5) Description of health product/service offering: Our Health in Our Hands

UpLift Health products target urban slum dwellers and rural poor :

1- Full Health Care Cover for 100 Rs /person /year:

• i- Hospitalisation Costs & Wage Loss.

o If hosp. in Public Health Care facilities: 100% cover + 75 Rs per day as wage loss indemnity for employed/working members during 2 months max.

o if done in a private Health Care facility: 80% cover up to Rs 10000 for major surgeries, Up to Rs 5000 in all cases of surgeries and C-section Deliveries, Up to Rs 2500 in all cases of surgeries & normal deliveries. Including 50 Rs per day as wage loss indemnity for employed/working members during 15 days max. • ii- OPD Visits, Drugs & Tests: 30% reduction on OPD from your registered generalist. Discounts on Tests & Drugs

• iii- Prevention, 1 free preventive checkup per year, Specialised Health Checkup and Health Awareness Talks organized as per opportunity.

2- Minimal Health Care Cover for 50 Rs /person /year:

• i-Hospitalizations Costs with 30 days before and 60 days after and Wage Loss. 80% cover up to Rs 5000 for major surgeries, Up to Rs 2500 in all cases of surgeries and C-section Deliveries, Up to Rs 1500 in all cases of surgeries and normal deliveries. Including 50 Rs per day as wage loss indemnity for employed/working members during 15 days max.

• ii- Prevention: Specialised Health Checkup and Health Awareness Talks organized as per opportunity.

3- Life and Accident cover for 100 Rs per year per Person Benefits: 50 000 Rs capital indemnity in case of Accidental Death or total permanent disability 25 000 Rs in case of partial permanent disability 20 000 Rs capital indemnity in case of Natural Death 1000 Rs in case of spouse or kids death/partial disability

For all three products: Free guidance on health at any time. These products not only provide access to health care but also constitute an incentive to control the health care providers’ charges and quality of care.

6) Description of innovation: UpLift Health is a Community owned centre with competences and services in micro insurance and especially in health Mutuals.

(UpLift India Association is a non profit company owned by its member organizations. Each Partner organization owns 1 share of 10,000Rs. These partner organizations share their processes and exchange techniques to improve their impact with slum dwellers.)

The mutualism system proposed to communities people in a position of responsibility towards their own health and towards health care providers or insurers.

A full tool set for setting up a mutual is available to communities: - community needs analysis, cum capacity diagnosis - their own product design and pricing for health or life micro insurance, - a specific micro insurance Software - a budget/business planner, - a set of promotional tools, - an operation manual with forms for enrolment, claim settlement, and health card.

These tools can be given for free or along with our technical guidance to any community wishing to join the organisation’s association (namely UpLift India Association). Joining allows every individual community data sets to be consolidated for the benefit of each community.

A set of common services shared by partner communities is also available: - a network of 60 health care providers (hospitals, labs, blood banks...). Any complaint from the community’s members is studied and reported to the health care providers: public or private. - a hot line available 24 hours a day, 7 days a week answer any call from the communities members and provide guidance toward the most appropriate health care provider in case of emergency or on health in general. This will be transformed in a call centre.

The community ownership, the focus on members health, and the target of equity bring a positive change to today's private based service provider / partner agent offer.

7) Operational model: Our organization focuses on community satisfaction towards our services in the health sector. And since they are members of our board of directors, it is in our best interest to meet their expectations!

Each community who wants to join should be working with the poor, ideally having some financial transaction management system in place. After accepting this new comer, we have the following process: 1- Assess the systems and needs of organizations to improve reach and impact, 2- Assess the needs and design the corresponding products on one side and plan the organization capacity building, 3- Work with the community to develop Health Micro insurance/Mutual, 4- Extend the health care providers network, 5- Develop Standardized Simple Processes, 6- Provide on-going training & coaching, 7- Facilitate cooperation amongst partner organizations: cross visits, sharing results, information and methods, peer learning, benchmarking for a better quality 8- Offer risk management and reinsuring solutions, 9- Visibility and advocacy on social security

At the field level, once the product is designed, the processes mapped and staff trained, promotion starts:

-Families enrol as a whole or have to pay an extra amount (in order to avoid adverse selection), this payment is done at the time of the enrolment form filling, or renewal form filling. -Once the payment is done, a health card is provided to the family in order to provide them access to the quality health care network. They are then covered from the 1st of the following month.

-In case of health problem the claimant calls the doctor on line and get on line advise/guidance toward the most appropriated health care provider. He is so far reimbursed a few days later ( a cashless process should be implemented soon) Each claim is discussed in the corresponding cluster and validated by the group. The doctor checks the coherence of expenses with the diagnosis. The check/cash disbursement is done to the claimant.

8) Human resources: A- Grassroot Partner Organizations Services Executives or Arogya Sakhi: based in the villages or in the slum enrol and collect yearly contributions. Coordinators check claims & clients satisfaction, supervise claim settlement meetings and ensure a good understanding of the settlement by the group. An encoder encodes and produces all monitoring reportings. An Organization Director/supervisor B- Federal organization (UpLift) A Doctor on line: guide members toward health care providers, health check up camps organization, awareness talks design. Another doctor sets up a quality health care provider network controls quality provided. He participates to claim meetings and checks claim coherence. A trainer provides support to partner organizations staff in promotion. An accountant provides support in accounting specificities. An actuary / statistician provides analysis and pricing services. He controls the risk management within partner organizations. A micro insurance specialist designs operational manuals, products and processes. A project manager follows up various partner organizations in their mutual setup & growth projects.

9) Key operational partnerships: Partnerships exist at various levels: 1 - Health care providers: More than 60 hospitals have signed an MOU where quality standards and prices discounts are settled. 2 - Technology: a software company provides development forces for maintaining and Improving Syslift software. 3 - Insurers: the life insurance part of the contract is beard by a public insurer. 4 - Government health dpt: a director of a public hospital and member of the municipal corporation health department is a member of the board and facilitates the relations with public health care facilities. 5- A partnership with a French mutual is under discussion. This partnership would bring further technical support and governance stability thanks to their experience in running community mutual organizations. 6- A partnership with the government and associated adviser international organization will also bring further support in terms of replication, and ownership by some other organizations. All these partnerships are important to the association, as they stabilize/structure the system with a long term vision.

10) Financial Sustainability

          • Fees charged to clients?: Yes

          • How do you assure affordability?: The product pricing is decided by members themselves. Once this price is decided, our role has been to bring more value for this money thanks to discounts negociations with health care providers. The other added value for money consists in awareness talks, health checkup camps, and the path of health care that should prevent useless expenses done with quack doctors or pharmacists.

          • Earned incomes as a percentage of operating costs: 60%

          • Other funding sources: 60% of this project is sustained by the cost of the support structure. Once the association services and tools are shared with more organizations, the whole system will be financially viable.

Today, at the grassroot organizations level, the health mutual funds services can be sustained depending on the operation expenses level and numbers (business plan breakeven conditions).

          • Strategy for long-term sustainability: For each partner organization, a consolidation of the renewal rates thank to a cashless facility will attract even more families to join and enables the organizations to reach breakeven.

Our strategy relies on replicating this model for more grassroot organizations so that this centre serves many more organizations and much more people. So far we were in testing mode, and the team should be ready soon for replication and giving away ready made tools for whoever wants to setup a similar centre.

11) Current and Future Impact

          • Total number of clients: 22000

          • Clients in the past year: 16000

          • Percentage of low-income clients: 90%

          • Impact: These activities bring different form of impact : Firstly they bring financial security. They know that in case of health problem, there is a financial solution. That is a psychological relief. Secondly, Its community based and transparent management bring also a sense of empowerment thanks to the information shared at the time of claims. Thirdly for the persons who had a health trouble, they could be hospitalized thanks to this system, without being bankrupted. We observe an hospitalization rate of around 1,8% when only 0,7% of similar population segments are hospitalized every year. (the average being 2%).

          • Overall "market": In a context where 85% of the population is not covered against health risks financial consequences, the potential demand for these products is extremely large. It concerns not only the informal sector but could also concern formal sectors. (Many unions, and cooperative are more interested in such systems than in group insurance policies.)

But, one needs to consider also that since the poor will not be able to afford fully their own health costs, a redistribution system will need to be setup. UpLift centre will offer a platform for such solidarity.

To be more specific in the near future, the demand assessed through organizations interested in Mutuals for next year should concern around 1 000 000 persons in maharashtra. But many more would probably be interested in running similar activities once they get to know about it.

12) Scaling up strategy

          • Stage of the initiative: Scaling Up stage.

          • Expansion plan: The strategy for the next 3 years consists in :

1- consolidating systems with our partner organizations who started 3 years ago and uniformizing their processes. This step includes also a consolidation of our central team with the hiring of 4 new experienced staff.

2- Promoting a campaign strategy around mutuals within communities along with appropriate tools and media.

3- Advocating this social security resource centre model with the government (GTZ and ILO are supporting this initiative)

4- preparing a web based service platform with software, tools downloadable in order to ease our services.

5- Studying the feasibility of setting up a proper health line call centre to guide partner organizations mutuals members.

13) Policy change: The first policy change required would be to formalize the Mutuals legal frame as strongly as micro insurance agents legal frame has been so far formalized by IRDA. The second would be to make such community based social security centres as a real strategic step for implementing social security in India. The third change required from the government would be to advocate for a social equitable model for health financing where people would be able to pay according to their means and receive as per their needs. This social security centre then would become a public entity, still governed by communities, but controlling redistribution of a certain share of contributions towards poorest communities.

14) Origin of the initiative: In 2002, a poor lady from a Pune slum, member of Annapurna Parivar Vikas Samwardhan groups, was diagnosed a serious heart problem. She was supported by her group members to be hospitalized. How can one afford a 1 Rs. lakh open heart operation when the family monthly income is 4000 Rs? The need for a social protection was expressed. Annapurna Parivar Vikas Samwardhan along with Inter Aide started to study what the market can offer as a protection for 50Rs a year per person. As the insurance companies are not sharing profits, the incentive to be healthy is absent, the members therefore decided to setup their own mutual fund, and to manage it guided by experts from Inter Aide and UpLift India Association. This process was facilitated by François Xavier Hay, 37, French actuary, working for Inter Aide as a program manager since 2000 and helping NGOs in their microfinance activities.

Contact Information:
François-Xavier  Hay
Managing Director
UpLift India Association
(Non Profit Company)
India