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«Protecting the poor A microinsurance compendium Edited by Craig Churchill Protecting the poor A microinsurance compendium Protecting the poor A ...»

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CBO Community-based organization CCA Canadian Co-operative Association CEO Chief executive officer CETZAM Christian Enterprise Trust Zambia CGAP Consultative Group to Assist the Poorest CHR Community Health Fund (Tanzania) CICS Claims in course of settlement CIDR Centre International de Développement et de Recherche (France) CIF Centre d’Innovations Financières CMF Centre for Microfinance (Nepal) CoP Colombian Peso (currency) CPI Consumer Price Index CRIG Community rural insurance group CRMST Coordination Régional de Mutuelles de Santé de Thiès (Senegal) CSG Commissioners Standard Group CSR Corporate social responsibility CU Credit union CUNA Credit Union National Association (United States) DAC Development assistance committee DFID Department for International Development (United Kingdom) DID Développement International Desjardins (Canada) FAQ Frequently asked questions xviii Table of Acronyms FCFA Franc de la Communauté financière de l'Afrique FDCF Financial Deepening Challenge Fund FFP Fondo Financiero Privado (Bolivia) FHPL Family Health Plan Limited (India) FINCA Foundation for International Community Assistance FSB Financial Services Board (South Africa) GK Grameen Kalyan (Bangladesh) GLICO Gemini Life Insurance of Ghana GNF Guinean Francs (currency) GPS Grameen Pension Scheme (Bangladesh) GRET Groupe d'échange et de recherche technologique (France) GTZ Gesellschaft für Technische Zusammenarbeit (Germany) GUPR Gross unearned premium reserve HIV Human immunodeficiency virus IAIS International Association of Insurance Supervisors IBNR Incurred but not reported claims IBSL Insurance Board of Sri Lanka IC Insurance Commissioner ICD International Claims Diagnostic ICMIF International Cooperative and Mutual Insurance Federation ID Identification IDB Inter-American Development Bank ILO International Labour Organization IRDA Insurance Regulatory and Development Authority (India) IT Information technology ITN Insecticide-treated nets JCCU Japanese Consumers’ Co-operative Union K Kwacha (Malawian currency) KSK Kasagana Ka (Philippines) LIC Life Insurance Corporation of India LKR Sri Lankan Rupee (currency) MAF Mutual assistance fund MBA Mutual benefit association MDGs Millennium Development Goals MFI Microfinance institution MHIB Micro Health Insurance for Poor Rural Women in Bangladesh MHO Mutual health organization MIAN Micro Insurance Association Netherlands MIS Management information system MIX Microfinance Information eXchange MMF Members’ mutual fund MORO Meeting of Reinsurance Officials MOUS Memorandums of understanding MUSCCO Malawi Union of Savings and Credit Cooperatives NACSCU National Association of Credit Unions (Poland) NGO Non-governmental organization NHHP Nsambya Hospital Healthcare Plan (Uganda) NIC National Insurance Company (India) NUCS National Union of Cooperative Societies (Jamaica) OECD Organisation de coopération et de développement économique/Organisation for Economic Co-operation and Development OI Opportunity International OIBM Opportunity International Bank of Malawi PAD Provision for adverse deviation PC Personal computer PCC Protected cell company PDA Personal digital assistants Php Peso (Philippines currency) PHR Partnership for Health Reform (USA) Table of Acronyms xix PML Probable maximum loss POGI PhilHealth Organized Group Interface PPP Public-private partnership PRSP Poverty-reduction strategy paper Q. Quetzal (Guatemalan currency) R South African Rand (currency) RBC Risk-based capital RIMANSI Risk Management Solutions, Inc. (Philippines) ROSCA Rotating savings and credit association RS Reinsurance Services Rs. Rupees (Indian currency) SA South Africa SACCO Savings and credit cooperatives SAIA South African Insurance Association SBS Seguro Basico de Salud (Bolivia) SEEP Small Enterprise Education and Promotion SEWA Self-employed Women’s Association (India) SHG Self-help group SI Seguro Integral (Paraguay) SIDA Swedish International Development Cooperation Agency SK Shashtho Kormis (health paramedics in Bangladesh) SKOK Cooperative Savings and Credit Unions (Poland) SMI Seguro Materno-Infantil (Peru) SOCODEVI Société de Coopération pour le Développement International (Canada) SS Shashtho Shebikas (community health workers in Bangladesh) SSS Society for Social Services (Bangladesh) STEP Strategies and Tools against Social Exclusion and Poverty TA Technical assistance TOT Training of trainers TPA Third-party administrator TPD Total and permanent disability TSKI Taytay Sa Kauswagan (Philippines) TUW SKOK Mutual Insurance Company of Cooperative Savings and Credit Unions (Poland) TV Television TYM Tao Yeu May (Viet Nam) UEMOA Union économique et monétaire d’Afrique de l’Ouest UHC Uganda Health Cooperative UIIC United India Insurance Company, Ltd.

UK United Kingdom UMASIDA Umoja wa Matibabu Sekta Isiyo Rasmi Dar es Salaam UMSGF L’Union des Mutuelles de Santé de Guinée Forestière (Guinea) UNCTAD United Nations Conference on Trade and Development UNDP United Nations Development Programme UNICEF United Nations Children’s Fund US$ United States Dollar (currency) USA United States of America UTM L’Union Technique de la Mutualité Malienne (Mali) VHS Voluntary Health Service (India) WHO World Health Organisation WWF Women’s World Foundation (Colombia) Zl Zloty (Polish currency) ZOC Zone operations centres


Low-income households are vulnerable to risks and economic shocks. One way for the poor to protect themselves is through insurance. By helping lowincome households manage risk, microinsurance can assist them to maintain a sense of financial confidence even in the face of significant vulnerability. If governments, donors, development agencies and others are serious about combating poverty, insurance has to be one of the weapons in their arsenal.

Among low-income populations, risk pooling and informal insurance are not entirely new. Informal risk-sharing schemes have been around for generations, even in some of the most inaccessible places. However, these schemes are usually limited in their outreach and the benefits typically cover only a small portion of the loss. A key aspect of the interest in microinsurance is to explore ways of significantly increasing the number of poor households that have access to insurance while enhancing the benefits.

1 In search of good and bad practices To learn how to extend insurance to low-income households, the CGAP Working Group on Microinsurance launched a research project in 2003 to document the experiences of microinsurance operations around the world and identify good and bad practices.1 This project conducted a series of case studies of insurance companies, microfinance institutions (MFIs) and community-based insurance schemes from around the world to learn about the provision of life and health insurance to the poor. While other types of insurance are also relevant for the low-income market, including property and agriculture insurance, this initiative focused on the two risks – death and illness – that are most frequently identified in demand research.

1 SIDA, DFID, GTZ and the ILO provided support for this project.

2 Introduction

The research focused on organizations that had at least three years of experience and covered at least 3,000 lives in order to assess their results rather than their plans. The project primarily looked at experiences in Africa, Asia and Latin America, and sought microinsurers that employed a variety of

different models and delivery structures, such as:

– Partnerships between insurers and distribution agents such as cooperatives and MFIs2 – Regulated insurance companies that serve the low-income market directly – Healthcare providers offering a financing package and absorbing the insurance risk – Community-based programmes that pool funds, carry risk and manage a relationship with a healthcare provider – Government-sponsored or -subsidized insurance schemes – Self-insuring MFIs that assume the risk of offering insurance to their clients The potential sample of microinsurance schemes that met these criteria is not extensive. Many microinsurance schemes are new or the products were only recently introduced. Most microinsurers have focused on the simplest insurance products to manage, especially credit life. After that, the volume of available microinsurance reduces as product management complexity increases. To some extent, the products most in demand in this under-served market, such as health insurance, are precisely those that are the least available.

Nevertheless, a number of appropriate organizations were identified and contacted, and they agreed to go under the microscope of (largely) external analysts. Most case studies were conducted by two-person teams that consisted of an insurance expert and a development professional who together could consider both the technical and the social aspects of extending insurance to the poor. The teams all used the same research frameworks and analysed their findings using a common case study outline to facilitate an analysis of lessons across the microinsurance schemes.3 2 Throughout this book, the term microfinance institution is used to refer to any formal or semi-formal organization that has savings and/or credit transactions with low-income households, which includes microcredit NGOs, credit unions or savings and credit cooperatives (SACCOs), regulated microfinance banks and others. According to the Microcredit Summit (www.microcreditsummit.org), at the end of 2004, there were more than 3,000 MFIs around the world providing credit and other services to 92 million low-income people, of whom 66 million were among the poorest when they took their first loan.

3 There are a few exceptional case studies, structured differently in order to consider different perspectives on microinsurance. For example, ICMIF (2005), Lessons learnt the hard way, analyses nine insurance companies, current or former members of the International Cooperative and Mutual Insurance Federation, which all experienced difficulties in one way or another; their experiences are documented anonymously. Similarly, Leftley (2005) looks at microinsurance experiences from the perspective of a technical assistance provider, Opportunity International, which has supported numerous MFIs to negotiate partnerships with insurance companies.

Introduction 3

In all, twenty-five case studies were conducted, analysing the experiences of more than 40 organizations that are involved in microinsurance either as a risk carrier, distribution channel or both, as summarized in Table 1. Examples from the case studies are sprinkled liberally throughout this book to illustrate lessons and recommendations. Instead of repeating the bibliographic references from these case studies, readers are instructed to take note that whenever there is an uncited reference to these microinsurance providers, the experience is drawn from the associated case study. Appendix I specifies which schemes are covered in which case studies.4 This book synthesizes lessons drawn from these experiences. These lessons were analysed by 38 authors with a range of backgrounds (see Appendix II for the authors’ biographies) – including academics and actuaries, insurance and development professionals – most of whom participate in the CGAP Working Group on Microinsurance. The conclusions they reach and recommendations they make reflect their personal opinions and are not general recommendations from the Working Group as a whole.

Some of the findings remain inconclusive. Observant readers are likely to notice differences of opinion on a range of issues, including the usefulness of credit life insurance, the role of reinsurance, the appropriateness of endowment polices, the benefits of composite products, the enthusiasm of commercial insurers for the low-income market, the promotion of informal or unregulated insurance schemes, exclusions for pre-existing conditions, and many more.

By and large, however, despite the fact that this book covers different insurance products delivered by a variety of institutional arrangements across four continents, a clear picture of microinsurance is beginning to emerge, particularly regarding the challenges of insuring the poor as well as many of the solutions. The findings reveal that microinsurance is indeed viable, and even profitable under certain circumstances, but a number of difficulties must be overcome for it to succeed.

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