UPSC GS Paper II: Social Justice, Health Policy, NHM, Ayushman Bharat, Mental Health Act

Must?Know

• National Health Mission (NHM) launched in 2013; subsumed National Rural Health Mission (NRHM, 2005) and National Urban Health Mission (NUHM, 2013) for integrated healthcare delivery across rural and urban India.
• NHM aims to reduce infant mortality rate (IMR), maternal mortality ratio (MMR), and total fertility rate (TFR); IMR was 30 per 1,000 live births (SRS 2022), MMR was 97 per 100,000 live births (2018–2020).
• ASHA (Accredited Social Health Activist) – one per 1,000 population in rural areas; introduced under NRHM to act as a bridge between community and public health system.
• ASHAs are trained for maternal and child care, immunization, and referral services; incentivized, not salaried.
• Janani Suraksha Yojana (JSY) – conditional cash transfer under NHM; launched in 2005 to promote institutional deliveries among poor pregnant women.
• JSY covers both rural and urban areas; cash assistance varies by state (e.g., ?1,400 in rural areas of Haryana, ?700 in urban areas).
• National Mobile Health Unit (NMHU) scheme – one per 100,000 population in hilly, tribal, and remote areas; provides outreach services including maternal care and immunization.
• Ayushman Bharat launched in 2018; two components: Health and Wellness Centres (HWCs) and Pradhan Mantri Jan Arogya Yojana (PM-JAY).
• HWCs (renamed from Ayushman Bharat – HWCs in 2018) aim to deliver comprehensive primary care; target of 150,000 by 2022; as of 2023, over 110,000 operational.
• HWCs provide free essential drugs, diagnostics, and expanded range of services including screening for hypertension, diabetes, and cancer.
• PM-JAY is the world’s largest government-funded health insurance scheme; provides ?5 lakh per family per year for secondary and tertiary hospitalization.
• PM-JAY covers over 10 crore poor and vulnerable families (~50 crore beneficiaries); based on Socio-Economic Caste Census (SECC) 2011 data.
• PM-JAY is cashless and paperless at empanelled hospitals; includes pre- and post-hospitalization expenses.
• PM-JAY portability allows treatment anywhere in India; uses centralized IT platform (National Health Authority, NHA).
• Ayushman Bharat Digital Mission (ABDM) launched in 2021; creates digital health ID, health data consent framework, and provider registry.
• Mental Healthcare Act (MHCA), 2017; enacted to align with UN Convention on Rights of Persons with Disabilities (UNCRPD), ratified by India in 2007.
• MHCA decriminalizes suicide attempt (Section 115); mandates that person attempting suicide be presumed to be under severe stress and not punished.
• MHCA recognizes right to access mental healthcare and treatment from government-run services; Section 18 outlines minimum services to be provided.
• MHCA prohibits electroconvulsive therapy (ECT) without anesthesia and in minors; requires informed consent for treatment (Section 21).
• MHCA establishes Central and State Mental Health Authorities (CMHA, SMHA) to regulate mental health institutions and professionals.
• MHCA allows advance directives (Section 5); individuals can specify preferences for treatment during mental illness, to be respected by nominated representatives and clinicians.
• National Mental Health Programme (NMHP) launched in 1982; aims to ensure availability and accessibility of minimum mental healthcare.
• District Mental Health Programme (DMHP) initiated in 1996 under NMHP; implemented in districts under National Mental Health Policy, 2014.
• India’s public health expenditure was 2.1% of GDP in 2023–24 Union Budget; target is 2.5% by 2025 as per National Health Policy, 2017.

Difficulty Level

Intermediate – requires integration of policy details, legal provisions, and programmatic timelines; frequent multi-layered questions in prelims and mains.

Common UPSC Traps

Trap: Ayushman Bharat includes both PM-JAY and Ayushman Bharat Digital Mission (ABDM) – Fact: ABDM was initially a component but later declared a separate mission; official NHA documents list PM-JAY and HWCs as the two core components of Ayushman Bharat.

Trap: ASHAs are government employees with fixed salaries – Fact: ASHAs are community health volunteers, not regular employees; receive performance-based incentives from NHM funds.

Trap: Mental Healthcare Act, 2017 replaced the Indian Lunacy Act, 1912 – Fact: MHCA, 2017 replaced the earlier Mental Health Act, 1987, which had replaced the Indian Lunacy Act, 1912.

Trap: PM-JAY covers outpatient department (OPD) expenses – Fact: PM-JAY covers only inpatient hospitalization, pre- and post-hospitalization (30 and 15 days respectively), not standalone OPD.

Practice MCQs

Question: Which of the following statements best reflects the significance of Section 115 of the Mental Healthcare Act, 2017?
A) It mandates the establishment of mental health institutions in every district.
B) It prohibits the use of electroconvulsive therapy in all cases.
C) It decriminalizes attempted suicide and presumes severe stress.
D) It grants the right to free mental healthcare to all citizens.
Answer: C
Explanation: Section 115 decriminalizes suicide attempt, a shift from IPC Section 309; reflects human rights-based approach.
Why others fail: D is incorrect because while the Act recognizes the right, it does not mandate free care for all, only "available to the extent possible."

Question: Under the Ayushman Bharat – Pradhan Mantri Jan Arogya Yojana (PM-JAY), who is eligible for health coverage?
A) All senior citizens above 60 years
B) All women and children below 5 years
C) Families listed in SECC 2011 as deprived and poor
D) All beneficiaries of Janani Suraksha Yojana
Answer: C
Explanation: PM-JAY uses SECC 2011 data to identify 10 crore poor and vulnerable families for coverage.
Why others fail: A and B are incorrect as PM-JAY is not age- or gender-specific; it is socio-economically targeted.

Question: Which of the following is a key feature of Health and Wellness Centres under Ayushman Bharat?
A) They provide tertiary care with specialized surgeries
B) They are funded solely by state governments
C) They offer free essential drugs and diagnostics
D) They replace district hospitals in rural areas
Answer: C
Explanation: HWCs provide comprehensive primary care including free drugs, diagnostics, and preventive services.
Why others fail: A is incorrect because HWCs do not offer tertiary care; they refer to higher centers.

Question: The Accredited Social Health Activist (ASHA) program is a component of:
A) National Vector Borne Disease Control Programme
B) Revised National Tuberculosis Control Programme
C) National Health Mission
D) Integrated Child Development Services
Answer: C
Explanation: ASHA was introduced under NRHM (2005), now part of NHM, to strengthen community-based healthcare.
Why others fail: D is tempting due to overlap in maternal and child health, but ASHA is not part of ICDS.

Question: Which of the following correctly describes the National Mobile Health Unit (NMHU) scheme?
A) It operates only in urban slums
B) It provides telemedicine services exclusively
C) It targets hilly, tribal, and remote areas with mobile clinics
D) It is managed by private NGOs under CSR funding
Answer: C
Explanation: NMHUs are mobile clinics deployed in underserved areas to deliver maternal, child, and communicable disease services.
Why others fail: A is incorrect because NMHUs are primarily for rural and remote regions, not urban slums.

Last?Minute Revision

• NHM launched in 2013; subsumed NRHM (2005) and NUHM (2013).
• ASHA introduced in 2005 under NRHM.
• JSY launched in 2005 to promote institutional deliveries.
• Ayushman Bharat launched in 2018 (HWCs + PM-JAY).
• PM-JAY provides ?5 lakh per family per year.
• PM-JAY covers 10 crore families based on SECC 2011.
• HWC target: 150,000; over 110,000 operational by 2023.
• ABDM launched in 2021; not a component of Ayushman Bharat per NHA.
• Mental Healthcare Act passed in 2017; implemented in 2018.
• MHCA, 2017 replaced Mental Health Act, 1987.
• MHCA decriminalizes suicide attempt (Section 115).
• ECT without anesthesia is prohibited under MHCA.
• Advance directives allowed under MHCA (Section 5).
• Central Mental Health Authority established under MHCA.
• NMHP launched in 1982.
• DMHP started in 1996.
• National Health Policy 2017 targets 2.5% of GDP for health by 2025.
• Public health spending: 2.1% of GDP (2023–24).
• ASHAs are not salaried; receive incentives.
• PM-JAY does not cover outpatient services.
• Portability under PM-JAY allows treatment anywhere in India.
• UNCRPD ratified by India in 2007; MHCA, 2017 aligns with it.
• Janani Suraksha Yojana is part of NHM.
• One NMHU per 100,000 population in remote areas.
• Right to health not a fundamental right, but derived under Article 21.
• Verify from standard source: exact number of HWCs as of 2024.