Uttar Pradesh records more than five million births every year, the largest birth cohort in India.Behind every newborn who receives timely care for a heart defect, every malnourished child caught early and treated, lies a system being rebuilt deliberately, collaboratively, and with urgency.The State Agency for Comprehensive Health Insurance and Integrated Services, the implementing body for Ayushman Bharat PMJAY in UP, is driving a transformative shift in how maternal and child health is delivered.They are harnessing PMJAY as a strategic platform connecting financial protection with real clinical access, and bringing together the National Health Mission, the Integrated Child Development Services and district health systems into a unified, patient-first approach to care.The 28-Day Window: Neonatal SurvivalNeonatal mortality within the first 28 days remains one of UP’s most intractable health challenges. Birth asphyxia, sepsis, prematurity, and respiratory distress are the overwhelming drivers, yet each requires specialised care unavailable at most primary facilities.Neonatal Intensive Care Units, concentrated in the private sector, cost Rs 50,000 to over Rs 2 lakh per admission, an impossible bill for a family below the poverty line.PMJAY’s benefit basket changes this equation. The scheme covers neonatal care from basic to critical levels, including NICU admission and ventilatory support. It also covers Retinopathy of Prematurity (ROP) screening and treatment, BERA hearing testing, and cochlear implants.For a premature baby facing blindness or lifelong deafness, these are not routine services, they are life-defining and cashless under PMJAY.Born Different: Closing the Gap in Congenital CareEvery year, an estimated six lakh newborns in India are born with congenital anomalies conditions such as congenital heart disease, cleft lip and palate, clubfoot, and neural tube defects accounting for 13-16% of all neonatal deaths.In UP alone, an estimated 1-1.5 lakh children are born with such anomalies annually. The NHM’s Rashtriya Bal Swasthya Karyakram screens children for birth defects and refers them to District Early Intervention Centres (DEICs).But DEICs are limited in number, the volume of cases referred routinely exceeds their capacity. Children identified through RBSK screening who require surgical or specialised intervention beyond public hospital capacity can now be directed to empanelled private facilities where their treatment is covered under PMJAY, with no cost to the family.Navigating this pathway is further supported by Ayushman Sampark (1800-1800-4444), the dedicated state helpline for guided assistance.The Weight of Hunger: Addressing Severe Acute MalnutritionSevere Acute Malnutrition remains a critical challenge. Poshan Tracker data from Nov 2025 records SAM prevalence at 0.87% of children under five in UP but given the state’s child population, the absolute numbers demand action.A care coordination pathway is being developed under PMJAY with ICDS, linking anganwadi centres directly to Nutrition Rehabilitation Centres and PMJAY-empanelled hospitals. Anganwadi workers screen for PMJAY eligibility, ensuring malnourished children are enrolled and connected to cashless care before their condition becomes a crisis.A System Built Around the ChildPMJAY provides free treatment up to Rs 5 lakh per family per year shielding families from catastrophic health expenditure. What sets Uttar Pradesh apart is its growing emphasis on digital enablement, tools like e-Kavach and CRM integration are being explored to ensure that beneficiaries are not just enrolled but actively guided through the system ensure no child falls through the gap.These efforts reflect a broader shift from fragmented service delivery to a coordinated, patient-centric model of care.(Writer is an IAS officer currently working as CEO of PMJAY- SACHIS in Uttar Pradesh)
