Nathalie – Health Insurance updates

Over a month in to our trip and we’re all finally really busy with our projects. I’ve been working at the clinic (Casse de Sante) in Kuwde every week day morning. My daily routine has been the following: wake up at 6:30am, take a bucket bath, have my oatmeal, walk down to the clinic with my host father (10 minute walk down a steep path), and continue analysing the insurance system data. At 11am, I take a break and walk back up the steep path to my homestead and help my host mother prepare my lunch. After eating, I usually spend some time reading under the trees, sometimes I return to the clinic and other times I hike down to Farende (1 hour hike) to see the other Duke Engagers and spend some time at the internet – catching up with the news, my friends, and trying to brainstorm ways of improving the health insurance system at the clinic.

Work at the clinic has been extremely interesting this past two weeks. I have looked through three pools of data that the clinic has collected since August 2011: (1) the people who are insured, (2) the people who are uninsured, and (3) the women who give birth at the clinic. The results from my analysis show that almost every family involved in the insurance system has benefitted from the system. Impressively, the insurance system is still self-sustaining. From the data on the uninsured people, I have identified six families that would have benefitted immensely from the insurance system since August 2011. From the data on women that have given birth at the clinic, I have seen that they are the ones that suffer the most because they have to pay the highest fees.

My goals over the next two and a half weeks:

Starting Friday, I will begin to interview two families who are uninsured and could benefit strongly from the insurance system. My aim is to try and understand why they haven’t already joined the insurance system and show them the exact amount they would have saved over the past two years had they joined the insurance system. I will continue to interview the other families in the beginning of next week. Next, I would like to interview some of the members of the insurance system to see if they have any feedback on ways of improving it, etc. I would also like to target the families that have dropped in the insurance system in 2013 and understand why they didn’t continue (did they think they were losing money?, were they not able to pay this year?, did they forget to sign up again?, etc.) Lastly, I would like to have a community meeting with all the women in the village that are still of age to give birth. I would like to make them aware of the insurance system and show them how much money they could save (especially when more than one person in a family is pregnant in any given year, since the standard insurance fee covers an entire family).

Some initial ideas for improving the insurance system:

Over the past few weeks working at the clinic, I have noticed that many people simply forgot to sign up for the health insurance in 2013. I have also noticed that if we were to incentivise pregnant women to join the insurance system, they would need to be able to join the system at any point in the year. Currently, the system only allows people the option of joining the insurance in January/February. This means that if the family forgets to join in those months and pay the 1800CFA fee, they have missed their opportunity of being part of the insurance system for that year and must wait an entire year to join it again. I have therefore thought of implementing a more flexible system in which people could join at any point within the year. This could give people the opportunity to join who might have forgotten to pay the fee at the beginning of the year or who might not have had enough money to pay in January/February. Furthermore, it could incentivise women to join the insurance system when they get pregnant, with the hopes that they will continue with the insurance system after their pregnancy ends (since babies get sick here very often). Hopefully this improvement in the system could increase enrolment and make it more appealing for people to join.YOTO

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