Implementing a participatory model of micro health insurance among rural poor with evidence from Nepal

This paper reports on two voluntary, contributory, contextualised, community-based health insurance (CBHI) schemes, launched in Dhading and Banke (Nepal) in 2011. The implementation followed a four-stage process: initiating (baseline survey), involving (awareness generation and engaging community in benefit-package-design), launch (enrolment and training of selected community members) and post-launch (viable claims ratio, settled within satisfactory time, sustainable affiliation). Both schemes were successful on four key parameters: effective planning; affiliation (grew from 0 to ∼10,000) and renewals (>65 per cent); claims ratio (∼50 per cent); and promptness of claim settlement (∼23 days). This model succeeded in implementing CBHI with zero premium subsidies or subsidised health-care costs. The successful operation relied in large part on the fact that members trust that they can enforce this contract. Considerable insurance education and capacity development is necessary before the launch of the CBHI, and for sustainable operations as well as for scaling.