Start Date: March 2011 End Date: March 2012 Status: Completed
Recognising that household expenditure resulting from catastrophic illness drives the poor into a vicious cycle of poverty, debt and ill health, India's Eleventh Five Year Plan (2007-2012) highlighted the need to plan for universal health coverage building on the experience of health financing schemes established in a number of states to address the financial burden of serious illness in poor households. Madhya Pradesh introduced the State Illness Assistance Fund (SIAF) in 1997-98 to provide financial assistance for the treatment of serious illnesses, to households living below the poverty line. The Government of Madhya Pradesh commissioned an independent review of the SIAF with an aspiration to enhance the effectiveness and efficiency of the scheme. M Rao was invited to lead the review.
The aims of the study were to
- Undertake a rapid review of the State Illness Assistance Fund (SIAF) in relation to its objectives
- Examine the extent to which the SIAF was contributing to achieving overall health improvement in Madhya Pradesh and in particular, its accessibility to the targeted BPL population
- Assess how the scope of the SIAF could be expanded (in terms of its population coverage, budgetary provision and types of diseases covered) and recommend an appropriate mechanism for its effective delivery.
The methods included a literature review and collation of evidence from health financing schemes in other developed and developing countries, analysis of secondary data obtained from the SIAF database, consultations with leading policy makers in the Government, members of DFID's Technical Assistance Support Team in MP, senior staff of public, private and trust sector health delivery organisations and district level health officials and focus group discussions with local government representatives, members of local communities and beneficiaries. A questionnaire survey of a small sample of beneficiaries or care givers of beneficiaries was also undertaken, to understand their experience of accessing and utilizing the scheme. Lastly, the review team facilitated a stakeholder workshop in June 2011 to present the preliminary findings and to test out the team's conclusions and recommendation with the stakeholders before finalising the report.
Positive findings were that the SIAF had been allocated increasing levels of funding during the previous decade and the scheme was perceived as highly beneficial by the 'below poverty line' (BPL) individuals who had received quality care without incurring catastrophic out of pocket expenditure.
But overall, only a small proportion of BPL families benefited from the scheme particularly in the poorest districts of MP, with funding limited to few treatments and at private or trust hospitals. Out of pocket expenditure was incurred despite the availability of the scheme. Several financial and non-financial barriers militated against the largely illiterate or semi-literate families having access to the scheme funding. These included lack of awareness of entitlements and eligibility for grants, a complicated and bureaucratic funding application process and confusion regarding diseases and treatments covered by the scheme and the process of applying for funding. Inefficiencies were also found in relation to treatment package costs and verifications of treatment.
Project Lead: Professor Mala Rao
Project Team: Lipika Nanda, Sandhya Kanneganti, Ranjani Gopinath, Subodh Kandamuthan, Sofi Bergkvist, Neena Minhas, Crystal Morris
Project Partners: Administrative Staff College of India, Hyderabad