Baseline FindingsJan 2011

VimoSEWAArogya Sanshodan

Today’s Presentation

Overview of Swasthya Sanshodan project

Summary of baseline findings

Analysis plan

Your feedback on data, analysis and use

Action Research – Why?

VimoSEWA claims 2007-9Primary illness 40% of claimsHysterectomy top claim for rural women, avg

age 37

Effectiveness of health education Longstanding SEWA activity, in different formsRecent studies show impact on neonatal

mortality Can it work for primary care and

hysterectomy?

Research QuestionsCan health education reduce unnecessary

hospitalisation for diarrhea and fever?IncidenceExpenditureHealth seeking behaviour

What are the drivers of hysterectomy? How does education impact on knowledge and

response to hysterectomy and gynecological care?

Do insured members seek health care differently?Does an education program work differently for

the uninsured?

Intervention Design

Selected 28 sevikas who work where VimoSEWA/LSM active

Randomly selected 14 sevikas to implement health education

Focus on diarrhea, malaria/fever and hysterectomyFilm, games and demonstrationsCapacity building and regular feedback

Over 2 years, 5 survey rounds amongst insured and uninsured to capture health seeking behavior

Study Coverage

70 HH sampled in each cluster 35 uninsured – from area listing35 insured – from Vimo MIS

Insured Uninsured Total

Urban 420 396 816

Rural 560 558 1,118

Total 980 954 1,934

HH Profile Rural Urban

Nuclear Family 57% 62%

HH size 5.8 5.8

Yrs in current home

17 yrs 19 yrs

Religion 93% Hindu6% Muslim

83% Hindu16% Muslim

HH income (annual)

INR 79,260 INR 83,337

HH expenditure INR 66,505 INR 66,120

Education: % ever studied

Respondent Profile

Rural Urban

Age 37 39

Marital status

92% married7% widowed

83% married13% widowed

Women working

85% 61%

% SEWA members

53% 60%

% SEWA Bank

13% 55%

Women’s Work

Housing : % HH by Type

Household Toilets

Drinking WaterRural Urban

Own Tap 74% 78%

Shared Tap 13% 12%

Use chlorine 27% 46%

Filter with cloth

94% 83%

Take with doyo

22% 40%

Mosquito precautions

Ration Cards/BPL

SEWA Health Services

VimoSEWA Services

VimoSEWA Coverage

VimoSEWA reach Rural Urban

% of SEWA members 89 74

% of Bank members 77 69

HH with anyone ill – last month

Illness Rates – last month

Leading Illnesses - Women

Place of OPD Treatment

Avg private exp: Rs. 380Primarily private care, but less so in city

Note slight differences within HH

Avg private exp: Rs. 501

% HH reported hospitalisation in last 6 months

Hospitalisation per 100; last 6 mos.

Rural and Urban

Hospitalisation amongst women

Rural Urban

Rates: Rural Vimo/Non-insured

Rates: Urban Vimo/Non-insured

Where Hospitalised - AllRural

Urban

Place of Hospitalisation

Expenditure – Vimo and NV

Are VimoSEWA members different?

DIFFERENCESSES – only urban

More salaried Higher expMore pucca houses

DemographicMore widowsLess educated

(urban)Much more likely to have a ration card

SIMILARITIESSES

Income ToiletsHousing (rural)

DemographicHH sizeFamily structure

Reproductive Health

Rural Urban

Hysterectomy

Age at hysterectomy

Hysterectomy Reasons

Place of Hysterectomy

Analysis PlanBaselineWomen’s illnesses and health seeking behaviour Insured and UninsuredSocial Determinants of Health

OverallImpact of health education – with qualitativeHysterectomy – with qualitative Community health workers – performance and roles