An innovative approach to rural health care in Nepal: Combining community based primary health care, microfinance, and health insurance

Creating a sustainable primary health care system in rural resource-limited settings depends on addressing issues which include: a) setting up an efficient health service facility; b) removing barriers to utilization of health services; c) empowering users financially; and d) providing access to care via micro-health insurance in an incremental approach. Using institutional and community collaborative partners, a simple yet up-to-date primary health care centre was constructed in Bahunepati, a rural village in Nepal. It was managed by Dhulikhel Hospital Kathmandu University Hospital. Community meetings were held with 60 families at greatest need to discuss the goals of a microfinance program. The female head of household received a loan equivalent of $100 USD, to be paid back in 3 years. We provided training in multiple sessions on various health-related topics and introduced the concept of health insurance at these meetings. Each woman paid a premium of about 2 USD/month to cover primary health care services for herself and her children available at the health centre. An assessment after six months showed very encouraging results in terms of appropriate health care utilization and financial viability of the program. The women visited the centre for all major health conditions that they and their children encountered during this period. The insurance premiums covered almost 85% of the total cost of the health services used. Voluntary participation of the women in the educational health programs exceeded 90%. This program provides a model for improving access to health care in rural areas of developing countries.