Health insurance takes root in Orissa village

At the time when over 200 people died of cholera in southern Orissa's Rayagada, Koraput and Kalahandi districts recently, the deadly virus did not enter villages in the neighbouring villages of Gajapati district.

The virus did not spread into the villages of at least five blocks of Gajapati district as the tribal villagers are well-informed in their health care, thanks to the People's Rural Health Promotion Scheme, an integrated health insurance launched by the People's Rural Education Movement (PREM) in association with Plan International.

The scheme was launched 4 years ago to provide medical services, as well as health insurance to tribals and fishermen of the operational areas of PREM with a minimum and one time premium.

Praising the scheme the International Labour Organisation says, "Preventive health care programme of PREM-Plan and peripheral care offered through Village Medicine Depots help to reduce referral morbidity and thereby reduce the expenditure load on PRHPS."

Under the scheme, if a patient suffers from any disease, he is first treated at the Village Medicine Depot set up by the organisation. A trained lady from the respective village is appointed to provide medicine to the patient for minor ailments. After three days, if there is no improvement, the patient is referred to the nearest Public Health Centre and to the medical college at Berhampur.

At the VMD, the treatment is given for at least 15 minor diseases including fever, malaria, diarrhoea, dehydration, minor injuries, cough, scabies, safe delivery and immunisation. The quality and low-cost medicines are stocked in the VMD. Trained women of the respective villages serve the medicine with elaborate health advice on sanitation and hygiene.

In order to insure his health, a person has to be enrol his or her name under the scheme paying Rs 30. The fund collected from the members becomes a corpus and managed by the villages themselves. "Our role is very limited as the scheme is operated by the villagers themselves," said PREM president, Jacob Thundiyil.

The scheme is presently operating in 333 villages under 4 blocks "" Mohana, Nuagada, Gumma and Rayagada in Gajapati district, 144 villages in 3 blocks "" Krushnaprasad, Bramhagiri and Kakatpur in Puri district and covers over 80,000 people.

"We are planning to extend the scheme to Gunupur block in Rayagada district, Sanakhemundi and Dharakote blocks in Ganjam district and Vizianagaram district in Andhra Pradesh and to cover another 40,000 people,"he said.

The organisation has been provided some infrastructural facilities in all the referral government hospitals including the MKCG Medical College and Hospital, Berhampur for better treatment to their insured patients.

In MKCG Medical College and Hospital, PREM was donated at least 15 beds in the Orthopedic department.

"We never refer to any patients to the private nursing homes" he said. In this way we teach the people about the access to the government hospitals," he added.

All the referral ad treatment expenditure will be borne by the organisation if the patient is enrolled under the scheme.

"The distance from our village to PHC is about 10 km while the district hospital and medical college are about 40 km and 160 km away respectively. Serious cases are taken to Paralakhemundi district hospital by bus or tractor. From the insurance we are being reimbursed the cost of the medicines," said Digu Digal of Sadanga in Gumma block of Gajapati district.

"In our village one person had gone through a stomach operation, another person had a paralytic stroke. The scheme helped both the cases," said Janab Majhi of Paleri village of the same district.

Jacob, the founder of the scheme said the People's Rural Health Promotion Scheme was aimed at breaking the link between ill-health and poverty by ensuring the health care of the tribal and fishermen who are the focal groups of PREM-Plan's development activities.

The scheme is embedded in the other health and development activities of PREM-Plan. He was influenced by other community health insurance schemes of RAHA in Chattisgarh and ACCORD in Tamil Nadu to launch the scheme with improvisations for the project areas of the organisation.