about insurance

1. HEALTH AND RIGHT TO INFORMATION ACT
M. Sheela Priya, IAS (Retd.)
State Chief Information Commissioner
Tamil Nadu

2. CONTENTS
 Right to Information Act
 RTI in a nutshell
 Healthcare in India
 Factors affecting health indicators
 Deconstructing RTI’s usage
 How RTI potentiates numerous healthcare bodies
 Possible impact & augmentation
 Making RTI robust

3. Grievance
Redressal
Right to Know
Good
Governance
Accountability
Transparency
RIGHT TO INFORMATION ACT, 2005
No. 22 of 2005
“An Act to provide for setting out the practical regime of right to information for citizens to secure access to information
under the control of public authorities, in order to promote transparency and accountability in the working of every
public authority, the constitution of a Central Information Commission and State Information Commissions and for
matters connected therewith or incidental thereto.”
“AND WHEREAS democracy requires an informed citizenry and transparency of information which are vital to its
functioning and also to contain corruption and to hold Governments and their instrumentalities accountable to the
governed”

4. Section 4 – Suo
Motu Disclosures
• Public authorities to:
• Maintain, categorize, index,
and computerize records
• Suo Motu Disclosures of
organizational information
• functions & duties
• directory of officers and
employees
• decision making hierarchy
etc.
Section 8 –
Exemption from
Disclosure
• Any information falling under
Section 8 (1) (a to j) is
exempted to be disclosed
under this act
• Under second schedule
organizations such as
Intelligence Bureau, BSF, NSG
Directorate of Enforcement are
exempted to reveal any
information (Section 24)
• -
Section 25 –
Monitoring and
Reporting
• Annual reports must be
prepared by State/Central
Information Commission to be
laid before house of
parliament/state legislature
• For each year; no. of requests
received, processed, rejected,
revenue generated, penalties
imposed, actions taken etc.
must be furnished by each
department every quarter
Section 26 –
Outreach
Programmes
• Encourages appropriate
Government to develop and
organise educational
programmes to the general
public on how to exercise the
rights under this act
RIGHT TO INFORMATION (RTI) – IN A NUTSHELL

5. HEALTHCARE IN INDIA
Rates
&
Life
span
Indicators
Spending
As of 2016,
Rs. 52,800
Crores @
1.12% of
GDP
Estimated
to be 2.5%
by 2025
IMR
Average 34
per 1000
live births
MMR 167
per 100000
live births
Life
expectancy
67.9 years
Death rate
– 6.4%
Birth rate –
20.4%

6. FACTORS AFFECTING HEALTH INDICATORS
Government/Public
Healthcare Planning
Number of healthcare centres
Last mile connectivity/accessibility
Quality of infrastructure
Human Resources – Skill levels,
number of personnel
Preventive healthcare programmes
Financial support, healthcare
schemes, insurance, PPP, NGO
Citizen’s role – User
Behavioural Aspects
Awareness – on availability of
resources & options
General & health literacy
Discerning knowledge between safe
& unsafe practices
Participation & Community
involvement
Avoiding quack doctors
Increased institutionalized deliveries

7. CURRENT STATE ANALYSIS – DECONSTRUCTING RTI’S USAGE
R T I
GOOD GOVERNANCE, CURB CORRUPTION
TRANSPARENCY, ACCOUNTABILITY
Suo Motu
•Section 4
•Section 25
CIC & SIC
•Three tier
structure to
provide info
on request
PRESENTLY
DOMINATED
ROUTE
EXPECTED
PARADIGM
SHIFT

8. HOW RTI CAN POTENTIATE VARIOUS HEALTHCARE FRAMEWORKS
Suo Motu
(Proactive)
Grievance
Redressal
(Reactive)
 Paradigm shift – from grievance redressal to information
dissemination tool
 Awareness and health literacy is central to improving
healthcare indicators
 Preventive healthcare produce greater impact whilst
expending lesser resources – funds, manpower etc.
 Suo Motu disclosures can enable RTI to integrate goals,
functions & objectives of various healthcare bodies and
framework envisaged by GoI
 Achieve higher adoption of NRHM schemes, increase
insurance coverage

9. NHSRC
CBHI
NHRM
DGHS
CHC/PHC/S
HC/DH
Govt.
Insurance
Scheme
Clinical
Establish-
ment Bill
RTI
CITIZENRY
Increasing Awareness,
health literacy &
community participation
Information on healthcare
facility, schemes, insurance,
curbing quack doctors
SUO MOTU
DISCLOSURES

10. POSSIBLE IMPACT FROM RTI IN HEALTHCARE
Curbing corruption
• Educating women to derive the fullest out
of JSY schemes and its financial
incentives will increase institutionalised
deliveries and therefore reduce IMR &
MMR
• By knowing exact benefits through Suo
Motu disclosures, not only via internet,
but also through panchayat meetings can
curb corruption & middle men
Insurance Schemes
• NHP 2017 indicates 35 crore individuals
have health insurance i.e. 27% of our
population. More than 80% of them are
under central govt. scheme
• Through RTI disclosures, larger adoption
in RSBY, Rashtriya Arogya Nidhi, TN CM
Comprehensive Health Insurance
Scheme, Gujarat CM Amrutam etc. can
be achieved.
Demanding healthcare
rights/Curbing quack doctors
• Clinical Establishment Act regulates
medical infra owned/managed by govt.,
trust, private including single doctor clinic
• RTI disclosures can reveal minimum
standards & infra that patients deserve
• This can help promote AYUSH while
curbing quack doctors

11. AUXILLIARY AUGMENTATION –EHR, HMIS, CEB
RTI
EHR
HMIS
NRHM
PHC/CHC
INFRA
QUALITY
CLINICAL
EST. BILL
MoHFW has notified standards for Electronic Health
Record (EHR) 2016. Digitization of records minimizes
human error. Helps retrieve critical life saving information
instantly.
What is measured is managed! Health Management
Information System (HMIS) tracks quantitative aspects
about HR, Infra, Medicine Stock etc. at every CHC, PHC
etc.
Disclosure of reports, engaging ASHA workers, panchayat
boards, local community to tackle practical difficulties will
enable improved operational efficiency
Disclosing health indicators, improving health literacy,
incentives etc. will improve efficacy of NRHM schemes

12. Ensuring
compliance of all
PA’s under section
25 of RTI act
Under section 26 –
Increasing budget
allocation
Classifying nature
of RTI request
(Funds, quality,
vacancy,
grievance, public
welfare etc.) with
each PA
80% of cases
should statistically
arise from 20% of
the causes.
Identifying root
causes can help in
proactive actions
External Audit
MAKING RTI ROBUST
CURRENT LIMITATIONS FUTURE AREAS FOR IMPROVEMENT
 Section 25 – reporting and monitoring
focusses excessively on quantitative
aspects – no. of requests to each PA,
processed vs. rejected etc.
 Identifying qualitative aspects of the RTI
queries will enable proactive measures by
addressing root causes
 Lack of external audit on CIC & SIC & all
PA’s to comply with annual reporting.
E.g.: CIC last annual report was from
2015-16, TN SIC 2014-15.
Promote RTI
Case Tags
Pareto Analysis