This Learning Journey was created with contributions from:
Sapna Desai (VimoSEWA) and Jeanna Holtz (the Facility)
The Self Employed Women’s Association (SEWA) is an Indian trade union registered in 1972 which today has over 1.3 million members in nine states of India. SEWA members are poor women workers in the informal economy, including agricultural labourers, service providers, home-based workers, and vendors. Since 1992, SEWA has offered a composite insurance product (life, hospitalization, accident, and asset insurance) known as VimoSEWA (meaning SEWA insurance) for members and their families in India.
VimoSEWA’s experience confirms a high demand by clients for protection against the costs of prevention and treatment of illness. Over 90 per cent of VimoSEWA’s claims are for illness. More specifically, the data indicate that at least one third of these claims result from preventable acute illnesses such as malaria, gastroenteritis, and water-borne diseases that, if treated early on, should not require hospitalization. Unnecessary hospitalization results in loss of income and assets for the poor and negatively affects health. Furthermore, fewer hospitalizations can improve the viability of insurance by reducing claims expenses.
VimoSEWA believes that preventive health information, access to immediate treatment, and outpatient health care services can reduce the number of patients hospitalized for common illnesses, resulting in savings for families who otherwise incur avoidable out of pocket expenses, as well as for the insurance programme. The project aims to test if implementing targeted community health education and referral for common illnesses has an effect on insurance claims, health-related expenditure, and health-seeking behaviour.
The project was implemented in three stages. In the first phase, VimoSEWA reviewed health claims in Ahmedabad city and district, in order to identify patterns that may influence health-seeking behaviour and incidence of primary illness. Data reviewed included geographic location, population demographics, average cost of illness, and choice of healthcare provider. In addition, a baseline survey of insured households was conducted. VimoSEWA sought to gain insight into healthcare preferences, and how they vary depending on the illness and at which point in the continuum of an illness that insurance is utilized.
In the second phase, VimoSEWA developed specific health interventions to target common illnesses. The interventions included community-based group health education, a doorstep primary service by community health workers (CHWs), links with outpatient services, provision of herbal medicines, and referral to government services. Finally, during phase three, the effectiveness of the interventions was tested. A sample of 1,960 households from two wards of Ahmedabad city and two areas of Ahmedabad district were studied. Control groups of insured and non-insured households received SEWA’s ongoing health services, but no targeted information or special educational materials for common illnessesthat were targeted as part of the study.
At the end of the study, statistical analyses of the claims database, household surveys, and interviews with claimants and non-claimants provided information on the impact of health education delivered by community health workers on both the insured and uninsured, as well as how insurance affects health-seeking behaviour. Results from the study will be used to inform VimoSEWA’s approach in all programme areas in Gujarat and the six other states of India. Project leaders believe that the results will have implications for health insurance providers who serve poor households throughout the world.
Date of last Learning Journey update: April 2013