Socio Economic Caste Census

Maharashtra: Villages to Boycott Enumeration Process Over Census Excluding OBC Data

Nearly 100 villages from Thane and Palghar districts have passed resolutions opposing the home ministry’s decision to drop OBC data from 2021 Census.

Wada, Maharashtra: After the Ministry of Home Affairs (MHA) announced it would not include the OBC caste data in the 2021 census, several villages in Thane and Palghar districts decided to protest the move. Within two weeks of the announcement, nearly 100 villages across the two districts passed a resolution to boycott the enumeration process, unless the OBC population is counted and a caste-based census is conducted. The enumeration process for the 2021 census is likely to begin in a few months.

At Valshet village in Shahpur taluka, gram panchayat representatives and residents met on August 21. The agenda was clear. “We wanted to discuss what is in store for the OBC communities. Since 1931, the census has not counted the OBC population. What is assumed is from nearly 90-year-old data. So, we passed a resolution boycotting the enumeration in the current form,” Ramesh Nichite told The Wire. OBCs constitute almost 100% of his village, where more than 700 people live. There are also one or two families from the Katkari community, a Particularly Vulnerable Tribal Group (PVTG).

The resolution to boycott the enumeration process states, “Refusing to collect data on the OBC community in the census would mean denying the constitutional right provided under Article 340 to over 60% population of this country.” Under Article 340 of the Constitution, the president of the country is to appoint a commission to look into the social and educational backwardness of the OBC communities.

“But how do you investigate our condition, and further improve it without even knowing how many of us exist,” asks Prakash Patil, a school teacher in Mumbai and a resident of Shahpur in Thane district. His village, Dahivali, also passed a resolution to boycott the process.

The resolution passed by one of the villages boycotting the 2021 census’ enumeration process. Photo: Sukanya Shantha/The Wire

Show of solidarity

These efforts and the show of solidarity by OBC communities across the two districts have helped the campaign gain momentum. Several other villages have also joined the protest. In one week, at least 50 villages passed similar resolutions, just from Shahpur taluka of Thane district. This growing awareness among the OBC communities, Hiraman Valimbe, says is the “OBC Sangharsh Mohim” (OBC struggle campaign). His wife Sadhana Valimbe, sarpanch of Dahivali, held a meeting in her village of over 1,700 persons to explain the “rights denied to the community in the absence of census data”. “There is specific data for both the Scheduled Castes and the Scheduled Tribes in the country. But the government does not have proper estimates of the largest section of this country,” she told The Wire.

To take the protest forward, over 1,000 villagers from several talukas of Thane and Palghar districts met at Wada taluka on Sunday for the “OBC Janjagruti Samiti”. They discussed the need for a caste-based census and the inclusion of OBC caste data into the census. This was the second such meeting in the past month.

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“If you aren’t counted, you don’t exist. You need to demand your visibility first to be able to ask for what belongs to you rightfully,” explained Sunil Deore, at the meeting. Deore is a Raigad-based social activist and a crusader fighting for the OBC castes’ inclusion in the census data. In his speech, Deore spoke about several instances in the past when caste-based data collection could have been initiated but was sabotaged by the ruling parties. He referred to several commissions, set up both in the pre-independence and post-independence era, and the reasons why the OBC communities were earlier included in the census but were dropped after 1931.

“The data that the government is relying on is pre-independence, and Pakistan was still a part of India at that time. If 30% of colonial-era India has gone to Pakistan, our population has to be computed again. Our share will also go up from the previous estimation of 52%, to over at least 60%. But to be able to prove this, we need new data,” he said.

Socio-Economic Caste Census

In 2011, the UPA government undertook the Socio-Economic Caste Census to get data on the caste and economic status of every household in the country. This was done as a separate exercise on completion of the census enumeration process. The Registrar General of India (RGI) and the ministries of rural development and housing and poverty alleviation were involved. While the government released the socio-economic data from the census in 2015, the caste data has not been released.

The 1931 census pegged the OBC population at 52%, the Scheduled Castes at 15.5% and the Scheduled Tribes at around 7%. Even in the absence of any recent empirical or scientifically derived data, the Supreme Court in 1993 limited OBC reservation to 27%, which activists say is less than a half the actual OBC population.

The Supreme Court in 1993 limited OBC reservation to 27%. Photo: PTI

The 2011 census data showed an exponentially high number of castes, around 46 lakh. Calling the data faulty, many experts have pointed to using unscientific methods and the enumerators’ inability to sift through the sub-castes and gotras as commonly mentioned by people when asked about their caste identities. The government too termed the Socio-Economic and Caste Census (SECC) 2011 data as an “errored” one, withholding it from the public.

Also Read: Is Abrogation of Reservation on the Cards?

Even though the upcoming enumeration process is a few months away, the MHA started the pre-tests on August 12, which is scheduled to be completed by September 30. In Maharashtra, work has already begun in Jiwati taluka of Chandrapur district. Government officials have confirmed that over 70% of the work has been completed in the region. In Thane district, Badlapur town has been chosen for the pre-test. However, the work is yet to commence.

The new format has substantial changes, with additions such as details of internet connection and the “other” category in the gender column.

Allocation for Government’s ‘Largest’ Insurance Scheme Swells to 5x

The Rs-10,000-crore allocation is for insurance premiums as well as developing the entire backend infrastructure to roll out this programme.

New Delhi: Nearly two months after announcing “the world’s largest healthcare programme” in February with scant details, the government appears to have finalised the basic contours of its new health insurance scheme.

On March 21, the union cabinet approved the Ayushmann Bharat National Health Protection Mission (NHPM), the central government’s new health insurance programme. It plans to offer a coverage of Rs 5 lakh to 10 crore (100 million) of India’s poorest families. The central and state governments have been expected to pay the full premium on this insurance.

“For 2017-2018 and 2018-2019, we have kept Rs 10,000 crore for this. We have to work for and go forward in that direction,” J.P. Nadda, the health minister, said on March 22.

About 1,347 “packages” are being considered for insurance, which will cover diseases and claims.

Importantly, preexisting health ailments as well as cancer treatment will be covered under this scheme. Aadhaar will not be mandatory but will be encouraged. There will also be a transport allowance per hospitalisation and patients are expected to be able to avail this coverage in any part of India.

These details come nearly two months after the government first announced the insurance scheme. As The Wire had reported at the time, the health ministry had not been in the know about the details of the scheme. Instead, NITI Aayog had taken the lead.

The Rs-10,000-crore allocation is a large increase from the Rs 2,000 crore assigned to the NHPM in this year’s budget. Many had questioned if Rs 2,000 crore would suffice to insure 10 crore families, in all expected to be around 50 crore people.

However, Rs 10,000 crore is not for the insurance coverage itself. It is to fund a host of backend processes that the government has started to develop, including IT systems and the database of those who are eligible.

The value of the insurance premium has also not yet been finalised as negotiations are still underway with various state governments as well as with insurance companies. The Centre and states are expected to contribute to this in a 60-40 split. The government plans on taking the next few months to develop packages and assign rates. This is to control costs and avoid a situation where package costs become inflated by hospitals to benefit insurance company collections.

The 10 crore families will be those listed in the government’s Socio Economic Caste Census (SECC), which is different from the poverty-line estimation of beneficiaries. In the SECC, beneficiaries will be included in the scheme based on whether they have rooms with kucha walls or roofs, whether they have adult members, whether it is a female-headed household, whether there are able-bodied family members, and whether the household is landless and engaged in manual labour.

Some rural families are automatically included, such as those involved in manual scavenging, primitive tribal groups and legally released bonded labourers.

Role of state governments a challenge

The central government could face some resistance from states like Tamil Nadu and West Bengal, which have already criticised the government’s scheme and said that their governments run their own schemes.

Writing in The Wire, Derek O’Brien, a parliamentarian of the Trinamool Congress, had recounted the previous announcement of a health insurance scheme by the current government. This had been in the 2016-2017 budget speech. O’Brien wrote:

The scheme was announced with much fanfare but never quite materialised. State governments were particularly disappointed. They were asked to slow down enrolments under the Rashtriya Swasthya Bima Yojana (RSBY), because this new scheme was supposed to replace the RSBY. Soon, when the BJP-led government realised it had not done the groundwork for the ambitious new scheme, it quietly asked state governments to resume enrolling families for the RSBY.

Nadda had said that the NHPM would in fact strengthen the spirit of “cooperative federalism” and that the mission could easily be “merged with the ongoing health protection or insurance schemes in various ministries and governments.” This is exactly what states like West Bengal have already resisted.

The central government has said that state governments will be allowed to expand the NHPM “both horizontally and vertically. States will be free to choose the modalities for implementation. They can implement through insurance company or directly through Trust, Society or a mixed model.” To be able to implement the scheme, the states will need to have a dedicated ‘State Health Agency’.

What the Centre’s New Health Insurance Scheme Means for States That Have Their Own

Several states have wider and more inclusive insurance schemes, and the government’s ‘world’s largest healthcare programme’ will likely cause unnecessary disruptions.

A patient is examined by a doctor in the dengue screening outpatient department at a hospital in New Delhi October 5, 2006. Credit: Reuters/Adnan Abidi

The ‘Kerala model’ of insurance was cited at NITI Aayog’s press conference last week on the National Health Protection Scheme. In a slide titled ‘Galvanising public sector through NHPS,’ journalists were told – citing Kerala’s example – that the money through this scheme can, in fact, be “ploughed back into public health systems”.

“In Kerala, 55% of the total money went back to public health sector,” stated the slide.

Amitabh Kant, NITI Aayog’s CEO and a Kerala cadre IAS officer, was present at the event. Dinesh Arora, NITI Aayog’s director for health, who has been a health secretary in Kerala, too cited the Kerala model.

While the central government this year decided to ramp up its insurance scheme – providing coverage of Rs 5 lakh to ten crore families – many other states such as Andhra Pradesh, Tamil Nadu and Kerala have had their own insurance schemes for years. The schemes are, in fact, much wider and more inclusive than the government’s “world’s largest healthcare programme”.

Kerala’s insurance scheme has 92% enrollment

In states like Kerala, where the largest number of claims are from public hospitals, most of the money received is “ploughed back into public health systems” through programmes of upgradation of facilities and expansion of services. Over the past few years, the trend of claims from public hospitals has risen from 40% to the current 64%.

The Rashtriya Swasthya Bima Yojana (RSBY) scheme, launched in 2008, has been working in several states with some variations. Tamil Nadu has the Chief Minister’s Comprehensive Health Insurance Scheme, with coverage of up to Rs 1 lakh, and in critical cases up to Rs 2 lakh.

In Kerala, the Comprehensive Health Insurance Scheme (CHIS) offers Rs 30,000 like the RSBY. The scheme has been rejigged from time to time. In 2011 with the left government in Kerala, they introdiced CHIS Plus, which gave an additional Rs 70,000 aimed at people with heard conditions, cancer, renal failure and tertiary care.

Kerala’s CHIS is an example of the RSBY being modified to include both the below poverty line (BPL) and the above poverty line (APL) sections of society.

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Under the scheme, BPL card members are required to only pay a registration fees of Rs 30, while the APL ones need to shell out the entire amount of the premium. Hence, the population that figures in the BPL list of the planning commission as well as those who are on the state’s BPL list are included in the scheme rolled out in 2008.

In a decade since the roll out of the scheme, the percentage of enrollment of target families is at 92% in Kerala, with services being provided from 554 hospitals.

Every year, the Centre and state governments roll out new plans during budgetary allocations to tackle the increasing healthcare costs and to deal with rising health inequities. However, with constantly changing numbers and allocations, it becomes difficult to meet these new scheme requirements and the changes that follow. Some states have their own versions of the RSBY scheme that cater to the needs of the state.

What problems can the new NHPS cause to working schemes?

First of all, since the Centre’s scheme is not universal, one issue will be in figuring out who can and who cannot avail this scheme. While Kerala identifies people on the BPL list, the Centre will be relying upon the Socio Economic Caste Census (SECC). So what will happen to the existing beneficiaries already covered under the state-specific comprehensive schemes but who aren’t in the Centre’s BPL and only in the SECC list?

Also read: NITI Aayog Comes to the Rescue As Health Ministry Clueless on ‘World’s Largest Healthcare Programme’

Secondly, governance of this scheme after it is rolled out is not clearly mentioned. NITI Aayog has suggested two methods – one where the state takes charge and runs it on a trust model or the second where the private insurance agency takes charge and runs it. Some states already have a weak healthcare systems and may not have the capacity to launch this as a state undertaking. In these states, like Bihar and Uttar Pradesh, that do not have any experience of an active role in public health, an insurance scheme like this will further push the state away.

In these states, as the state is pushed away, it might not be a case of money being “ploughed back into public health systems”. For example, government data say that in Bihar, 930 private hospitals were empanelled for the RSBY scheme and only 135 government ones.

Thirdly, will the state-run schemes even exist or will they have to be subsumed with the central government’s schemes? With the arrival of NHPS, some of these state initiatives might be phased out because there will no longer be fund allocation for RSBY.

Despite the Centre’s repeated explanations of cooperative federalism and health being a state subject, with this move by the Centre, states might find their own schemes being pulled out from under them.

This might happen even though states like Kerala are, in fact, far more invested in public health than the central government has ever been – the budgetary allocation for health currently stands at 1.2% of the GDP, while Kerala allocates 3.7 % of its allocation of development schemes towards public health.

Also, while the finance minister did mention in his Budget speech about upgrading sub-centres to health and wellness centres (which he also said in his speech last year), Kerala already has an ongoing programme. Under the Aardram Mission, the state government had already begun upgrading primary health centres (PHC) to family health centres (FHC) in September 2017. The service provision through FHC will be institution based, field or outreach based. Curative, counselling, health education, immunisation, medico-legal, pharmacy and laboratory are some of the institution-based services. Field based services include outreach activities carried out for various public health programmes.

Is insurance the answer to inequities in access to healthcare?

The original RSBY was conceived to help those who could not afford to access healthcare at a hospital nearby and at no extra cost. It was envisaged as a cashless scheme where the only money transacted was for the enrollment and the travel allowance provided at the end of a hospitalisation.

Over the years, numerous studies and evaluations have come up with evidence about roughly the same set of problems that this cashless system presented to the beneficiary. From unreadable thumb print readings causing delay in treatment to problems of fraudulent use of cards and packages to tide over the costs of out patient procedures which are not covered under the scheme.

Also read: The Government’s Previous Health Insurance Schemes Failed. Why Should the New One Work?

After a decade of its initial roll out, there have been definitive studies which have proved that insurance is not the answer to today’s inequities in healthcare.

There have been numerous studies that have shown the disastrous effect of out-of-pocket expenditure (OoPE) accounts, such as pushing a large section of the population below the poverty line in their attempt to seek healthcare. Can a new insurance policy which focuses only on in-patient care decrease OoPE?

Studies world over have indicated that increasing the role of private providers with public insurance does not solve the issue of out of pocket expenditure or the different malpractices to claim higher package costs.

The evidence on the implementation and problems in coverage of RSBY, and failure of the scheme to tide over the high OoPE, should be the biggest concerns to be taken into consideration while scaling up the scheme to include more people and with increasing number of private providers being roped in to render services.

Jisha Jayashree is a PhD candidate at the Centre of Social Medicine and Community Health, Jawaharlal Nehru University. Her PhD looks at the role of the private sector in Ayurvedic education in Kerala.