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About the Project
Project Name: 
Bringing "Health" into Health Insurance: Evidence for a Converged Approach
Type of Facility Project: 
Innovation Grant
País de operaciones: 
Asia and the Pacific
Project Thematic Focus: 
Insitutional models and business processes
Type of Risk Carrier: 
other self-insurance scheme
Type of Distribution Channel: 
Mutuals, community-based organizations
Project Description: 

Building on SEWA's existing community health program, VimoSEWA will conduct action research among insured households in urban and rural locations. The objective is to measure the impact of integrating community health activities with health insurance on reducing insurance claim rates and illness expenditure of households. Health insurance has proven to be a primary need of the poor: over 90% of VimoSEWA's claims are for illness expenditure, one-third of which are for highly preventable illnesses such as malaria, gastroenteritis and other water-borne diseases. SEWA's experience indicates that these diseases, if treated early in a primary health setting, often do not require hospitalization. Untreated, these illnesses may eventually require costly hospitalization, and cause unnecessary loss of income and assets by the poor. Such negative outcomes also impede the viability of health insurance.


This research initiative will target workers in the informal economy in urban and rural Gujarat, India. SEWA members are home-based workers, producers, vendors, and manual laborers including agricultural laborers. They do not have basic statutory social protection such as health care benefits, maternity or sick leave, pension and access to child care.

Lessons from the Project
Learning Agenda: 

As very little evidence exists in this area, VimoSEWA aims to create both an implementation model and evidence base for integration of health activities with health insurance. This project will address five key questions through action research using a controlled study of the impact of health interventions amongst insured households.

  • How does a community health program impact health seeking behavior?
  • Does a community health program reduce health insurance claims and/or out of pocket illness expenditure for preventable, primary illnesses?
  • What health education messages are effective in reducing unnecessary hospitalization?
  • What is the pattern of treatment sought for the most common illnesses?
  • Does a community health program contribute to the viability of health insurance?
Emerging Lessons: 
  • A survey must be carefully tested and piloted before household interviews commence. 
  • A grassroots organization has a particular advantage to design and carry out action research.  
  • It is essential to analyze health claims on a frequency and cost basis per member (or per 1000 members) to uncover what is really driving results. 
  • Hysterectomies are a leading source of expenditure and claims. 
  • Epidemiological statistics can help interpret claims data.  
  • Hospital claims data require significant time and effort to sort and code to obtain more useful analysis
  • Urban clients have more claims and the cost per claim is higher than their rural counterparts.
  • Drugs are another key driver of claims costs.
  • Implementing guidelines on how to conduct health education sessions can ensure consistent quality. 
  • It’s important to have a research coordinator to interface with implementing team and researchers. 
  • In hindsight, VimoSEWA would have allotted more time for design of the research for the project, and to ensure sufficient coordination between an academic, research agency, advertising agency and intervention teams all at once. 
  • Investment must be made to ensure data quality at outset.
About the Organization
Tipo de vínculo con el Fondo: 
Innovation grantee
Country of Head Office: 
Region : 
Asia and the Pacific
Type of institution : 
Non government organization
Participation in Microinsurance: 
Risk carrier
Organizational Overview: 

SEWA is a trade union of 1.1 million poor, self-employed women workers. Established in 1972, its main goals are to organize women for full employment and self-reliance. VimoSEWA is SEWA's insurance unit in which the workers themselves are the users and managers of all services. It was developed in 1992 in response to members' needs for protection. VimoSEWA promotes an integrated insurance product of life, health, accident and asset coverage for poor workers and their families.

More about the Organization

"I am an agarbatti worker. I earn 30 rupees per day rolling incense sticks which we call agarbattis. I live in a small ten-by-fifteen room with my family. Earlier we did not have running water. I got sick with typhoid and malaria and spent a big part of my savings on my illness. Luckily, I was insured by SEWA and was reimbursed within a week. Our lives are like this - up and down. We need social security like insurance."

Jaitoonbibi, Agarbatti worker, Ahmedabad city, Gujarat

"All that we women know is work and more work. Whatever we have been through we cannot change. But we dream of a better life for our children. That's why VimoSEWA is so important for us."
Chanchiben, agricultural laborer, Kheda district, Gujarat