Details for Reform Option "Quality antenatal care for insured women workers, Gujarat"
For women working as unorganised labourers in the informal sector, health is the most important asset. Yet it is the most neglected aspect of their life. Reasons vary from affordability to availability of services within easy reach.
In order to provide quality care during antenatal and postnatal period, Vimo SEWA launched an intervention on pilot basis in March 2003, called Quality Antenatal Care for Insured Women Workers. The project was in partnership with United Nations Population Fund (UNFPA) and was conducted in three phases for a period of 6 months in Ahmedabad city.
Vimo SEWA is the insurance scheme for workers in the informal sector (For details please see PROD entry no 137).
The target area for the project was chosen on the basis of high concentration of Vimo SEWA members, particularly in the reproductive age group. Beneficiaries under the scheme were restricted to those who were pregnant and were members of the fixed deposit scheme of Vimo SEWA.
The first phase mainly focused on the quantitative and qualitative research of the area to understand the existing trends in health care, level of awareness among people on care during pregnancy and average expenses incurred to avail of the services. Simultaneously, mapping of the existing health facilities (both government and private) was done and they were encouraged to form a network. With the help of different stakeholders, who were brought together in a workshop, a standardised antenatal care package was designed. (For the package of services, see reference section) Vimo SEWA would pay the cost of the service, which was fixed at INR 200. Duration of the first phase was 6 months.
Based on the learning from the first phase SEWA started the interventions to increase the demand for antenatal care among Vimo SEWA members as well as to ensure that the required services would be available on demand. The strong linkage between the Quality Antenatal Care network and Vimo SEWA insurance scheme ensured affordability of the services. Services were cashless transactions, which made it easier for members to access them.
To generate the demand for the services, Aagewans, Vimo SEWA-supported field level workers, were trained for spreading health messages and generate awareness among family members, pregnant women, their husbands and also the community in general.
Both government and Trust hospitals were roped in to respond to the newly created demand for antenatal care. As it was difficult to render cashless services in the government facilities, it was decided, in consensus with Ahmedabad Municipal Corporation, that an Aagewan would accompany members availing of antenatal care; she would keep record of the number of patients and accordingly make payment to the health facility on the same day for services rendered.
The third phase comprised an end line study and a closure workshop.
Initially two government hospitals and 4 Trust hospitals were involved in the network. After the successful completion of the project networking of the hospitals has increased.
Antenatal Care details between August 2003 and June 2004:
Number of the pregnant women identified - 138
Number of the women who opted for institutional delivery - 94
The funding support for project interventions were entirely by UNFPA while the INR 200 per member for the ANC package over and above the cash maternity benefit of INR 300 for each pregnant Vimo SEWA member was borne by SEWA.
Ahmedabad city in 2003.
Approximately one year.
Integration: of the health services and insurance. Cashless transactions made access to health services easier.
ANC mandatory: A standard protocol is developed and providing basic clinical and laboratory services to pregnant women become binding for health care providers in the network.
Referral links: Early detection of complications during pregnancy increases scope for appropriate referral linkage and avert obstetric emergencies.
Interaction between Aagewans and service providers: As Aagewan is a link between beneficiaries and healthcare providers there is a need for more open dialogue to promote the services.
Cross utilisation of providers: The tendency among patients to utilise more than one health facility poses difficulties in monitoring the pregnancy.
Male involvement: Getting male partners to participate in the decision-making process is a complex task.
MoU between the hospitals and SEWA.
Who needs to be consulted
Government Health Facility.
Scheme is self-sustainable as beneficiaries are the fixed deposit members of the insurance scheme and they are getting the package of services which is pre-determined in the MoU.
Chances of Replication
Providing basic minimum care to pregnant women in the informal sector and encouraging them to go in for institutional delivery is one of the goals of the scheme, but it needs to take care of the members for default, irregular visits as well as involvement of the male partners.
In this project, UNFPA’s role was that of a funding agency as well as of an advisor. Six monthly review meetings were held with representatives of UNFPA.
Dr. Anuradha Davey, National Institute of Medical Statistics, May, 2006.