# 2. Organization and Management

The insurance plan began with the ope-1ing of the health center, in February 1987. The Development Commission of St. Alphonse parish was instrumental in creating the health center and mounting an awareness campaign amnng the population in the health center's catchment area. The Development Commission has been in existence for over 10 years, and manages a diverse range of activities in addition to the health center, including a food cooperative, tie-dying cooperative, and an adult literacy program.

The health insurance plan-awareness campaign took a full year and involved considerable effort. Four members of the Development Commission worked full-timc for two months, conducting door-to-door vi;its to explain the purpose of the insurance plan. They were assisted by six students from the National Art Institute who were enrolled in the Institute's program in 'animation culturelle.' The students worked full-time for three months.

In spite of this concentrated effort, most residents were not convinced about the benefits of joining an insurance plan. The plan bcgan with only 50 members. The St. Alphonse insurance plan is a direct insurance plan, offered by the provider, which is both the center and the zone. Accounting for the insurance plan is mingled with that of the health center. The price of the premium is set by SPTK/health zone central office staff. It was not possible to meet with these people, so little is known about how the premium price is established.

Individuals may join the plan at any time during the year, with coverage starting immediately and lasting one year from the time of enrollment. The only restriction is that people cannot join the plan while they are sick. Enrollees receive a membership card which specifies name, age, sex, membership number, date joined, and date of expiration. The health center nurse also records information about each enrollee in a membership register. This register records membership number, date (without year), name, address, sex, and age. Membership numbers are sequential until 1,000, then begin again with number 1. When a person wishes to renew his or her membership, a new card is issued (with a new membership number) and the old card is destroyed. Therefore it is difficult to analyze renewal rates.

There are few recurrent costs associated with administration of the insurance plan. Since the plan began, no new registers or membership cards have been purchased. The membership verification process is very simple (the receptionist compares the membership card to the person's national ID card), and accounting is combined with that of the health center, so personnel expense for record-keeping is negligible. The current cost of printing a membership cards is about 20 Z ($0.06), so the card expense for the 620 current members is approximately 12,400 Z ($35).

To identify plan members, as mentioned above, the membership card is compared to national ID card. Cards are not checked against the membership register.

Premiums are deposited in an account at the parish, as are all receipts of the health center. A member of the Development Commission works at the health center as an administrative assistant, and prepares a monthly financial report according to the SPTK model. The report shows cash flows as well as an income statement. Premiums are recorded as a cash receipt, but not as income. No interest is earned on premiums.

# 3. Resource Mobilization: Financial Situation of Plan **and Center**

Table C.3 presents the combined financial situation of the insurance plan and the health center for 1988 and 1989.

The data show that the health center is extremely profitable, with a margin of almost 65% in 1988, and _52%_ in 1989. Insurance premiums and member co-payments do not contribute a 38