Heal thyself

EAR TO THE GROUND

Villagers and slum-dwellers in Maharashtra run their own health insurance fund, with spectacular results.

Dandekar bridge slum in Pune is unlike any other slum in the country. When someone here falls ill, the family just has to dial a 24-hour helpline, whose doctor advises them which government hospital the patient should consult. The family also receives money for treatment.

When the rest of the country is going in circles seeking health insurance for the society's most vulnerable, these slum-dwellers are part of a health security fund to which each person contributes Rs 60 annually. The unique fund is run by the slum-dwellers themselves along with those living in 88 other slums in Pune.

So far, 30,000 have joined the fund, which covers all Pune slums and some villages in two other districts of the state. Dandekar bridge slum in east Pune accounts for 8,000 members.

The fund was started as an experiment four years ago by an NGO, Swayam Sikshan Prayog, and Uplift India Association, a Section 25 non-profit company started by some NGOs who share resources for income-generation projects. The NGO runs 13 offices in Pune slums while a committee comprising members settles claims.

Sailesh Bangali, a daily-wage worker living in Dandekar bridge, is a member of the fund. "When his father had a paralytic stroke recently, he came to us," says Kumar Shailabh, administrator of the Uplift project.

"We sent him to a government hospital. The treatment was done in Rs 800, whereas otherwise it would have cost him at least 25,000. We are advocating use of government hospitals," says Shailabh. The annual reimbursement limit is Rs 5,000, he says. While diagnosis is through allopathy, ayurvedic and homoeopathy are allowed for treatment. There have been 140 cases in Pune town this year. In Dandekar bridge slum, there have been 110 cases in four years.

All these cases were taken care of and we saved Rs 7 lakh between January and July this year, said the NGO. In Osmanabad and Sholapur districts of Maharashtra, 30 villages each are experimenting with such funds.

Each village has a security fund, explains actuary and consultant to the project, Frenchman Francois Xavier Hay, the managing director of Uplift and the guiding force behind the project.

He says the working of the project is simple. In France, he adds, 90 per cent insurance takes place through small mutual funds. No one goes for the expensive health insurance, says Hay, who also works for GTZ, a partner in the project. Another partner is French NGO Intel Aid, French Mutual MACIF, besides the International Labour Organisation. A total of 60 hospitals in the area have become a part of the network.

If you ask where are the deposits invested, the actuary has a ready answer: There is no need to invest. Investments are made for operators to make money. Here, the money is enough to take care of the people the project serves.

Adds Shailabh: "While in insurance schemes, there is a transfer of risk, in mutual funds, it is pooling of risks. We pool the funds and keep them locally, to be managed by the community itself. No one takes the money back, but anyone who needs it gets it."

Won't the money be exhausted? The money goes on increasing as more and more members are added, explain the enthusiasts of the project. The fund maintains a reserve and it remains with the community to take care of the extra expenses, says Xavier Hay. Trust yourself, it works, he adds.