Small miracles, big results

“Health is wealth” as the saying goes, and it is often the poor in India who end up paying the costespecially mothers and their children. Nine women die every hour from complications related to pregnancy or childbirth, adding up to 78,000 deaths a year. A million babies die annually. India has the unfortunate distinction of claiming more than a quarter of the newborn deaths in the world.

So how does one tackle a problem of this magnitude?

In the informal settlements of Nanded, Maharashtra, a project called Sure Start, in collaboration with the local community, has taken an innovative approach to tackling this

issue and is an example of the power of partnership.

The project—a five-year initiative based at PATH, an international not-for-profit organization supported by the Bill & Melinda Gates Foundation—has launched a community-based health insurance scheme that includes maternity coverage. This involves members of a community forming a partnership and each contributing a small amount of money toward an insurance fund. The fund is then used to meet certain specific health care costs of the contributors. A community-based organization, Rifaee Falaee Anjuman, is running the insurance scheme in Nanded, while the Institute of Public Health and Sri Samarth Shikshan Prasarak Mandal (SSSPM), an educational organization, are providing technical and administrative support.

Sure Start had to tackle a number of roadblocks while implementing the community health insurance

initiative. For example, most of the women who attended the first group meetings about the plan didn’t enroll afterward. It was only after Sure Start approached the community’s men, who are the primary decision-makers, that the community as a whole seriously considered the insurance idea.

The project team also had to deal with religious concerns. Initially, community members found the scheme unacceptable due to confusion about the details. To clear up the widespread misperceptions, the Sure Start team explained the plan to the people (especially the community’s religious leaders), leading to cautious acceptance.

The greatest challenge of all was financial. Most community members found the first premium estimate—Rs. 450 (US$9)—unaffordable. Sure Start was able obtain a subsidy from a member of the local legislative assembly, who offered to pay Rs. 200 (US$4)

from his development fund toward each person’s premium amount. This made the plan affordable to families.

The ceaseless efforts of all the participants involved in the scheme’s implementation have reaped significant results. Some 200 families have paid a premium of Rs. 250 (US$5), which means that they now receive maternal care, newborn care, hospitalization for general illness, and reimbursement of transportation expenses. As these families discuss their positive experiences with the rest of the

community, more widespread acceptance is expected to follow. Six hospitals—three public and three private—have enrolled in the plan.

The SSSPM has also integrated the national government’s Janani Suraksha Yojanascheme into this program. The scheme gives money to mothers as an incentive if they opt to have their babies in a hospital. Should patients require a procedure included in the government’s program, the staff ensures the money is made available.

The community-based insurance initiative in Nanded is a striking illustration of the power of collaboration. It shows how the unique capabilities of distinct entities can come together to create a new, self-sufficient structure that can work for the benefit of the underprivileged.

Sure Start works to educate women in India on maternal and neonatal health. Sure Start, an initiative by PATH, supported by the Bill & Melinda Gates Foundation works to promote safe childbirth practices in India.

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