Association for Public Policy Analysis & Management

A key challenge in the effective implementation of public health programs is the inability of government agencies to reach out to intended beneficiaries. This problem is further exacerbated when beneficiaries enrolled in these programs are either unaware of the benefits or do not know how to avail them. Existing literature on the role of information in improving utilization of public health programs in developing countries emphasizes the role of ‘word-of-mouth’, especially in communities that have low literacy rates and limited access to information technologies. However, due to limited budgets and staff, implementing agencies often rely on the more conventional and easy-to-use awareness methods such as posters, pamphlets, advertisements in newspapers and radio stations.

Unlike public programs that provide beneficiaries with regular benefits (for example, social security payments or cash transfers for food), the need for public health programs arises sporadically, limiting ‘word-of-mouth’ awareness. A case in point is the Rashtriya Swasthiya Bima Yojana (RSBY), Government of India’s national health insurance scheme that provides fully subsidized health insurance to approximately 40 million low-income households. Though the program has achieved high enrollment rates, utilization rates remain very low. This can be attributed to the insurance companies’ incentives to enroll households (as the government pays premiums per household enrolled) but ensure low claims by sharing limited information.

This poster presents findings from an experiment that estimated the effect of village-level awareness meetings by a community-based organization (CBO) in 66 villages of Karnataka, a state in South India, during the first year of RSBY implementation. The study used a ‘phase-in’ design: awareness meetings were organized in 32 randomly selected villages, followed by meetings in the remaining villages after a gap of two months. The study uses the difference-in-difference approach to calculate changes in utilization rate (i.e. the proportion of enrolled households using the health insurance program) before and after the intervention. The study finds a large increase in utilization rates in both groups of villages, making a strong case for a one-time investment in village-level awareness meetings to improve the performance of RSBY.

The paper also highlights an important positive externality that resulted from the village-level awareness meetings. As the public health insurance program relied on private insurance companies and hospitals to provide healthcare, the village-level awareness meetings provided a good opportunity for monitoring program implementation. The CBO staff collected feedback from those attending the meetings and reported numerous cases of beneficiaries not receiving health insurance cards despite enrolling in the program and cases of beneficiaries being turned away from empaneled hospitals. Due to the limited staff and resources available to the implementing agency, this was an effective way of getting feedback from remote locations. This study is a good example of how research can play a crucial role in making government more effective.