Working for the health of the many: How Asher Hasan is bringing insurance coverage to Pakistan’s low-income workers


Growing up in the UK and coming of age in Pakistan, TEDIndia Fellow Asher Hasan observed a vast discrepancy: those with and without access to basic healthcare, and the devastating social consequences of this disparity. He tells TED Blog the story of how he witnessed a single health disaster ruin the hopes of his childhood friends, and how this compelled him to attempt to transform a broken healthcare system with his Pakistan-based health micro-insurance company, Naya Jeevan, which offers not only quality, affordable healthcare to the urban poor, but also the financial and social inclusion the rest of us take for granted.

What does your organization do, and why?

The name Naya Jeevan traces its roots from Sanskrit, and means “new life” in modern Hindi and Urdu. We are committed to bringing low-income families in the emerging world out of poverty by providing them with affordable access to quality healthcare, financial inclusion and socio-economic opportunity. This is important because in many developing countries, catastrophic medical events trigger financial shocks that can decimate low-income families, especially as they have no public support system or safety net.

We collaborate with large, multinational corporations, and cascade our health plan up and down their value chains, essentially targeting low-income businesses and workers — mainly informal workers, domestic workers, factory workers and so on — who are either on the supply side or on the distribution/retail side. We encourage corporate executives and managers to enroll their informal domestic employees.  So, for example, you could be a small-hold farmer supplying milk to a dairy company. You could be a retailer — or a micro-retailer, in some rural village — who happens to be selling a basket of products that includes products by Unilever, P&G, and so on.

For example, Unilever, which is re-launching our domestic worker plan this year, encourages its officers and managers to enroll their domestic staff — their drivers, maids and those workers’ families — in our healthcare program. The premiums are deducted from the payroll of the Unilever manager or executive. Or a corporation might directly finance the healthcare of micro-retailers who are selling their products.

The beneficiary can make co-payments, typically by mobile phone, using mobile financial services now widely available in South Asia. Enrollment in a mobile bank account will soon be part of the health plan we offer, because the people we typically serve are also unbanked. This way, they get the additional benefit of building up a financial transactional history that serves as a de facto credit report for them.

Naya Jeevan addresses socio-economic empowerment as well, tackling the informal system of what I call socio-economic apartheid in many developing countries, where there’s a rich, elitist class, and then there’s the other 90%  that serves them. The rich get so used to this social dynamic that they almost start treating those who work for them like subhumans. I’ve seen many instances where even friends and family, in certain instances, have abused their domestic staff — yelled at them, beaten them, and so on. It’s absolutely disgusting, and it has to stop. Because this master-servant mindset is still pervasive, employee benefits of any type have never before been extended to these informal employees. Prior to Naya Jeevan, nobody ever considered the possibility of giving health insurance to their maid, or to their driver, or to their driver’s child, for example.

There’s a personal hook to this story…

There’s very much a personal hook to the story. My father was born in India, but some of his family members were raised in Pakistan. As a young man, he went to the UK, so I was born and raised there until I was 11, when my dad passed away from cancer. My mom, who was also born in India but raised in Pakistan, brought us back to Karachi, and I finished my schooling there.

When I first travelled to Pakistan, I was really shocked to see the tremendous disparity between rich and poor — between the elites who had unlimited access to resources and opportunity, and everybody else, who didn’t. I was especially shocked about the lack of access to healthcare in comparison to the UK, where everyone, regardless of income, has access to a national health insurance system, and where, relatively speaking, people of varying incomes have a fairly comparable quality of life.

I had direct exposure to this disparity between rich and poor. My mother had a maid with six kids, who were all within my age range, between 8 and 14. I was 11 when I first moved to Pakistan, and grew very close to these kids. Essentially, they were like my siblings. These kids were brilliant, dynamic — and I’m convinced that if they had the opportunity or had they been born in a different country, they could have become leaders of our country. They were far more intelligent than I was, that was for sure. And even though their parents — the maid and her husband, who was a mechanic — were very committed to educating them, there was a glass ceiling, a predefined trajectory that their lives seemed to be taking.

The year I left for the US for college, their father had a stroke. He’d had many, many years of uncontrolled blood pressure. Typically, in the lifestyle of low-income laborers, there’s no concept of preventive health care. It’s very much crisis management. He was taken to a public hospital, not diagnosed in time, not treated in time, and ended up paralyzed and completely incapacitated.

This had a devastating effect on the family. The kids’ mother, a very proud lady, did not want to depend indefinitely on charity, so she made the rather fateful decision to pull all six kids out of school and place them in different child labor situations. Two ended up in houses working as maids, two ended up on the street selling candy, two ended up working in apprenticeships. All six of them ended up being sexually, physically and psychologically abused.

When I returned to Pakistan during my sophomore year for a visit, I was really disturbed to see the profound impact their father’s incapacitation had on their lives. These once dynamic, bubbly kids who were full of life were completely jaded and disillusioned. It was almost like their lives had been sucked out of them and they had simply given up. Rabia, who is three years older than me, said, “You know, I’m the daughter of a maid and I’m destined to be a maid. This is my ‘kismet’ (fate). We can’t expect to be treated like royalty, or to come out of poverty.” Her father’s stroke was the first trigger event that put me on the path of doing what I do.

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