Lalitpur Medical Insurance Scheme visit

- The scheme is run by Shanti Nepal, a Christian group originally spun off of UMN (United Mission to Nepal)

- LMIS formed and operational July 2004, after takeover from outgoing UMN.

- Instituted in rural Lalitpur at the Chapagaun PHC. Chapagaun was formed (along with 4 other PHCs) by UMN more than 15 years ago. When UMN left, they turned over 4 centers to the MOPH, and the last one was turned over to Shanti.

- The original insurance scheme was devised by UMN, but has undergone modification at Chapagaun and 3 centers, and completely abandoned at another PHC.

- There is a nominal fee just to cover drugs. The scheme has never intended to finance other aspects of the clinic.

- Originally, the institution was very simple: The head of the household pays a simple flat premium (10Rs). The family is then eligible for all clinic services for the year.

- Poor and disadvantaged parties ere seen free of charge.

- Based on the principle of involving the VDC more in the clinic: The Committee was originally brought in to discuss the entire process.

- Later versions of the scheme involved "registration fees" to prevent the overuse of drugs and clinic facilities (45Rs).

- Control over the rates of the premium were later turned over to the VDC almost completely (I don't know if we want to do this, given our target group).

- Apparently, the measure was successful, the Chapagaun PHC reported a coverage of 80% of households in their cachement area (which is not bad considering there is a semiurban component of the village which contains other hospitals and clinis)

- The scheme has a separate fund for charitable causes and for referrals (to Patan).

- Man Shakya believes the key to sustainability is in giving more power to the local community (they will give valuable input and will pressure the MOPH). He noted that in the PHCs that were turned over to the MOH, absolute coverage actually decreased and community decision-making input decreased as well. He stresses the need to make any turnover gradual (5 years) since 3 of the PHCs were turned over right away, and they are significantly less successful than one of the PHCs which was turned over gradually (3 years).

- He also believes that clinics need some sort of user fee (at least nominally for those who can pay), since this makes locals actively involved in the process. Free service makes communities mere beneficiaries, not active partners in village development. As such, instituting a financing project later will result in resistance and foot-dragging. (Maybe, but we're an MHC clinic, no? I'm not entirely sure how applicable this is to us)

- Chapagaun's own LMIS is now moving into a more advanced model, with a database, insurance-holder cards, and sliding-scale premiums (carriers, tiers, etc.).

Man Shakya only had two really general documents for me, but noted that the Health Economics and Financing Unit at MOH has conducted surveys of the Chapagaun clinic and others with similar schemes. If we ask, we should be able to get some documents from them. In addition, he left me with directions to the Chapagaun clinic and another contact:

Ram Krishna Prajapati (5570524). If we want to visit, we must call ahead of time.