Composite healthcare for transgender under PM-JAY: a significant step towards inclusive society

Sir,

Transgender people have a different gender identification than those who had male and female anatomies at birth. Male to female (MTF) and female to male (FTM) are all included in the transgender category, as well as transgender males and females. Numerous transgender individuals, including Hijras, Aravanis, Kothi's, Jogatas/Jogappas, and Shivshaktis, live in India.¹ Census 2011 reported there are 4.87 milliom transgenders live in India.² Because of their diverse bodily types, transgender people experience humiliation, dishonour, and exclusion from society. As a result, transgender children are abused, subjected to unjust treatment, and punished by their own families in an effort to conform to conventional norms, which makes them most disadvantaged and vulnerable groups in India. One of the most distinguishing features of Indian culture and economy is inequality. Healthcare is one area that exemplifies this, as health outcomes in India continue to be closely correlated with socioeconomic status, identity, and community. The most disadvantaged and vulnerable communities are denied access to healthcare due to a confluence of complicated hurdles. While certain obstacles, like poverty or the distance to medical facilities, are easier to comprehend, others, like systemic prejudice or policy gaps, call for a more in-depth investigation. The transgender population is a prominent social group in India that experiences systemic exclusion from healthcare. There is no recent public data on the exact number of gender and sexual minorities in the country, however last census which was carried out more than ten years back reported 4.87 million transgender live in India.²

Recently, the Ministry of Health and Family Welfare, Government of India, in collaboration with the Ministry of Social Justice, Government of India, launched composite healthcare packages under the Ayushman Bharat Pradhan Mantri- Jan Arogya Yojana (AB PM-JAY) which is the Government of India's flagship National Health Protection Scheme. The AB PM-JAY package, particular packages like sex reassignment surgery (SRS), hormonal treatment for transgenders, and other customised packages that could include hormone therapy, laser ablation surgery, and other services are all included in the composite healthcare for transgenders. They would be able to seek treatment at any of the AB PM-JAY-empanelled hospitals across the country that offer specialised packages. According to the MoU, healthcare benefits are available to transgender people throughout the country who have a transgender certificate issued by the National Portal for Transgender Person and all so transgender people who are not getting assistance from existing federal or state-sponsored programmes. The provisions were chosen with the community's long-standing stigma and isolation in mind. The inclusion of comprehensive healthcare benefits was thus recognised as a key step in combating this stigma. Despite the fact that the scheme was founded with noble intentions, various studies found that AB PM-JAY was only able to provide coverage for roughly 47.4% of the beneficiaries in the first four years.³ Over 55 crore people were to receive healthcare through the AB PM-JAY, however efficient execution has not been possible. Raising awareness, implementing suitably and working toward quality assurance can make AB PM-JAY effective, which will benefit to the transgenders also. The Government of India should implement at the national level specific national health programmes aimed solely at the mental and physical health of the transgender community, which will help in achieving Universal Health Coverage (UHC) and lead to inclusive society.

REFERENCES

1. 1. Rizvana MSA, Britto R, George N. Health care services and challenges among transgender in India. Int J Community Med Public Health. 2021;8:3143-5.
2. 2. Naik N. Transgenderism in India : Insights from current census. Popul Assoc Am. 2019;1-4.
3. 3. Sriee GVVP, Maiya GR. Coverage, utilization, and impact of Ayushman Bharat scheme among the rural field practice area of Saveetha Medical College and Hospital, Chennai. J Family Med Prim Care. 2021;10(3):1171-6.