The document proposes a microfinance health insurance scheme to improve access to quality primary healthcare in rural communities. It would establish a nodal center at community health centers to provide minimum premiums, cashless benefits, and reimbursement for out-of-pocket medical expenses. Profits would be reinvested in self-help groups and cooperatives to generate revenue and develop local infrastructure. This aims to increase utilization of existing healthcare services, strengthen referrals, empower communities, and boost the local economy through a sustainable community-level solution.

1. Universalizing Access
to
Quality Primary Healthcare
Healing Hands

2. Problem Statement
Problems of Primary Healthcare:-
Approachability for community Increase trust
Accessibility to Health delivery Increase number.of service providers
Acceptability for Community Involve Community
Affordability for Community Mitigate financial shock of health expenses
Accountability of Health Delivery Assured health delivery
Way
Forward

3. PROPOSED
SOLUTION

4. P
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D
S
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T
I
O
N
Microfinance Health Insurance Scheme with a Nodal Center at
CHC
 Minimal premiums
 Cashless benefits
 Reimburse Out- of- pocket spending on medication due to non-
availability.
 Include private healthcare providers for assured service in case of
non- availability at CHC.
Profits from Insurance Scheme re-invested in local community via
Federation of Self Help Groups (SFG) or Co-operatives to increase
revenue generation and community development.
Microfinance Health Insurance

5. Microfinance Health Insurance
Minimum Premiums
Cashless Services
PHC, CHC and
Selected Private set ups
Re imbursement of
Out-of-pocket expenditure
on medication
due to unavailability
 Improved Demand for Healthcare Services.
 Strengthening of Referral system.
 Increased Utilization of existing set up.
 Empowering community.
Investment in
Local Co-operative
Heathcare and Associated
Infrastructure Development
Contingency Fund for
Medical emergencies
 Improved health seeking behaviour
 Sustainability at local level.
 Boost to local economy
 Overall Community Development
 Health education at workplace.
Health Education and
Behaviour Change
Communication
P
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N

6. P
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Flaws in
Existing System
Merits of Proposed Solution
Low utilization of existing
Healthcare
Services
Increased Utilization of existing Infrastructure by
i) Increased trust in existing system due to assured service
delivery.
ii) Improved Health-seeking behaviour
iii) Change in felt-need through community
involvement.
Unavailability of Services and
Medication
Viable alternative services by including Private Sector
and re-imbursement of Out of Pocket Expenses for
unavailable drugs.
Minimal emphasis on
Prevention
Community Infrastructure development to improve access
to clean drinking water, proper sanitation and good
nutrition to promote overall health of community.
Low involvement of
community
Direct community involvement by incorporating
representatives in the Nodal Office at CHC level to guide
overall functioning and improve accountability.
Required Massive Budget
Allocation for upgradation
Budget generation at local level – Improvement in
services without additional budget requirement, So
Sustainable!

7. P
R
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P
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E
D
S
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N
Pre- existing infrastructure.
 No specialized resource required,
can be locally sourced
 Increase in Scale
-Running costs decreases
-Revenue generation
increases.
 Running cost generated within the scheme
without reliance on outside monetary input.
 Flexibility in service provision according to existing infrastructure.
 Decreasing costs with increasing duration due to improvement in overall
health.
SCALABILITY
As more number of clients
(insurees) join the scheme
i) Risk pool increases
ii) Revenue generated
increases
iii) Average cost per
insuree decreases.
Community Level National Level
SUSTAINABILITY

8. IMPLEMENTATION

9. Marketing
and
response
evaluation
Launch
Insurance
Scheme
Start
Investment
in
Co-operatives
Monitoring-
Change in
health seeking
behaviour
Evaluation –
Change in
Health Indices
&
Start
Investment
In
Community
Infrastructure
Developement
2 months 6 months 2 years 5 years
IMPLEMENTATION TIMELINE

10. IMPLEMENTATION - Requirements
LEVEL HUMAN
RESOURCE
MATERIALS FUNDS
STATE
CHC
PHC
VILLAGE
Training team (5 membered)
NGOs and Health Officers
Education and
Marketing Media
5 lakhs p.a.
Nodal Office
Nodal Officer (new post)
MO-PHC
BDO
Representatives of villages
Health insurance cards
Guidebooks
Insuree registers
Claims register
Stationeries
10 lakhs p.a.
Accounts Manager
(existing post NRHM)
Premium collection register 10,000 p.a.
Reps. of villages
(selected by Panchayat)
Marketing Team
MO-PHC
Community level workers
Health education material
Insuree register
Marketing material
10,000 p.a.

11. IMPLEMENTATION
Source of Funding
Initial Funds
for Start Up Allocated under NRHM
Maintenance
Fund
Generated at Community level
within the Scheme

12. IMPACT
Monitoring and Evaluation

13. IMPACT
 OPD footfalls.
 ANC registration.
 Bed Occupancy rates.
 Claims received.
 Grievance Redressal
- Average time
- Maximum time
 Maternal Mortality Rates.
 Infant Mortality Rates.
 Immunization Coverage.
 Household medical.
expenditure as percentage
of annual spending.
Data from SRS and Census
Monitoring Evaluation
Projected Impact – Improved health service delivery, Improved Health Seeking
Behaviour, Boost local economy and Overall community Developement

14. Strength Weakness
Opportunity Threats

15. Existing Infrastructure
Strengthen Referral
Empower People
Reduce Out-of-Pocket
expenditure
Boost Local Economy
Improve village
infrastructure
Sudden increase in
Claims during
Epidemics
And Diasters
Can be implemented
under NHM along
with proposed
charges for services
at CHCs.
Low trust in
Govt. services
Requires mass
participation for
profit
 Client attrition and
non-payments.
Strengths
ThreatsOpportunities
Weakness
Mitigation of threat by Risk Pooling over time and over place( Interlink with other CHCs)

16. Thank You

17. Annexure

18. Problem Analysis
Availability and accessibility of health care is important for overall health status of
any community.
Both physical and financial accessibility is equally important.
Physical Accessibilty
28.8% of population ( in sample studies ) were having positive health seeking
behavior towards government health care facilities.Majority of the sample studied i.e.
71.2% were having negative health seeking behavior towards government health
care facilities.
Financial Accessibility
Medicine accounted for 70% of treatment cost followed by investigation and
consultation cost. Out of pocket expenditure was the most common financing option
(93.6%) and in 5.6% cases they borrowed money or sale assets and in 0.8% cases
government health insurance were the financing option.

19. Problem Analysis
Micro- Insurance for health with involvement of Private healthcare providers solves
issue of physical and financial accessibilty.
Organization of community based health insurance or government insurance with
contribution from public is urgently needed to protect the poor from slipping into
poverty and indebtedness.

20. References
Raykumar P et al
Health care seeking and treatment cost in a rural community of West Bengal, India ,
[theHealth 2012; 3(3): 67-70]
Mandal S, Kanjilal B, Peters DH, Lucas H.
Catastrophic out-of-pocket pay-ment for health care and its impact on households:
Experience from West Bengal, India.
 Ray TK, Pandav CS, Anand K, Kapoor SK, Dwivedi SN.
Out-of-pocket expenditure on healthcare in a north Indian village.
[Natl Med J India. 2002;15:257-60.]
Rose Ann Dominic et al
Health seeking behavior of rural adults.
[NUJHS Vol. 3, No.3, September 2013, ISSN 2249-7110]

21. References
 Ghosh et al
Factors affecting the healthcare seeking behaviour of mothers regarding their children in
a rural community of Darjeeling district, West Bengal.
[International Journal of Medicine and Public Health,Jan-Mar 2013,Vol 3,Issue 1 ]
 Programme Evaluation Organisation, Planning Commission,Government of India
Evaluation Study of National Rural Health Mission (NRHM) in 7 States [2011]