Himabindu Reddy: Encourage Preventative Health Care
Mid-Year Public Progress Report
Himabindu Reddy and two other Indicorps fellows are partnering with Chaitanya to create access to quality affordable health care for SHG women. Through the project, the team hopes to see an increase in wellbeing, both financial and health-related. Born in Andhra Pradesh and raised in Cary, North Carolina, Bindu graduated from Washington University in St. Louis with a double major in Biology and Anthropology.
Chaitanya & Community Background
Chaitanya is a community leader in Maharashtra that is well known for the catalytic role it has played in the formation of Self-Help Groups (SHGs) in rural Maharashtra. SHGs promote mutual savings and micro-lending, allowing rural women an opportunity for financial independence and leadership in the community and their own households. In the fifteen years since Chaitanya’s founding, its role in the formation of Maharashtra’s first federation of SHGs was perhaps most notable. With this new avenue for unification, women were given an additional platform to access larger loans for income-generating activities, as well as to address local social issues on a larger scale. Currently, Chaitanya’s first federation has grown to become a self-sustaining community resource, with staff and leadership drawn heavily from the women members themselves. SHG federations across the state have now expanded to become the vital linkage between SHG groups, allowing women to share resources, knowledge, and experience.
Women in longstanding SHGs and federations have been empowered to play a role in the development of their own communities and families. The vast majority of women in SHGs in this area are poor and live in rural, remote localities. Many come from tribal backgrounds. Previously, without access to bank products and caught under a trap of gender inequality, opportunities for improvement were difficult to come by. Through Chaitanya’s work, financial inclusion has been increased while also addressing social issues. One such issue is women’s and family health. Government services are often inadequate and private health care can be astronomically expensive, leaving many families with few options when they need medical attention. To rectify this, Chaitanya is seeking to use the strength and solidarity of the existing SHG network to create a solution in which women and their families will be able to access quality, affordable medical care.
Health care costs usurp a major portion of a family’s annual income in this area. As the cost of medical treatment becomes increasingly expensive, this financial pressure can topple already poor families deeper into poverty. In order to prevent such financial catastrophes Chaitanya is embarking on a new initiative to promote affordability and accessibility in health care. The approach is two pronged: first, the development of a community-based health insurance scheme that would offer coverage benefits for SHG members to access affordable healthcare, and secondly, a campaign to educate rural women about the benefits of insurance coverage as well as the importance of preventative health care, so as to reduce the burden of major illnesses. Initially, I was to focus on the latter aspect. Interestingly, the roles of the Chaitanya fellows have completely reversed, and I am now engaged in the more technical and business aspects of designing the structure and operations of the insurance program. However, the overarching goals remain the same; by creating a program which empowers women and increases the accessibility of health care, we hope to see an increase in wellbeing, both financial and health-related. Ideally, such a program will allow women to take ownership over their family’s healthcare seeking behavior, to become more savvy about when and how to use health facilities, and to improve their and their family’s health.
One of the most vital aspects of this project is addressing the needs of the many stakeholders involved. As such, I have been given the opportunity to interact with a variety of people in cities, towns, and villages, each of which represents a unique culture in itself. From the rural community members who will define, enroll, and use the coverage, to the doctors and hospitals in small towns and big cities who will make up the network of providers, to the technical support which will come from Chaitanya’s own office and from the Uplift Pune office, bringing together many stakeholder is a major part of my role in this project. It is one that I enjoy immensely, I feel like I am traversing through a microcosm of the larger India and its many parts. Through the project, I am able to see many sides of India, and more than that, I am able to discover ways to build partnerships between these different worlds.
In keeping with Chaitanya’s overall mission, a central feature of our vision for this project to ensure the empowerment of the SHG women. As such, we have chosen to use a model of community-based health insurance which maximizes community involvement. The community members who enroll will be a part of the decision making process at many levels; in the design of the product, as resource persons and referral points, and as claims reviewers. In this way, the process, operations, and benefits of the insurance are demystified, transparent, and adaptable– something that could never be achieved with ordinary commercial insurance.
Project Implementation Progress and Future Plans
The first six months have been heavy in research work and background information gathering. Thoroughness in this process meant that actual implementation and operation were delayed, but we felt it was important to be informed and deliberate in how we proceeded. Efforts to introduce health insurance in our communities had occurred in the past, and their failures left a feeling of bitterness and mistrust among those who had lost money in the fiasco. In this vein, we took several steps to become better informed about the micro- and community-based health insurance market as well as our own community’s expressed needs.
In the early days of the fellowship, we gathered information about existing and nascent government schemes, which our own offering would need to complement. In exploring the benefits, disadvantages, and coverage of available options, we looked at the experiences of other NGOs in India and abroad, commercially offered micro-health insurance schemes, in-house schemes operated without outside assistance, and programs offered by Third-Party Administrators and technical support organizations.
Having equipped myself with a working understanding of the current options in this sector, I next wanted to build an understanding of our community and its needs. Because Chaitanya assists in the operation of SHG groups from a broad range of socioeconomic backgrounds and localities even within the single pilot block, the needs of women may vary and should not be assumed. In order to gain a better understanding of our target population, we conducted a survey to collect baseline information and to aid us in assessing their needs. This included collecting information about general household data, healthcare usage history, capacity to pay, need for health insurance, and preferences in health insurance schemes. Our aim was to capture both quantitative and qualitative information to give us a more complete understanding of the target population. In addition to the comprehensive data we collected from the villages, the additional benefit of my field research experience was the opportunity sit down face-to-face with the women whom the insurance program would benefit. Understanding their lives, their history, and their stories put a human face on what we were here to do. No longer was I here blindly putting together a working insurance scheme; I now had a real purpose, a more meaningful purpose.
The next step was to understand the existing health system. Using the list of doctors and hospitals that our community members had used in the past as a starting point, we approached doctors in the local area for additional information. From this study, we gathered information about the availability of facilities, services, and specialties, as well as the pricing of health care services. We were also interested in gathering physicians’ input on what they felt would be the most important points of coverage, based on their own interactions with rural patients. We also took this opportunity to gauge their interest in participating in our network, and their willingness to offer discounts or other benefits.
Armed with this information, we set out to make a decision about which way to proceed. After completing a cost-benefit analysis, we ultimately felt it would be best to pursue a partnership with an NGO in Pune, which provides technical support and risk management services. With this decision in hand, the educational and promotional campaign has begun to raise awareness and to encourage community involvement in the further planning of the details of the program. There are several steps which are currently taking place and which will need to happen in the future. These are as follows:
1. Product design: Finalize details of coverage, premium, etc.
2. Create two-year plan: Budget, Enrollment projections
3. Create operations manual: Details of set-up, enrollment, operations, etc.
4. Create health care provider network: Negotiations with doctors and hospitals
5. Trainings: Health insurance team members, Community resource persons, Claims committee members
6. Enrollment: Village by village, SHG by SHG
7. Operational phase: Referrals, Claims meeting, Reimbursement, Health camp, Health talk, Continuing trainings
8. Monitoring and evaluation: (tentative; at the least, set up a system and train team members to use it)
I came to Indicorps with a very project oriented agenda; I wanted to work in the social sector, I wanted to gain experience in grassroots, I wanted to apply what I’d learned through four years of college, and I wanted to create this “change” that I felt so passionately about. In some ways, that is what I’m working towards, but I think the most significant thing about this year isn’t so much about the project, but about me. Part of it has been specific to India – reconnecting to a place that I love, redefining the why and how of that love. But part of it has been deeply personal.
One of the biggest and most pervasive challenges this year has been dealing with the language barrier. Coming to a place without the benefit knowing any of the local languages beforehand, I felt almost stripped, defenseless, and at times, useless. Rectifying this requires building language skills, which means studying, reading, and practicing. But more importantly, it requires building the confidence to persevere despite the disadvantage, to be creative in communication. I can’t say that I’ve completely achieved this yet; I still struggle, still find myself retracting when it becomes too hard, but I do know that I’ve come further than where I started. In light of the challenge of communicating and becoming close to people without the benefit of a common language, I know I’ve pushed myself beyond inhibitions that I had harbored, and it has paid off. It’s exciting to think how far I’ll be able to push myself now, how much more I’ll be able to relate with communities when language is no longer an issue. This is something I struggled with in previous work I’d done in the States, but those challenges seem miniscule now.
During this Fellowship year, almost everything has been different from what I’m used to. It is like standing in front of a huge mirror in which every flaw and weakness is highlighted and reflected back to me. It’s no longer possible to just brush personal shortcomings aside; I have to confront them. This has been the type of environment where both the best and the worst in a person are exposed. It has not always been the most comfortable of processes, but I have come to learn a lot about myself. Most importantly, I think I have learned the importance of having patience and sincerity in everything I do. I’m not saying that I’ve corrected all my weaknesses to become the ideal person. But I think I’ve come to see myself in another way, coming to a place now where I’m ready and willing to look at and improve myself.
India has also taught me the importance of community. I’ve always seen myself as living a transitory life, moving from place to place, from community to community. With very few exceptions, I never really felt particularly attached to people and places, relying only on myself to find a sense of peace and belonging. This isn’t something I necessarily want to change – I still believe that true happiness must be found without any external attachments. But in a country where community and personal connections are the heart and soul of daily life, it is hard to ignore the role of community in my own life. The time has come to acknowledge the attachments that I’ve discovered, both in India and in the United States, and more than simply recognizing the people and places that are important to me, but also appreciating them for shaping me into the person I am and will be.
Perhaps the most important aspect of my personal journey is realizing that this journey is open-ended. I’m a pretty self-assured person – I know what I want, what I believe, what my life will be. Or so I thought. This year has been an invaluable opportunity to reevaluate what I need, what I love, and what I believe. Reflecting on this, seriously and deeply, led me to realize that perhaps I don’t have all the answers figured out as I’d thought. Becoming okay with this uncertainty in understanding myself has, in itself, been a huge challenge, but a valuable one. Something that is often repeated is to “let your life be your message.” But what exactly is that message, what is my message? If you asked me right now, I’d be able to give you a vague idea, but I’d have great difficulty in pinning it down to a fully developed personal philosophy. And that is okay, because I’ve come to understand that a person, and their message, can evolve. This year, for me, has been a part of my evolution.
Himabindu Reddy, August 2009 Indicorps Fellow