Indo-German Programme on Universal Health Coverage (IGUHC)


Research and Evaluation

Evidence is key to policy making and programme implementation. IGUHC’s technical assistance is based on rigorous research and evaluation. Research and Evaluation is an important component of IGUHC’s role for evidence informed policy making and mid-course correction in programme implementation when necessary.

IGSSP the predecessor project of IGUHC has commissioned myriad research and evaluation which has provided several policy recommendations to RSBY and PM-JAY. It has conducted process evaluations and outcome evaluation to assess RSBY is achieving its objectives. Gender has been a focus area for all the research and evaluation conducted since 2012. IGUHC’s mandate is also research utilization so it promotes exchange of knowledge and information.

In 2012 the IGSSP commissioned a quasi-experimental mixed method evaluation assessing the process of RSBY implementation, as well as access to health services and out-of-pocket expenditures on hospitalisation, in selected districts of the states of Bihar, Karnataka and Uttarakhand. This evaluation explored the experiences of families enrolled in RSBY as compared to those not enrolled. Hospital staff, representatives of insurance companies, and state-, district and field-level implementers were also covered as part of this evaluation. In 2013, similar evaluations were supported in the North-Eastern States of Manipur, Meghalaya, Mizoram and Nagaland.

Consecutively IGSSP commissioned a three-year longitudinal panel evaluation to measure RSBY’s impact on access to health facilities, out-of-pocket expenditure on hospitalisation, and beneficiaries’ health status. This evaluation, carried out by two consortia of reputed Indian and German research agencies, includes two rounds of data collection in eight states (Bihar Uttarakhand, Uttar Pradesh, West Bengal, Gujarat, Kerala, Mizoram and Tripura) and another four rounds of data collection in four states, making it the most extensive and only long-term of evaluation of RSBY’s outcomes to date. In addition to its support for these specific evaluations, the Indo-German Social Security Programme also provides support to states to build their capacity to commission and oversee their own evaluations.

Other than evaluations IGSSP has conducted thematic research on gender and RSBY which portrays the empowering effect of insurance on girls and women in India.

In April 2018 IGSSP commissioned another mixed method cross-sectional evaluation with a counterfactual design across selected districts in seven states (Bihar, Chhattisgarh, Gujarat, Karnataka, Meghalaya, Tamil Nadu and Uttar Pradesh. The purpose of this evaluation was to assess implementation of RSBY in comparison to their objectives and to measure the impact on OOP expenditure, access to quality healthcare and health seeking behaviour. The evaluation provided data on the impacts that RSBY have had at household and individual level. Concurrently IGSSP commissioned a counterfactual hospital evaluation in 3 states.  The data collection partners for these evaluations were reputed international organizations.

The results of both these evaluations will serve as baseline for the evaluation commissioned in 2019 to an international research consortium with documenting the transition from RSBY to PMJAY as well as assessing the short-term impact of PM­JAY, aiming to inform the future direction of the scheme. The consortium is led by the Heidelberg Institute of Global Health (Faculty of Medicine, Heidelberg University) and includes the German Development Institute / Deutsches Institut für Entwicklungspolitik (DIE), City University of London, IQVIA (India) and Nielsen (India).