Sure Start taps into the power of new ideas to provide care to those who need it most

In the informal settlements of Nanded, Maharashtra, an example of the power of partnership is blooming. There, Sure Start has launched a community-based health insurance scheme that includes maternity coverage. With community health insurance, members of a community form a partnership and each contribute a small amount of money toward an insurance fund. The fund is used to meet the specific health care costs of the contributors.

The community health insurance initiative required Sure Start to overcome numerous roadblocks. For example, women who attended the first group meetings about the plan did not enroll in significant numbers. It was only after Sure Start approached the community’s men, who are the primary decision-makers, that the community as a whole seriously considered the insurance idea.

The most fundamental challenge was financial. Most community members considered the first premium estimate—Rs. 450 (US$9)—unaffordable. Sure Start was able to reduce this premium amount by obtaining a subsidy from a member of the local legislative assembly. The people’s representative offered to pay Rs. 200 (US$4) toward each person’s premium amount, thus making the plan affordable to families.

The ceaseless efforts of all participants involved in the scheme’s implementation have reaped significant results. Some 220 families have paid a premium of Rs. 250 (US$5), which means that they now receive maternal care, newborn care, hospitalization for general illness, and reimbursement of transportation expenses. As enrolled families’ positive experiences spread through the community by word of mouth, more widespread acceptance is expected to follow. Six hospitals—three public and three private—have enrolled in the plan.

Sure Start has also integrated the national government’s Janani Suraksha Yojana scheme (this incentivizes institutional deliveries) into this program. Should patients require a procedure included in the government’s program, the staff ensures the money is mobilized.

The impact of collaboration

In Nagpur, Maharashtra, Sure Start has established 97 emergency health funds with special provisions for maternal and newborn health care. These funds allow the urban poor to access resources for health needs. To date, 176 users have been educated on how and when to use these funds. The project includes a prepaid card system, which has been implemented to improve accessibility of essential and emergency specialized services. So far, 512 families have benefited from using these funds, including 72 mothers and newborns.

Public–private partnership

In 2007, Sure Start approached Dr. Vidya Kshirsagar, who has long worked to provide specialized health care to the poor mothers and children of Navi Mumbai with an ambitious idea: in order to ensure that everyone receives the services they need, why not link up those who have the expertise, those who have the funds, and those who have the infrastructure?

Sure Start’s organization of a public–private partnership between the Navi Mumbai Municipal Corporation and local nongovernmental organizations, community groups, professional associations, medical institutions, and private hospitals has helped Dr. Kshirsagar achieve her goal. Now, the people of her city have access to services such as gynecological visits, pediatric care, nutrition consultations, and yoga classes—as well as the promise of good health for themselves, their children, and future generations.

Dr. Kshirsagar feels an immense pride in what her community and her partners have been able to achieve. “I believe PATH, the Navi Mumbai Municipal Corporation, and our partners are giving new meaning to the words, ‘Together we can!’” she says.
Indeed, in this age of high-flying health insurance schemes and exorbitant medical bills, there is something wondrous about a group of disparate people coming together to create small miracles with big results.

Example of impact

Due in part to Sure Start’s efforts, there has been a sharp increase in the percentage of women attending an antenatal checkup for the first time in the first three months of pregnancy. In Navi Mumbai, the figure has increased from 49.4 percent in 2008 to 68.8 percent in 2009.

Photos: PATH.