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WORKSHOP ON COUNTRY ANALYTIC WORK

WORKSHOP ON COUNTRY ANALYTIC WORK. Micro-insurance in Less Developed Countries. AFD’s objective :. Support to the development of health insurance in low-income countries, specially in Sub-Saharan Africa

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WORKSHOP ON COUNTRY ANALYTIC WORK

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  1. WORKSHOP ON COUNTRY ANALYTIC WORK Micro-insurance in Less Developed Countries

  2. AFD’s objective : Support to the development of health insurance in low-income countries, specially in Sub-Saharan Africa (the results of the study served as an input at the workshop on « health insurance as a way to improve access to health care », organized by WBI, Joint Africa Institute and the French Cooperation, with the collaboration of WHO, ILO, GTZ and CIDA)

  3. 3 perspectives :  capacity of private insurance to extend coverage to low-income groups of population  capacity of micro-finance organizations to support the development of micro-insurance  capacity of large development NGOS to include health insurance into their portfolio of activities

  4. A/ SOUTH AFRICA : CAN PRIVATE INSURANCE COVER LOW-INCOME WORKERS ? CONTEXT AND ISSUES : • 7.5 million formal employees, mostly civil servants, are currently not covered by health insurance (medical schemes)

  5. Willingness of the government to force private insurance into offering coverage, but no incentives proposed • Low quality of public health services, both at primary and hospital levels • Contract with private providers which offer low cost care based on capitation

  6. RESULTS : THREE MAIN OBSTACLES • The cost of health insurance premium is too high (around 15% of the income) Only 1.5 to 2 millions (out of 7) chose to subscribe • Benefits are not attractive enough : they cover only primary care in private facilities, excluding access to secondary and tertiary care of good quality • Health care is, in practice, provided free of charge in public health facilities

  7. B/ CAN MICRO-FINANCE PROMOTE THE DEVELOPMENT OF MICRO- INSURANCE ? Experience from Mali (NYETA MUSOW et KENEYA SO) CONTEXT : • Large experience of mutual health societies in Mali, of which development is guided through UTM (Technical Union of Mutual societies) • Very slow development in terms of coverage (30 000 insured in a country of 11 million inhabitants)

  8. Attempt to look at groups of population already organized on an economic basis, especially through micro-finance organizations • Analysis of Nyeta Musow achievements NYETA MUSOW • 12,000 potential women beneficiaries • 1,700 covered after one year • Benefit package : complete pregnancy-delivery care (including complications) and hospital care

  9. Beneficiary’s contribution (women + under five children) = about 3 USD/year • Achievements : - women satisfaction - benefits are largely covered by contributions • Challenges : - extending coverage among beneficiaries of the micro-finance organization as well as other groups - problems of contracting with public health facilities - low quality of care in public facilities, which are not attractive to beneficiaries

  10. PERSPECTIVES • Creation of a health center owned by the mutual society, open to members as well as to others • improvement of the benefit package : coverage of primary care with co-payment • increase in the number of beneficiaries, through coverage of husbands and families who are non-members of the micro-finance organization

  11. C/ CAPACITY OF LARGE NGOS TO DEVELOP MICRO-INSURANCE EXPERIENCE FROM BENGLADESH (BRAC, GRAMEEN KALYAN AND DSK) CONTEXT : • Micro-insurance added to a large portfolio of activities, including health care programs and activities

  12. Large coverage of micro-insurance : BRAC (34 500), GK (262 000) and DSK (80 000) • Despite low benefits package (prevention, pregnancy delivery, and primary care with co-payments)

  13. COMMON FEATURES : • Development of micro-insurance benefits from close ties with beneficiaries • Specific targeting of vulnerable groups (women and indigents) • Financial guaranty provided through other sources of revenues • Provision of « in house » care

  14. Effective management, but careful supply of insurance products • Mitigated results in terms of coverage of the ultra poor

  15. CONCLUDING REMARKS I - Contribution of micro-insurance to the improvement of health services : - effectiveness of micro-insurance is dependant upon quality of care - it increases when there is a coordinated support to health services II - Private sector alone cannot extend coverage to low-income groups, but can play a role as a management agent.

  16. III - Micro-insurance has many interests in using economic networks developed by micro-finance organizations. However, they represent two different businesses which are bound to split.

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