Helping Communities Manage risks from the ground up.

(WAVE I):

The CBHI India project was initiated in August 2009. The project's core research hypotheses as well as data collection tools were refined in the following months, in light of the discussion held at the project's first Advisory Board meeting in November 2009. Baseline quantitative, qualitative and spatial research was carried out for 8 months, running consecutively from January to August 2010. CBHI implementation activities for each site have been ongoing since Apr 2010, and have been intensified from September 2010 onwards, following the completion of baseline research. Highlights include:

1. Research

• May 2010: Baseline quantitative survey completed (5,214 households)
• July 2010: Baseline spatial survey completed (3,092 health service providers)
• August 2010: Baseline qualitative survey completed (106 FGDs and 82 KIIs)

⇒ Research Output: The first academic paper was published in October, 2011 in Trials Journal (http://www.trialsjournal.com/content/12/1/224)

2. Training and Implementation

• May 2010: Initiation workshops completed
• June 2010: Design workshops completed
• July 2010: Awareness Tool Development workshops completed
• August 2010: Benefit Options Consultations undertaken
• October 2010: Facilitator Training for Awareness Creation and CHAT conducted
• November 2010: Benefit options finalized and Insurance Awareness Campaign launched
• December 2010: Ground Structure and MIS Training undertaken
• February 2011: First CBHI scheme launched in Pratapgarh, Uttar Pradesh
• March 2011: CBHI scheme launched in Vaishali, Bihar
• June 2011: CBHI scheme launched in Kanpur Dehat, Uttar Pradesh

⇒ During the first wave of implementation, 710 households (covering 2,629 individuals) were enrolled in the three study areas

• PROGRESS (WAVE II):

The second wave of the project was scheduled after the completion of the first wave of the CBHI schemes. Following the initiation of the CBHI schemes, the data collection tools were revised, based on the learning of the baseline survey. The second wave of the study started with the first round of Midline qualitative survey in February, 2012, followed by the quantitative survey (focus was on treatment group only), spatial survey and second round of qualitative survey. Training and implementation workshops were also conducted simultaneously. Highlights of the second wave are:

1. Research

• February 2012: Midline qualitative survey (1^st round) completed (42 case studies)
• April 2012: Midline quantitative survey completed (3,776 households)
• June 2012: Midline spatial survey completed (285 health service providers in selected villages)
• June 2012: Midline qualitative survey (2^nd round) completed (revisiting 42 case studies)

2. Training and Implementation

• November 2011 to February 2012: Benefit Options Consultation Workshops completed
• November 2011 to February 2012: Training on MIS completed
• November 2011 to March 2012: Facilitator Training for Awareness Creation and CHAT conducted
• December 2011 to April 2012: Ground Structure Training undertaken
• March 2012: CBHI schemes launched in Pratapgarh, Uttar Pradesh and Vaishali, Bihar
• June 2012: CBHI scheme launched in Kanpur Dehat, Uttar Pradesh

⇒ During the second wave of implementation, 1,306 households (covering 4,050 individuals) were enrolled in the three CBHI schemes with an overall 60% re-enrolment rate for the households (54% for individuals).

• 3. Dissemination

Publication:

• Doyle Conor, Pradeep Panda, Ellen Van de Poel, Ralf Radermacher and David Dror), (2011), “Reconciling Research and Implementation in Micro Health Insurance Experiments in India: Study Protocol for a Randomized Controlled Trial”, Trials, 12:224. http://www.trialsjournal.com/content/12/1/224
• Dixit, Shikha and Pradeep Panda (2013): " Spatial research methodology supplementing cluster randomized control trials: learning from a study of community-based health insurance schemes in India", International Journal of Geoinformatics, (forthcoming in March issue).

Presentation:

Papers presented in the Conference in Twente

The project partners organized a panel session on “Developing Efficient and Responsive Community-Based Micro Health Insurance in India” at the Research Conference on Microinsurance, organised by University of Twente, during 11^th – 13^th April, 2012. The following five papers were presented there:

• Reconciling research and implementation needs in micro health insurance experiments in India: study protocol for a randomized controlled trial (Authors: Conor Doyle, Pradeep Panda, Ellen Van de Poel, Ralf Radermacher and David Dror). (Presented by Pradeep Panda and Ellen Van de Poel)
• Health shocks and financial implications for households in rural India (Authors: Marta Quintussi, Ellen Van de Poel, Pradeep Panda and Frans Rutten (Presented by Ellen Van de Poel)
• Group health insurance choices in rural India (Authors: Ralf Radermacher, Marta Quintussi, Pradeep Panda and Christina May(Presented by Marta Quintussi)
• Factors influencing uptake of micro health insurance products in rural India (Authors: Conor Doyle and Pradeep Panda) (Presented by Pradeep Panda)
• Understanding enrolment decisions in a micro health insurance programme in Northern India – qualitative evidence (Authors: Katja Roth, Christina May, Sudeshna Ghosh and Pradeep Panda) (Presented by Christina May)

Papers presented in the Conference in Erasmus University

Two presentations were made by the researchers at the high level international conference on access to health insurance, held at Erasmus University Rotterdam on 5th June, 2012, as follows:

• Understanding demand and increasing uptake – Recommendations derived from micro health insurance in India (Presented by Dr. Pradeep Panda and Christina May)
• Trust in health insurance – Lessons from the field on what enhances it and what does not? (Presented by Prof. David Dror)

Paper presented in the International Health Economics Association World Congress, Toronto

• Reconciling research and implementation needs in micro health insurance experiments in India: study protocol for a randomized controlled trial (Authors: Conor Doyle, Pradeep Panda, Ellen Van de Poel, Ralf Radermacher and David Dror).   (Presented by Conor Doyle in July, 2011.

Paper presented at the Elsevier Health System Reform in Asia Conference, Hongkong

• Health shocks and financial implications for households in rural India (Authors: Marta Quintussi, Ellen Van de Poel, Pradeep Panda and Frans Rutten). (Presented by Ellen Van de Poel  in December, 2011)

Poster presented at an International Conference in BerlinCooperative Responses to Global Challenges

• Illustrating the project and its implementation and evaluation approach 2012: “Developing efficient and responsive community-based micro health insurance in India”,  21-23 March 2012, Berlin, (http://www.coopsyear.hu-berlin.de/). Katja Roth and Christina May presented the poster.

India Day 2011

• As part of the yearly India Week in Cologne, the Department for Cooperative Studies presented the CBHI India project to professors, students and other interested public with a poster and other information material on the University’s India Day on June 08th 2011.

4. Exposure Visit

• In September 2011, three researchers from University of Cologne (Hans Jürgen Rösner, Katja Roth and Christina May) visited the project sites in Kanpur Dehat district and Pratapgarh district in Uttar Pradesh. They met with the implementing partners and groups of insured members to discuss project-related as well as general issues of healthcare financing and microinsurance and also explored the healthcare situation by visits to private and public hospitals.
• In February/March 2012, four researchers from University of Cologne (Hans Jürgen Rösner, Katja Roth, Christina May and Marta Quintussi) re-visited India and the project sites in Pratapgarh district, Uttar Pradesh, and Vaishali district, Bihar. They met with implementing staff, insured and non-insured households as well as healthcare providers working under the health insurance schemes. They also advised and accompanied the qualitative data collection taking place during that time and discussed the new approach of case studies with the local researchers.
• Summer School 2011- From September 19th to October 3rd 2011, the Department for Cooperative Studies, University of Cologne, and the Micro Insurance Academy together with the Professional Centre of the University of Cologne organized a Summer School for students on “Micro Health Insurance in Developing Societies – Protection for the Poor?” The Summer School took place in New Delhi, India, and comprised theoretical as well as practical studies. In the second week of the programme, the 16 students and 4 accompanying staff (including three members of the CBHI India project) visited the project partners Shramik Bharti and BAIF, the study sites and the villages and had discussions on healthcare, healthcare spending and micro health insurance with the local NGO staff, local doctors, accredited social health activists (ASHAs) as well as with insured and non-insured community members themselves.

They also visited private and public hospitals. The students learned fundamentals of healthcare financing in India, insurance and micro health insurance and were introduced into the work of the CBHI India project. The Summer School as well as the project activities achieved good media coverage, including the Cologne newspaper “Kölner Stadt-Anzeiger” as well as the University of Cologne’s newspaper and radio programme.

• The Micro Insurance Academy was a Knowledge Provider for the South-South Knowledge Exchange on Health Insurance for the Informal sector between India and Nigeria, organised by a Development Impact Evaluation (DIME) team of the World Bank comprising Edit V. Velenyi (Health Economist/Mission Head) and Marcus Holmlund (Economist/Field Coordinator). The Knowledge Recipient was the National Health Insurance Scheme (NHIS). The 10-member high-level delegates from NHIS visited one of the EC-FP7 sites (Vaishali) during April 4-5, 2011. They were impressed by the good practices and compiled practical lessons from CBHI.
• A delegation from Bangladesh visited Micro Insurance Academy during April 17 – 19, 2012. The team was headed by Dr. Tim Evans, Dean, BRAC University, School of Public Health & Team with Mr. Adib Hossain Ishrath and Ms. Fatema Binte Rasul. They had field visit to one of the EC-FP7 sites (Vaishali)  on April 19, 2012, to get a first-hand exposure about the functioning of CBHI.
• A delegation from Bangladesh (Director and others from Institute of Microfinance, InM) visited Micro Insurance Academy during 28th May to 3^rd June, 2012. The team comprised of Dr. & Mrs. Md. Mosleh Uddin Sadeque, Dr. & Mrs. Md. Abdul Latif, Professor Syed M. Ahsan, Dr. Syed Abdul Hamid and Dr. Md. Rifat Haider. The team went to one of the EC-FP7 sites (Vaishali) during June 2-3, 2012, to understand the design and operational issues in CBHI implementation.