# Bridging the Healthcare Gap: A Mixed-Method Study on the Impact of Ayushman Bharat Health Account (ABHA) on Underprivileged Populations of Bhopal and Raisen Districts

## TL;DR

This study examines how well the Ayushman Bharat Health Account (ABHA) is being adopted by underprivileged communities in Bhopal and Raisen districts, highlighting barriers like lack of mobile phones and poor awareness.

## Contribution

The study provides new insights into the sociodemographic factors influencing ABHA adoption and identifies specific challenges in rural and urban underprivileged populations.

## Key findings

- Only 3.4% of rural and 2.3% of urban residents had ABHA, with significant differences between regions.
- Unlinked Aadhaar numbers, lack of mobile phones, and low awareness were major barriers to ABHA adoption.
- Gender, residence, education, and employment significantly influenced ABHA generation.

## Abstract

Background and objectives: The Ayushman Bharat Health Account (ABHA) represents a significant advancement in India's healthcare infrastructure, particularly aimed at enhancing access to medical services for underprivileged populations in both rural and urban settings. The study aimed to evaluate the awareness and understanding of the ABHA among underprivileged populations in both rural and urban settings, to analyze the attitude of the community toward digital health records and the ABHA system, and to analyze the relationship between the status of ABHA and various sociodemographic characteristics of the study population.

Materials and methods: A mixed-method study was conducted in Bhopal as part of the baseline survey for the multi-centric study under the Indian Council of Medical Research (ICMR) Task Force Project titled "Task force study for evaluation of community level acceptability, scalability and linkage within the health system of ICMR pre-validated Labike technologies for screening & diagnosis in rural and urban population - An Implementation research". A door-to-door household survey was conducted among a selected underprivileged population living in both rural and urban areas. Categorical variables were expressed as frequencies and percentages, and chi-square was calculated to study the association between sociodemographic characteristics, such as gender, age, residence, education, and employment, and ABHA status, and thematic analysis was conducted for qualitative data.

Results: The study's results illustrate the distribution of participants by various sociodemographic characteristics among 5709 participants. A total of 2460 (43%) of the participants were females, and the majority of the participants (2187, 38.3%) belonged to the 15-30 years of age. In this study, only 96 (3.4%) and 66 (2.3%) of residents of rural and urban areas of central India had ABHA, and this difference was statistically significant. Unlinked Aadhaar numbers (40.6% rural vs. 51.2% urban), a shortage of mobile phones, and poor awareness levels, which revealed notable differences between rural and urban populations, were the main obstacles to the generation of ABHA. This study assessed the relationship between a number of sociodemographic factors and the generation of an ABHA. The factors that significantly influence the likelihood of ABHA generation are gender (χ² = 11.6, p < 0.05), place of residence (χ² = 5.8, p = 0.01), educational status (χ² = 4.4, p = 0.03), and employment status (χ² = 14.4, p < 0.0001), as evidenced by the statistically significant association found between these factors and ABHA generation.

Conclusions: The study found many obstacles despite the promising framework that ABHA developed while evaluating awareness and understanding of the ABHA among underprivileged populations in both rural and urban settings. The study analyzed community attitudes toward the ABHA system through in-depth interviews, which found four major themes: (1) unavailability of mobile phones; (2) Aadhaar not linked to mobile numbers; (3) not willing to get ABHA number; (4) unaware of ABHA and no interest in getting it. This study also assessed the relationship between the status of ABHA and various sociodemographic characteristics of the study population, in which gender, residence, education, and employment were found to be statistically significant.