Project Chairman: Prof. A K Azad Khan, President, BADAS
Project Coordinator: Md. Kamruzzaman Shubho, AD (Projects), NHN
Member of Steering Committee:
- Prof. A K Azad Khan, President, BADAS
- MD. Sayef Uddin, Secretary General, BADAS
- Dr. M A Samad, CEO, NHN
- Dr. M A Mazid, Chief Coordinator, BADAS
- Md. Rafiqul Islam, Deputy Managing Director, UICL
- Ghaus Mohammad, Director, New Asia Group
- Farook Azam Khan, Advisor, CT Health
- Md. Kamruzzaman Shubho, AD (Project), NHN
A project of BADAS (Diabetic Association of Bangladesh) in collaboration with the UICL (United Insurance Company, Limited) & New Asia Group of Garment for providing comprehensive Medicare to approx. 9000-10,000 garment industry workers. In the pilot phase Swiss Micro Insurance Consultancy Group (SMCG), Swiss Tropical and Public Health Institute (Swiss TPH) and TRCL (Telemedicine Reference Centre Ltd.) has been collaborated to set up the initial system from their practical experience and expertise.
BADAS successfully completed 2nd year of the Health Micro Insurance (HMI) that has provided health care support to the garments workers in collaboration with National Health Care Network (NHN), one of the largest enterprises of BADAS. Through HMI garments workers were able to access health service facilities from NHN centers in return for a minimalistic premium paid to an insurance company. In case of referrals and higher care components other BADAS centers are also used. The premium is reimbursed by the workers’ employer, which covers the costs for the health service.
Initial Intervention Strategy
The Health Micro Insurance project for garment workers in Bangladesh has been developed by the senior managements of BADAS, UICL, TRCL and the New Asia Group of garment factories. BADAS and UIC have been experimenting with an insurance scheme on a limited scale and sought a mechanism for up-scaling and technical support to conduct that process in a professional way. They associated Prof. Niklaus Gyr of the Academy of Swiss Insurance Medicine in Basel who has a long-term relationship with BADAS and the SDC (for health policy work). Through him, actuary, legal and other expertise was mobilized in Switzerland to give the project the final shape and seek financial support. The SDC contribution sought was used to finance the major part of the technical assistance and some project (non recurrent) expenses, while all operational costs, notably the health services costs and all the insurance risk related costs was borne by the insurer UICL. The approach was to develop a scalable, salary based premium through the New Asia Group of garment industries, linked with the health service provider BADAS to create a sustainable health financing mechanism. Gate keeper and the crucial data processing function will be provided through the telemedicine service.
To increase health service coverage
- with improved disease prevention,
- immediate access to health information, and
- efficient cost control,
through a health micro financing plan by testing the economic viability of a health insurance for industry workers.
To make the program cost effective BADAS introduced three innovations: Preventive Health Promotion Initiative, Call Center and Outdoor Treatment
- Health Promotion Initiatives: The Mechanism of Micro health insurance was likely to be misunderstood because; insurance has always has a negative image in the society. A lot of literature, group meetings, postering, along with exhibition of video, drama were required to alter the perception of insurance. The Health Promotion initiative was elaborated to improve the health status of garment workers and to understand the concept of Micro health Insurance, covered by Bangladesh University of Health Science (BUHS). Initially the plan was to place the preventive part so that it would not hamper production time. However workers were not interested to provide time for educational purpose. Moreover it was not possible to arrange time in between working hours. Following that we tried to make booklets and video with different modules. Booklets were distributed in the project time period. Video clips were produced on those five modules to be played in the factories. However this material was produced and made public too late to measure any impact.
- Call Center: A medical call center staffed by qualified personnel was run 24 hours, 7 days a week and gave medical advice over phone and generated e-prescription to the insured workers. Since the registered members for the call center were limited, doctors manning the call center received only a few calls per day. As a result it was difficult to retain the services of the doctors for the call center. It was not cost effective to continuously run the call center. Right now BADAS has introduced a universal call center Ibrahim Health-Line with a large number of registered members.
- Outdoor Treatment: Initially the Insurance Company, UICL, presumed imbruing outdoor medical facilities would not be cost effective. Customary practice of insurance companies in Bangladesh were to provide coverage for indoor medical facilities. However president BADAS. Prof. A K Azad Khan estimated that imbruing outdoor medical facilities would lead to lesser cost of Insurance. He also felt only covering indoor medical facilities would result in manipulation of medical costs by the insured members.
Insurance Program at a Glance:
- Duration: 1 year from 24. April 2014 to 23 April 2015.
- Group health insurance for around 8000 workers belonging to the lowest salary groups of 7 garment factories.
- Inpatient and outpatient treatment covered by the insurance scheme
- Annual coverage up to 15‘000 BDT / year (premium per month 41 BDT)
- Insurance Company & Garment Industry equally share benefit and loss
- Duration: 2nd phase from 1 January 2016 to 31 December 2016.
- Group health insurance for around 10,000 workers belonging to the lowest salary groups of 9 (Nine) garment factories.
- Annual coverage up to 15‘000 BDT / year (premium per month 49 BDT)
- Inpatient and outpatient treatment covered by the insurance scheme
BADAS provides comprehensive health coverage which includes
- Outpatient treatment,
- Routine investigations,
- Major and Intermediate surgery,
- Ancillary services and
- Maternity benefits.
Garment workers Treatment Process:
During working hours:
- The patient goes first to the factory medical facility
- If the factory medical facility is not able to treat the patient, the patient will be sent to any of the BADAS healthcare center.
- Factory physicians also can provide medicine according to patient’s need.
Outside working hour
- To get healthcare facility at first patient needs to call medical call center to talk with a Register doctor.
- If doctor from medical call center prescribes medicines then patient can go to pharmacy (BADAS Pharmacy only) to collect those medicines.
- If doctor from medical call center advises patient to visit those any of the three BADAS healthcare medical clinic/hospital then patient will go there for medical needs.
In case of Emergency
- If patient has an emergency, then he/she will go to the nearest BADAS designated clinic/hospital (Three BADAS healthcare center in Gajipur) directly.
- If necessary Physician will refer:
- National Healthcare Network (NHN) , Dhaka
- Bangladesh Institute of Health Science (BIHS)
- BIRDEM & BIRDEM2
- Ibrahim Cardiac Hospital & Research Institute.
In all conditions patients need to carry factory Id card, without factory Id card they will not get this service.
BADAS Pharmacies are available in BADAS outpatient and Hospital places & open 24 hours (day and night), 7 days a week. Patients will collect medicine from these pharmacies.