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Swayam Shikshan Prayog (SSP)

About the Project
Project Name: 
Enhancing community resilience in low-income households in India
Type of Facility Project: 
Innovation Grant
Pays d’opération: 
Asia and the Pacific
Project Thematic Focus: 
Consumer education
Project Description: 

With over 70% of healthcare spending being out-of-pocket, about 20 million people in India annually fall into poverty due to health related events. To access health care, many poor households have to take emergency loans at high interest rates (3-5% per month) or to sell their productive assets, therefore reducing future earning potential.

In partnership with Oriental Insurance Company, the project seeks to build resilience in low-income households by improving healthcare access and creating an economic safety net through grassroots women's groups. Members pool savings to create a self-sustaining Community Health Fund (CHF). Building on more than a year of field demonstration, a hybrid model is proposed to provide: 1) insulation from high cost health events through a group insurance policy and "cashless" (i.e. no out-of-pocket cost to members) access to hospital services, and 2) reduction of 30% in healthcare costs through quality primary care and preventive services designed to lower incidence of disease.

The project also aims to offer the following insurance benefits: 1) affordable annual premium (USD 13 - 22 for a family of 5) and 2) a simple product that is easily understood and adopted by clients; and 3) offer additional coverage for catastrophic cases.

The CHF will forge partnerships across the health value chain - insurers, hospitals, doctors and pharmacies - focusing on acceptability, affordability and quality to build a robust, low cost and low overhead comprehensive health system.

Consortium Members: 

Swasth India Services (SIS) focuses on providing good health care to low-income households - both urban and rural - across India. SIS works with communities to implement health care projects encompassing both a delivery network and appropriate financing options.


The project targets low-income women in households earning less than US$5 per day, in 100 villages in two districts in the state of Maharashtra. The majority of these women and their families depend on agriculture for their livelihood, and thus experience irregular and unpredictable income patterns. About 50% of the targeted households report no or minimal savings, with 20% taking high interest loans in the last year to respond to a health problem. Nearly 30% of illnesses go untreated due to a lack of financial resources to pay for care.

Lessons from the Project
Learning Agenda: 
  • What are the essential factors that contribute to an effective community regulated, microinsurance health model that works for the poor?
  • What are the requirements for making community health and insurance partnerships work to serve low-income clients?
  • What is the economic and social impact on clients and their families (e.g. reduced health expenditure, lower child and maternal mortality, improved health status of women)?

Emerging Lessons: 
  • Attractive rates can be negotiated with hospitals, if approached with the broader social objectives. The larger hospitals are more compliant to agreed processes than smaller ones.
  • Outpatient doctors are more amenable to work in the program, if approached with the broader social objective.
  • The introduction of the subsidized programs like RSBY may impact interest of BPL families to enrol in private health insurance programs like the CHF.
  • Low income clients need to see greater benefits with or be able to afford higher priced product options.
  • Seasonality influences WTP and enrolment, particularly in rural, agricultural and undiversified economies.
  • A simple definition of a Family (who can enrol under a policy) can create unanticipated bias.
  • The 'average premium per life' is USD 2.4.
  • SSP believes that a defined enrolment period will not significantly contribute to reduced adverse selection.  
  • Based on Customer Satisfaction Survey, customers currently perceive hospitalisation as a greater health event than regular outpatient events.
  • It can be difficult to impossible find local staff in a low income, rural community with the skills to do both sales and health promotion.
  • A social mission can be more motivating than financial rewards to recruit and retain CHWs. 
  • Training of field health and insurance promoters is more successful when done in iterative, ongoing sessions.
  • Recognition and certification are valuable elements for CHW retention.
  • It can be challenging to set up an independent community pharmacy.
  • A successful drug supply chain may require more than one pharmacy delivery model.
  • Doctors resist the increased use of lower cost drugs, if approached with a commercial proposal.  
  • Patients can resist a change in a prescription to a lower cost alternative, so it’s important to overcome their perception that cheaper drugs may be inferior.
  • It’s easy to underestimate the complexity of a project and resources required, or to anticipate where the bottlenecks will occur, or fully anticipate impact of challenges in one facet of the project on others. 
About the Organization
Relationship with the Facility: 
Innovation grantee
Country of Head Office: 
Region : 
Asia and the Pacific
Type of institution : 
Non government organization
Participation in Microinsurance: 
Distribution channel
Organizational Overview: 

Swayam Shikshan Prayog (SSP), meaning Self Education for Empowerment, is a development organization that provides access to social and economic opportunities through technical support. It promotes community-driven entities and forges partnerships with institutional actors. Since 1993, SSP has mobilized grassroots women's groups around reconstruction and local governance issues. It transforms mass-scale disaster recovery processes into development opportunities by restoring livelihoods, setting up sustainable federations and enterprises, and addressing gaps in village development and local governance. SSP operates in ten disaster prone districts in three states of India and reaches over 300,000 families.

More about the Organization