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Evaluating Impact: Turning Promises into Evidence Vajpayee Arogyasree Yojane (karnataka) Suvarna Arogyashree Suraksha Trust (SAST) Dr.Narayana Swamy, Mr. Suresh, Dr. Rachana, Dr. Vinod kumar mishra, Dr. William Joe, Dr. Saudamini Das, Dr. Nandita Saikia, Dr. Sohini Paul, Dr. Nagi Reddy,Dr. Poonam Munjal Moderators: Anna Custers, Nikhil Wilmink, Anveshika Khandelwal New Delhi, India March, 2013

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Page 1: Evaluating Impact: Turning Promises into Evidencepubdocs.worldbank.org/en/271681463426759089/8-India...Evaluating Impact: Turning Promises into Evidence Vajpayee Arogyasree Yojane

Evaluating Impact: Turning Promises into Evidence

Vajpayee Arogyasree Yojane (karnataka) Suvarna Arogyashree Suraksha Trust (SAST)

Dr.Narayana Swamy, Mr. Suresh, Dr. Rachana, Dr. Vinod kumar mishra, Dr. William Joe, Dr. Saudamini Das, Dr. Nandita Saikia, Dr. Sohini Paul, Dr. Nagi Reddy,Dr.

Poonam Munjal Moderators: Anna Custers, Nikhil Wilmink, Anveshika Khandelwal

New Delhi, India March, 2013

Page 2: Evaluating Impact: Turning Promises into Evidencepubdocs.worldbank.org/en/271681463426759089/8-India...Evaluating Impact: Turning Promises into Evidence Vajpayee Arogyasree Yojane

1. Background

Tertiary level Medical coverage to BPL cardholders

Introduced in 2010

80 lakh eligible families

Launched in 24 districts out of 30 so far

134 empaneled hospitals, direct cash transfer from SPV(SAST) to hospitals

Assured amount is Rs. 1.5 lakh /year/family

Insurance amount is extendable by additional RS. 50,000 if required

28000 patients already treated

80 awareness camps per month per district

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VAJPAYEE AROGYASHREE Access to Quality Healthcare to poor

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Objectives: Ensure BPL families’ access to quality tertiary medical treatment of catastrophic illnesses through an identified network of health providers. Establish Public Private Partnership to stimulate latent demand for tertiary care and administer universal quality care Beneficiaries: Below Poverty Line (BPL) families

in Karnataka as identified by BPL ration cards issued by Food and Civil Supplies Dept.

Salient Features of the Scheme

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0

2000

4000

6000

8000

10000

12000

0 - 10 11 - 25 26 - 45 46 - 60 > 60Neonatal 310 39 2 0 0Polytrauma 3 10 7 3 0Burns 143 305 208 24 4Renal 162 560 1183 684 446Neurological 245 412 1700 997 265Cancer 344 839 3702 3788 1550Cardiology 3008 2529 4343 3692 1393

Age Wise Distribution of Tertiary Cases Neonatal

Polytrauma

Burns

Renal

NeurologicalCancer

Cardiology

Overall, the most vulnerable age group for tertiary ailments is between 26 – 45 years followed by 46 – 60 years, which is the most economically productive age group.

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• Cardiology: In the age group of 11 – 25, 1372 female cases against 1157 males. • Cancer: Between the age group of 26 – 45, there are 2345 female against 1357

males. • Neonatal: in the age group 0 - 10, there are 178 boys compared to 132 girls.

0

2000

4000

6000

8000

10000

Cardiology

Cancer Neurological

Renal Burns Polytrauma

Neonatal

Male 9013 4740 2315 2338 290 16 205Female 5952 5483 1304 697 394 7 146

Gender Wise Beneficiaries - Specialty Categorization

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Comparison of 2 Major Specialties

Cardiology : Total approved cases 14965 Afflicts 37% (5537) of the formative & learning age group of 0 – 25 years. 54% (8035) of the economically productive age group is between 26 – 60 years.

Cancer: Total approved cases 10223 73% (7490) between the age group of 26 – 60 years.

0 - 10 20%

11 - 25 17%

26 - 45 29%

46 - 60 25%

> 60 9%

Cardiology 0 - 10

4%

11 - 25 8%

26 - 45 36%

46 - 60 37%

> 60 15%

Cancer

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2. Results Chain

Input Activities Outputs Outcomes Long-term outcomes

o Funding, personnel and infrastructure from Government of Karnataka

o Special purpose vehicle-SAST

o Technical assistance, monitoring and evaluation by the World Bank

o 54 empaneled hospitals across state

o Implementation Supporting Agency

1. Awareness camps-Launching camps, regular camps. 2. Identification of beneficiaries-camps, Arogyamitras, ASHAs. 3. Eligible patients seeking treatment 4. Empaneling new hospitals 5. Preauthorization and claim settlements.

1.1 One Mega launch camp per district, 80 camps in a District /month 1.2 6000-8000 people attending launching camp, 800-1000 attending Taluka level camps 1.3-4 hospitals attending each Taluka level camp 2.1 300-400 beneficiaries identified in mega camp 2.2 15- 20 beneficiaries identified in taluka camps 3. 28000 patients sought treatment since inception 4. 80 additional hospitals empanelled

1.1.1 Increased awareness of the scheme 2.1 .1 Increased early detection of diseases 2.1.2 Increased enrolment of the patients 3.1.1 Increased number of patients seeking treatment… 3.1.2 Increased utilization of health care services 4.1.1 Increased coverage of health care providers

o Better health and economic indicators

o Increased life expectancy

o Increased quality of life

o Decrease in co-morbidities

o Reducing income shocks

o Providing quality health care

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3. Primary Research Questions

What is the effect of VAS on out of pocket expenses for medically catastrophic illness covered under VAS ?

Is there a change in health outcomes (including specific diseases) for BPL families and do BPL families utilize VAS hospital facilities?

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4. Outcome Indicators

Health expenditure and consumption patterns of BPL families. Assets and Debts of the BPL families. Labor market participation Interviews to gauge number of visits to hospitals under the scheme as well as family clinics and other health care facilities (augmented with monitoring data from the hospital) MONITORING DATA Number of patients undergoing treatment under the scheme Mortality, number of cancer, cardio cases age and gender wise Resources and Claims given to hospitals Quality of services provided by hospitals and hospital feedback Participation in health camps of BPL Families.

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5. Identification Strategy/ Method

3 Districts from treatment area 3 Districts from control area Target is the BPL households. BPL households are not statistically identical 1200 sample from each district There are 7 selected diseases for tertiary care Difference in Difference Method All the BPL households from the selects districts are the target ASHA worker help can be taken for initial survey of potential target households ASHA worker lists all the potential target households Health screening camps can be arranged to further filter these potential target households into: Eligible households Not eligible households

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5. Identification Strategy/ Method

3 Districts from treatment area 3 Districts from control area Target is the BPL households. BPL households are not statistically identical. 1200 sample from each district There are 7 selected diseases for tertiary care Difference in Difference Method All the BPL households from the selects districts are the target ASHA worker help can be taken for initial survey of potential target households ASHA worker lists all the potential target households Health screening camps can be arranged to further filter these potential target households into: Eligible households Not eligible households

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6. Sample and Data 6 districts where scheme has not been launched -3 treated & 3 untreated Sample size is to get around 1200 persons suffering from diseases that are covered under VAS. ASHA workers will administer the questionnaire regarding symptoms / warning signals of the diseases to everybody in the village. Expected to find about 3600 patients with positive symptomatology for these diseases. These 3600 patients will be screened for the above diseases with X-Ray, ECG, Ultrasound Abdomen and Hemogram. Expected to find about 1200 positive cases with diagnosis of the diseases covered under VAS Household questionnaire Baseline-just before the scheme is introduced-Treatment is started-launching of the scheme.

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Sample and data-2 Eligible households can further be classified into those likely to undergo treatment in the next 1 year and those who are unlikely to undergo treatment during the next one year Randomly select 1200 households from the above two groups on probability proportion to size from each group. Base Line Survey at the beginning Mid Term Assessment after 1 year End Term assessment after further 1 year.

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7. Time Frame / Work Plan April 2013: ASHA worker data collection and data entry; May and June 2013: Health camps screenings July 2013: Sample selection – 7200 total. July 2013: Questionnaires and pilot testing by agency September 2013 to December 2013 Data collection; December 2013 and January 2014: Data entry January 2014: Implementation of program starts; January 2014: Base Line starts January 2015: Mid term assessment starts January 2016: End term assessment starts March 2016: Draft report May 2016: Final report August 2016: Peer reviewed articles (2)

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8. Sources of Financing

SIEF

WORLD BANK

3IE

GOVT. OF KARNATAKA

TOTAL COST:US $ 15,00,000

Major Costs:

Screening of the patients for the diseases covered under VAS.

Incentivising the ASHAs for administering the questionnaire.

Backend Work of Data Analysis and Data Collation.

Capacity Building.

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Strategic Impact Evaluation Fund

www.worldbank.org/sief

The World Bank

Human Development Network

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THANK YOU