Calcutta Kids (CK) is a nongovernmental organization (NGO), with the mandate of making quality health care affordable and accessible to all, through appropriate use of community health workers trained by CK. CK was established by Mr. Noah Levinson and Sohrab Noshirvani with a mission to target the empowerment of the poorest children and expecting mothers in the under-served slums in and around Kolkata, India. The aim was to increase their access to health and nutrition services, provide health information, and encourage positive health-changing behaviour. The primary objective of Calcutta Kids was to initiate community-based programmes that advance the promotion and delivery of good health care, medical advocacy, and health education.

In Kolkata, one does not have to search for poverty.  Poverty reigns, and yet somehow… people are always smiling. Kolkata is one of the most magical places one can find, because it is so much about people. CK started its operation in Howrah, a city adjacent to Calcutta. Howrah is one of the oldest cities in India and densely populated with workers from various industries located in the area. This place has observed a gradual decline in organised industrial activity and as a consequence the occupational characteristic of the population is also gradually changing from organised to unorganised labour force.

Fakir Bagan in Salkia is one of the largest slums in West Bengal is located in Howrah. Calcutta Kids started their intervention in Fakir Bagan through their Maternal and Young Child Health Initiatives (MYCHI) programme in 2005. The programme created a significant impact in reducing malnutrition and death at the time of delivery through counselling and monitoring the progress and health status of a mother in pre and post natal phases. This community level interventions are carried out by the Community Health Workers (CHWs) trained by CK. In March 2009, Calcutta Kids started to offer a health micro-insurance to the citizens of Fakir Bagan. This insurance covers the inpatient hospitalisation and has very few exclusion clauses. From the experience of other health micro-insurance programmes in India and other countries, CK has observed that one of the major challenges for health micro-insurance programmes is low renewal or retention rate of the clients in successive years. Therefore, CK planned to provide an add-on service to their clients and it was called, “Out Patient Counselling Services” (OPCS) to incentivise clients to renew their policies in the basic health micro-insurance programme.

This OPCS service is undertaken by the CHWs of CK. Through this service, insurance clients who access outpatient care at a network facility (network clinics) will be visited in their homes by a health worker two days later. The health worker will ensure that the client follows the doctor’s prescription and instructions, provide simple behavioural advice to the client regarding treatment and will note the client’s health status and present this to a doctor, who will advise follow-up options.  CK is assuming that the insured clients will perceive this service as an added benefit of taking health micro-insurance.

The Centre for Insurance and Risk Management (CIRM) works with CK as a research partner to assess the impact of OPCS on renewal rate of the insurance programme. CIRM is designing a randomised controlled trial experiment to analyse the impact of OPCS. To understand the client’s perception and feedback, CIRM will also use qualitative research methodologies for this project.  It will be really interesting to observe how this OPCS operates over a span of time and the clients’ response towards it. This intervention may have some impact on the regular out of pocket (OOP) health expenditure for low income households. If this type of behavioural counselling works and helps to retain clients, then it might be used in other health micro-insurance programmes which run using the community health workers.

Key words: Health Micro-insurance, Out Patient Counselling Service (OPCS), Community health worker, Out-of-Pocket (OOP) health expenditure, Randomized controlled trial

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