MHIP beneficiary Xiomara learns about healthy eating habits

Teresa de Jesus is a 27 year old mother of three who lives with her husband and nine other family members in a three room tin house. No one in the family has steady work, but they take advantage of every opportunity that presents itself. Teresa's strong work ethic and dedication to improving the health of her children earned her a spot in the MHIP 2008 Class.

"I was a mother without experience, without anyone to explain to me the health of my children. Since becoming a member of MHIP, my family has organized itself and now works as a team to practice lifelong habits that are improving my family's health. I have learned about personal hygiene, nutrition, common illnesses, and more. Before, everyone in the family slept in one bed, the roof leaked, and the floor was made of dirt. But with the points earned through participation, we now have a new roof, a cement floor, and a separate bed for our children to sleep in. Before, my children were malnourished and my daughter had a horrible tooth infection, but thanks to MHIP, they received the medical attention needed to get back on track. I don't know why it is called 'Micro Health Insurance' when to me, it has been such a HUGE help in improving my family's health and living situation."

Philosophy

Innovation is a key component to FIMRC's strategy for providing access to health care in the developing world.  FIMRC maintains that each individual has the strength and desire to positively change his or her own health. Often lacking, however, are the resources necessary to make the needed modifications that ultimately result in a higher level of baseline health.

FIMRC created the Micro Health Insurance Program (MHIP) to address this lack of educational and economic resources. Established on June 10, 2008 in the community of Las Delicias, El Salvador, MHIP is the first non-monetary model of health insurance that combines health education and community development projects with improved access to medical services to provide comprehensive health care for the entire family, all at zero financial cost to participants.

MHIP participant Griselda leads a health education session

How It Works: Education and Access

Education and improved access to medical services are the key components of MHIP and are fostered through five major initiatives.

1. Health Education Sessions: FIMRC strongly believes that education is essential to avoiding preventable illnesses and improving overall baseline health. Weekly health sessions presented by MHIP staff and FIMRC volunteers address both immediate and long-term health concerns of individual families and the community at large. Past topics have included nutrition, health and hygiene, upper respiratory infections, and breast cancer.
2. Home Visits: Once participants are informed of potential health risks and how to prevent them, they must demonstrate application of this knowledge and a pro-active attitude towards health. MHIP staff conducts regular home visits to monitor and reinforce the application of all information shared during the health lessons.
3. Community Participation: A child's health is affected by both the home environment and by the health conditions and practices of the community at large. MHIP participants organize and implement projects and health related events that encourage community-wide positive behavioral change. 
4. Monthly Wellness Visits: MHIP participants attend monthly wellness visits to monitor healthy growth and development and to catch any illness before it becomes too grave. Monthly visits also foster trustful and communicative relations between the attending physician and participants.
5. Quarterly Feces Exams: Parasites and worms are unfortunately a fact of life for many children in the developing world. In addition to education on proper food preparation and treatment of drinking water, MHIP provides quarterly testing of feces and treatment in the event a child is diagnosed with parasites or worms.

In return for active participation and demonstrated positive behavioral change, participants accrue health credits which can be used to "purchase" tangible goods that improve baseline health. Examples include water filters, mosquito nets, and concrete floors.

MHIP participant Teresa displays her newly constructed floor,
one of the incentives offered in the program

Health credit points were used to "purchase" enough cement to construct this home

Compliance and Services Offered:

All participants, regardless of their length of participation, receive the benefits of weekly health sessions, monthly home visits, monthly wellness checks and vitamins, and quarterly feces exams. Any non-clinic formulary medicine prescribed is also offered, free of charge. In the near future, access to additional Children's Health Services and Maternal Health Services will be offered depending on a family's rate of compliance. Compliance will be determined by the number of health credits accrued per trimester and will be divided into three color groups.

Satisfactory Compliance: Earned 40% to 69% of total health credits per trimester
Above Average Compliance: Earned 70% to 89% of total health credits per trimester
Exemplary Compliance: Earned 90% to 100% of total health credits per trimester

For a list of future Children's Health and Maternal Health Services, please contact FIMRC at This e-mail address is being protected from spambots. You need JavaScript enabled to view it .

MHIP beneficiaries Ricardo Josue, Fernanda & Stefanie
show off their "Healthy Habits" report card

History of Program and Results

June 2008 to April 2010
MHIP was first established in the community of Las Delicias, El Salvador on June 10, 2008. 13 families with a total of 30 children were selected as a "test" group while the children of 20 other families were selected as a "control" group. Only those families in the test group received weekly health sessions, home inspections, and vitamins. They also received preferential treatment in various economic initiatives including the establishment of a sorghum milling cooperative and home gardens. All children participated in the quarterly feces exams.

The hypothesis was that by the end of the first year, those families selected for the test group would have a higher level of baseline health as evidenced by an increased knowledge of how to prevent illnesses, a higher standard of health and hygiene in the home, and fewer diagnoses of acute illness as compared to those families in the control group.

Based on a comparative analysis of attendance records, program evaluations, home inspections, lab results, and clinical diagnosis between June 2008 and April 2010, the following conclusions were drawn.

• Interest in the program remains high. Attendance to weekly health sessions is steady and participants demonstrate a genuine interest and curiosity for the topics presented each week. They also readily identify the benefits of the program including improved access to medicine, free health education, and the ability to improve their living conditions through purchases made with health credits.
• The living conditions in the test families' homes have greatly improved with many now properly treating their drinking water, maintaining barriers between animals and the living space, and installing cement floors with the help of their health credits.
• After almost two years, the children in the test group were diagnosed with fewer cases of diarrhea, parasites, and anemia suggesting that a holistic and proactive approach to patient care is effective.

MHIP beneficiaries Anderson & Bryan lead the way in bobbing for apples

April 2010 to December 2010

In order to continue examining the effectiveness of the FIMRC MHIP model of micro-insurance and to maintain a high level of participant satisfaction and community buy-in, various structural and programmatic changes were implemented in December 2010. The test group "graduated" and their weekly health sessions now include a higher level of self-study and community outreach. Demonstrated application of lessons learned during the health sessions and proactive behavioral change are stressed. Thus far they have participated in a trash campaign, taught healthy food choices to the local daycare students, and discussed the benefits of the program with the control group participants.

The control group was also promoted and is now receiving the benefits of weekly health sessions, monthly home inspections, monthly wellness check-ups and vitamins, and access to all of the Children's Health Services. Within the upcoming months, they too will begin to share knowledge gained through small community improvement projects and a new control group will be selected.

As of December 14, 2010, there are 31 families with 78 children enrolled in the MHIP program.

Nine original MHIP participants and their children
are honored at the graduation ceremony in August 2010

Components of FIMRC's Micro Health Insurance Program (MHIP)

Interested in replicating this program? Please contact FIMRC at This e-mail address is being protected from spambots. You need JavaScript enabled to view it