Coming together to address health care needs
Meera Sundararajan

For someone struggling to make ends meet by earning wages falling sick is a scary thought. S/he can ill afford to fall sick as it means foregoing one’s wages and spending one’s meagre savings on doctor and medicines. Women, the pillars of poor households have to often deal with these crises taking loans to pay for medicines and hospitalisation. Any sickness speeds up the further descent of the family into poverty.This is also a reality of the lives of women in the Colachel region of Kanyakumari district in Tamil Nadu.

Kanyakumari is considered to be one of the more “developed” districts of Tamil Nadu. There is a high proliferation of private health care institutions which affect the health seeking behaviour of the people making them more inclined through these private institutions as opposed to government run health care institutions. One disadvantage of the using the private system is that it is very expensive and many a times the quality of health care is also dubious. These concerns were shared by the members of the women’s collectives that CARE works with in Kanyakumari. The women shared that although they get loans through the collective at subsidised rated but they did not have any safety net for health related risks.

After a series of discussions with the collectives, the women themselves came up with an option of pooling their risks. They decided that each family comprising of at least four members would contribute a sum of INR 390, approximately USD 8, to which would generate the pool fund to pay for health expenditure. The CARE team facilitated linkage with a private insurance company, Bajaj ,Allianz. Slabs for payouts were fixed with a maximum of INR 10,000 for surgery, INR 5000 for general hospitalisation and Rs 1000 for day care at hospital. The company agreed to share 50% of the payout within the fixed slabs.

To work out the economics, it was imperative that there be at least 1500 members. The federation leaders of the various women’s collectives decided to tackle myths and barriers by speaking to women one-on-one. Concerns like what happens if they do not fall ill or that we are a healthy family were raised. Practical analogies helped the women to understand the need for this safety net. They were also helped to understand the leveraging of larger resourced by investing a small amount as the actual costs far exceed the paltry sum of INR 390. Gradually the women were convinced and they began to join in. The numbers have now increased to over 1600.

The next stage was identification of a network hospital and a referral doctor. After a series of consultation that was also arrived at and the program began to be operational. While protecting from health risks and saving on expenditure is one side to this story- the women were thrilled about their ability to negotiate with the health care providers. No longer were doctors put on a pedestal. They are beginning to be perceived as professionals providing services for a fee which could be negotiated. Negotiations with pharmacies and doctors paid dividends. Pharmacies agreed to provide a discount of about 5% to federation members.

Dealing with claims has made members look critically at the quality of health care. The scene is now ready for some consumer education- women are beginning to see themselves as consumers who have the right to good services!
The women have learnt that it is critical to stay together if they need to negotiate- the have learnt power in numbers.

Meera Sundarajan is Manager, Monitoring, Evaluation and Documentation in the Tsunami Response Programme which works in 7 districts across the states of Tamil Nadu and Andhra Pradesh and the Union Territory of Pondicherry. She has over 15 years of rich experience in the field of social development. Meera has been associated with many pro-poor research and projects in areas like micro-financing, banking, fisheries development to trainings in local self governance.