Madhya Pradesh
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Madhya Pradesh
Background
Start Date: March 2011 End Date: March 2012 Status: Completed
Catastrophic illness can push poor households into a cycle of poverty, debt and worsening health due to high out-of-pocket expenditure. Recognising this, India’s Eleventh Five-Year Plan (2007–2012) highlighted the need to move towards universal health coverage, building on state-level health financing schemes designed to reduce the financial burden of serious illness.
In 1997–98, the Government of Madhya Pradesh introduced the State Illness Assistance Fund (SIAF) to provide financial support for the treatment of serious illnesses among households living below the poverty line.
To improve the effectiveness and efficiency of the scheme, the Government of Madhya Pradesh commissioned an independent review of the SIAF. M Rao was invited to lead this review.
Aims
The study aimed to:
- Undertake a rapid review of the State Illness Assistance Fund (SIAF) in relation to its stated objectives
- Examine the extent to which the SIAF was contributing to overall health improvement in Madhya Pradesh, with particular attention to its accessibility for the targeted Below Poverty Line (BPL) population
- Assess how the scope of the SIAF could be expanded — including population coverage, budget allocation and the range of diseases covered — and recommend an appropriate mechanism to improve its effectiveness and delivery
Method
The review used a mixed-methods approach, including:
- A literature review and collation of evidence from health financing schemes in both developed and developing countries
- Secondary data analysis using information obtained from the SIAF database
- Consultations with: Leading policy makers in the Government, Members of the Department for International Development (DFID), Technical Assistance Support Team in Madhya Pradesh, Senior staff from public, private and trust sector health delivery organisations, District-level health officials
- Focus group discussions with: Local government representatives, Members of local communities, Beneficiaries of the scheme
- A questionnaire survey of a small sample of beneficiaries or their caregivers, to understand their experiences of accessing and using the scheme
- A stakeholder workshop (June 2011), where the review team presented preliminary findings and tested conclusions and recommendations before finalising the report
Main Findings
Positive findings
The review found that funding allocated to the State Illness Assistance Fund (SIAF) had increased over the previous decade.
The scheme was perceived as highly beneficial by individuals living Below Poverty Line (BPL) who had accessed it. Beneficiaries reported receiving quality care without incurring catastrophic out-of-pocket expenditures.
Key challenges identified
Despite these strengths, the scheme reached only a small proportion of BPL families, particularly in the poorest districts of Madhya Pradesh. Limitations included:
- Funding restricted to a limited number of treatments
- Provision largely confined to private or trust hospitals
- Continued out-of-pocket expenditure despite the availability of the scheme
Several financial and non-financial barriers reduced access, particularly for largely illiterate or semi-literate families. These included:
- Limited awareness of entitlements and eligibility
- A complicated and bureaucratic funding application process
- Confusion regarding diseases and treatments covered
- Uncertainty about how to apply for funding
The review also identified inefficiencies related to treatment package costs and verification of treatments.
Impact
Impact
The review had a significant impact, particularly contributing to the development (2011–2013) of a more efficient financial support scheme for the care of seriously ill patients in Madhya Pradesh (MP).
Following the report’s recommendations, a State Steering Group was established in August 2011 to oversee the restructuring of the State Illness Assistance Fund (SIAF). The Group subsequently acted on a number of the report’s recommendations through Government Orders and directives.
Between October 2011 and October 2012, key reforms included:
- Strengthening the overall management of the fund, including increasing its total value
- Improving leadership and management within the unit responsible for fund delivery
- Renegotiating treatment package rates with healthcare providers
- Devolving authority to approve funding at district level
- Introducing improved verification procedures for funded treatments
Further reforms currently underway include:
- Introducing stronger accreditation procedures for providers
- Reducing bureaucratic processes associated with accessing funding
- The development and implementation of this more efficient health financing system has delivered clear benefits for many of MP’s poorest citizens.
Strengthening accountability and system integration
In 2013, patient feedback forms were introduced. These are achieving a response rate of approximately 50 per cent, which continues to grow. Feedback is now linked directly to the Management Information System (MIS), ensuring that patient experience informs provider monitoring and evaluation, and influences decisions regarding the commissioning or de-selection of providers funded under the scheme.
The MIS now integrates the multiple healthcare entitlement schemes operating in the state. This represents an important step towards the longer-term development of a more unified and comprehensive health service system.
Contact us
Project Lead: Professor Mala Rao
Project Team: Lipika Nanda, Sandhya Kanneganti, Ranjani Gopinath, Subodh Kandamuthan, Sofi Bergkvist, Neena Minhas, Crystal Morris
Funder: FID
Project Partners: Administrative Staff College of India, Hyderabad
