HEALING FIELDS FOUNDATION

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1 HEALING FIELDS FOUNDATION Hyderabad ANNUAL REPORT Making quality healthcare accessible and affordable to all people in India

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3 Introduction Poverty and Healthcare India faces unprecedented health challenges in the 21st century on account of its rapidly growing population. Besides, more than ninety percent of India s population does not have access to any form of health care financing or risk pooling. According to the World Bank, more than 40% of hospitalized people borrow money or sell assets to cover their medical expenses and of these 35% fall below the poverty line. World Bank report says that 20% of the population goes below poverty line with one incident of hospitalisation. There are studies to show that 70% of the common illnesses that require hospitalisation is preventable through basic health education, sanitation, hygiene and appropriate and proper nutrition and provide access to affordable health financing. Early marriages and pregnancies and lack of birth spacing are still major problems in India leading to maternal and infant mortality. Lack of proper toilet facilities and poor menstrual hygiene, lack of access to sanitary napkins, result in vaginal and urinary infections in young women leading to other complications. At Healing Fields we are creating innovative ways of addressing these needs through developing a relevant, efficient health education, and health financing model so that we could effectively intervene and stop the downward spiral of poverty and empower the women at the grass roots to take responsibilty of theirs as well as their families health and wellbeing. Nutrition Exhibition at Polkampally Govt school 2

4 Background Founded in 2002, Healing Fields is recognized as a pioneer in the areas of health financing and community health education. Healing Fields is an Ashoka Fellow led organization in recognition of the innovative work in Health financing. It has created benchmarks and evaluation measures for improving accessibility and affordability of health care services to the poor that are in use in many parts of India. Healing Fields focuses its activities on the improvement of health care with no bias against any caste, creed, religion or gender. Registration Healing Fields Foundation is a not-for-profit organization registered under the Andhra Pradesh (Telangana Area) Public Societies Registration Act, 1350 Fasli (Act 1 of 1350 F) vide no dated 29th November 2000, to carry out the charitable objectives set forth in the constitution of the institution. Healing Fields is also registered under the Foreign Contribution (Regulation) Act, 1976, vide Registration Number and under Section 12A and 80G of the Income Tax Act, 1961 hence donations made to the organization qualify for deductions in income tax for the donor. Vision Healing Fields Foundation is a not-for-profit organization with a vision to make healthcare affordable and accessible to all people in India, especially the poor, underprivileged & marginalized. 3

5 Mission Improve access to basic healthcare services Use innovative financing mechanisms to increase affordability of healthcare services to the population at large Improve the quality of healthcare delivery using health management tools Access, Affordability, Quality Group activity of Health Leaders Our Core Values Many organizations seek to provide access to quality health care for poor communities. At Healing Fields, we go one step further by aligning all our initiatives and programs with our core values of Care, Compassion and Sensitivity. 4

6 Pioneering Work Micro Health Insurance In 2008 Healing Fields conducted extensive surveys in rural and urban areas of Andhra Pradesh and Karnataka to understand the health financing and healthcare needs of the poor. Healing Fields developed an unique Health Micro- Health Insurance model in association with two private insurers, based on a thorough analysis of the survey results.. Pilot Program: 3 year pilot in 6 states Product Development & Partnership with 2 Insurance Providers Covered over people urban, rural & tribal population Liaised with 60 hospitals as Network Hospitals after rating Partnered with 19 NGO s Facilitation at Hospitals preventive education, post hospital follow up, drug compliance, feedback & renewal Operational Efficiency & Control through use of unique MIS. Lessons Learned Poorest of the poor are willing to pay for Health Insurance but this does not translate into affordability Outpatient coverage is an urgent and immediate requirement Innovation in Product design taking into consideration the needs of the poor is vital Premium Financing necessary in the form of loans or subsidy Facilitation and hand holding at Hospitals is very important in access of healthcare to the member Awareness among NGO s critical for utilization of services 5

7 Voluntary Enrollment scale is a challenge Critical mass needed to sustain incentives for NGO s Health Education and prevention is very important Constant feedback and monitoring is very essential Skewed market forces such as MFI mandates, Govt. subsidy programs posed a challenge. Impact achieved During the three years of the pilot implementation, the loan taking rate to meet health care expenditure was reduced by 70% among the insured population. In the last three years of the pilot, the savings made by our members on health care expenditure was more than Rs. 26,000,000. The utilization of the networked hospitals increased by 40% due to the availability of the facilitator Innovative products were developed to suit the requirements of the community like: migrant labor products, special product for construction workers, DRGs for Nurse manned dispensaries in tribal areas. Benefit package included Wage Compensation, Post hospital medicines, Personal Accident livelihood benefit, Co-payment at the time of discharge, Facilitation at hospital 6

8 Programs 1. Health Education Healing Fields has created innovative ways of addressing community health needs based on the SHG model. We are striving to create Community Health Leaders {CHL s} in communities and schools, who will provide health training to their village, slum members and peers in schools respectively, for preventing illnesses and harnessing the various local governmental programs. Profile of a Community Health Leader Selected from the local community, they re mostly women Semi-literate in local language Have entrepreneurial, leadership qualities Interested in skill up-gradation Undergo 6 months contact training & internship with HFF Work exclusively on health initiatives Provide last mile connectivity. Program Design Structured training program for 6 months with monthly contact sessions Training on different aspects of health & disease (lifecycle), hygiene, nutrition, prevention of illness, first aid, Government programs, health financing Interactive training role play, group work, presentations, workshops Trainees are taught to do baseline surveys, and 7

9 plan and implement projects related to the health needs of their community 6 months paid internship after contact classes where the trainees are expected to do 10 health education sessions a month and 2 community mobilization programs over 6 months Outreach through each health leader families Program Areas: Andhra Pradesh, Bihar, Orissa & Karnataka Program Impact: o No. of Health Leaders Trained/being trained o No. of community mobilization programs - 25 attended by 2000 members o No. of Villages Covered o No. of families receiving health education o Trainee feedback on effectiveness of training 85.64% of the participants found the program very useful. 8

10 o Pregnant women have started taking nutritious food from anganwadi centers, enlisted at Primary Health Centers for regular checkups after CHL education. Many women have opted to deliver at the hospitals and feeding colustrum to their new born. o Increased use of EMRI 108 services for taking the pregnant women to hospitals for delivery where available o Adolescent girls are being trained about menstrual hygiene practices, reproductive health, age at marriage & birth spacing o Sanitary pads have been sourced from another NGO GOONJ and distributed by the health leaders to about 500 women and adolescent girls in 25 villages and 1 government school. We are working towards converting this activity into an income generation project for the Community Health Leaders. Group work by health leaders First Aid training to health leaders 9

11 Case Study on complementary feeding Some women, namely Lakshmi, Anitha, Navaneetha, Mamtha,Lalitha, Rajini, Sarada and Balamani who are residents of Qutballapur in Ranga Reddy district of Andhra Pradesh, have children in the age group of 6 months to 3 years. After having watched advertisements for infant food supplements on TV, they were feeding Cerelac to their children as the major supplementary food. However, as they could not afford to buy the requisite number of food cans each month, they would dilute the feed with more water than required. As a fall-out, their children were found to be grossly undernourished on being medically examined by our health leaders. The women attended the health education session on nutrition for 0-3 year olds conducted by Rajini and Shankaramma, our health leaders from the first batch. There they were informed about the advantages of using low -cost home- cooked porridges made from locally available, and hence much more affordable cereals and pulses. Subsequently, they switched from the prepared infant food Cerelac to home-made food supplements, which enabled them to provide balanced and adequate nutrition for sustained growth and good health of their children. Besides this, as an added advantage of preparing infant food themselves, the women could save an average of Rs. 250 per month from their household expenditure. 10

12 Initiatives Undertaken by the Community Health Leaders CHL s a) Environmental Hygiene, Water and Sanitation Project- Our health leaders motivated the community to keep their surroundings clean in Sannur village of Warangal district. About 15 soak- pits were laid out with the help of our health leaders. Kitchen gardens were laid- out in 10 households and green leafy vegetables were planted in them. These families later reported an increase in their consumption of green vegetables. Besides this, these families could also save an average of Rs. 100 per month on the purchase of vegetables. As a direct, positive impact of better sanitation and hygiene the community has benefited from a decrease in vector- borne illnesses due to the construction of soak- pits. Community Latrines Project A survey conducted by the health leaders in the village of Raghotampally in Ranga Reddy District of Andhra Pradesh revealed an urgent need for basic sanitation and toilet facilities. 70% of the families were found willing to contribute in cash and kind for the construction of toilets. Government funds, available under the National Rural Health Mission (NRHM) program, were routed with the help of the Block Development Officer. A street play on sanitation was also staged by our health leaders as a step towards community mobilization. The average contribution per family was Rs The village 11

13 sarpanch also participated actively by supervising the construction by the local masons. Thereafter, the toilets are being utilized by the community under the supervision of the health leaders. 2. Sanitary Napkins Project- In surveys conducted by our health leaders as part of their training, it emerged that lack of information on menstrual hygiene and poor sanitation were a major cause of vaginal infections. Most of the women were using cloth, which was not being washed and dried properly, resulting in poor hygiene. Healing Fields received packs of sanitary napkins from Goonj and issued these to the female trained health leaders from Ranga Reddy district. Saida & Sashikala in Raipole; Rajitha in Cheededu; Umarani & Suguna in Japal; Bhagya in Yendlagoda; Lalitha in Polkampally and Andalu in Nagampally distributed the napkins to women and adolescent girls in their villages. They also imparted training regarding their proper usage and disposal. Altogether, our health leaders have distributed about 1000 packs of napkins to 500 women in 20 villages. 12

14 Feedback: Most of the respondents (96%) who have used the pads have found them to be very convenient and wanted to switch to sanitary pads. Many other women like Sunitha, Jyothi & Shashikala of Japal, have not only responded positively, but they are also willing to spend about Rs. 10 for a pack of napkins. Sanitary Napkins Income Generation opportunity for Health Leaders It is evident from these findings that there is a huge demand for sanitary napkins among the rural women although the commercial brands are neither accessible nor affordable to this group. Healing Fields has endeavored to bridge this gap in demand and supply by inculcating entrepreneurial skills among our Health Leaders. Healing Fields is now perusing to make this operation sustainable for the Health Leaders, where they manufacture the napkins locally and sell them to the women in the village, for a margin. In this we are collaborating with Government ICDS program and also other organizations. Case Study In Gunagal village, a Hand washing project was conducted for primary school children. Students from Class one to Class five were educated on the need to keep their hands clean in order to remain healthy. They were informed about personal hygiene and told to clean their hands with soap before having food. The older students of class five were required to monitor the younger pupils of classes one to four. All students were monitored by health leaders Sabitha and Sailaja. The school teachers and the parents of these students were very happy to observe the positive change in the children. 13

15 2. Health Savings Program One of the major findings of the health insurance program - that the poor spend an average of Rs a year on outpatient care, diagnostics and medicines reveals that these expenses often force the poor to borrow or mortgage their belongings. Therefore, it is important for the poor to have access to a savings fund to meet their health care expenditures. Health Savings Pilot Program A group of women save fixed amounts each month to meet their daily health care expenditures. These savings are available within the group as a floater fund. The group takes a joint decision to forward a loan to its members but solely to meet healthcare expenses. This loan has to be repaid with interest, in time- bound fixed installments. Pilot program started with 50 health savings groups, covering about 1000 women in 3 districts of Andhra Pradesh. Each group comprises about women; About 98 loans disbursed for common illnesses viz. fever, pneumonia, etc. 100% loan repayment rate; Total savings amount till now is approximately Rs. 58,000; A corresponding loan of Rs.1000 has been given to each group for building the corpus by Healing Fields. 14

16 Uniqueness of the program Health savings groups are not just financial groups but they are also involved in health education, prevention and promotion work. Initially these groups serve the purpose of providing health education. Healing Fields has empanelled a network of about 5 rated health care providers, with whom it is able to negotiate discounted prices for the group members. The trained health leaders are appointed as facilitators at hospitals and book keepers for the groups. Case Studies on health savings Punyavathi lives in Ibrahimpatnam. She had two children a daughter and a son. Her daughter had developed pneumonia. However due to paucity of funds they could not get proper treatment and managed with medications from the local RMP. This proved fatal for the little girl and she succumbed to her illness. Now their 2 year old son also developed pneumonia and initially they tried treatment with the RMP but of no avail. Punyavathi is a member of health savings group (Ayyappa Swamy group). So this time she took a loan of Rs from the group, and took her son to hospital and got him treated for pneumonia. Her son has soon recovered and is now healthy. Parijatha aged 26, lives in Eliminedu village. She was suffering from Chikungunya, and she did not have money to go to hospital. She became very weak due to this. Everyone refused to give her money to her even though she asked everybody. Her son was out of station then. Then she remembered about the health savings group. As she was saving money for health needs in the health savings group (Chaitanya group), she went to health savings group member. By then it was night. But still 3 members of the group signed and paid her Rs She was taken to hospital in 108 with the help of the health leader. After 6 days treatment in hospital, she recovered. 15

17 3. E learning The Healing Fields E- Learning portal has been designed in conjunction with its health education program. It is meant to support and reinforce the course- ware being used for the training of the community health leaders. E- learning will help in rapid scale- up of the program and also in empowering the coordinators at the district level in conducting the program independently and at the same time ensuring uniformity and consistency in the content and quality. Courses Available- Care of infants and children between 0-3 years Information on Breast Cancer Pregnancy and Childbirth The sample course is available on the following link: E- Learning in Progress 16

18 4. Research Research has always been a focus area of Healing Fields and all the innovations in our program were a result of research and understanding the needs of the poor through robust data collected from the field. The different research studies undertaken were: A study on the health and health financing needs of the poor in Northwest Karnataka (Study sponsored by Deshpande Foundation, Hubli) Mukti.K.Bosco, Gayathri Prashanth, Dr.Vimala Thomas, Healing Fields Foundation, 2009 Translation of health insurance policy innovation: a study on health micro insurance for below poverty line households of Latur District, Maharashtra Dr. Santosh S. Puri, MBBS, Apollo Institute of Hospital Administration, Osmania University, Hyderabad, Awareness, Causes & Effects of Hysterectomy Among Rural Women (with reference to Miryalaluda & Vemulapalli Mandals) Survey Report- Mukti Bosco, Padmaja, Healing Fields Foundation A Descriptive Study of Knowledge, Attitude, and Practices of Healthcare Providers Concerning Universal Precautions in Preventing HIV infections in rural areas of Andhra Pradesh, South India Dorothy Kaushik/Dr.Vimala Thomas/Mukti Bosco, Faculty, City College of San Francisco, California, USA. Research project in Pipeline: Healing Fields has been granted a research project on Health & Health Financing needs of tribal communities in Andhra Pradesh by the Indian Council of Medical Research (ICMR). 17

19 5. Mobile Technology A program for conducting surveys by using mobile phones has been developed and a suitable phone has also been identified; The survey done by the mobile reduces the cost and time involved in data collection, data entry and analysis. Sample surveys have been done by the health leaders and reports have been generated; This tool would be ideal for conducting surveys of distant locations like Bihar and Orissa. Sample analysis 18

20 6. Consultancies Over the last decade of operations Healing Fields has acquired strong sector knowledge and domain expertise. We harness this expertise in consulting other organizations in the similar kind of work. Some of the assignments of Healing Fields were: VIMOSEWA, Ahmedabad: Healing Fields has conducted a Program Review and Gap Analysis of the micro health insurance operations of VimoSewa, Ahmedabad. The recommendations put forth are being implemented Dia Vikas, New Delhi: Readiness Assessment of their MFI Partner to Implement a Micro Health Insurance Programme in West Bengal Bharati AXA General Insurance Company: Micro Health insurance products and DRGs were developed New Partnerships: CASHPOR: In implementing its Community Health Leader training program for 80 of their below the poverty-line clients in Buxar District of Bihar. 19

21 Regional Rural Development Centre, Orissa: CHL training program is being planned for 150 of their members in the Rajgandhpur district, Orissa. Discussions are in progress with Gramvikas, Orissa to partner with them to implement water and sanitation model in Andhra Pradesh through our health leaders Discussions are completed with the state board and 2 Government Schools have been identified in Bangalore to launch a school health leader education program Our Key partners We believe that a greater partnership between NGOs, providers, educators, private companies and government agencies will not only foster innovative social marketing but also allow all to share best practices, achieve economies of scale and scope and utilize research to identify changes in community demographics and needs. a) Donors Sir Dorabji Tata Trust, Mumbai Deshpande Foundation, Hubli, Karnataka American India Foundation Inteq Software Pvt Ltd. b) Technical Resource Partners National Institute of Nutrition, Hyderabad Indian Institute of Health & Family Welfare, Hyderabad Andhra Pradesh Mahila Abhivrudhi Sangha, Hyderabad 20

22 Gramvikas, Orissa c) Implementation Partners Cashpor Financial Services Regional Rural Development Center, Orissa Velugu Groups, Andhra Pradesh d) Audit Partners a. External Financial Audit: Delloitte Haskins & Sells b. Internal Financial Auditors: PMR & Sons consultants e) Research Partners: Industry, Academia and Multi-lateral Agencies Healing Fields participates in research projects and collaborates with like - minded institutions and organizations, both within India and internationally, that seek to promote the advancement of health care access for the poor. These include: Asia Micro-Insurance Network (AMIN) CLASS Consultative Group to Assist the Poor (CGAP) f) Technology Partners Azri Solutions ( Orange Healthcare Services 21

23 Volunteers: Volunteer Name From Area of work Esther Pang Deutche Bank Information systems Laura Mc Hale Deutche Bank Communication & Web site development Thien Trung Nguyen- Kelloggs University Process Costing of Micro Health Insurance Program Ravi Gupta Ohio State University Comparative study of CHL program to Govt. ASHA program Sareen Gogi Hyderabad, India E Learning & Mobile Technology Workshops and conferences: Clinton Global Initiative at New York from the 21 st to 23 rd September, 2009 Doing Good Doing Well International conference at Barcelona: Mukti Bosco was a panelist and spoke on Challenges in scaling Micro health insurance for the poor 22

24 People behind the work. Our Board: N. Rangachary : Chairman Mr. Rangachary is the first Chairman of the Insurance Regulatory Development Authority (IRDA). He was also Chairman of CBDT. Nimish R. Parekh: Co-Founder & President Mr. Parekh is a health care entrepreneur and launched the first Third Party Administrator in India by the name of Sedgwick Parekh Health Management, in He is the co-founder and Besides, he is also a member of the Advisory Board on Voluntary Health Insurance at the World Bank as well as served on different committees within IRDA, CII etc. Mukti K. Bosco: Co-Founder & Secretary General Mrs. Bosco graduated in Occupational Therapy from Christian Medical College & Hospital, Vellore. After completing her MHA, Mrs. Bosco collaborated with a group of professional friends to start Healing Fields. She has also been awarded ASHOKA Fellow. Dr Jyoti Parekh: Vice-Chairperson Dr. Parekh has been practicing medicine as a family physician for decades in Mumbai. She has vast experience in implementing health care programs for the poor in Gujarat. Dr.Vimala Thomas: Member Dr. Thomas is medical graduate of Madras Medical College and is the Associate professor of Department of Community Medicine at Osmania Medical College, Hyderabad. 23

25 Mohan Narayanan: Member Chief Executive, Kubos Mr. Narayanan, was the co-founder and former Vice President of Cognizant Technologies India. He has been instrumental in the development of MIS for Healing Fields. He plays a key role in implementing and auditing business processes and systems. Mr. Bosco Malapatti: Member Managing Director, ERP Info Solutions India Pvt Ltd Mr. Bosco Malapatti has over 20 years of experience in establishment and management of offshore software service operations. Formerly Chief Operating Officer of Intelligroup in India, Mr. Bosco holds a Masters Diploma in Business Management from Spicer Memorial College, Pune and the University of San Francisco, and is a Founding Member of Parivartan, Bangalore. Management Team: Mukti Bosco: Chief Executive Bosco Mukti K graduated in Occupational Therapy from Christian Medical College & Hospital, Vellore. She has completed her Masters in Health Care Management in Administrative Staff College of India with Johns Hopkins University. She is a member of IRDA sub-committee on micro health insurance. She has been invited to participate in the annual meeting of the Clinton Global Initiatives. In recognition of her work she has been conferred with the prestigious Ashoka Fellow as well MSDS award as the women Social Entrepreneur of the year Sareen Gogi: Chief Operating Officer Sareen is a seasoned Management Consultant and IT Strategist with more than 14 years of global industry experience. He had enjoyed a successful global career by delivering great value/results to organizations ranging from early start-ups to 24

26 Fortune 500 and donned various roles covering a wide spectrum of technical, consulting, project management & various management and leadership positions at world class organizations, Gayathri Prashanth: GM Operations Gayathri is a nutritionist with Masters in Healthcare Administration, and experience of working in hospitals and also NGOs like CARE India and AP State Aids Control Society. She takes care of operations and monitoring & evaluation at Healing Fields. Gaurishankar: Program Manager Gaurishankar is a Mechanical Engineer with extensive experience in training and health insurance. He was involved in the training of Arogyamitras of Arogyasri program of the Government of Andhra Pradesh Dr.Aravinda: Training Manager Dr.Aravinda is a medical professional with experience in planning and conducting health education programs at various levels. She has been involved with the development of the health education curriculum and training at Healing Fields. Lt. Col. Chand Sudan: Director Projects Chand is a retired Colonel from the Armed Forces and brings to the organization his process approach and is actively involved with Business Development 25

27 How you can help? Opportunity to help, volunteer and be a friend / ambassador of Healing Fields Foundation. Donate Healing Fields is supported through the generosity of outstanding partner organizations and people like you, who believe in providing quality and affordable health care access to all Indian families and communities. At Rs. 5000, you can pay for training a community health leader in a community who will in turn impact her village of 200 families At Rs. 10,000, you can also pay for the board and lodging of the health leader for training At Rs. 25,000, you can pay for training five health leaders. At Rs 2,00,000 you can pay for launching the Sanitary napkin initiative in 5 villages At Rs.10,00,000 you can pay training 60 health leaders who will reach out to 15,000 families Volunteer Healing Fields is a small organization looking to make a big impact. We welcome all levels of volunteers, from students to professionals, without bias against any caste, creed, religion, gender or nationality. Healing Fields has an ongoing need for volunteer illustrators, web developers, writers, market researchers, technology experts and professionals specializing in Community Health, Health insurance or finance. Healing Fields particularly welcomes multi-lingual volunteers in Telugu, Marathi, Bengali, Kannada, and Oriya. Please contact us if you are interested in our program. 26

28 Contact Details : Healing Fields Foundation, , Manasarovar Complex, Secretariat Road, Hyderabad , Andhra Pradesh, India. Telefax: /42 secretariat@healing-fields.org Website : 27

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31 HEALING FIELDS FOUNDATION Hyderabad Balance Sheet as at March 31, 2010 Liabilities As at March 31, 2010 Amount in Rupees As at March 31, 2009 Amount in Rupees Assets As at March 31, 2010 Amount in Rupees As at March 31, 2009 Amount in Rupees Capital Reserve Fixed Assets (as per Schedule D) 26,783 3,958 Opening Balance 7,12,787 18,40,986 Corpus Donations received Current Assests, Loans and Advances during the year (as per Schedule A) 1,27,700 21,98,654 8,40,487 40,39,640 Interest Receivable on FD - 29,498 Add: Excess of Income over Expenditure - - Less: Excess of Expenditure over Income (16,482) 8,24,005 (33,26,853) 7,12,787 Cash and Bank Balances Cash on hand 1,053 3,393 Outstanding expenses (as per Schedule B) 3,95,164 2,77,885 Balances with banks in savings accounts - Andhra Bank 1,51,437 1,000 Deshpande Foundation Project grant - 4,65,469 in savings accounts - Andhra Bank 5,28,813 2,76,475 in FCRA account- Andhra Bank 1,34,219 10,429 in fixed deposit with Andhra Bank - 8,15,522 9,00,000 11,91,297 Loans & Advances (as per Schedule E) 63,130 - TDS receivable 2,06,434 1,30,909 SDTT Health Education receivable - 7,929 Service fee receivable 15, Rent Deposit 91,800 91,800 12,19,169 14,56,141 12,19,169 14,56,141 Schedules referred to above form an integral part of the Balance Sheet As per our report of even date attached For and on behalf of the Board For Deloitte Haskins & Sells Chartered Accountants Secretary K.Rajasekhar ( Healing Fields Foundation ) Partner Membership No Secunderabad Date: July, 2010 Place : Hyderabad

32 Our Partners & Supporters Sir Darobji Tata Trust

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