India : Assessing the Reach of Three SEWA Health Services among the Poor

Abstract

This is a study of how well health and related services provided by a large, prominent Indian non-governmental organization have reached the very poor. The Self-Employed Women's Association (SEWA) is a trade union of informal women workers located in Gujerat State. The services are three primary components of SEWA's health program: its mobile reproductive health camps, tuberculosis detection and treatment program, and women's education program. The project's quantitative component compared the economic status of women attending each of the three services with that of the general population. Information about the economic status of approximately 1,500 women attending the services was collected through interviews at service provision sites. Information on the general population's economic situation came from pre-existing household data sets: a Demographic and Health Survey (DHS), and a survey by SEWA's insurance project. In urban areas, all three SEWA services were used predominantly by people from poorer households; about half the clients of each service belonged to the poorest third of the population. In rural areas, the economic status of those who used the two services offered (reproductive health and women's education) did not differ significantly from that of the general population. The project's qualitative component featured focus group discussions about the reasons why the services did or did not reach the poor groups for whom they were designed. In urban areas, the reasons identified for the services' attractiveness to the poor included proximity, delivery (in part) by the poor themselves, promotion efforts in poor communities, relatively low cost, and SEWA's favorable reputation. The barriers identified in rural areas were the timing of service, which coincided with working hours, and the services' perceived high cost.