INTRODUCTION

India is one of the developing countries in the world having 1.37 billion populations as per 11 march 2019, of which 70% and 30% population lives in rural and urban area respectively.In India 276 million people fall under below poverty line out of total population. Below Poverty Line is an economic benchmark (Rs 27,000 per annum) used by the government of India to indicate economic disadvantage and to identify individuals and households in need of government assistance and aid. The annually 3.2% Indians falling below the poverty line and also the report pointed out that three forth Indians spending their entire income on health care and purchasing drugs so there is a need of educating the people about availability of government heath schemes to cover below poverty line (BPL) families.¹

There are various government schemes under the health sector which provide financial assistance for below poverty line (BPL) families, both at central and state level. Expectation of high quality and low cost of health care in insurance facility led the people to accept health scheme. These health schemes reduce the out-of-pocket expenditure and provide financial protection to BPL families.²

Rastriya Arogya Nidhi (RAN) scheme was launched in 1997 this is the only scheme which comprehensively covers tertiary care cost for majority of the life-threatening diseases among BPL patients. Ministry of Health and Family Welfare provides financial assistance of Rs.5 crore for the people who belong to BPL families suffering from major life-threatening diseases like heart, liver, kidney and cancer, etc. The 12 super specialty Government hospitals like AIIMS, RML Hospital, PGI, JIPMER, NIMHANS, SGPGMS CNCI, KGMC, and SKIMS. The financial assistance to such patients is released in the form of ‘one time grant’ to the Medical Superintendent/Director of the hospital in which the treatment is being received.³

Ministry of Health and Family Welfare is giving financial assistance to the poor patients for treatment at different hospitals in all over the country. Under this Rastriya Arogya Nidhi scheme Health Minister’s Cancer patient fund (HMCP) has been setup providing financial assistance to the poor patients suffering from Cancer.⁴

Ayushman Bharat Yojana or Pradhan Mantri Jan Arogya Yojana (PMJAY). It is a centrally sponsored scheme launched in 23^rd September 2018, under the Ayushman Bharat Mission of ministry of health and family welfare in India. The scheme aims at making interventions in primary, secondary and tertiary care systems, covering both preventive and promotive health, to address healthcare holistically.⁵

Ayushman Bharat is National Health Protection Scheme, which will cover over 10 crore poor and vulnerable families (approximately 50 crore beneficiaries) providing coverage up to 5 lakh rupees per family per year for secondary and tertiary care hospitalization. The current ongoing health schemes like Vajpayee Arogyashree, Yeshaswini Scheme, Rajiv Arogya Bhagya Scheme, RastriyaSwasthayaBimaYojana (RSBY) including RSBY for senior citizens, Indira Suraksha Yojana, Cochlear Implant Scheme etc, will all be converged under this new Arogya Karnataka Scheme.⁶

Health Ministry said as many as 13,657 health and wellness centre (HWCs) were operationalised within the period of the corona virus pandemic itself (between January to July 2020). In the last five months, 1.41 crore individuals were screened for hypertension, 1.13 crore for diabetes and 1.34 crore for oral, breast or cervical cancer, the ministry said. Despite the challenges posed by the COVID-19 pandemic, medicines were dispensed to about 5.62 lakh hypertension patients and 3.77 lakh diabetes patients at the HWCs in June alone, according to the statement.⁷ Covid-19 patients admitted in hospitals are seeking care under the Ayushman Bharat Pradhan Mantri Jan Arogya Yojana (AB PM-JAY).Currently, 499 Covid-only private hospitals and 439 Covid-only public hospitals are under AB PM-JAY.

The good health will built good nation. The healthy people are capable of saving world from current and future issues of health. Expectation of high quality and low cost of health care facility led the people to accept the health scheme. This could be possible through educating the below poverty line people to get the benefits of various government health schemes.

Planned teaching programme is systematically developed instruction that is designed to provide information regarding improving knowledge of people living in below poverty line regarding government health schemes (Rastriya Arogya Nidhi and Ayushman Bharath).

NEED FOR THE STUDY:

Poverty and ill-health go hand in hand. In developing countries high out of expenditure, absence of risk pooling mechanism in health financing systems and high level of poverty are said to result in catastrophic health expenditure. Health schemes are the need of the hour in the absence of universal health coverage.⁸

A study was conducted in Sweden to describe adolescents and young adults’ knowledge about their health schemes, and to identify factors associated with correct knowledge of health schemes in this population. A total of 50.7% of respondents correctly identified their type of health schemes. Approximately half of adolescents and young adults do not know how their medical bill was paid. Those who correctly identified health schemes had a higher mean age. Only 48.5% of participants who were 11-18 years old could identify health schemes type, versus 53.1% of 19-21-year-old and 64.7% of 22-24 years-old (p=0.02). The study concluded that the knowledge was lacking among adolescents and young adults on type of health schemes and need more awareness was found.⁹A Study was conducted in India among 376 patients who utilize the health services in view of life-threatening diseases. The aim of the study was to achieve equity in health service utilization. The result of the study shows that annual report of Rastriya Arogya Nidhi 2015-2016 reported that Rs. 14.76 crore has been released for the treatment of 376 patients. For State Illness Assistance Fund, Rs. 11.75 crore has been released in total in the year 2015-16. For the HMCPF scheme, Rs. 979 lakhs has been released to the RCCs and totally 260 patients have availed the fund in the financial year 2015-16. For health minister’s discretionary grant (HMDG) scheme, Rs. 219 lakhs has been released and totally 280 patients have been benefitted under this scheme in the year 2015-16. The above study concluded that Rastriya Arogya Nidhi (RAN) is a major financial assistance scheme which can have significant impact on the economic livelihood of patients from below poverty line with major diseases.¹⁰

A Descriptive study was conducted In Karnataka among 25,951, 644 (49.11%) female population to document the health problems encountered in rural and urban community. The analysis found that about 1.5 lakhs cancer cases at any given time and about 35,000 new cancer cases are added to each year. Incidence of breast cancer increased from 14.5% in the year 1990 to 23.5% in the year 2005. Cases of breast cancer among a younger age group have increased by 15 to 20 per cent. The study concludes that as increase mortality rate of cancer due to the high cost of treatment modalities. In this life threating disease Rastriya Arogya Nidhi (RAN) is the best health scheme to support the people who fall under the below poverty line.¹¹

A Cross-sectional study was conducted in Bengaluru among 447 households who met the inclusion and exclusion criteria. The samples were interviewed to assess the awareness and utilization of health schemes. The result of the study showed that mean age of the head of the family of study household was 44±12 years, most of the households were headed by males (89.7and), majority (79%) belongs to lower class of socio-economic status. The study revealed that only 10.5% of households were having adequate knowledge regarding health schemes and 6.7% of households were covered under some forms of health schemes. Out of these only 1.6% of households were covered under Arogya Karnataka (Ayushman Bharath), none of the households had utilized Ayushman Bharath in last one year. The article reveals that awareness campaign should be undertaken to increase the awareness regarding government health schemes and its benefits to reducing the out-of-pocket expenditure as well as financial catastrophes during illness.¹²

From the above research findings, personal experience and interest in community has motivated the researcher to conduct Planned teaching programme for improving the knowledge of below poverty line people to generate awareness about selected government health schemes. This intervention will benefit the below poverty line people to reduce the effects of morbidity by supporting them financially during the time of illness. These schemes will also enhance living standards and promoting the health in rural community.

STATEMENT OF PROBLEM:

A Study to assess the effectiveness of planned teaching programme on knowledge regarding the government health schemes (Rashtriya arogya nidhi and Ayushman Bharath) among the people living in below poverty line in selected rural community, Bengaluru

OBJECTIVES:

1. To assess the pretest knowledge score regarding the government health schemes (Rastriya Arogya Nidhi and Ayushman Bharath) among the people living in below poverty line.

2. To determine the effectiveness of planned teaching programme on knowledge regarding the government health schemes (Rastriya Arogya Nidhi and Ayushman Bharath) among the people living in below poverty line.

3. To determine the association between the pretest knowledge score and selected socio demographic variables of people living in below poverty line.

OPERATIONAL DEFINITIONS:

1. Assess: Assess is an activity to decide the level of the government health schemes (Rastriya Arogya Nidhi and Ayushman Bharath) among the people living in below poverty line.

2. Effectiveness: It refers to the improvement in level of knowledge on government health schemes (Rastriya Arogya Nidhi and Ayushman Bharath) among the people living in below poverty line after the Planned Teaching Programme as determined by a structured knowledge questionnaire.

3. Planned teaching programme: It is a method of teaching used to impart knowledge regarding the government health schemes to the people living in below poverty line with the use of flash cards and charts for a period of 40 minutes.

4. Knowledge: It is an ability of the people to understand and to answer the structured knowledge questionnaire on government health schemes (Rastriya Arogya Nidhi and Ayushman Bharath).

5. Government health schemes: are the schemes provided by the government for the welfare of people living in below poverty line. In this study the researcher wants to know the knowledge of the below mentioned schemes.

*Rastriya Arogya Nidhi: This scheme was launched in 1997 this is the only scheme which comprehensively covers tertiary care cost for majority of the life-threatening diseases among BPL patients.

*Ayushman Bharath: This is National Health Protection Scheme, which will cover over 10 crore poor families (approximately 50 crore beneficiaries) providing coverage up to 5 lakh rupees per family per year for secondary and tertiary care hospitalization.

6. People living in below poverty line: Below Poverty Line people (age group between 18 to 50 years) are those people whose economic benchmark is less than Rs.27000 per annum by the government of India to indicate the individuals and households in need of government assistance and aid. In this study the researcher will select the individuals who are holding the BPL card issued by the Government of India.

7. Rural community: In this study rural community is the selected rural area in Bengaluru from where the researcher will select the sample.

HYPOTHESES:

H₁: There will be significant difference in the knowledge score on government health schemes (Rastriya Arogya Nidhi and Ayushman Bharath) among the people living in below poverty line after attending planned teaching programme at p≤0.05.

H₂: There will be a significant association between pre-test level of knowledge on government health schemes (Rastriya Arogya Nidhi and Ayushman Bharath) and selected demographic variables of people living in below poverty line at p≤0.05.

RESEARCH METHODOLOGY:

Research methodology is a way to systematically solve the research problem. It may be understood as a science of studying how research is done scientifically.

Research Approach:

In this present study, by viewing the nature of the problem and objectives, the researcher adopted a quantitative approach because it involves the generation of data in quantitative form, which can be subjected to rigorous quantitative analysis in a firm and rigid fashion.

Research Design:

The selection of design depends upon the purpose or the objectives as well as the hypothesis framed for the study. The research study selected for the study is pre-experimental design i.e. one group pre-test post-test design.

Population:

The target population of the comprised of people living below poverty line in selected rural community Bengaluru.

Sampling Technique and Sample Size:

There are several techniques of sampling. In this study, purposive sampling technique will be used for selecting 60 samples.

RESULTS:

This deals with the analysis and interpretation of data collected through structured knowledge questionnaire from people living in below poverty line (N=60). The purpose of this analysis is to reduce the data to a manageable and interpretable form so that the research problems can be studied and tested. The results were computed using descriptive and inferential statistics based on the objectives of the study.

Classification of Respondents on Pre test and Post test Knowledge level on Government health schemes

Table: 1 Classification of Respondents on Pre test and Post test Knowledge level on Government health schemes. N=60

Knowledge Level	Category	Classification of Respondents				χ ² Value
		Pre test		Post test
		N	%	N	%
Inadequate	≤ 50 % score	44	73.3	0	0.0	86.12*
Moderate	51-75 % Score	16	26.7	18	30.0
Adequate	> 75 % score	0	0.0	42	70.0
Total		60	100.0	60	100.0

* Significant at 5% level; χ² (0.05, 2df) = 5.991

The Graph and The Table:

Reveals that 44(73.3%) study participants had inadequate knowledge whereas 16(26.7%) had moderately adequate knowledge and none of them had adequate knowledge in pre-test. But in post test 42(70%) of study participants had Adequate knowledge whereas 18 (30%) had moderately adequate Knowledge and none of them were had Inadequate Knowledge.

Table: 2 Association between Demographic variables and Pre test Knowledge level on Government health schemes n=60

Demographic Variables	Category	Sample	Knowledge Level				χ ²Value	P Value
			Inadequate		Moderate
			N	%	N	%
Age group (years)	18-25	15	13	86.7	2	13.3	9.49*	P<0.05 (7.815)
	26-33	21	17	80.9	4	19.1
	34-42	19	13	68.4	6	31.6
	43-50	5	1	20.0	4	80.0
Gender	Male	21	12	57.1	9	42.9	4.33*	P<0.05 (3.841)
Gender	Female	39	32	82.1	7	17.9	4.33*	P<0.05 (3.841)
Educational status	No formal education	21	16	76.2	5	23.8	1.71 NS	P>0.05 (7.815)
	Primary	16	13	81.3	3	18.7
	High school	16	11	68.8	5	31.2
	PU college	7	4	47.1	3	52.9
Occupation	Home maker	39	31	79.5	8	20.5	6.84*	P<0.05 (5.991)
	Daily wages	11	9	81.8	2	18.2
	Farmer	10	4	40.0	6	60.0
Combined		60	44	73.3	16	26.7

Religion	Hindu	32	25	78.1	7	21.9	6.72*	P<0.05 (5.991)
	Muslim	8	8	100.0	0	0.0
	Christian	20	11	55.0	9	45.0
Type of family	Nuclear	34	29	85.3	5	24.7	5.74*	P<0.05 (3.841)
Type of family	Joint	26	15	57.7	11	42.3	5.74*	P<0.05 (3.841)
Family income/month	<Rs.10,000	11	10	90.9	1	10.1	2.40 NS	P>0.05 (7.815)
	Rs.10,001-15,000	14	9	64.3	5	35.7
	Rs.15,001-20,000	24	17	70.8	7	29.2
	>Rs.20,000	11	8	72.7	3	27.3
Combined		60	44	73.3	16	26.7

The above table shows that the obtained values of Age (χ 2 =7.815), Gender(χ 2 =3.841), Occupation(χ 2 =6.84), Religion(χ 2 =6.72), Type of family(χ 2 = 5.74), Information on RAN and Ayushman Bharath(χ 2 =6.06) and Source of information on RAN and Ayushman Bharath are greater than the table value (P<0.05). This implies significant association between the knowledge and Age, Gender, Occupation, Religion, Type of family, Information and Source of information on Rastriya Arogya Nidhi and Ayushman Bharath . Hence research hypothesis is accepted.

DISCUSSION:

The analysis was done to find out the association between pretest level of knowledge and age, gender, educational qualification, religion, type of family, family income, information on Ayushman Bharath and RAN and source of information.

Socio-demographic variables with pretest knowledge score:

· Age χ 2=9.49, (S), P<0.05.

· Gender χ 2=4.33, (S), P<0.05

· Occupation χ 2=6.84 (S), P<0.05

· Educational qualification χ 2=1.70 (NS), P>0.05

· Religion χ 2=6.72 (S), P<0.05

· Type of family χ 2=5.74 (S), P<0.05

· Family income χ 2=2.40 (NS), P>0.05

· Information on ayshman bharath and RAN χ 2=6.06 (S), P<0.05

· Source of information χ 2=6.10 (S), P<0.05

These findings indicated that except for educational qualification, and Family income with pretest knowledge score, χ2 values of all other socio-demographic variables were less than the table value at 0.05 levels of significance. Therefore, the null hypothesis is rejected. Variables with regard to age, gender,occupation, educational qualification, religion, type of family, Information on Ayshman Bharath and RAN, Source of information, research hypothesis is accepted at 0.05 levels of significance.

CONCLUSION:

The study showed that there is highly significant difference between the pre test and post test knowledge among people living in below poverty line on government health schemes (Rastriya Arogya Nidhi and Ayushman Bharath). The improvement mean was (9.87). The planned teaching programme had enhanced the knowledge of among people living in below poverty line and it will help them in increasing the knowledge of government health schemes (Rastriya Arogya Nidhi and Ayushman Bharath).

NURSING IMPLICATIONS:

The investigator observed that following implication drawn from the study are vital concern for nursing practice, nursing education, nursing administration and nursing research which provide way towards better improvement in knowledge of the people living in below poverty line regarding government health schemes (Rastriya Arogya Nidhi and Ayushman Bharath).

RECOMMENDATIONS:

Based on the study, it is recommended that:

· A replicate of present study can be conducted with a large population and wider area for wider generalization.

· A study can be done to evaluate the effectiveness of planned teaching programme on Government health schemes (Rastriya Arogya Nidhi and Ayushman Bharath) among people living in below poverty line.

· A similar study can be replicated with other group.

· A comprehensive study may be conducted to compare the different instructional methods on knowledge of Government health schemes (Rastriya Arogya Nidhi and Ayushman Bharath) among people living in below poverty line.

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Received on 19.12.2024 Revised on 28.02.2025

Accepted on 03.04.2025 Published on 21.05.2025

Available online from May 23, 2025

Int. J. of Advances in Nursing Management. 2025;13(2):91-96.

DOI: 10.52711/2454-2652.2025.00019

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