Beneficiary and stakeholder perspectives on the utilization and implementation of the Swasthya Sathi Scheme in Murshidabad District, West Bengal, India: a qualitative study

Abstract Background Out-of-pocket expenditure remains a major challenge to healthcare access in India and often places a substantial financial burden on households. To improve financial protection and access to healthcare services, the Government of West Bengal introduced the Swasthya Sathi Scheme, a state-funded cashless health insurance programme that provides coverage of up to INR 500,000 (approximately USD 5210) per family annually. This study aimed to explore beneficiaries’ experiences of using the Swasthya Sathi Scheme and stakeholders’ perspectives on its implementation in Murshidabad district, West Bengal. Methods A qualitative exploratory study was conducted in Murshidabad district, West Bengal, between December 2024 and March 2025. A total of 28 in-depth interviews were conducted with 16 beneficiaries who had utilized the scheme and 12 individuals involved in its implementation at hospital, block, and sub-divisional levels. Participants were recruited using purposive sampling. Interviews were conducted in Bengali, audio-recorded, transcribed verbatim, translated into English, and analysed thematically using ATLAS.ti version 8. Results Five themes emerged from the analysis: awareness, accessibility and scheme coverage; delivery of scheme services and healthcare utilization; coordination and support systems; health-seeking behaviour and scheme enablers; and challenges in scheme access and implementation. Participants described the scheme as an important source of financial support that improved access to healthcare services, particularly for costly treatments and surgical procedures. Community-level enrolment camps, involvement of local stakeholders, and the cashless nature of the scheme were identified as important facilitators of utilization. However, participants also reported challenges related to limited awareness of scheme entitlements, card-related issues, operational constraints, and socio-cultural barriers that affected access and implementation. Conclusions The Swasthya Sathi Scheme was perceived as an important mechanism for improving access to healthcare services and reducing financial burden among beneficiaries in Murshidabad district. While participants reported positive experiences with the scheme, several implementation challenges continue to affect its utilization. The findings highlight the importance of awareness, community engagement, and effective administrative processes in supporting the implementation of publicly funded health insurance programmes.