Health Security Scheme (HSS) for rural artisans March May June April July February A co-contributory health-financing scheme for Ayesha Abed Foundation artisans and their family members Tanvir Hossain, Manager, Marketing & Sustainability World Bank BEES Network Meeting – September 2015

Concept Why HSS? “Strengthen economic empowerment of all artisans by improving their financial security for catastrophic health shocks” 25 BDT Artisan AAF per artisan 50 BDT HSS Fund How?

Concept Who benefits? Artisans can register up to 4 family members Children and either spouse or parents Artisans who are active and active artisan’s family members Active = has worked at least four out of six months

Concept Eligible beneficiaries who seek emergency care or who are hospitalised at an empanelled hospital are provided with a fixed amount of money Amount calculated according to type of admission and length of stay

Benefit 1,000 BDT 6,000 BDT* 10,000 BDT* Emergency: Medical: Surgery: Complicated child birth: 1,000 BDT up to 3,000 BDT* (500 BDT per 48 hours) 6,000 BDT* 10,000 BDT* *(Initial 1,000 BDT provided on admission)

Mother & Child Maternity Clinc Manikgonj Nilphamari Empanelled Hospitals Sadar Hospital Mother & Child Maternity Clinc Islamic Bank Hospital Diabetics Hospital Orthopedic Hospital Dhaka Medical College RangpurMedical College Public Option Maternity Public Option Empanelled Pharmacies Private Option Public Tertiary Care Option

Operations In Event of Illness Informs HSS Point-Person, who informs PO Informs HSS Point-Person, who bkashs payment In Event of Illness Admitted at Hospital RPO/PO Verifies Admission Slip and Facilitates bKash Payment Beneficiary Provides Admission & Discharge Slips at Centre with completed Verification Form Informs Incharge to check if artisan is eligible Receives First Payment Visit Hospital & Meet RPO/PO

Sensitisation & Registration Production centres: Total Beneficiaries covered: Artisans registered: 3 11,268 3,812 Manikgonj Nilphamari Kushtia 2.2 Family Members Total Population Covered: 15,080

Artisan’s Unique Artisan Code: 7002WW011 BRAC Production Centre Code Section Code Artisan’s Original Code Manikgonj Main Centre: 7002 Wood Work Section: WW 011 (three digit) Artisan’s Unique Artisan Code: 7002WW011 Integration: Main Centre Wage Reports HSS ID Cards HSS Database

Medical Hospitalisation Original to Reality Budget – Utility Rates 6.5% reality Conservative 8% estimate Medical Hospitalisation 1.7% reality Conservative 3% estimate Surgical Hospitalisation

Original to Reality Budget – Utility Rates Medical 3,000 BDT Emergency 1,000 BDT 50% Emergency 44% C-Section Surgical 10,000 BDT C-Section 6,000 BDT

Case Study 1 7101HE080 Shahanaz Her Son: Sagor Son was hit in the eye with a cricket ball and was taken directly to eye specialists in Rangpur Medical College

Case Study 2 7030HE010 Shandona Rani Artisan Herself Artisan underwent an illegal abortion which caused severe bleeding. Artisan also suffers from anemia so the loss of blood was very dangerous. Artisan went to Islamic Bank Hospital and was referred to Dhaka Medical College. Her medical bill was excessively high partly due to requiring large amounts of blood from a rare blood group.

80% of beneficiaries from Manikgonj 67 Cases 209,500 BDT Cases Nilphamari 47 Cases 72,000 BDT

Usage 69% Family Members Registered 31% Artisans 52% Artisans 42% Family Members Usage

Usage

79% of all benefits directly to women and children Usage 53% Female Beneficiaries Registered 79% of all benefits directly to women and children 47% Male 21% male adults

Usage 15 1 52 46

HSS Future What’s next for HSS? Upscaling to cover 80,000 people Impact assessment by BRAC University Out patient care (preventative care) M-health Prescription drugs coverage