Online Program

291704
An innovative approach to rural health care in Nepal: Combining community based primary health care, microfinance, and health insurance


Monday, November 4, 2013 : 5:15 p.m. - 5:30 p.m.

Biraj Karmacharya, MBBS, MSc, PhD, Department of Epidemiology, University of Washington, Seattle, WA
Annette L. Fitzpatrick, PhD, MA, Departments of Epidemiology and Global Health, University of Washington, School of Public Health, Seattle, WA
Akina Shrestha, MPH, Department of Community Programs, Dhulikhel Hospital Kathmandu University Hospital, Dhulikhel, Nepal
Sachita Shrestha, BPH, Department of Community Programs, Dhulikhel Hospital Kathmandu University Hospital, Dhulikhel, Nepal
Prabin Shakya, BPH, Department of Community Programs, Dhulikhel Hospital Kathmandu University Hospital, Dhulikhel, Nepal
Samita Giri, MPH, Department of Community Programs, Dhulikhel Hospital Kathmandu University Hospital, Dhulikhel, Nepal
Chandra Yogal, BPH, Hebrew University Braun School of Public Health, Jerusalem, Israel
Shrinkhala Shrestha, MPH, Department of Community Programs, Dhulikhel Hospital Kathmandu University Hospital, Dhulikhel, Nepal
Roshan Mahato, BPH, Department of Community Programs, Dhulikhel Hospital Kathmandu University Hospital, Dhulikhel, Nepal
Rajendra Koju, MD, Department of Medicine, Dhulikhel Hospital Kathmandu University Hospital, Dhulikhel, Nepal
Archana Shrestha, MPH, Department of Epidemiology, School of public health, Seattle, WA
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.

Learning Areas:

Conduct evaluation related to programs, research, and other areas of practice
Provision of health care to the public
Public health or related research

Learning Objectives:
Evaluate a novel approach of rural health care in Nepal combining community based primary health care, microfinance and health insurance, in terms of 1. Implementation feasibility 2. Health care utilization 3. Health service seeking behaviour 4. Financial viability

Keyword(s): Community-Based Health Care, Insurance-Related Barriers

Presenting author's disclosure statement:

Qualified on the content I am responsible for because: I was the principal investigator of this research and was involved primarily in developing the concept, implementing, supervising and then later on analyzing the information obtained. I have been leading the Department of Community Programs at Dhulikhel Hospital since 2006. Since then I have been involved in developing innovative approaches to rural health care in Nepal. Currently I am also a PhD student in the Department of Epidemiology at University of Washington.
Any relevant financial relationships? No

I agree to comply with the American Public Health Association Conflict of Interest and Commercial Support Guidelines, and to disclose to the participants any off-label or experimental uses of a commercial product or service discussed in my presentation.