Building on SEWA's existing community health program, VimoSEWA will conduct action research among insured households in urban and rural locations. The objective is to measure the impact of integrating community health activities with health insurance on reducing insurance claim rates and illness expenditure of households. Health insurance has proven to be a primary need of the poor: over 90% of VimoSEWA's claims are for illness expenditure, one-third of which are for highly preventable illnesses such as malaria, gastroenteritis and other water-borne diseases. SEWA's experience indicates that these diseases, if treated early in a primary health setting, often do not require hospitalization. Untreated, these illnesses may eventually require costly hospitalization, and cause unnecessary loss of income and assets by the poor. Such negative outcomes also impede the viability of health insurance.
This research initiative will target workers in the informal economy in urban and rural Gujarat, India. SEWA members are home-based workers, producers, vendors, and manual laborers including agricultural laborers. They do not have basic statutory social protection such as health care benefits, maternity or sick leave, pension and access to child care.
As very little evidence exists in this area, VimoSEWA aims to create both an implementation model and evidence base for integration of health activities with health insurance. This project will address five key questions through action research using a controlled study of the impact of health interventions amongst insured households.
SEWA is a trade union of 1.1 million poor, self-employed women workers. Established in 1972, its main goals are to organize women for full employment and self-reliance. VimoSEWA is SEWA's insurance unit in which the workers themselves are the users and managers of all services. It was developed in 1992 in response to members' needs for protection. VimoSEWA promotes an integrated insurance product of life, health, accident and asset coverage for poor workers and their families.
"I am an agarbatti worker. I earn 30 rupees per day rolling incense sticks which we call agarbattis. I live in a small ten-by-fifteen room with my family. Earlier we did not have running water. I got sick with typhoid and malaria and spent a big part of my savings on my illness. Luckily, I was insured by SEWA and was reimbursed within a week. Our lives are like this - up and down. We need social security like insurance."
Jaitoonbibi, Agarbatti worker, Ahmedabad city, Gujarat
"All that we women know is work and more work. Whatever we have been through we cannot change. But we dream of a better life for our children. That's why VimoSEWA is so important for us." Chanchiben, agricultural laborer, Kheda district, Gujarat