to a hospital which was not empanelled. The doctor here put a plaster on his arm but said that hospitalization and an operation was needed. The family took this child to the empanelled Sethi Hospital, and introduced him as a child whose name was present on the card. The original child’s fingerprint was missing from the card so they were able to use the scheme and get free treatment. The hospital did not raise any objection. Ramsen and his family were satisfied with the treatment and were happy with the behavior of the hospital staff. However, they were not paid Rs. 100 as transportation charges and nor were they given any slip.

Such frauds are very common especially in cases where children are involved. The fact that details like photographs and fingerprints of dependents are often missing from the card makes these frauds possible. People are not afraid of being caught and don’t think of this as anything wrong.

Gomti, MUBARAKPURGomti is a 39 years old widow. She experiences severe pain in her legs. She suffers from chronic osteomyelitis. It has been more than a year now. Both her toes and the small finger of her left leg have been amputated. This is the first time she has been enrolled in RSBY. She was not made aware of the enrollment process on previous occasions and hence missed the enrollment. She had the first two amputations in the previous year by spending her own money. This time she went to an empanelled hospital in Sitapur. She was given free treatment but was not given Rs. 100 for transportation. While she is happy and thankful to the hospital for the free operation but she still does not know what ails her. The pain is also not going away. She was given a few medicines and pain killers but has no idea what they are for and how long she has to take them and whether she would get better any time soon. The medicines are expensive and are not providing immediate relief. She is slowly losing the fingers on her feet one by one and has undergone four separate operations. She is losing patience and hope. Gomti is extremely poor. She survives on her son’s income and has given up hope.

Course Guide Training Course on RSBY for Civil Society Organisations

Documents

Transcript of Course Guide Training Course on RSBY for Civil Society Organisations