5) Description of health product/service offering: Informal economies are common features of most developing countries, including Nepal. They significantly contribute to employment, production and income generation. It is informal in the sense that it is not regulated by government statutes and legislation. Since there is minimal control, workers in the informal economy are more vulnerable to exploitation.There is strong need of social protection in developing countries, especially those with large informal economies.Most people in the informal economies are particularly vulnerable to health risks in the sense that they are exposed to dangerous working conditions,non-existent provident measures and low and irregular earnings.Without such social protection, many individuals delay seeking health care or may not seek it at all. When someone falls ill: oThe family budget is affected. Often income is reduced. oPressure is placed on the other family members to produce income,often forcing them into child or bonded labour. oOften the family incurs debt and/or is forced to sell capital goods, husbandry, livestock or equipment from income generating activities in order to pay fro treatment. Due to lack of money, often the waiting period for treatment and the seriousness of the illness increase. This means that treatment will take longer and will be more expensive.In the worst-case scenario, an avoidable death occurs.Costs are physical as well as financial. The targeted beneficiaries of this project are those vulnerable people who are unable to afford health services.My idea is to start a Health Micro-insurance (HMI).It is a form of micro insurance in which resources are pooled to meet unpredictable medical expenses.This HMI scheme will enable members to be covered for a number of health risks,in line with a defined benefit package. In return the member should contribute certain amount as premium.The expected outcomes of this project are:Attitudinal and behavioural change of the people Reduced vulnerability of poor

6) Description of innovation: Bringing attitudinal and behavioural change of people is one of the main focuses of the project which I think is novel. Most of the projects tend to focus towards providing economic benefit or other type of benefits but when project pulls out, their effectiveness gradually decrease. By bringing attitudinal and behavioural change project will make people conscious about benefits of being healthy and using health facilities in time. So that, they are always willing to use health services. The project is interactive and participatory in nature which is quite difficult to witness in other projects. During early stages of the project, focused group discussions, meetings and seminars will be held with targeted beneficiaries to find out their actual needs regarding health and developing the best scheme for them. Health services are available but the main problem is affordability. Poor people can only dream of getting those health services in time because they are so poor that their income can’t even fulfill their basic needs. The project will ensure that health services are affordable to poorest of poor. The project will also organize awareness campaigns and health camps in trying out to reach everyone. Information, education and communication on and about the project is an ongoing process across all the stages of it. The project will use social marketing tools to promote it and its services within community.

7) Operational model: As stated earlier, the project is more client/member supported. The first and most important thing is to develop a scheme which will inspire the targeted beneficiaries to be part of it. These are the steps /activities that the project will undertake: Pre- feasibility, data collection, feasibility, preparing for implementation, implementation, operation & management and monitoring & evaluation. These activities will ensure that the aims and goals of projects are achieved and achieved in time. These activities include steps like establishing contact with the community, designing most appropriate scheme for them, assessing major risks and threats that can threaten the existence of the project, implementing, mobilizing and using resources efficiently and effectively and at last monitoring and evaluating the success or failure of project. This project is a living organization. It born, grows, changes in size. The project will also provide credit to its members when they need it but only for the purpose acquiring health services like surgery, hospitalization etc. The member will be divided into different user groups. The users groups will work as a linkage between members and project.

8) Human resources: The team in place is Rotaract Club of Kathmandu Metro. Currently there are 30 members in the Club. All of them will participate equally in this project under the Coordination of two people. a) Bhuwan K.C., Student of social science, currently doing bachelors in development studies from Kathmandu University. b) Prem Bahadur Rana, Student of social science, currently doing bachelors in development studies from Kathmandu University.

9) Key operational partnerships: The project is still in its start up phase. So it is still early to say with whom it will build partnership but when its operation phase will launch it will make a partnership with a health service provider i.e. hospitals, Clinics ,nursing homes etc. The partnership might be of two types: Co-payments: in this type of partnership HMI members have to pay certain percentage of service charge to service provider and rest of it will be paid by the project. In this model the role of health service providing partner will be to provide services in discount or deducted rate. Next model of partnership can be capitation: In this partnership the project will provide a flat rate per member per year/month contribution amount upfront to the health provider based on the total number of members enrolled in the HMI scheme.

10) Financial Sustainability

          • Fees charged to clients?: Yes

          • How do you assure affordability?: During pre-feasibility, data collection and feasibility stages of project we will basically try to understand the real need of needy people. For this purpose we will conduct a need identification survey through which we will ensure that what kind of services HMI scheme should include, what type premium method should be implemented (monthly, bimonthly, tri monthly, yearly), how much should be the insurance premium etc. The main objective of the project is to provide services in cheapest rate possible. We are also acquainted with the fact that if the premium rates aren’t affordable to targeted beneficiaries then we will fell short of member due to which project will be a failure. So we will try our best to ensure affordability.

          • Earned incomes as a percentage of operating costs: 95

          • Other funding sources: We have also presented our proposal to “Youth in Development partnership 2006” which is supported by “World Bank Poverty Reduction Strategy Resource Centre” and coordinated by AYON (Association of Youth organizations, Nepal). The project might need continuous support from donors to be sustainable because it is hard to make this project self sustainable due to its service sector which is health.

          • Strategy for long-term sustainability: To ensure financial sustainability, the project will start a credit program through which members of project can take loan from project for emergency cases and acquiring costly health services like hospitalization, surgery etc at minimum interest due to which project can generate some funds. The loan will be only available for getting health services. We will also propose to Gos, NGOs, and INGOs for financial and technical assistance. The most important source of funding would members themselves. The premium which will be collected from them will make the project financially sustainable.

11) Current and Future Impact

          • Total number of clients: 00

          • Clients in the past year: 00

          • Percentage of low-income clients: 80

          • Impact: This project is just under consideration. So it could be very early to presume what type of impact it will make. The main change it is going to make in society is on their behavioural part. By making health services cheaper it will encourage people to take those services as much as possible. At the same time many people in this part of people have strong cultural taboos and health illiteracy. The project will run health literacy campaigns through which superstitious beliefs of people can be brought down.

          • Overall "market": Most of the Nepalese people are under povery line. At the same time the informal nature of Nepalese economy doesn't provide enough social protection and security.They are always vulnerable to health risks. So a Health micro- insurance will provide them sufficient support during the hard times. Government isn't abl;e to provide them services in affordable price due to which they don't get services in right time due to which they risk their life. The project hasn't divided people on the basis of social and economic status so everyone is eligible to be member of this project but tjose with the critical and vulneralbe condition will be given special emphasis.

12) Scaling up strategy

          • Stage of the initiative: Start Up stage.

          • Expansion plan: In next three years the project intends to reach as many poor marginalized people as possible.In Nepal, there are so many rural areas where people have to travel many hours’ even days to acquire basic health services.The project will try to reach in those places through its scheme.At first we will build health posts which can at least provide basic health services and medicines to local people. And we will introduce the Health micro-insurance scheme to those people.The amount generated from the premium will be used to operate the health post of same area.We have planned to establish 10 health posts around rural area of Nepal.The project will also organized periodic health camps through which it will provide health services to people.These health camps will be focused towards provides health services to squatters and urban poor.We believe that not only in rural areas but also in urban areas there are countless underprivileged that are in want of health services.These health camps will basically be focused towards urban poor. Health literacy will also be focus area of project.This project will start counselling centres for Youths.These centres will be used for propose of counselling

13) Policy change: Nepal is a mountainous country. The main problem in Nepal is lack of infrastructures and inaccessibility to rural areas. Due to mountainous land structure it is difficult to build roads and hospitals in remote areas and cost of building those infrastructures is also comparatively very high. At the same time health workers are reluctant to go and work in remote areas due lack of facilities. In trying to reach out every citizen, government has built public hospitals in each development region and district headquarters.That is not enough. So the main policy change that should be brought can be government should provide more benefits to health workers who work in remote areas so that it can be a motivational factor.In remote areas there are health centers but no health workers.The health centers are vacant and compounders check the patients.Government should make strict rules against them.

14) Origin of the initiative: Once I was in Public Information Centre (PIC) of World Bank. While going through the publications of ILO (International labour organization) I got opportunity to know about Health micro-insurance. Health micro-insurance is one of the techniques to fight against health risks and provide social protection to vulnerable and poor people. This is a part of ILO’s STEP (strategies and tools against social exclusion and poverty) programme. After studying that publication, I realized that our Nepalese people are in prompt need of this type if insurance which can provide them social protection.

Contact Information:
Bhuwan  K.C.
Club service director
Rotaract club of Kathmandu Metro
(club)
Nepal