What is Social health security scheme? What is Disability? Provisions included in SHI for PWDs

1. Social Health Security
Scheme for People with
Disability (PWDs)
Swornim Bajracharya
Masters in Public Health
BPKIHS, Dharan

2. Background
• Disability is an umbrella term, covering
impairments, activity limitations, and participation
restrictions
• Disability is thus not just a health problem.
• It is a complex phenomenon, reflecting the
interaction between features of a person’s body
and features of the society in which he or she lives.
• Overcoming the difficulties faced by people with
disabilities requires interventions to remove
environmental and social barriers.

3. • People with disabilities have the same health needs
as non-disabled people – for immunization, cancer
screening etc.
• They also may experience a narrower margin of
health, both because of poverty and social
exclusion, and also because they may be vulnerable
to secondary conditions, such as pressure sores or
urinary tract infections.
• Evidence suggests that people with disabilities face
barriers in accessing the health and rehabilitation
services they need in many settings.

4. According to Nepal Constitution 2072, Nepal
Government has first time introduced Action Plan for
“Disability Management” for 10 years under Leprosy
Control Division.

5. According to New Disability Act by Nepal Government, disability has
been classified into 10 types
• Physical Disability
• Visibility related Disability
• Hearing related disability
• Disability related to hearing and visibility
• Speech related disability
• Mental or Psychosocial disability
• Intellectual disability
• Hemophilia related disability
• Autism related disability
• Multiple disability

6. • 1. Physical Disability: Physical disability is the problem that arises
in the operation of physical organ, its use and movement in a
person due to the results of the problems in nerves, muscles and
structure and operation of bones and joints.
• 2. Disability related to vision: A person not having knowledge
about an object's figure, shape, form and color due to following
problem.
• a) Blindness: Cannot distinguish the fingers of hand by both eyes
at a distance of 10 feet despite treatment inclusive of medication,
surgery and use of spectacle or lens or cannot read the letters
contained in the first line of Snellen chart (3/60).
• b) Low Vision: Cannot distinguish the fingers of hand by both
eyes at a distance of 20 feet despite treatment inclusive of
medication, surgery and use of spectacle or lens or cannot read
the letters contained in the first line of Snellen chart (6/18).
• (c) Total Blind: A person who cannot totally distinguish light and
dark

7. • . 3. Disability related to hearing: Not being able to
distinguish voice, place of rising and following tone,
and amount and quality of voice due to structure of
hearing organs. It is of following two types:
• (a) Deaf: An individual who cannot hear sound
above 80 decibels or who has to use sign language
for communication.
• (b) Hard of Hearing: An individual who needs
hearing aid to listen who can hear sound between
65 decibels to 80 decibels.

8. • 4.DeafBlind disability: A person having both hearing
and vision disability or having disability with joint
interaction two sensory organs.
• 5. Disability related to voice and speech: As person
due to functional limitation in the organs related to
voice and speech resulting into difficulty in rise and
fall of voice when speaking, unclear speech,
repetition of words or letter is regarded as a
disability related to voice and speech.

9. • 6. Mental or psychosocial disability: Due to the
problems and awareness arising in the mind and
mental parts that result into inability to behave in
accordance with age and situation to perform
intellectual functions such as orientation, alertness,
memory, language, calculation is regarded as mental or
psychosocial disability.
• 7. Intellectual disability: A condition where a person is
having difficulty in carrying out activities relative to
his/her age or environment due to the not having
intellectual development is regarded as intellectual
disability. (for example inclusive of Down Syndrome).

10. • 8. Disability Related to Genetic Bleeding (Hemophilia):
A person with physical condition where there is a
problem of blood clotting due to factor disorder in the
blood due to genetic effect.
• 9. Disability related to Autism: Person having problem
in nerve or tissue by birth and its function and
development. (a person who has difficulty to
communicate, to understand and use social rules, not
being able to perform normal behavior in accordance
with his/her age, shows abnormal reaction, keep on
repeating the same action, cannot socialize with others
or show extreme reaction)
• 10. Multiple disability: The same person having two or
more than two types of disabilities as mentioned
above. (For example Cerebral Palsy)

11. • In order to make the laws more comprehensive and
fully compatible with the rights-based approach,
the GON has prepared a draft bill to substitute the
DPW Act.
• The draft bill defines ‘persons with disability’ as
“the persons who are prevented from full and
effective participation on the grounds as of other
persons due to long-term physical, mental,
intellectual and/or sensory impairments in
interaction with various barriers". (GoN, 2014)

12. For the purposes of distributing disability identity cards,
the GON has classified disability, on the basis of its level
of severity, as follows:
• (a) Profound disability: Difficulty to perform daily
activities even with the help of others.
• (b) Severe disability: Inability to perform daily
individual or social activities without the help of others.
• (c) Moderate disability: Ability to perform daily
activities and participate in social life if barrier free
environment, appropriate training and education are
provided.
• (d) Mild disability: Ability to perform daily activities and
participate in social life if barrier free environment is
provided

13. • As discussed earlier, people with disabilities have
similar health needs as other without disability.
However, there health conditions are exacerbated
due to various environment condition around them
To facilitate ad support them, health security
scheme is very important

14. Nepal Health Security Scheme
This is a Prioritize government program based on
comprehensive social contributory scheme with
government
subsidies for the poor.
Objective:
• Ensure access to quality health service (equity &
equality).
• Protect from financial hardship and reduce out-of
pocket payments

15. Focuses on

16. Health insurance features in
Nepal

17. • It aims to enable every citizens of Nepal to access
quality health care services without placing a
financial burden on them.
• It is a family-based health insurance scheme
implemented by the Social Health Security
Development Committee.

18. Regulating and Coordinating
Mechanism

19. Implementing Institution

20. Benefit Package
• The benefit package is the services and drugs that
are available to SHSP members at health facilities
under the SHSP.
• These include
• Emergency services,
• Out-patient services,
• Selective inpatient services, selective diagnostic services
and
• Selective drugs,
• In addition to any free services and drugs available at
public health facilities through other programs.

21. OPD, Emergency Package
OPD
• Consultation,
• TC, DC, Hb,
• Stool RE,
• Urine RE/ME,
• Blood Sugar F/PP)
Emergency
• TC/DC Hb
• Urine RE
• Blood Sugar
• Serum Creatinine
• ECG
Can be claimed only for
patients discharged
from Emergency.
21

22. Services not included in the scheme:
• Cosmetic surgery
• Equipment like artificial organ, reading glass not more than 500 once in
a year, hearing machining etc.
• Artificial insemination services, organ transformation, Sex
transformation etc.
• Injuries treatment cost due to personal warfare
• Accident related treatment due to alcoholic and drug use
• Abortion
• In the case of dental treatment, modern dental implant, root canal
filling, etc.

24. Enrollment

26. 26

28. Implementing districts

30. Financial Management

31. Governance

33. Working

34. 10 Year Action Plan
Under the 10 years Action Plan for disabled
management, one of the specific objective is to:
• Within 2 years, enlisting the assistive devices in
positive list of social health security (health
insurance) programs
• Within 2 years, all PwDs will be covered by Health
insurance program, including classification, and
free medical provision

35. Activities
• Assistive devices in positive list from the negative one in
Social health security (health insurance) programs.(i.e. to
include all people with disability in security scheme )
• Health Insurance programs to be implemented for PwDs.
Monitoring indicators
• Provision of positive assistive devices in Social Security
scheme
• Inclusion of people with disability in Social Security Scheme
• Plan and policies for the insurance program for PwDs
• Selection and appointments of insurance companies.

36. Monitoring information sources
• Modified Social Health Security Scheme
• Inclusion of people with disability in Social Security
Scheme
• Insurance company appointments agreement
document.
• Statistic of PwDs getting Health insurance services.
Implementation
• Short term at the start and continue in future.
• Policy and plan’s document.