Helping Communities Manage risks from the ground up.

Hard work and dedication of the women's cooperative Bijaynee with support of the Mahashakti Foundation and the MIA in the Kalahandi district of Odisha (Orissa) - one of the most difficult areas of the state - has translated into the successful launch of a new health protection scheme under the MIA's structured technical assistance model. The scheme officially began on 15 February 2010, and saw 350 households (1397 members) enroll in the pilot phase of this community-based health insurance initiative. 

Thanks to the commitment of our local partner, the Mahashakti Foundation, and the efforts of the MIA team, low-income and vulnerable people now have access to an alternative form of social and financial protection. 

New interest in the microinsurance scheme is beginning to spread as insured members receive policy documents, information packages, and reimbursement of claims. To contribute to this, an innovative maternal check-up incentive has been introduced in the scheme: each pregnant woman will receive a cash bonus of 500 rupees if she undergoes three prenatal and three postnatal check-ups. 

From the field: 

"We received the first claim under the NIRAMAYA Community Health Protection Fund within 2 weeks of the scheme initiation. It was a claim for reimbursement of hospitalization expenses. To settle this claim, a Hospital Discharge Certificate was required as a proof in addition to other documents. The claimant had all other documents such as OPD Card, ward and bed number, test reports and medicine bills, but she did not have the Hospital Discharge Certificate. The doctor had advised the patient for a long-term treatment for full recovery, but due to lack of money the claimant decided to leave the hospital. Fearing that the hospital authority might not allow her to leave, she left the hospital in the middle of the night, unauthorised. 

After receiving the claim, the Claim Committee met in Tulapada (the beneficiary's village) to discuss the matter and check the genuineness of the case. The Committee decided in favour of the claim in spite of the fact that they did not receive one of the important documents. This reflects the power of CBHI - says MIA trainer Priya Panda. This case would be very difficult to verify for a commercial insurance. Additionally, the claim was settled in a week's time instead of months, which is how long it can take when such representation is accepted by a commercial insurer. The claimant has now been reimbursed and has recovered from her illness." 

As the scheme progresses, MIA staff will focus on how the process can be improved and how to increase enrollment rates, achieve high levels of retention and maintain client satisfaction. Additionally, we seek to formulate a successful demonstration case study for others to learn from and replicate.