Make Maternity Benefit Programmes ‘Talk’ To Each Other: A Case For Welfare Convergence

For the 260 lakh women who deliver a child each year, there is uncertainty over how they would cope with the wage loss, nutritional requirements and health needs during and after pregnancy. UNICEF has estimated that amid the pandemic, India will have 20 million children being born, which means increased risk added to their already existing challenges. For the most vulnerable, the state promises to deliver maternity benefits through four key welfare programmes through various ministries: 

• Pradhan Mantri Matru Vandana Yojana (PMMVY) run by Department of Women and Child Development (in some states executed by Department of Health);
• Supplementary Nutrition Programme (SNP), Integrated Child Development Services(ICDS) run by Department of Women and Child Development;
• Janani Suraksha Yojana (JSY) run by Ministry of Health and Family Affairs;
• The Building and Other Construction Workers (BoCW) Act (Maternity Benefits under this) administered by the Ministry of Labour and Employment.

The above mentioned programmes are substantial maternity welfare programmes run in the country and account for close to Rs 10000 Cr. in entitlements. More importantly, these are critical programmes, which along with other programmes, help fight high Infant Mortality Rates and Maternal Mortality Rates.

Here is a quick look at the enrollment rates along with benefits and budgets for each of the welfare programmes:

As you can see from the above list, at best, only 50% of Pregnant & Lactating Women end up receiving at least one of the benefits. Unless the databases talk to each other at the backend, it will be difficult to know what percentage of beneficiaries overlap. This issue has been highlighted before too; consider this report by IFPRI which says that while the data is available, it needs to be consolidated and validated. 

The reasons for low enrollments are due to lack of awareness among beneficiaries, conditionalities for each of the programmes, and lastly due to tedious processes—which we found in a recent study in Rajasthan for PMMVY. We found similar evidence for BoCW entitlements as well. Let us look at each of reasons in detail for the lack of enrollment and uptake of the programmes:

First issue is the lack of awareness around the maternity programmes. With over 400+ Direct Benefits Transfer programmes run by the central government and similar schemes being run by the state government, it is very difficult for beneficiaries to keep track and be aware of the programmes/schemes. So, if a lady construction worker or wife of a male construction worker is aware of PMMVY, but unaware of other programmes, she is deprived of the benefits from all those other programmes.

Second issue is about varying conditionalities. Fundamentally, all the aforementioned programmes are meant for Pregnant & Lactating Women, and even the outcomes can largely be bucketed into compensating for wage loss, better nutrition and health seeking behaviour. While most of the conditions are overlapping—like institutional delivery for PMMVY, JSY, there are certain conditions that are specific to the programme, like 90-day employer certificates needed according to the BoCW Act conditionality. Again, either the frontline worker or the beneficiaries first have to know the conditions, and then have to check if they qualify for each of the programmes or not.

Third issue is around the enrollment process. If beneficiaries are aware of the programmes and meet the criteria, and the conditions, they still have a huge hurdle of actually going through the process of enrolling themselves. While the enrollment for PMMVY would have to go through the Anganwadi worker (AWW) where as that of JSY and BoCW would be through different frontline workers; this means beneficiaries have to run around to figure out who the correct person is, and also then produce the similar set of documents again for each of the programme.

Case for Shifting Onus

Ideally, a single programme would be helpful for the beneficiary but given the political compulsions, it may not be feasible to implement it. Today, the onus and burden of being able to receive the benefits are either on the beneficiary, or on the frontline worker (read: ASHA or AWW). We need to transfer the onus on the scheme design and ensure backend complitatiblity of the programmes rather than leave it to the frontline support system.

The mentioned challenges of awareness, conditionalities and enrollment can possibly be solved by attempting to get the different MIS systems to ‘talk’ to each other—an attempt to this extent has been made between PMMVY CAS and JSY. 

Another instance of reimagining existing social schemes to identify and enrol beneficiaries is that for Pradhan Mantri Jan Arogya Yojana (PM-JAY) in Madhya Pradesh. According to a report published by National Health Authority, many poor families in Madhya Pradesh who were left out in the SECC 2011 list were identified through existing schemes—Sambhal Yojana and National Food Security Act. Databases were integrated into the SECC database through Samagra ID, which is a live database for the residents and has been used to verify left-out families to provide PM-JAY benefits. This is a good example of leveraging technology to identify and enrol beneficiaries without using frontline resources or spending on building new communication channels. 

At the National level, PM-JAY, a Ministry of Health and Family Welfare program, had collaborated with the Ministry of Rural Development to drive beneficiary identification through Ration cards. 

Also read: From Authority To Empathy: Patient-Centered Healthcare In India

A similar solution called the AAA (ASHA, ANM and Anganwadi) Platform is being implemented by Antara Foundation in Rajasthan, Madhya Pradesh and Chhattisgarh. This platform brings the three frontline workers—all of whom work on common beneficiary,i.e., pregnant mothers—on a common platform to synchronise data, review each other’s work, micro plan activities and share learnings. This led to an increase in identification of most vulnerable beneficiaries by over 60% in high risk pregnancies. 

Let us now look at some of the convergence principles at the design level:

Automatic enrollment system: If the beneficiary is aware of one scheme/programme, at the time of enrollment, conditionalities for other programmes can be checked too, and if found suitable/meeting the criteria /conditions they should be automatically enrolled into other programmes. For instance, at the time of enrollment into PMMVY, if the beneficiary is found to be a construction worker, she should be auto-enrolled for the BoCW entitlement as well as the JSY programme and the beneficiary should be made aware about the same. 

‘Only Once’ documentation demand: If a beneficiary is enrolled into any national scheme, details of the documents as well as others details should be pulled from the backend system by default. The provision to change the details should be there but the default information and documents should be pulled from the already existing enrollment details in the system. This will avoid the burden on the frontline workers of filling in the same details that, say, an AWW has filled and also collecting and verifying the documents.

Lowest common conditionalities: Various programmes, maternity benefits programmes in this case, should agree on the lowest common set of conditionalities that need to be fulfilled by a beneficiary rather than an elaborate set of conditions. For instance, having husbands’ Aadhar card has become a huge challenge for women to access PMMVY; whereas if this condition is not required under JSY or BoCW entitlement—the department should work towards ensuring the lowest common set of conditions and subsequently ease the access barriers.

Once a beneficiary enrolls into any program, the online system/form should be able to check for her eligibility for other programme(s) and auto-enroll her if she meets the eligibility. For instance, while registering either for PMMVY or JSY, if we take her or her husband’s profession as an input, and if found to meet BoCW entitlement conditionalities, she should be provided with that benefit too. Even if the frontline worker or beneficiary is not aware of the benefit, just by asking this one question, the beneficiary can be made aware and enrolled without having to apply to that scheme separately.

The pandemic is a good opportunity for us to converge programmes at the backend and move the onus of ‘receiving’ the benefits of welfare entitlements from beneficiaries and frontline workers to ‘delivering’ the benefits of welfare schemes through designs and systems at the backend.

Also read: Why Do We Need To Rethink Maternity Benefits In India?

Further Reading

1. Supplementary Nutrition Programme under ICDS: Case Study of Telangana and Tamil Nadu 
2. The problem with Conditional Cash Transfers
3. Shifting Schemes to Systems 

Mayurdhar Devolla is the lead of operations at Indus Action, a policy implementation organisation that works to bridge the gap between law and action. He works closely with the state teams at Indus Action and enjoys working with the government. His long-term focus is on building solutions for a positive social impact in education, sanitation, sports, and the environment.