Each government strives to change the socio-economic state of the country through grand social welfare schemes, audacious infrastructure projects, and well-intentioned policies. But bizarre things happen when tech replaces humans to a large extent, and when machines become the ends, rather than the means
By Alam Srinivas
- Ayushman Bharat is an umbrella project that comprises two components – access to and an expansive health insurance
plan to benefit almost 230 million people
- in a recent CAG report, beneficiaries for the health insurance component of Ayushman Bharat scheme were to be culled out of Socio-Economic Caste Census
- The health ministry admitted the shortcomings and said it was working to improve the beneficiary database. It would use data from other schemes
- Bharatmala Pariyojana scheme was planned to build 75,000 km of roads. But the first phase of 34,800 km increased cost Rs 846,588 crore
EACH government, irrespective of its politics, strives to change the socio-economic state of the country. Through grand social welfare schemes, audacious infrastructure projects, and well-intentioned policies, each regime wants to change the lives of the masses, especially the poor, in unimaginable ways. This is, after all, the desires and wishes behind politics and ideologies. If people are happier and more satisfied, if they have access to basic and other amenities, if they have job and business opportunities, if they earn and spend more, they will vote the ruling regimes to power, again and again.
The CAG report found flaws in the AB health insurance list, which was based on the outdated Socio-Economic Caste Census (2011). The list was seven years old, when the program was launched in 2018. Many names were missing, wrong, or blank. For example, 14.7 million had no gender and 2.28 million had invalid names like ‘AAAAAAAAA’
But funny things begin to happen when regimes and leaders put targets and figures on the top of their agendas, when quantity overrides quality, and when statistics becomes the new socio-economic God that is worshipped at the altar of governance. Through technology, or the new and modern rituals, the ruling class hopes to cut the tightening chains of delivery systems and corruption to please those in Heaven so that the socio-economic God is benevolent. But bizarre things happen when tech replaces humans to a large extent, and when machines become the ends, rather than the means.
These aspects of bizarre governance were on open display in two of the ambitious government projects – health-related Ayushman Bharat (AB), and roads-related Bharatmala Pariyojana (BP). AB is an over-encompassing umbrella project that comprises two components – revamp of the primary health system so that the poor can access it, and an expansive health insurance plan to benefit almost 230 million people. BP hopes to develop tens of thousands of km of national highways to optimise efficiency of the movement of freight and people. It was billed as the ‘mother of roads’ plan, a father of the autobahn idea.
In the first case, Ayushman Bharat, the problems lie with I/O incongruities, or vast divergences due to initial inputs that disrupted the expected outputs. Since technology was the main mode to achieve the grandiose targets, it was a clear case of garbage in, garbage out. Feed bad data into a machine, and worse outcomes result, especially if there is no monitoring, and data is never cleaned. In the second case, Bharatmala, the issues at stake were policy discretions that messed up things at both the planning and implementation stages. No one was on the same page; in fact, pages were torn and replaced.
Despite claims that the NFSA list was better and secure, CAG found that registrations were against invalid names and duplicates, and had “unrealistic dates of birth” and “unrealistic size of families.” Almost 750,000 were registered against one mobile number, 9999999999, and another 139,300 to another mobile number, 8888888888
I/O DISRUPTIONS: HUMAN-TECH INTERFACES
Input Stage: According to a recent audit report by CAG (Comptroller and Auditor General), the beneficiaries for the health insurance component of AB scheme were to be culled out of Socio-Economic Caste Census (2011). The list was seven years old, when the program was launched in 2018. This implied that eligible people could be ineligible, as they moved up in life. There could be new names, which did not appear in the old list.
There were other inconsistencies:
14.7 million names left the gender field blank, and 2.28 million had either blank or invalid names such as ‘AAAAAAAAA’, ‘ZZZZZZZZZ’, and ‘???’.
Not surprisingly, the health ministry accepted the deficiencies, and stated that it had “embarked on an exercise to enrich the beneficiary database.” This would be done by mapping data from other schemes (Ujjwala Yojana), and the “more dynamic” database under the National Food Security Act (NFSA). In January 2022, the Center allowed the potential beneficiaries to zoom from the initial 107.4 million (Census List); it added 120 million families from the NFSA list.
The result: the insurance scheme registered 78.7 million families, or 73% of the initial target, and only 20.8 million were from the Census list.
Despite claims that the NFSA list was better and secure, CAG found that registrations were against invalid names and duplicates, and had “unrealistic dates of birth” and “unrealistic size of families.” For example, there were over 43,000 families whose members ranged from 11 to 201 members each. In one case, the size was 201, in four between 101 and 200, and in 12 between 50 and 100. Almost 750,000 were registered against one mobile number, 9999999999, and another 139,300 to another mobile number, 8888888888. The ministry assured CAG that this will vanish with a new system, BIS 2.0, which would “arrest the prevalence of entering ‘random numbers’” that constituted the “overwhelming cases of mobile number inconsistency.”
Insurance claims are settled or rejected as per ‘Match Confidence Score’, which is generated online on a scale of 1 to 100 by matching documents with the beneficiary lists. A third of the 114 million approvals did not fetch any scores; they gave an error figure of 999. Another 15% were cleared despite their individual score being zero. Of the 9.5 million rejections, over 40% had individual scores between 51 and 100. The ministry stated that the scores were generated by an algorithm, and assisted human approvers
Intermediate Stage: Apart from the Census and NFSA lists, the Center allowed the states to use their own specific lists to pinpoint beneficiaries under Ayushman Bharat (AB) scheme. Thus, more discrepancies were added to the initial ones. CAG stated that of the Rs 42,434 crore insurance claims that were settled, more than 50% were in six states, which used their own IT platforms and, hence, their own lists.
In such cases, there was no master data of patients with the Center, as the names were on the states’ platforms and were not shared. In Tamil Nadu, 107,040 government pensioners were included, although no family with a government official was allowed as per the policy.
Output Stage: Insurance claims are settled or rejected as per ‘Match Confidence Score’, which is generated online on a scale of 1 to 100 by matching documents with the beneficiary lists. A third of the 114 million approvals did not fetch any scores; they gave an error figure of 999. Another 15% were cleared despite their individual score being zero. Of the 9.5 million rejections, over 40% had individual scores between 51 and 100. The ministry stated that the scores were generated by an algorithm, and assisted human approvers. The latter evaluated details, and took the final decision, which could nullify tech.
Patients were admitted in multiple hospitals at the same time. CAG stated that “illustrative data analysis revealed that 78,396 claims… were initiated… where date of discharge… for earlier treatment was later than admission date for another treatment of the same patient.” These claims are related to over 2,200 hospitals, especially in states such as Chhattisgarh, Gujarat, Kerala, Madhya Pradesh, and Punjab. The ministry claimed the lapses occurred in cases where a child was born in one hospital, and shifted to another for neonatal care. But almost half of the patients analysed by CAG were male.
Even as the ghosts of live patients were found in multiple hospitals, the dead came to life. The health ministry categorically stated that since July 2020 checks were in place to disable the names of dead beneficiaries. Yet, as the CAG audit found, 88,760 patients died during treatment under the AB scheme. Still, the IT system showed 214,923 claims related to fresh treatment of these patients were paid. Maximum number of such cases were observed in Chhattisgarh, Haryana, Jharkhand, Kerala, and Madhya Pradesh.
I/O DISCRETIONS: POLICY-PEOPLE FAILURES
Planning Stage: According to a recent audit report by CAG, the initial plan that was cleared by the Cabinet Committee on Economic Affairs (CCEA) for Bharatmala Project (BP) went for a toss, which resulted in mammoth cost escalations, inclusion of already awarded and developed projects, and going ahead without resolving earlier contentious issues. The original BP scheme comprised the development of nearly 75,000 km of roads. The estimated cost for Phase – 1, which included 24,800 km of national highways and residual roads (10,000 km), was Rs 535,000 crore. Phase – 1 was to end in September 2022.
When the roads ministry optimised the projects in Phase – 1, the length of highways shot up to nearly 65,000 km (including residual roads), or an increase of 160% over the initial 34,800 km. As of March 2023, 26,316 km were awarded, which was just over 75% of CCEA approved length. But the costs zoomed to Rs 846,588 crore. While CCEA estimated a unit cost of Rs 15.37 crore per km, the new figure was Rs 32.17 crore, or over 100% increase. Only 13,500 km, or 39%, was complete. This is surprising as length constructed per day went up from just over a km in 2018-19 to over 12 km in 2022-23.
Languishing projects from a pre-BP era were taken up again without resolving the existing impediments and bottlenecks such as availability of right of way, or pending disputes regarding forest land including wildlife sanctuaries. This resulted in them getting stuck again. CAG observed that “no rational, systematic and codified methodology was adopted in prioritisation of projects.” Timelines were not decided for awarding and constructing the projects.
Projects were taken up without detailed reports, or deficient cost-benefit studies. An example: Delhi-Vadodara Expressway of 828 km. The government audit observed that Phase-1 included national highways length of 34,972 km (49.29%) which was already developed or awarded under various schemes before the approval of BP Phase – 1 in October 2017. There were no new proposals to develop them further. Still, they were considered, which resulted in an “exaggeration… of the pool of national highways length.”
Implementation Stage: A couple of years after the program was launched, the total cost for Phase – 1 catapulted from just over Rs 700,000 crore to Rs 1,055,000 crore. This did not include the share of private parties (Rs 205,000 crore), which had to invest in projects given on BOT (Build, Operate, Transfer) and HAM (Hybrid Annuity Model). As expected, the Phase – 1 required higher support from the government (32% more), and forced the ministry to borrow huge sums from the market (over 100% more than CCEA estimates).
When costs skyrocketed to over Rs 700,000 crore, the roads ministry claimed that the CCEA lower estimates did not include interest on debt, and expenses on operations and maintenance of the highways. When the figure crazily soared to Rs 1,055,000 crore, the excuse was that “land acquisition cost was 2.4 times to three times… and civil construction cost was 1.2 times of what was proposed to CCEA”, besides increase in interest and lower receipts from the Center. The civil cost, for instance, did not include the expenditure on bridges, flyovers, intersections, underpasses, and tunnels.
However, CAG noted that costs took off because of these reasons:
- Choice of rigid payment, which is 30% more expensive compared to flexible pavement, but has a higher life cycle;
- Rs 100,000 crore due to more lanes – eight instead of six in case of 56% of 2,400 km of expressways, and similar changes in 47% of economic corridors of 10,400 km;
- Rs 80,000 crore due to hikes in prices of raw materials like cement, steel, and bitumen.
One of the objectives of BP Phase – 1 was to improve the Logistics Performance Index (LPI) of India. But no specific targets or milestones were set by the ministry. There were no outcome targets in terms of travel time, fuel efficiency, accident reduction, riding comfort, or user satisfaction. While the country’s LPI score went up between 2007 and 2023, its global ranking improved by one point to 38. But although the score on infrastructure quality, one of the six parameters in the index, was up, the ranking on this specific was down five notches to 47. To be fair to the ministry, India’s LPI ranking, which stood at 44 in 2018, improved to 38 in 2023, and so did the overall score. The ranking in infrastructure quality was up from 52 to 47.
The CAG audit found 88,760 patients died during treatment under the AB scheme. Still, the IT system showed 214,923 claims related to fresh treatment of these patients were paid. Maximum number of such cases were observed in Chhattisgarh, Haryana, Jharkhand, Kerala, and Madhya Pradesh
In a bid to reduce government exposure, and encourage private investments, the original plan was to construct 60% of the roads under HAM mode, 30% EPC (Engineering, Procurement, Construction), and 10% BOT. The idea was simple: in HAM, the private player constructs the road with financial help from the government, which collects the toll, and gives annual annuities (fixed sum) to the builder. In EPC, the government pays the contractor. In BOT, the private players bring in funds, collect the toll for a specified period, and transfer the projects to the government.
For the government, the best bet is BOT, but few private parties wish to take such huge risks and sink in money. For the private firm, the best odds are in EPC, as the government takes the risks. The better balance is in HAM, where both are invested. Hence, it made sense to award more projects on the safer and stable HAM mode, and the least on BOT. As the awards were given, CAG found that a mere 1.75% of km length was being developed under BOT, more than 48% EPC, and less than 50% HAM. As the ministry had earlier predicted, this mismatch and reduced private investment increased the financial burden on the government. Thus, Rs 157,000 crore approved for other roads schemes were utilised to achieve BP Phase – 1 targets.
Clearly, when targets and numbers become paramount, nothing can be left to chance. The efforts of the policy makers and public officials are geared to achieve them by hook or by crook. No policy or implementation stone is left unturned. Human intervention ensures that technology takes a back seat, as does governance. This obviously leads to different forms of corruption, which negates the objectives of the schemes.
A HIGHWAY TO HEAVEN
The blind chase of targets has led to the worst outcome for Dwarka Expressway, a road that aims to ease the traffic congestion between Delhi and Gurugram by running parallel to NH-48. The per km cost was an astounding Rs 251 crore against CCEA estimate of Rs 18 crore, or 14 times the original figure
DWARKA Expressway, which runs parallel to NH-48 to decongest traffic between Delhi and Gurugram, epitomises the worst that can happen in the race to blindly chase targets. The per km cost was an astounding Rs 251 crore against CCEA estimate of Rs 18 crore, or 14 times the original figure. The main reason was the change in plans. When Haryana could not move forward on the project, it handed over 90 m of right of way free of cost. According to CAG, 70-75 m of right of way was enough to build the proposed 14 lane highway. However, for no reasons on record, the portion in Haryana, where its length was 19 km, was envisaged as an eight-lane elevated corridor.
The ministry stated that the elevated road was to ensure minimal entry-exit arrangements, and smooth traffic movement. The vehicles that did not cross Gurugram border on the other side, and constituted intra-NCR traffic between Delhi and Gurugram only, could use the old six-lane highway. Herein lies the glitch. As per feasibility studies, of the more than 300,000 vehicles that ply between Delhi and Gurugram, over 81% are passenger vehicles that are inter-city traffic between Delhi and Gurugram. The traffic that really needs the elevated corridor comprises just over 55,000 passenger vehicles, excluding freight ones. CAG stated that it did not make sense to build an eight-lane elevated road for traffic that was less than a fourth of the inter-city one, which was envisaged to use the old six-lane road.
Obviously, the toll tariff for a project that costs Rs 251 crore per km was estimated at almost five times the Rs 60 charged from a car for a single trip on the existing toll plaza at the Gurugram border. To find a solution, the ministry bought the toll collection concessions of both the existing toll and Dwarka Expressway. Both were combined as a loop, and linked via the Intelligent Transit System. The result: every commuter using either NH-48 or Dwarka Expressway would be tolled. The idea was to prevent traffic diversion to un-tolled portions. But now, the inter-city traffic between Delhi and Gurugram, which forms the bulk and was not tolled as it used NH-48, will need to pay the tariff. And the ministry has done nothing to improve this highway. These commuters will subsidise the high cost of Dwarka Expressway.
Dwarka Expressway was appraised and approved without a detailed project report. The final feasibility report was filed after the project was cleared. The ministry maintained that the project was given as a “variation to consultancy services” of an existing contractor, who had to prepare feasibility for Delhi-Jaipur Expressway. There was no provision for a detailed report in the consultancy agreement. The Dwarka project was given under EPC rather than the proposed HAM. The ministry stated this was to avoid delays, as was normal with HAM projects. CAG found that the EPC tenders were finalised 1-3 years after they were issued. This defeated the purpose of choosing EPC. The ministry had to bear the burden of Rs 7287 crore for a 29-km stretch. In case of HAM, it would have to pay 40% during construction, and the remaining as semi-annual annuities spread over 15 years.