Community Health Protection Programme

Implementing Agency – People’s Education and Development Organisation (PEDO)Technical Agency – UPLIFT, PuneFinancial Support – Save the Children

Genesis

Ultra poor scoping study &

vulnerability analysis 2010

High incidence of shocks and

stresses leading to child

vulnerability

30% indebtedness on health incidence.

No mechanism available for coping shocks and stresses

Need to develop programs to address high number of

health incidences and

reduce vulnerability.

Two feasibility studies done through Micro Insurance Academy and UPLIFT, India for developing Community Base Micro Insurance Programme

Highlights of the study undertaken by UPLIFT- base for developing the mutual model

Average Out of Pocket Expenses for single event of hospitalisation ranges from 15000-25000 Rs & Rs200-5000 spend on OPD care.

Information asymmetry

High incidence of communicable diseases (TB, Malaria, Diarrhoea), Malnutrition (predominantly anaemia) and reproductive diseases (genito-urinary system)

Belief on faith healers in case of general health events.

Travel to nearby Modassa, Himmatnagar, Ahmedabad for surgeries or serious cases

Indebt-ness of those with history of medical events very high. (Health Loan through 11,63,300 in 3 federations: 2012-13)

Loss of savings, earnings, assets selling high and taking out children out of school are uncounted.

Objective of the programme

Right information for Right

Treatment

• 24X7 help line, handled by general nursing midwife’s• Referrals of beneficiaries to hospital for further treatment and follow up• Follow up with network hospitals to ensure appropriate treatment and discount to

CHPP members

Reducing out of pocket expenses

• Community based health insurance policy managed by SHG federations• A panel of network hospitals so that treament can be availed on discounted rates.• Encourage usage of government health services , which are of minimal charge or free

of cost

Preventive Health Care services

• Guidance centers with paramedical staff to provide health check ups and referrals• Health Check up camps for general or sepcific health ailments , mostly in

collaboration with government health service providers and netwrok hospitals • Health talks on awareness and prevention during SHG meetings

Geographical coverage and targets

3 federations - Mada, Jhontri, Genji

Panchayat covered-31

Village Covered- 110

Targeted SHGs – 550

Cluster (consist of 25-30 SHGs) – 20

Target to enrol 9000 families across 3 federations.

Risk Sharing Mutual Model

Programme offers:

Health guidance centre

24X 7 helpline

Health camps

Health talks

Referral and guidance service towards network health care providers

Reimbursement for hospitalisation expenses (Family floater up to Rs. 12,000/-).

CHPP PolicyPremiumRs 120/ person for family of 3 and moreRs 360 for single individualRs 480 for couple

ClaimRs 12,000 per year per policyDay discharge: Maximum of Rs. 2500General: Maximum of Rs. 7500

Hospitalization reimbursementsGovernment hospitals: 100% of total expenditureNetwork/ Trust hospitals: 70% of total expenditureNon-network/ private hospitals: 50% of total expenditure

Operational actions▪ Client Education:

1- Discussion on different platforms (SHG Meetings, Cluster Meetings and Federation Meetings)2- Usage of different IEC (Audio tool, Brochure, Pamphlets, Poster, flip book)3- Training and orientations program for Federation Leaders4- Case sharing

▪ Reimbursement for hospitalisation expenses.1- Reimbursement in case of hospitalization.2- Decision taken by a trained claim committee consist of federation members and leaders.3- Helps reducing the out of pocket expenses.

Success stories

Case 1-

• Seeta w/o Gebi Lal lived in Genji- Pakron

• Suffered from Colic Pain• Earlier went to modasa & Doctor

advised her for surgery which was cost Rs. 15000/-

• Called on Helpline & referred to Network Hospital by GNM.

• Treated in Rs. 700/- and saved Rs. 14300/- in single incident.

Case 2-

• Ganga w/o Hari Dev lived in Jonthry- Bhinda

• Suffered from Peripheral Arterial disease which is cost Rs. 15,000/- in private hospitals.

• Called on Helpline & referred to Network Hospital by GNM.

• Spent - Rs 7273 (Seven thousand two hundred seventy three)

• Received claim amount – Rs. 5091 (70% as per the product policy)

• Saved – around Rs. 8,000/- by using CHPP.

Progress so far▪ Total enrollment: 4,306 SHG members and 15922 family members

(Dec 2014) ▪ Total 71.41% of households against target renewed policy▪ Total premium collected: Rs 45,76,310/- (Till Dec 2014) ▪ Total Rs 5,12,421 claims received by 190 households (Jan-Dec 2014)▪ 5,841 members benefited from the Guidance Centres (Jan-Dec 2014)▪ Rs. 10,83,342/- saved on OPD care i.e. Consultancy fee @ Rs. 50/- per

patient and medicine exp. available for them) ▪ 1315 members benefited from health camps (Jan-Dec 2014)▪ 242 members accessed referral services by General Nurses and

Midwives through 24X7 helpline (Jan-Dec 2014)