SAMPADA
At Sampada we are building a bottom-up model of health financing that understands the complexity of lending for health in retail, and crafts a client journey that understands the risks on ground and builds the rails to manage them — and it does so with its heart in the right place.
Our partnership with Uplift Mutuals brings the health focus into the model, where medical underwriting, navigation support, follow-up and access to primary care are all woven into a seamless business-with-a-heart design.
Our specially designed wallets bring savings for specific health events with prevention integrated into them, and our partnership for mutual health microinsurance shows that we want to build viable lending and not a debt trap.
Every member takes shares and holds a vote. Borrowers and shareholders are the same people.
Origination, collections and closure each run on a numbered SOP, versioned and reviewed six-monthly.
Clinical, credit, quality check and disbursement sit with four different teams.
2017, at Thakurli East, Thane. Reg. TNA/DDR/RSR/CR-1747/2017.
A household in a health crisis needs three different things, often in the same week: money it has already put aside, money it can borrow against a bill, and cover so the next event does not start the cycle again. A member gets all three on one membership, at one counter, from people she already knows.
Goal-based doorstep savings for expectant mothers and mothers of children under five, to carry the cost of antenatal care, a safe delivery, post-natal care and the child's first years. Every wallet opens with a written month-by-month financial plan and a first check-up with the hub doctor.
For planned and unplanned treatment, typically sanctioned within a day of the file clearing. The alternative in these settlements is a moneylender at 120% a year unsecured, or 30–60% against pledged gold. Repayment is monthly, on a date the member sets herself.
Community-held cover carried with Uplift Mutuals and embedded with the medical loan, so protection begins during the crisis that brought the household in rather than after it. Claims are decided by a Benefit Management Committee of elected women members. For most members it is their first insurance of any kind.
Lending for health in retail was never easy. Our learning curve of 24 months has taught us that credit underwriting alone won’t work for unsecured loans to individuals.
We improved our diligence by bringing in medical underwriting to qualify for the lending, where we evaluate the medical costs similar to an insurance claim to understand if the costs are within range.
Then comes the health loan training through the home visit, where the terms and conditions of the lending are not only verbally explained to all the loan stakeholders but also given in writing to the client, to maintain transparency and avoid mis-selling.
Credit Score Check, Medical Underwriting and Home Visit are the three checks that have made lending — and consequently repayment — possible.
About two in three applications do not become loans. Most were not turned away. They were sent to a government hospital, helped to claim a scheme they were already entitled to, or given a lower price we had agreed with a hospital — and the family paid nothing.
Our business plan expected to lose 3% of the book, rising to 5% by year four. So far it is 1.25%.
No bank, no NBFC and no microfinance lender we know of writes unsecured credit against a medical bill for these households. That means there is no standard we could copy and no one to benchmark against. Every check on this page came from something that went wrong, or nearly did, and was then written into the procedure.
That is also why the procedures carry version numbers and a six-month review. We expect to keep changing them. What is written here is where we have reached after twenty-four months, not where we think we will stop.
Most of these loans have nothing pledged against them, so there is nothing to take back. We cannot hand the risk to anyone else either. What we can do is bring it down in stages, so that what reaches the book is only what we could not take out earlier.
A second doctor, not the one at the hub, checks whether the treatment is needed and whether the price is fair, and says how much the loan should be. Getting the hospital price down, or getting a government scheme to pay, means we lend less or nothing.
Credit record, income, what the family owns, and what the officer sees at the house. The Branch Manager can refuse the loan on repayment ability alone, however strong the medical case is.
Compulsory savings accumulate through the tenure and can be transferred against the outstanding at closure. Two post-dated cheques are held on the disbursement account. Guarantors are verified at their own homes — one for loans up to ₹15,000, living within about 300 metres; two above that.
Insurance comes with the loan, so if someone is admitted again while the loan is running, there is cover instead of a missed payment. When illness is the reason for a delay, our team helps the family put in the claim.
When the person who earns is in hospital, the money coming in falls and the money going out rises in the same week. No process changes that. Some loans will go bad. Some members will need a late charge waived or a new date agreed, and our rules allow for both, decided by the Chairperson and written down.
Our business plan expected to lose 3% of the book, rising to 5% by year four. So far the four steps above have held it to 1.25% at 30 days. That difference is what the doctor’s step has bought us so far. It is a number we have to keep earning, not one we can assume.
Seven health services run alongside the lending — teleconsultation and health camps, a 24×7 doctor-led helpline, navigation, discounted medicines and investigations, a negotiated provider network, access to public entitlements and chronic disease management. All of them are run by Uplift Mutuals, who have worked in these settlements since 2004, and all of them write into the same member record we make the loan decision from.
Eighteen posts across fourteen roles, about 12.6 full-time equivalents. Four posts are doctors — hub, helpline, triage and provider-networking — totalling 1.6 FTE of physician time per hub, provided through Uplift Mutuals. Clinical underwriting therefore costs the cooperative under two doctor-equivalents per hub.
| Role | FTE | Posts |
|---|---|---|
| Health Financing Officers | 100% | 4 |
| Community Health Workers | 100% | 2 |
| Encoders | 100% | 2 |
| Health Wallets / Savings Officer | 100% | 1 |
| Hub Doctor | 100% | 1 |
| Hub Manager | 100% | 1 |
| Call Centre Officer | 25% | 1 |
| Medical Helpline Doctor | 20% | 1 |
| Medical Triage Doctor | 20% | 1 |
| Provider Networking Doctor | 20% | 1 |
| Area Manager — Emergency Medical Loans | 20% | 1 |
| Area Manager — Wallets & Insurance | 20% | 1 |
| Accounts Officer | 20% | 1 |
| Software Manager | 10% | 1 |
| Total per hub | 12.6 | 18 |
FTE means full-time equivalent. The hub has eighteen posts, but several are part-time or shared across hubs — a Health Financing Officer is at the hub full time, the Software Manager for a tenth of the week — so eighteen posts come to about 12.6 people’s worth of time.
A lender with no doctor cannot check an illness. A doctor with no loan book cannot help when the family has no money. A helpline with neither can only give advice. The hub works because savings, credit, cover and care are at the same counter, written on the same member file, and handled by people who see the same families week after week.
It is also why we only open where Uplift Mutuals has already been working for years. The hub opens where people already need it, and where they already know the doctor.