In September 2000, representatives from 189 member states of the United Nations met at United Nations headquarters in New York and adopted the Millennium Declaration, a series of collective priorities on peace and security, the eradication of poverty, the environment and human rights.
Following this declaration, a set of eight goals, the Millennium Development Goals (MDGs) were drawn up as the blueprint to achieve noticeable results and improve the lives of people in developing countries by the target date of 2015.
The eight MDGs include specific, measurable targets and timelines, for developing countries as well as for donor countries, civil society organizations and funding institutions such as the World Bank. All nations agreed to undertake specific follow-up measures to ensure that these goals were achieved in their own countries and commitments have been made to fund these initiatives.
The MDGs’ Priorities for Children
Each child is born with the right to survival, food and nutrition, health and shelter, an education, and to participation, equality and protection. The MDGs are especially important for the well-being of children: they promote health; quality education; protection against abuse, exploitation and violence.
Our report pertains to the following millennium development goals:
Goal 1: Eradicate Extreme Poverty and Hunger
Extreme poverty hinders children’s access to nutrition, health care and education. Providing children with basic education, health care, nutrition and protection fulfills their rights, increasing their chances of survival and of a productive future.
Goal 2: Achieve Universal Primary Education
Educating children is a tool to achieve all the MDGs. Primary education also includes the education of health in which it is taught how to take care of health as prevention is better than cure. Especially because many children in Pakistan have the propensity to fall sick frequently and thus cannot continue their education. So for getting education the child’s health should be safeguarded at all costs.
Goal 6: Combat HIV / AIDS, Malaria and Other Diseases
Diseases undermine the development in the third world countries – malaria, measles, polio and tuberculosis cause the deaths of millions of children who do not have good nutrition, sanitation or healthcare. We can prevent this substantially by promoting long-term primary health education and providing them with health insurance to safeguard their futures.
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What is Primary Health Care?
Primary health care is a vital and an indispensable care of your health and it is also a foundation of the health care system which involves providing several initial primary level services to individual families and communities, through a team of health professionals, consultants and various doctors.
Primary Health Care is based on 4 Key Pillars:
PHC is about working in teams to provide beneficial health care facilities to communities and individual, and to improve the continuity of care. It also diminishes duplication by ensuring your access to proper health professionals.
PHC provides enhanced adroitness of information between doctors and expanded access to information and using modern tools like electronic health records and diagnostic devices to advance the eminence, access and coordination of health information.
PHC gives you greater access to the right services when and where you need them.
PHC believes in your better care and focuses on prevention, chronic conditions, and encouraging support for self-care.
What Is Health Insurance?
Insurance is loss by illness or physical injury. It facilitates you with all kinds of expenses from Medicare to all kind of hospital expenses. Health insurance can be directly purchased or can be given to any respective employee.
Importance of Health Insurance
Health insurance provides health in an affordable way for you and your loved ones that include your Medicare and family protection from the lofty fee of healthcare.
(Rarely medical bills can be monetarily devastating and families pull through from such debts in a certain long period).
Protects Your Future
When someone gets insurance of his car or home, they mean to protect their family and themselves from financial sufferers. Insuring your health is same as that. Health care is way much costly than an insurance of other things.
Read the facts below:
The average cost of a trip to the emergency room for an adult is about $700, not including any hospital facilities, which may increase the bill to well over $1,000
A broken leg can cost up to $7,500
Average expenses for childbirth are up to $8,800, and well over $10,000 for C-section delivery
The total cost of a hip replacement can run a whopping $32,000
Above instances sound scary, but with the right plan, one can protect Himself from most of these and other types of medical bills.
Gets You the Care You Need
Many people who do not have health insurance fails to get the medical care they need. That is because they are worried about the best treatment expenses. The key of beneficial health insurance is access to a large network of doctors and hospitals.
Read the H.I benefits below:
Quick and easy access to desirable medical needs.
Peace of mind during a hard time because one knows they are covered.
Affordable access to care and health information to keep you glee and healthy
Is There A Need For Health Insurance In Pakistan?
In Pakistan and India, at least one third of the 1.3 billion lives in urban hubs and of this population estimated 400 million earn less than $3 a day. The Pakistani government use just 0.9% of its GDP on health and even India uses only 1.9% of its GDP on a woefully under-resourced, inundated public health sector. Thus 97% of all healthcare outlays occur from out-of-pocket and “catastrophic” medical costs and treating major diseases in low cost are a main precipitant of cohort poverty.
Major Health Insurance Providers (Underwriters) In Pakistan
Allianz EFU Health Insurance
Adamjee Health Insurance
IGI Health Insurance
United Insurance Company of Pakistan
Pak Qatar Takkaful
Health care for the underprivileged
Developing nations are overwhelmed by effort of under nutrition and a host of viruses. Outbreaks of diarrhoeal diseases give a rough steer to the poor hygiene of the community (clean and safe drinking water is a dream for millions even now).
In many nations health care is provided jointly by the government and the private sector, but the handful of public health institutions are the only hope for the needy people. The services of private hospitals are not up to the mark of the massive bulk of population belonging to the low-income zone. The private zone is apparently concerned only in remedial medicine and these hospitals and clinics are essentially run with a yield aim except for a handful of society that runs on charitable basis. We cannot blame the former group as it is not their duty to offer free health care to poor people.
Many agendas aimed at the bar of transmissible diseases are run in under developed countries with the help of WHO, but even these agendas failed to give needed effect. The reasons for the failure of these national health agendas are multi factorial; the vital being is the lazy loom by the government officials implicated in implementing the agendas.
(Rarely beneficiaries get less than 1% worth of what is imagined in the agenda).
Consequently, the deprived of Pakistan are losing faith in the healthcare industry on the whole. The reasons can be summed up as follows:
Lack of funds in the public health sector
Lack of resources and equipment in government hospitals
Lack of spur in government hospitals
Lack of primary health education
Poor utilization of services
Improper staff recruitment in government hospitals
Inappropriate allocation of funds
What is Naya Jeevan?
NAYA JEEVAN® is a not-for-profit social enterprise dedicated to enhancing the lives of low-income families.
Naya Jeevan works in collaboration with corporate, academic, and non-profit institutions so that a new wave of social responsibility can be catalyzed that can then be leveraged to realize a positive sustainable outcome for all stakeholders.
Naya Jeevan believes that philanthropy should not be a transient, ad-hoc event but be institutionalized as a fully integrated part of society.
To provide underprivileged children and their families throughout the emerging world with quality and affordable access to catastrophic healthcare.
Reduction in poverty and mortality rates attributable to acute infectious diseases and lack of timely treatment.
Reduction in disease outbreaks due to lack of preventive care.
Reduction in the incidence of recreational/addictive substance abuse.
Reduction in maternal mortality attributable to emergent pregnancy complications.
Mitigation of urban child labor and child exploitation.
Collective Social Responsibility through joint partnerships with the corporate, non-profit, academic and service sectors.
Integrated social empowerment of the low income population.
Business objectives to catalyze an ecosystem effect
By reducing the financial impact of catastrophic medical expenses
Reduction in maternal/child morality
Through timely intervention and 24/7 access to ambulances, medical doctors, ERs, trauma centers, etc.
Improvement in primary health outcomes
Through preventive health education and behavioral change workshops
Reduction in substance/drug abuse
Through rehabilitation workshops and access to treatment centers
Mitigation of child/labor/sexual/physical abuse
Healthy breadwinners will enable children to remain in school and away from premature labor
Naya Jeevan Value Added services:
24-hour medical hotline:
24/7 access to a qualified medical doctor
Help with navigating the complex world of hospitals
Help with claims management, settlement and trouble-shooting
Beneficiary orientation (Training)
Animated interactive presentation at client premise by a qualified medical doctor (same set of doctors who manage the helpline).
Managing expectations – what is covered, what is not, where to go, access to hospitals
Case based claims scenarios
Building of rapport and trust with beneficiaries
Access to subsidized OPD and pharmacy network
Quality checks on standard of treatment at the treating hospital
Health awareness sessions (Workshops)
Primary health care workshops on topics such as
Nutrition and Weight Management
Anti-smoking/ tobacco & dental issues
Annual health check-ups (Screening)
Head to toe examination at client’s premise
No compromise on working hours
Early diagnosis of diseases and management
Aggregate Annual Health Report of employees (a health-o-meter of the organization)
Targeted Preventive Health Workshops based on the findings
Health insurance of underprivileged NGO schoolchildren – project overview
In February 2011, Naya Jeevan started on the innovative idea of insuring the health of children that fell under the umbrella of other NGOs. The idea was to provide quality healthcare to these children as they were willing to study but a disease or an injury incurred by them or a family member could potentially put an end to their dreams forever. Furthermore, most of these children did not have any awareness about primary health care, or about ways of preventing/ mitigating common ailments prevalent in their locality. Thus they would end up going to untrained professionals with inadequate or no qualifications for treatment of such ailments/ injuries, further exacerbating not only the medical problem at hand but also the unstable financial conditions of their families.
This project is designed to provide quality health care to underprivileged schoolchildren who cannot afford quality health which includes primary health care.
Importance of Access
Most children are healthy. Some may ask, therefore access to health care is important for children. In some important ways they are distinct in age groups. For health services they are entirely dependent on their adult caregivers, and are unaware from the advantages of health care and its benefits.
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Children’s health needs are also significantly different from those of adults. With the time children grown with a rapid change and it may cause them to get ill or get injured during their activities and if those diseases or injuries are not treated well so they can leave a huge affect on a child’s physical and emotional development.
The type, cruelty, and rate of health conditions that children practice also differ from adults. Children’s can experience a wider range of health issues if not have been taken care well and even though certain childhood conditions are quite mild in single instances, they have the tendency to lead to life-long disabilities.
For example, chronic ear infections, if unchecked, can lead to hearing impairment, and possibly learning disabilities.
The Limitations of Insurance
Children have a beneficial impact on access when extending health insurance to low- income. This does not mean that children will inevitably have full access to health care, especially the deprived ones.
Insured low-income children use fewer services than the richer, insured children. Moreover, poor children with insurance are less likely to go to a private physician’s office and utilize community health centers, compared to their better-off counterparts. There are a number of reasons for these differences.
The families of poor children with insurance face nonfinancial fences to health care that insurance cannot address, including transportation, child care, inconvenient location of services, and service hours that conflict with work. Children of immigrant families may face additional barriers, including an inability to speak in their primary language, fear of exile, and cultural conflicts with Western medicine.
Therefore, providing insurance without developing a delivery system to serve the needs of low-income children does not have to produce the desired outcome of improved access to quality health care.
NGO Schools under the Naya Jeevan health plan
The project is a pilot to test out health insurance in NGO schools across Pakistan. In 2011 Naya Jeevan enrolled 8,334 NGO school children in the plan across the country. Participating Schools are
Manzil School, Karachi
Zindigi Trust, Karachi
IISAR Foundation, Karachi
DIL Schools, Khairpur
Mashal School, Islamabad
Manzil School (Karachi):
Manzil is a Non-Profit Organization providing free education to children in the slum areas of Karachi. Starting with only 20 students in 2002, today Manzil has around 200 students who are being equipped with the highest quality of education, practical knowledge, skills and work ethics. It is situated in Quarter No1.Railway line near Bath Island Clifton. Manzil was started by a PhD student at CBM Ms. Shazia Mirza, after she observed the socio-economic divide in the region. She lived near the slum in a well off neighborhood and her house maid came from Raitee Line Bastee. Sensitized by the proximity of this other world, she started the school in a one room rent out from her pocket money. The majority of the community/bastee is ethnically conservative Pathans. The winning of the trust of this community has been one of the major successes of the initiative.
Zindagi Trust Schools (Karachi):
Zindagi Trust’s program educates children who work in the urban slums of Pakistan. With nearly 2800 students, a 2.2-year accelerated primary education course is taught to the children who spend most of their days toiling in car-repair shops & other general stores in Karachi, Lahore & Rawalpindi. Permission is sought from the students’ parents and employers before enrolling them in the free schools to ensure success. The use of Government Buildings allows for a proper school experience with classrooms and blackboards.
Right now Naya Jeevan is giving health plan to seven such schools in Karachi.
IISAR Foundation (Karachi):
IISAR was founded in 1990 by Prof. Dr. Ahmed Saleem Siddiqui, with an aim to impart & promote quality education irrespective of differences. IISAR is a world class center having concentrations in teaching and research, revelation-based knowledge and technology-based learning across the full range of the social, political and economic sciences. It’s a non-profit organization and has an outstanding reputation for academic excellence.
Mashal school (Islamabad):
Mashal is a self-funded school (i.e. registered trust), comprising of 406 children in classes ranging from nursery to class 8. These children face hardships at home, as well as at work, when selling items such as flowers, shopping bags and sweets, and washing cars on the streets. They have little choice, but to survive on their own in the company of gangs on the street. They are vulnerable to abuse and exploitations of all forms. Despite most of the children’s traumatic past experiences, through the assistance of Mashal School, they are able to overcome their inhibitions and eventually develop a sense of trust and dignity which allows them to finally live their lives as children and possess a deserved sense of belonging.
DIL schools (Khairpur):
Developments in Literacy (DIL) has been working in Khairpur District, Sindh, since 1998. DIL’s mission is to combat illiteracy in the remote, underdeveloped regions of Pakistan by opening non-formal primary and middle schools for girls. DIL hopes to break the entrenched social taboos against female literacy by working with the communities and gradually empowering young girls to improve their future prospects through education. However it is only possible for a child to concentrate on their studies when they are in good health. Education does not only include learning how to read and write but also the knowledge of how to look after one’s self and make one’s life better. Thus DIL has embarked on a journey to improve both the health and nutritional status as well as alleviate the levels of literacy in the children of Khairpur.
In 2011 with co-operation and research we introduced Profit and Loss Insurance (PLI Policy). The difference between the PLI Policy and the regular insurance policy can be explained by analogy of credit and debit. In conventional health insurance for the price of the premium you get a binding promise from the insurance company to cover claims under the plan. A group may have paid 50,000 PKR in premiums but used services of up to 100,000 PKR. On the flip side they client may have not used any services and have lost all the money in the premium. A managed care/PLI model is similar to a debit card. You spend what you have and the insurance company charges a fee for that. However, if you have any money left over, it is carried over to the next year unlike the premiums. Also, because it is your money you can choose which claims you want to settle in spite of them being policy exclusions.
During this pilot year of micro-health care for children Naya Jeevan has tried to assess the efficacy of both models. The total coverage limit for both was set at 50,000 PKR for the inpatient and the rest of the money used as a pool for outpatient expenses on a reimbursement basis.
Number of school children:
Number of claims:
Health Awareness Services provided by Naya Jeevan:
Aga khan anti-tobacco workshop:-
Naya Jeevan partnered with Aga Khan University and there team of doctors delivered an anti-tobacco workshop at the schools. Many of the children re addicted to some form of tobacco over there. Thus many have sub-mucosal fibrosis, which is an irreversible narrowing of the mouth cavity due to oral tobacco use. Two children were found to have pre-malignant oral lesions. AKU delivered this workshop free of cost.
In-house preventive health workshops:-
Naya Jeevan believes in primary healthcare prevention. Children can’t be in the best health if they don’t have information about the disease process. Healthcare workshops belong to a mini interactive lecture series in collaboration with other corporate partners and the topics chosen are based upon the feedback received.
Examples of healthcare workshops held to date are hand washing, dental and smoking/drug addiction, etc. Several workshops were delivered by our Medical Services team, including “Healthy Heart”, “Sad Teeth & Happy Teeth”, “Dental Hygiene” and “Hand Hygiene” at schools.
Trainings are also being given by Naya Jeevan to parents who come to attend regular parent-teacher meetings at the schools, and to the teachers/ administrative staff.
We have been conducting refresher trainings in many of the NGO schools, and have come to realize, among many things, that it would be of great help if instead of visiting these schools and delivering the trainings in person, we could have these schools periodically play a video recording of our training whenever they had a substantial number of parents visiting the school.
Challenges of the program
Data files are especially cumbersome. They are on hard copy and had to be re-entered into electronic form. This takes a lot of time and effort. Even the cards’ distribution is a difficult area as they had to be delivered class wise.
Problems of unaffordability (both time and monetary) of parents to reach the panel network hospitals according to existing protocols has been a major barrier. Many children only suffer minor medical problems and need outpatient treatment. Therefore, collaboration with reliable hospitals in their vicinity is in progress.
Language barrier has resulted in poor retention of information so far. Therefore, repeated refresher trainings were given to parents and teachers so that they may know the proper use of card. The small number of rejected claims shows that re-fresher trainings were effective.
Lack of trust from parents was also a challenge in the reimbursement process. Parents weren’t sure that we will reimburse the money and that too within a month. Other than this they were not comfortable in submitting original medical bills and receipts to us.
Lack of availability of audio-visual equipment/ electricity/ adequate space in every school to accommodate large groups of parents and teachers.
The lack of interest shown by the teachers has been a major barrier. This has been solved by making them a stakeholder in the health plan also, with the understanding that they will take responsibility of taking the lead on making the health plan more comprehensive for the children.
The slow process of setting up funds in vicinity hospitals: So far, Islamic International Medical Complex has been set up for Mashal School in Islamabad with plans for this model to be replicated to all schools systems.
Keeping a proper school wise backup of claims that can be shown to anyone who wants to access the information anytime.
Why We Chose Naya Jeevan
Naya Jeevan targets that need of the underprivileged population that is not fulfilled by any other NGO i.e. affordable healthcare. Therefore, by increasing awareness about the importance of health insurance, and prevention of basic medical and dental issues (that can cause devastating health-related and financial problems later), one can greatly impact the quality of life for many low-income people.
Through Naya Jeevan we intended to visit schools and putting up a workshop regarding health to kid. From this guidance the schools were expecting that the children will adjust their routine that wuill help them to take care of their health. Less resource was obtainable to present them that did not help to make children go fully aware with their health knowledge. We as health students have a lot of health awareness and of facts related to it which can be effortlessly distribute to those kids who are ignorant of diseases and health issues that need to be taken care of.
Materials and equipment:
Since these schools have no capital for organizing workshop we had to assemble every resource our self. All multimedia (speakers, projectors and screen) were organized by Naya Jeevan. We arranged pictorial illustration and miniature stories regarding health and distributed among kids.
Our volunteer work
As Naya Jeevan gives workshop to school children to improve the health education in and to increase awareness of how to take care of live. We volunteered with Naya Jeevan and visited one of the schools and gave workshops. This was quite an interactive session and we gave workshops in small groups so that they may understand well. This is quite a good learning for them and also for us.
The following are the workshops we prepared and delivered for these schoolchildren:
Hand Hygiene:Description: http://t2.gstatic.com/images?q=tbn:ANd9GcQvwd7yWW5ALmEZzijVQp0qSPcJA3RH57G9IRZevZXWqafhPy7B
The Naya Jeevan Hand Hygiene workshop was developed to enlighten our valued beneficiaries about the importance of keeping your hands clean as our hands are the primary tools that enable us to accomplish various tasks. At the same time it also serves as a main mode of transmission of various infectious agents.
The key learning objectives of the workshop include:
When is it necessary to wash hands?
What are the proper steps of hand washing?
What is feco-oral route of transmission of germs?
What are the important infections that can spread through feco-oral route and how can they be prevented?
Duration: 60 minutes
In Pakistan, it’s the communicable diseases constitute the bulk of most illnesses. Just in recent years we have seen epidemics such as dengue fever. Description: C:UsersZaraDesktopimagesCAGJG6QU.jpg
This workshop discusses at length, the prevention and combat strategies for infections such as typhoid, malaria, dengue, gastroenteritis, various forms of hepatitis and other most prevalent ones in Pakistan
Duration: 50 minutes
Delivered by a dentist, this workshop deals with all the common teeth issues that result from poor oral hygiene.
The dentist talks about the proper way of brushing teeth and the products like Paan, Gutka, betel nuts, cigarette etc that must be avoided in order to maintain oral hygiene.
It also highlights some of the oral cancers that can result from use of addictive substances such as tobacco.
Duration: 30 minutes
Balanced Diet:Description: C:UsersZaraDesktopdiet imagesimagesCAQNOBSE.jpg
A balanced diet is one that includes the Recommended Dietary Allowances, also called RDAs, for all the essential nutrients. These include proteins, fats, carbohydrates, vitamins and minerals.
The physician discusses the nutritional requirements (in calories) for individuals based on gender, age, profession, physical activity and co-morbidities.
Duration: 50 minutes
Sustainability of results
The project strongly inculcates the spirit of giving back and community engagement.
Diffusion of a new idea goes through the following stages
The Schools had problems like
Non active involvement of teachers as of no personal benefit.
Language fence. We have to speak in easy language
Lack of partial resources
Building faith in children
Regulate in their ambiance.
Schools were very keen on having their children screened, especially eye and dental screenings.
Children cannot afford the taking care of their and were sad that they can’t even buy a toothpaste and will continue with tooth powder
The outcomes of these workshops:
Children specifically big children started taking care of their health
More calls started coming on helpline regarding basis health information
These workshops created so much impact on the children that they also educated their family about health.
There was a major issue in the panel hospital that hospital staff did not treated the poor children well considering it was a private hospital. We went to these hospitals and talked to those hospitals to treat these children well.
After a week we got calls from schools that these workshop created a big impact and wanted us to design more workshop for the kids
The school also reported us that these workshops created a big living difference and major difference were seen.
The school children used to eat a lot of bubble gum and beetles. After the workshop the school noticed that 30% stopped eating it.
It was also identified by the schools that there should be refresher workshop as the children memory forget the things soon.
This is a new product that has required constant tweaking throughout the year and training and re-training of the schools.
NGO schools currently require very close and regular contact throughout the year to encourage the uptake of services.
The product has to be as simple as possible with cashless card based services for everything including out-patient services. Re-imbursement scenarios have to be kept at a minimum.
Teachers have to be active stake-holders.
Conclusion and recommendations
All children need health care, whether for regular check-ups, for episodic health problems such as ear infections, or for chronic conditions. Because health services are relatively expensive, children’s access to care is largely dependent on whether or not they have health insurance. Unfortunately, far too many children are not covered and therefore, do not receive needed care.
The health plan in the original format has not been successful. Naya Jeevan has quickly moved in to alter the original plan and make sure that the children benefit from their coverage. These include
Insuring the teachers to make them a stakeholder in the children’s health. Most teachers are from the same community as the school and thus are the most important factor in increasing uptake of services.
Depositing funds at a nearby identified network hospital is of essence. After the funds have been deposited, Naya
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