Combining health care, microfinance, and insurance in rural Nepal.

Combining health care, microfinance, and insurance in rural Nepal.

Nepal
Organization type: 
nonprofit/ngo/citizen sector
Project Stage:
Growth
Budget: 
$1,000 - $10,000
Project Summary
Elevator Pitch

Concise Summary: Help us pitch this solution! Provide an explanation within 3-4 short sentences.

Dhulikhel Hospital, a not-for-profit, non-governmental organization in Nepal works in developing innovative models for rural health care.

About Project

Problem: What problem is this project trying to address?

Despite improvements in the economy since the end of a turbulent civil war, the health care infrastructure of Nepal remains in shambles. Three major problems exacerbate the problem: 1) access to health care is limited, especially in rural areas where governmental clinics are many miles apart and seldom staffed or equipped; 2) regardless of access, people do not seek care for treatment of even severe illnesses due to lack of education and mistrust of the system; and 3) even if people sought out health care, poverty prevents all but the elite from paying for it. An approach that is able to simultaneously develop health care and services, orient the people to understand the need for and to utilize such a system, and build capacity so that health care can be afforded, is desperately needed.

Solution: What is the proposed solution? Please be specific!

Community based health care run by a not-for-profit organization can bring quality health services to rural areas of a developing country. However, it is essential to address health care not as an isolated entity but to integrate community development and capacity building into the system. Dhulikhel Hospital is a not-for-profit tertiary care center providing health services also at numerous outreach centers located in impoverished rural villages in Nepal. About four years ago we initiated a community development program targeting women for social support and to participate in a microfinance loan program. Recently we added a component in which health education and participation in a minimal-cost health insurance program has helped these women to get health care at the outreach center. This system has been extraordinarily successful thus far. We believe that this integrative approach is an excellent model that we would like to evaluate and offer as a model to other regions and nations.
Impact: How does it Work

Example: Walk us through a specific example(s) of how this solution makes a difference; include its primary activities.

Provision of health care in a rural community is the first step to building a comprehensive health system. Using institutional as well as collaborative partners and community, a simple yet up-to-date health clinic was constructed in Bahunepati, a rural village in Nepal. The second step was to organize the women of the village. Community meetings were held targeting 60 families at greatest need to discuss the goals of a microfinance program and to build trust. The women continued to meet to develop their projects and was provided the equivalent of $100 USD each, to be paid back in 3 years. The funding has been used for a variety of projects including purchase/raising of goats and pigs, candle-making, etc. Loans were disbursed only after the women were organized in groups and hence a structure for expanding the scope to include issues of health care became established. We provided training in multiple sessions on various health-related topics and introduced the concept of health insurance at these meetings. Each woman paid a premium of about 2 USD that would cover, for the woman and her children, a 24-hour health care provided by a physician and assistants, access to basic medicines and surgical procedures (limited under local anesthesia), and basic obstetric- gynecological care. Partnership with the government for free obstetric care and family planning made the cost of services for these almost negligible for the center. An assessment after six months revealed very encouraging findings in terms of appropriate health care utilization and financial viability of the program.
Sustainability

Marketplace: Who else is addressing the problem outlined here? How does the proposed project differ from these approaches?

Thus far, we are the only ones to have such an approach to health care. We have developed this program in partnership with the government of Nepal and private individuals/organizations working in the community and thus have no competitors. Although there are a few private medical clinics in the area providing a very narrow range of medical services, they are at least three times more expensive than ours and the level of care is questionable. We work closely with them for timely referral of patients. The closest government health facility is about two hours walking distance and lacks regular man-power as well as medicines. However, as partners, we also get some items (e.g., family planning materials) free of cost from the government.
Team

Founding Story

Our “aha” moment came after we began talking to the women to understand the impact of this program on their lives. A brief assessment after six months revealed that 95% of women were very satisfied with the scheme and the services. The insurance premiums covered almost 85% of the total cost of the health services used by the women and their children; DH covered the rest. The women visited the center for all major health problems that they and their children encountered during this period. Voluntary participation of the women in the health programs (mainly training and awareness) was about 90%. A survey of 50 other women in the surrounding area who had not been included in the program revealed that 42 of them would like to join a similar program (that they came to know through their peers). This has given us the confidence to expand the program by increasing the numbers, adding other family members and moving into other rural areas in Nepal, and possibly in other countries too.
About You
Organization:
Dhulikhel Hospital
About You
First Name

Biraj

Last Name

Karmacharya

About Your Organization
Organization Name

Dhulikhel Hospital

Organization Country

, BA

Country where this project is creating social impact

, BA

How long has your organization been operating?

More than 5 years

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Innovation
How long have you been in operation?

Operating for 1‐5 years

Which of the following best describes the barrier(s) your innovation addresses? Choose up to two

Access, Equity.

Social Impact
Please describe the goal of your initiative; outline what you are trying to achieve

The goal is to develop an alternative way to address quality health care in rural areas by developing an adjunct sustainable health education and insurance program in rural communities of a developing country. We want to make sure that even in rural areas, a provision of good health care is developed (by involving a not-for-profit tertiary level organization, community and government), people are made aware about health issues (through low-cost, regular, effective health education programs) and are also made capable to contribute a small amount of money for securing a good health care for their families (through the insurance coupled with microfinance). This is a fundamental basis for long term community development and prosperity.

What has been the impact of your solution to date?

A fully functioning community based rural health center, that provides round the clock basic health services, has been established in Bahunepati, a rural village in Nepal. Sixty families have been empowered through the microfinance program leading to better livelihood. The women have also been trained in various health related topics and are acting as the messengers of health in the community. Women and children of these sixty families have been able to get regular quality health service through the health insurance program. There is more confidence amongst health service providers (DH) and community also that this can be a viable option for developing sustainable rural health care. There is an interest of more families to get involved in similar programs and more interest has been created amongst other organizations, government and communities to learn from this experience so that a tailor-made program designs of similar kind can be implemented in other rural areas in Nepal.

What is your projected impact over the next five years?

Within another year we hope to expand the program to at least one more site and develop a scientific quantitative analysis of our pilot program in order to establish it as a successful model of rural health care in developing countries. Hence, over another four years, we hope to document and disseminate results of our program to increase collaborations with other stakeholders and replicate similar programs in other areas of Nepal, and to allow use of our model in other developing countries. We hope to shift the paradigm of the way health care is viewed in rural areas in developing countries. We hope to make DH a center of excellence for rural health care in developing countries over the next 5 years and we will have benefitted (directly or indirectly) at least 100,000 families by then.

What barriers might hinder the success of your project? How do you plan to overcome them?

Our first challenge is to conduct a rigorous scientific assessment of our program. One of the developers of this project is currently studying public health and is accumulating the skills necessary to lead this effort. Any linkage with experts in similar area would be a huge asset for him. We plan to address the second barrier of poor publicity by disseminating through the scientific and general publications and presenting at forums. We plan to address the third barrier of inadequate funds by networking and soliciting additional support from organizations with similar mission to help us develop a team of professionals with leadership and management skills (for scaling up the program) and to expand our work. Ashoka can play an instrumental role in achieving all these three steps.

Winning entries present a strong plan for how they will achieve and track growth. Identify your six-month milestone for growing your impact

Scientific analysis, documentation, and dissemination of results with a strategy for expansion.

Identify three major tasks you will have to complete to reach your six-month milestone
Task 1

Develop and implement a comprehensive (quantitative and qualitative) evaluation of our program.

Task 2

Document and structure our methods and develop means for disseminating the program.

Task 3

Develop a consolidated strategy for fund raising and expansion of the project.

Now think bigger! Identify your 12-month impact milestone

Include 60 more families in at least 1 more site; collaborate with others interested in using/supporting our model.

Identify three major tasks you will have to complete to reach your 12-month milestone
Task 1

Publish program methods/results in a journal and via web while establishing a continuing system for evaluation.

Task 2

Finalize plans and implement the program to new families in another rural health center and begin evaluation models.

Task 3

Establish relationships and obtain pledges of support from foundations and other funding agencies.

Sustainability
Tell us about your partnerships

NepaliMeds and Microcredit for Mother supported for the seed money of microfinance. Community of Bahunepati together with Dhulikhel Hospital and NepaliMed supported for the infrastructure and the set-up of the health center. Dhulikhel Hospital oversees the technical management of the health center, running health education programs and also possible financial back-up in this process of getting the program self-sustainable. Partnership with government is another strong aspect, mainly in getting some resources from government’s free supply program, e.g., in family planning.

Are you currently targeting other specific populations, locations, or markets for your innovation? If so, where and why?

We plan to expand the program to the community at Dapcha in Kavre district where DH already has a community based rural health center and also has sixty women enrolled in the microfinance program. These women have already been trained in various health related areas, particularly mother and child health. So, it would be easy for implementing the insurance program. A preliminary survey on the willingness of the women to participate in such program was also very positive and there is also commitment from the community to organize such program.

What type of operating environment and internal organizational factors make your innovation successful?

The community based and not-for-profit nature of Dhulikhel Hospital is the major factor that makes our innovation successful. The management is very positive and encouraging in new initiatives like this. Another factor is the reasonably young team that is leading this endeavor, as they are quite open minded, daring and passionate about their work. The belief that every village has some heroes is our fundamental assumption and hence our ability to identify capable people in the villages and work with them make our initiatives successful and well accepted. All activities are collaborated and consulted with community. Excellent international collaborations help us to complement the efforts by providing their expertise that we lack, e.g., in developing evaluation strategies and guidelines.

Please elaborate on any needs or offers you have mentioned above and/or suggest categories of support that aren't specified within the list

We would welcome collaborations with Ashoka or other organizations to help train our team on issues like fund-raising and communication on an international scale.We are also very eager to help any sort of similar initiatives.We believe creating a model of success for equitable rural health care is the most important and difficult task.We are motivated to work hard and learn from others to do this.

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