What is the Jowar Health Assurance Scheme?
Any health care system designed for the poor living in rural India has to be accountable, affordable for the poorest, appropriate, accessible, and equitable. In addition, to be successful it has to have proactive community-level participation from the consumer.
The Jowar Health Assurance Scheme with a successful track record of 34-years fulfills these very basic tenets of health care delivery. By its success, it today serves as a role model for a compassionate way of delivering health care to the rural masses and is worthy of being replicated in other part of the world.
This uniquely successful participatory scheme has been guided over the past 34-years by Professor Ulhas Jajoo (Refer Our Inspiration), Professor of Medicine, Mahatma Gandhi Institute of Medical Sciences (MGIMS) at the helm. The question on how universal health coverage can be achieved successfully in rural India was in Dr. Jajoo’s mind, when he joined as a junior faculty member at MGIMS in 1977. Fresh out of medical school training and fired up by the idealism portrayed by his forefathers and with Mahatma Gandhi, Vinobha Bhave, and Jai Prakash Narain as role models, the quest to answer this very question is at the heart of this programme. This programme is a reflection of the arduous experiential journey Prof. Ulhas Jajoo took alongwith his like-minded friends over the past-34 years as they guided this programme to its current state.
Prof. Jajoo set out to provide universal health coverage for the rural poor in the Sevagram area of Vidarbha in Maharashtra, India. Kasturba Health Society and Mahatma Gandhi Institute of Medical Sciences were keen and willing partners to help extend comprehensive preventative, promotive, and curative health care to the villages. Together, joining hands, Prof. Jajoo and the institute hospital started a long journey of fruitful collaboration in 1979.
Each participating village was made responsible to pay a payment with the rest of the health expense being covered by the hospital with financial support from the central and state governments. This co-payment (hardly 10% of total amount spent on them) was in the form of a common fund created by the villager by collecting Jowar (sorghum) during the annual December harvest time. Each family in the village contributed based on the size of the individual families land holding. Thus families contributed according to their capacity but received services according to their needs. The collected harvest was then sold to generate a fund which was then used to provide health assurance for the villagers by strengthening primary care services within the village, and also by subsidizing tertiary level health care for all the participants.
This micro-finance health insurance scheme allowed individual villages to get the benefit of universal health coverage. For a mere 10% equity it allowed these villages to gain access to additional public health resources from the central and state government through Kasturba Hospital who picked up the additional 90% of the health care expenses. Thus crafting and implementing this scheme created an environment of active self-participation in health care decision making by the villagers and made it accessible and affordable by linking to existing governmental resources.
Prof. Jajoo summarized for us, ‘The whole Jowar Health Assurance Scheme experiment is an ongoing saga in an attempt to identify respected individuals, empower by bringing them together, inculcate a culture of decision making by consensus and initiate acts of common faith. This ‘one step in the right direction’, stems from the philosophy of ‘think globally and act locally”. The ultimate goal of the Village Assurance Scheme and other programmes is to gain “Gram Swarajya’, as envisioned by Shri Vinoba Bhave- a dream of an ideal society based on principles of freedom and fraternity, wherein the poor and the downtrodden are embraced and empathized-Antyodaya, leading them from darkness to light-Tamsoma Jyotirgamaya!’
The popularity and success of this programme in rural India also formed the backbone for implementing other major reforms (Refer Programmes) initiated by Prof. Jajoo in the involved villages. The Jowar insurance scheme was tweaked at a conceptual level to ensure that families take this route of self-empowerment and betterment. This body of work clearly shows how effective health care delivery can become an integral part of socio-economic fabric of rural India and also help tackle major socio-economic problems ailing rural India.
This was implemented in 1980 and subsequently adapted and modified over the past 34 years. Its ongoing nature attest to the success of such an approach of being able to provide an assurance of ‘an affirmation of just health care service’ by linking primary healthcare in rural India with a hospital-based tertiary care.
In short, the scheme ensured (a) Accessible hospital services of optimum quality, (b) Accountability of healthcare system to the consumers, (c) Affordability of the services to the poorest, (d) Effective healthcare, the proof being no maternal mortality, no measles, polio, tetanus, whooping cough and no misutilization of services, (e) Enhancement of the self-confidence of the organizers, (f) Participatory culture at the community level.
A journey that started in the latter half of the 1970’s as health insurance has evolved into an ongoing process of health assurance, with constant and consistent tweaks to ensure complete participation by the target community. View More Images