A community health volunteer
at work

PEOPLE’S RURAL HEALTH PROMOTION SCHEME: A SUCCESSFUL PEOPLE-MANAGED HEALTH PROGRAMME IN INDIA

Traditionally Adivasi, Dalit and fisher people are socially excluded in Orissa. Poverty, lack of awareness and non-availability of facilities has resulted in non-accessibility of healthcare for such marginalized communities.

This has left members of the communities vulnerable to ill health and diseases such as malaria, which is endemic to parts of PREM’s project area (and affects approximately 35% of the project population). Historically, infant and maternal mortality rates have been high due to a lack of pre-natal and delivery services, while TB, Sickle Cell anaemia and water-borne diseases, such as diarrhoea and typhoid, are major health hazards among the Adivasi and Dalit people.

PREM’s experience in providing referral medical care to approximately 10,000 foster children, along with their siblings and family members, between 1996 and 2001 provided the organization with critical data on annual healthcare need and expenditure among its project population and enabled it to develop a vision for the wide-scale provision of healthcare facilities and services.

A village pharmacy depot

Universal birth registration ensures that every member of each community can access
government provisions for
health, education and welfare

A community health worker and young mother and child at an immunization camp

The challenge for the organization was to provide medical care in inaccessible areas and at the same time raise funds to support the treatment. In addressing this challenge PREM took the initiative to launch an experimental and innovative micro-insurance health scheme through village committees, called the People’s Rural Health Promotion Scheme (PRHPS). The approach to operating the scheme was based on collecting a small annual premium fee from each and every member of the project population and use the collected funds to provide necessary healthcare.

A three-tiered delivery system was formulated to provide healthcare in each village, at local Public Health Centres and, in referral cases, at district hospitals, medical colleges and private nursing homes as per necessity.

The pilot project was initiated in 500 villages with a target membership of 100,000 people, with each person, including children, paying Rs. 20 per for annual membership. In the process a sum of Rs. 2,000,000 was collected in the first year. Approximately Rs. 1,500,000 was spent in providing healthcare facilities to the project population and a sum of Rs. 500,000 per year, along with the returns from the investments, contributed to the corpus. It has been estimated that, long-term, PRHPS will become self-sustaining.

In the three-tiered delivery approach, village level pharmacies were developed in each of the 500 villages. Local young men were trained as para-medical activists to distribute medicines deposited at village pharmacies for the treatment of common ailments. Each village has a committee that makes decisions on cases requiring referral to Public Health Centres or local hospitals and management of the funds available. Those who need further treatment are helped to attend Public Health Centres and hospitals which are run by the government.

The results of the pilot project showed that about 75% of reported ailments were cured though first line intervention at village pharmacy level, where 15 to 20 types of medicines are available. In cases where illness continued for two to three days, the patients visited Public Health Centres where another 15%-20% of cases were cured. Only 5%-10% of the cases were referred to district level hospitals, medical colleges or private nursing homes as per the necessity. The scheme bears the expenditure incurred for purchase of medicines and fees for hospitalization to a maximum level of Rs. 3,600 per member per year.

In 2007 the International Labour Organization (ILO) conducted a study on a number of people-managed healthcare projects, including PRHPS. In its report ILO described PRHPS as ‘one of the best case studies’ in Asia.

Subsequently, PREM was invited by the Ministry of Labour, Government of India, to make a presentation about the programme to policy makers. In April 2008 the Government of India implemented a similar programme on a massive scale.