Survey on Limitations and Challenges for Access to Social Security Scheme and Social Health Insurance for the Marginalized Households

The programs were initiated in 2016 as a pilot project in three districts, with the objectives of providing social security benefits to eligible individuals, including old age pension, disability pension, and survivor's pension, as well as medical and maternity benefits to registered members. The study's main objectives are to identify the limitations and challenges for access to social security scheme and health insurance, to understand and communicate problems and ways of solution to local government in working areas, and to assess the level of knowledge regarding social security and health insurance. The study is qualitative and quantitative, with 30 key informants purposively selected for in-depth interviews. The results of the study reveal multiple interrelated limitations and challenges, including poor educational awareness, promotion, and marketing, reimbursement delay, lack of trust, weak commission and incentives, lack of coordination between insurance board and district health entities, lack of support of local government on SHIP and prioritizing poor, lack of human resources, poor quality health service, poor identification problems, poverty, problem of citizenship and birth registration certificate, banking service far from community, and geriatric and disable unfriendly banking service. Participants also reported possible solutions to combat these implementation problems, including increasing educational awareness, improving human resource management in health facilities, making availability of medicine, lab service, radiology, and specialization service, providing more appropriate salary, incentives, commission, and motivational support, political support, integrating different programs into the insurance scheme, early evaluation of service sites before implementing the scheme, inline insurance board with other health-related government stakeholders, allocating budget prioritizing poor during Annual work planning and budgeting, making criteria identifying of the impoverished and strict implementation, providing subsidy or making free the premium to ultra-poor, finding out readily solve the citizenship and birth registration issue, and mobile temporary banking service. The study concludes that the National Health Insurance Program and Social Security Scheme are Nepal's most ambitious programs, ensuring their effective implementation is necessary. Multiple sectors, including political parties, government program managers, stakeholders, and local authorities, need to work better to make the national health insurance program and social security scheme successful. The Health Insurance Board, Federal, and local government should take special initiative to root out genuine problems. The study's findings are based on the analysis of quantitative and qualitative data, including in-depth interviews with key informants, focus group discussions, and survey data. The study's results highlight the need for improved awareness, education, and promotion of the social security scheme and health insurance program, as well as the need for better coordination and support from local government and other stakeholders. The study's findings and recommendations have implications for the effective implementation of the National Health Insurance Program and Social Security Scheme in Nepal, and highlight the need for improved awareness, education, and promotion of the programs, as well as better coordination and support from local government and other stakeholders.