The role of Grameen Kalyan in The role of Grameen Kalyan in promoting Health Equitypromoting Health Equity

Shaikh Abdud DaiyanShaikh Abdud DaiyanManaging DirectorGrameen Kalyan

What do we understand by Health Equity?What do we understand by Health Equity?

A community in which any group of individual A community in which any group of individual defined by age, gender, racedefined by age, gender, race--ethnicity, class or ethnicity, class or residence can achieve its full health potential.residence can achieve its full health potential.

And would continued improvements in health And would continued improvements in health for all but bringing the bottom; up at the same for all but bringing the bottom; up at the same rate or faster than the top. rate or faster than the top.

Clearly we could say : whatever the socioClearly we could say : whatever the socio--economic condition the people with equal needs economic condition the people with equal needs for health care should be treated equallyfor health care should be treated equally

Few constraints/issues need to clarifyFew constraints/issues need to clarify

• Per capita health budget• Utilization of existing health services• Improving the existing health services• Definition of sickness to the rural poor• Uneven competition among health service provider• Why GB involved in health services

Grameen BankGrameen Bank•• A specialized financial institution A specialized financial institution

in Bangladeshin Bangladesh

•• Provides group based credit Provides group based credit to the rural poorto the rural poor.

•• Disbursed > US $ 6 bn among Disbursed > US $ 6 bn among 4 m family.4 m family.

•• Covers more than 52 thousand Covers more than 52 thousand villages of the country through villages of the country through 1,457 branches.1,457 branches.

··Male & Female ratio : 05: 95Male & Female ratio : 05: 95

Grameen KalyanGrameen KalyanHealth ProgramHealth Program

•No(s) of Regions :5 •Number of Health Centers-30•No(s) of union covered : 45•No(s) of Upazilla :26•No(s) of Districts: 9•Target population : 1.5 million•No(s) of maternity center : 16•No(s) OT for cataract Opr. : 1•No(s) out reach centers for cataract operation : 7•No(s) of patient visited : 2003 : 146,2722004 : 243,503•Grameen : Non-Grameen 75:25•Female : Male 65:35

Head Office

Regional Offices

Health Program of GK

Provides primary health care services to GB borrowers

and other villagers.

Provides diagnostic & medical servicesincluding referral services for secondary/tertiary health care.

Find a least cost solution for a sustainable rural

health care program

Objectives

Charged according to the insurance plan

Health Service

Non cardholdersCardholders

GB & all villagers

Pay full price for medicine &

consultation service

Health Center at a glanceHealth Center at a glance

Center Director - MBBS

Office Manager

DMF/ParamedicDMF/Paramedic

Lab Tech.

CHA CHA CHA CHA CHACHA

Female Male

CHA – 1 CHA – 6

CHA – 2 CHA-5

CHA –3 CHA - 4

10 Km Radius500+ 100 = 600 Families

For each CHA (3600 Families)Among 7000 Families

a .GPMb. Special Services

RHGynae & ObsMCHFP- MethodSTD/HIV/AIDSMHIP

c .Minor OperationPiercing of Ears & Nose etc.

d.Organize MHP e.ECG & USG f.HE

a. GPMb. Special Services

STD/HIV-AIDSFP – Male Method

c. Minor OperationCircumcised, Piercing of Ears & Nose,Dressings, Extractionof small Infections etc.

d. Organize MHP EYE-Optometry

e. ECG & USG f. HE

Female Female

Organogram Organogram of a HCof a HC

MHP = Mobile Health Program MHIP = Micro Health Insurance Program CHA = Community Health Assistant

DMF = Diploma in Medical FacultyGPM = General Patient ManagementRH = Reproductive HealthHE = Health Education

Premium and Service PackagePremium and Service PackageFees (Taka) & Service Package Amount in Taka

Yearly Premium for all villagers 150Yearly Premium for GB members 120Medical Consultation Fees in Tk. (NGB/GB) 10 & 5Max. Mem. of family included 6Annual basic pathological tests (routine) 10Refrred consultantion visits%off price 50%Basic med**%off Manuf. Retail price 25%Other med %off Manuf. Retail price 10%Basic pathological tests%off Mkt. Price 50%Hospitalization, max. coverage/compansasion up to 2000EPI/HE/House visit by health assistants FreeAnnual chech-up for main person insured FreeNo of Health centers under this plan 30* Govt. handedover one HC to GK** 15 essential medicines are considered basic

Free domicilliary services provided by the HAs Free domicilliary services provided by the HAs

Antenatal & Postnatal Checkup

Assist safe delivery & ensure routing checkup

TT to pregnant mothers and immunization

Patient refer to HCReferred complicated pregnancy

Iron folic acid tablet distribution

F/planning materials distribution

Provides health educations

Collect consent from villagers

Identify eye patients through E chart

68,292

243,503

80,000

115,636

146,272

133,236131,898

24,688 34,933

107,173

1996 1997 1998 1999 2000 2001 2002 2003 2004 Apr-05

Total No. of Patients: 1996 to 2004

17171414

2828

232314141313

1010

10% patient treated

10% patient treated

under safety net

under safety net

3030

Operational Cost Recovery : 1996Operational Cost Recovery : 1996--20042004

38%

50%

65%72%

77% 77% 81% 85%89%

1996 1997 1998 1999 2000 2001 2002 2003 2004:

Development of new services according to health needs of different groups

(To reach the un-reached)

►Prevention of cataract blindness

►Safe motherhood

►Diabetic patient management

►Community cardiology

►Mobile health program

Operation started on 17 April 2002 at Alenga Health Center and implanted IOL

Fees for IOL operation forthe cardholdersGB : Tk. 2000NGB : Tk 2500 Others:Tk 3500

In Mega Camp we provide free operations In Mega Camp we provide free operations for the destitutefor the destitute

Operated 3000 C

ataract Blind

Operation Theater : Prevention of Cataract Blindness Project

Safe MotherhoodSafe MotherhoodSafe Motherhood

ConclusionConclusionThe health insurance scheme was first The health insurance scheme was first introduced in 1993 as a pilot project. introduced in 1993 as a pilot project.

Still, we have to go a long way, to make the Still, we have to go a long way, to make the program sustainable.program sustainable.

Our experiences indicate a positive direction, a Our experiences indicate a positive direction, a direction of hope; a hope for the improved direction of hope; a hope for the improved health of millions of poor people in Bangladesh health of millions of poor people in Bangladesh through health insurance. through health insurance.

Introducing MHIS is important to get an extra Introducing MHIS is important to get an extra mileage in poverty eradication efforts and also it mileage in poverty eradication efforts and also it is an essential ingredient to ensure better health is an essential ingredient to ensure better health for more productive involvement in economic for more productive involvement in economic activities and improving health equity.activities and improving health equity.