Submitted by Angie Tyler, CRS international development fellow based in Benin
March 26, 2015
In Benin, CRS has been piloting a health microinsurance (HMI) product since March 2012. We have been delivering it to members of Savings and Internal Lending Communities (SILC) through NSIA (a local insurance company) and Caritas Natitingou in northern Benin.
From March 2012 to December 2014, coverage has nearly doubled from 715 to more than 1,300 SILC members and their dependents. The project team recently conducted an evaluation of progress. The evaluation included 12 SILC focus groups to learn more from their experiences in using the health microinsurance product.
Delivering Health Microinsurance through Savings and Internal Lending Communities: An Evaluation of CRS' Experience in Benin
The focus group discussions highlighted the relevance of HMI to savings group members. Members noted that they feel less stress and anxiety about illness. Nekima, a member of the Tetoma SILC group, told us that “[with HMI,] health is no longer a major concern for us and for our children.”
The evaluation notes a higher likelihood that HMI participants will seek care at the first sign of illness. Pascaline, a participant in a focus group, mentioned, “Thanks to HMI, we no longer let an illness become serious before going to the clinic, and we don’t have to worry about paying large fees.”
Finally, the groups recognized the lower out-of-pocket health costs. Pascaline commented, “We pay in advance for our health costs. Health services can be expensive and saving up in advance is much better than paying up front. We pay 3,480 FCFA [US$7] for the year and [with the program] we can afford health care costs, even if they are as high as 40,000 FCFA [US$80].”
Opportunities for improvement
The evaluation did note some negative aspects of the health microinsurance delivery. Jean-Pierre, the Caritas Natitingou project coordinator, identified that there is a need to improve communication with SILC groups and prospective participants. Though Caritas field agents hold regular “learning conversations” about HMI with the SILC groups, it is unclear how effective this has been at generating interest and at recruiting more members. Better communication might involve designing more engaging marketing materials about HMI and including mechanisms to gauge whether they have been effective.
Caritas Natitingou staff spoke of a need to adjust the product design to better meet beneficiary needs. The current HMI product excludes certain conditions, which creates confusion and frustration for SILC users. Therefore, a dialogue is needed to identify how the HMI package of services can be expanded while still offering an affordable product.
Finally, the evaluation found a need to motivate health centers to work with the insurance provider. Right now, overworked and understaffed health centers in rural areas are hesitant to take on HMI as they see it more in terms of adding to their workload than in expanding services to the poor. At the same time, offering a subsidy to encourage health centers to accept the use of HMI would threaten the initiative’s sustainability. This latter issue raises a key challenge. It calls for the CRS microfinance community to identify cost-effective strategies to motivate and incentivize the HMI stakeholders and ensure the initiative’s long-term success.
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