Baseline Findings Jan 2011 VimoSEWA Arogya Sanshodan

Today’s Presentation Overview of Swasthya Sanshodan project Summary of baseline findings Analysis plan Your feedback on data, analysis and use

Action Research – Why? VimoSEWA claims Primary illness 40% of claims Hysterectomy top claim for rural women, avg age 37 Effectiveness of health education Longstanding SEWA activity, in different forms Recent studies show impact on neonatal mortality Can it work for primary care and hysterectomy?

Research Questions Can health education reduce unnecessary hospitalisation for diarrhea and fever? Incidence Expenditure Health seeking behaviour What are the drivers of hysterectomy? How does education impact on knowledge and response to hysterectomy and gynecological care? Do insured members seek health care differently? Does an education program work differently for the uninsured?

Intervention Design Selected 28 sevikas who work where VimoSEWA/LSM active Randomly selected 14 sevikas to implement health education Focus on diarrhea, malaria/fever and hysterectomy Film, games and demonstrations Capacity building and regular feedback Over 2 years, 5 survey rounds amongst insured and uninsured to capture health seeking behavior

Study Coverage 70 HH sampled in each cluster 35 uninsured – from area listing 35 insured – from Vimo MIS InsuredUninsuredTotal Urban Rural ,118 Total ,934

HH Profile RuralUrban Nuclear Family57%62% HH size5.8 Yrs in current home17 yrs19 yrs Religion93% Hindu 6% Muslim 83% Hindu 16% Muslim HH income (annual)INR 79,260INR 83,337 HH expenditureINR 66,505INR 66,120

Education: % ever studied

Respondent Profile RuralUrban Age3739 Marital status92% married 7% widowed 83% married 13% widowed Women working 85%61% % SEWA members 53%60% % SEWA Bank13%55%

Women’s Work

Housing : % HH by Type

Household Toilets

Drinking Water RuralUrban Own Tap74%78% Shared Tap13%12% Use chlorine27%46% Filter with cloth94%83% Take with doyo22%40%

Mosquito precautions

Ration Cards/BPL

SEWA Health Services

VimoSEWA Services

VimoSEWA Coverage VimoSEWA reachRuralUrban % of SEWA members8974 % of Bank members7769

HH with anyone ill – last month

Illness Rates – last month

Leading Illnesses - Women

Place of OPD Treatment Avg private exp: Rs. 380 Primarily private care, but less so in city Note slight differences within HH Avg private exp: Rs. 501

% HH reported hospitalisation in last 6 months

Hospitalisation per 100; last 6 mos. Rural and Urban

Hospitalisation amongst women Rural Urban

Rates: Rural Vimo/Non-insured

Rates: Urban Vimo/Non-insured

Where Hospitalised - All Rural Urban

Place of Hospitalisation

Expenditure – Vimo and NV

Are VimoSEWA members different? DIFFERENCES SES – only urban More salaried Higher exp More pucca houses Demographic More widows Less educated (urban) Much more likely to have a ration card SIMILARITIES SES Income Toilets Housing (rural) Demographic HH size Family structure

Reproductive Health RuralUrban

Hysterectomy

Age at hysterectomy

Hysterectomy Reasons

Place of Hysterectomy

Analysis Plan Baseline Women’s illnesses and health seeking behaviour Insured and Uninsured Social Determinants of Health Overall Impact of health education – with qualitative Hysterectomy – with qualitative Community health workers – performance and roles