DEPROSC-Nepal has been implementing CBMHI project in Dhading district since 2010 with the financial support of MISEREAR, Germany. Save the Children, Nepal has taken lead and Micro Insurance Academy, India has been providing technical support to DEPROSC Nepal for its implementation. It has a field office at Gajuri and deploying a separate team headed by Project Manager at the district. The project is being implemented in 15 VDCs of Dhading district namely; Baireni, Dhusa, Kalleri, Pida, Jogimara, Kumpur, Gajuri, Naubise Benighat, Thakre, Naubise, Salang, Jeevanpur, Kewalpur and Gaganpani.

Donor:

Save the children & Micro Insurance Academy, Germany/India

Project Objectives

The objective of the project is to increase the access of health facility and distribute the financial risk among the community. The project intends to achieve it through:

  • Increased level of awareness among the beneficiaries on financial risk and benefits of health insurance,
  • Increased capacity of community institutions to manage self-administer micro health insurance scheme,
  • Adoption of health insurance policy by locals and its implementation,
  • Increased exposure to policy makers of different levels on micro insurance,
  • Greater access to inclusive micro health insurance.

Project Activities

Awareness on Community based Health Insurance, Dadhing (CBMHI, DEPROSC-Nepal)
Awareness on Community based Health Insurance, Dadhing (CBMHI, DEPROSC-Nepal)

The participation of community in micro-health insurance program is increasing due to increasing level of awareness and benefits of the program.

Enrollment of 2018 January slot has been completed with total achievement of 6354 members from 1456 HHs. Out of 6354 members, 3320 (52.25%) are female. Children enrolment is 2106 (33.14%). The enrolment of female children is 42.40%. The renewed members is 69.20% among the previous year’s members 6406. Janajati and Dalit participation is 1910 (30.05%) and 410 (6.56%) respectively among the total members (6406). Total premium collection is Rs 23,43, 410 from 6356 members of 1456 HHs.

The claim collection and reimbursement during this reporting period is Rs 16,00,473 for 1866 claimants.The details of claims are as follows:

  • Total number of claims reimbursed: 1866 (Children 267)
  • Total amount of claims reimbursed: NPR 16,00,473
  • Claim percentage (compared on total premium): 68.30
  • Percentage claims reimbursed for children: 17.88 %
  • Percentage of claim amount reimbursed for women: 67.02 %
  • Percentage of claim amount reimbursed for men: 32.98%
  • Percentage of total claim amount reimbursed as per benefit headings are as follows:
    1. Hospitalization: 34.45%
    2. Lab testing: 34.83%
    3. Imaging: 28.14%
    4. Transportation: 2.58%

The project staffs, facilitators and activists are intensively making door to door visit for clarifying the benefit package, terms and conditions and providing health insurance education. They have been visiting each enrolled house. The activists are also facilitating for raising awareness on the importance of health behavior and health security fund for future etc.

Main Characteristics of CBMHIP

  • Community managed,
  • Female led and managed (Committees, Activists, Facilitators etc.) Premium amount and benefit packages are decided by community
  • Cash base and reimbursement,
  • Door to door service (Awareness, Enrollment and Claim reimbursement)
  • Claim screening and reimbursement decisions are done by community
  • Claim settlement within one month, Individual premium and family floater benefit package, Premium of Rs. 405 per person/year and benefit package of Rs. 53200 per family, Private and government service providers are designated by community as per their need,
  • Designated only qualitative service providers (having at least MBBS doctors, Lab and Imaging facilities)
  • Recruitment of Activists/ facilitators from their own community,
  • Inclusive of female, children and elderly people,
  • Organization registered as NGO, in Dhading.

Project Achievements over the time

S.N Enrollment Slot Enrolled No Enrolled HHs Permium Per Person/Year Rs Annual Premium Amount Rs. Female Enrollment Renewal HHs Percentage Average HHs Size Claim No Claim Amount Rs Claim percentage Female Claim Percent
1 1 January, 2011 514 182 336 172,704 290 0 2.82 105 69063 39.99 48.27
2 1 July, 2011 394 157 336 132,384 238 0 2.51 104 74998 56.65 51.01
3 1 January, 2012 1415 455 336 447,460 794 63.74 3.11 490 311177 69.54 69.32
4 1 July, 2012 645 246 336 209,274 377 59.87 2.62 250 184500 88.16 67.99
5 1 January, 2013 2718 964 389 1,008,903 1608 61.1 2.82 1070 856910 84.93 70.64
6 1 July, 2013 1276 459 389 473,588 754 62.2 2.78 498 367747 77.65 68.63
7 1 January, 2014 3933 1207 389/506 1,450,731 2278 58.61 3.26 1447 1212629 83.59 65.08
8 1 July, 2014 1625 509 389 592,150 945 59.04 3.19 547 453608 76.6 71.65
9 1 January, 2015 4245 1022 405 1,571,665 2322 59.98 4.15 1199 1072350 68.23 70.32
10 1 July, 2015 1303 321 405 484,785 719 53.63 4.06 394 359115 74.08 68.95
11 1 January, 2016 4627 1127 405 1,717,820 2450 74.17 4.11 1497 1217878 70.9 68.25
12 1 July, 2016 1847 447 405 683,075 994 70.4 4.33 636 557529 81.62 70.38
13 1 January, 2017 4372 1020 405 1,615,200 2340 82.34 4.29 1334 1134343 70.23 67.13
14 1 July, 2017 2034 470 405 749,770 1048 66.38 4.33 606 308085 41.09 64.59
15 1 January, 2018 4330 988 405 1,599,325 2277 63.18 4.38 616 517838 32.38 65.07
16 1 July, 2018 2160 504 405 802,225 1112 71.7 4.3 0      
Total 37438 10078   13,711,059 20,546     10793 8697770 63.44  

 

Lessons Learned

  • Health insurance is a complex financing mechanism so it takes long time to realize its importance in their life and society.
  • Regular monitoring, feedback and suggestion are necessary to make program more effective and reliable.
  • Re-insurance of member is necessary to recover the financial risk coverage at the time of disaster and epidemic.
  • Affordable and acceptable benefit package helps poor people to join the scheme easily.
  • Legal identity of the scheme will develop the trust among the community, stakeholders which leads to sustainability of the scheme.
  • Proper utilization of seed fund is needed to make program sustainable after the support of project.
  • All family members should be enrolled to make scheme balanced and sustainable.
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