National 7 (Spotlight Weekly)

Eastern Awareness

The popularity of a year-old scheme tells a refreshing tale

By THAKUR AMGAI

As the newly appointed health minister, Dr. Upendra Devkota, was announcing his 13-point reform package, including the introduction of a health insurance program, late last year, some people in eastern Nepal were already enjoying such a scheme for nearly a year.

The health insurance program, which is a new concept in South Asia, has great significance at a time when health facilities are becoming increasingly expensive every day. In the past few years, due to various reasons, the quality of public health facilities has been deteriorating.

With the mushrooming of private-sector institutions, health care has become more accessible for urban residents who can afford it. For the vast majority of the general public across the country, quality care has become too expensive, if it is available at all.

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For the people of eastern Nepal, the health insurance program has proved to be a boon. After getting insurance coverage, Anita Shrestha of Dharan-8 gave birth to a second child at a fraction of the cost she had incurred during her first delivery five years ago.

That is a sentiment shared by the wider community. "Health insurance has been a boon, both in terms of ease and finance, for general people like us," says Umesh Gautam of Sundarpur Village in Morang. He underwent a major operation last month at a highly subsidized cost.

The program, which started with 4,372 people last year, has a membership base of 14,170. The three-fold increment in a short span of time underscores its popularity. The B.P. Koirala Institute of Health Science (BPKIHS) in Dharan started the scheme in December 2001.

The first institution to provide health insurance program in Nepal, BPKIHS also remains the only one doing so. Inspired by the success, the government and the private sector are planning to start their own ventures soon.

The institute started the program as it is prioritizing rural health, said Dr. Shekhar Koirala, vice-chancellor of BPKIHS. After the introduction of the insurance program, public awareness about health issues has also largely increased, according to sources at the institute.

Figures show that the rural population is ahead of their urban counterparts in insuring themselves, which is encouraging news to an institute working for improving rural health. Some 2,500 people from Mrigaula village of Morang district have insured themselves. "Jhi Pucha" of Morang, Nepal Bhasa and Sanskriti organization and Reyukai Branch, Dharan, are among the high insuring organizations.

In total, about 35 organizations have referred members for the insurance scheme. The number of organizations is high, as there is no provision for personal insurance. Those who want to be insured need to be affiliated to an organization and apply through it.

Asked to explain the reason for the provision, sources at the institute said they intended to promote the participation of local organizations in building health awareness across the community. Among the 3,900 families covered, the number of females exceeds males, which gives a gender perspective on health consciousness in the eastern region.

The insurance charge is relatively cheap. A dual rate for urban and rural residents has been fixed to ensure social justice. The annual charge for adults of urban areas is Rs.600, and that for urban children is Rs.300. For rural residents, the charge is Rs.180 for adults and Rs.90 for children.

"We provide cheap health service to rural residents with low economic status and take a relatively higher charge from urban people with higher purchasing power," says Dr. Koirala. Obviously, that would be a useful criterion for all would-be providers to follow.