PROJECT REPORT

ON
Microinsurance : The Role of Community Based Insurance and financial
sustainability.

UNDER SUPERVISION OF:

SUBMITTED BY:

1|Page
 CERTIFICATE
This is to certify that ___________ a student of IMT – CDL Ghaziabad has
completed major project work on MICROINSURANCE under my guidance and
supervision.

I certify that this is an original work and has not been copied from any source.

Signature of Guide _____________

Name of Project Guide

2|Page
 ACKNOWLEDGEMENT

I would like to express my gratitude to all who have shared their valuable time and
helped me directly or indirectly in the preparation of this project.
I am thankful to my project guide ___________, who guided and helped me
through the course of the development of the project.
I would also express my sincere thanks to all my friends and my seniors for their
timely support in the analysis part of this project report

XXXX

3|Page
 CONTENTS

1. Introduction 5
 What is Microinsurance 5
 A historical perspective
1) The Micro insurance: History 8
2) Products and Implementation Model 9
10
2. Literature Review 11
 Features of Microinsurance 12
 IRDA Regulations for Microinsurance, 2005 13
 Financial Aspects: Pricing 12
14
3. Objective of study 16-17
4. Methodology 18-19
5. Main Report 20
 Chap 1: The Problem and the Target groups: Why 21
microinsurance is different?
 Chap 2:Assessing the Impact of Community Based 27
Programs
 Chap 3: What should be the Qualitative and 29
quantitative standards?
 Chap 4: What are the best possible indicators to assess 32
Microinsurance scheme’s financial and sustainable
aspects?
 Chap 5: The Reinsurance 34
 Chap 6: The Conclusions Drawn. 36
 Chap 7: Recommendations 40
6. References 43-44

4|Page
 INTRODUCTION

5|Page
What is Micro insurance?

Many problems arise in the path of development of the developing countries. There are
structural constraints like poor infrastructure and low investment rates. And then there are, social
issues such as poverty, hunger, illiteracy, high mortality rate, prevalence of epidemic diseases,
unemployment, etc. hamper human development.
Lack of finances contribute to the majority of problems. There is a general view that there exists
a strong positive relationship between the financial development and economic growth. Hence,
the governments try hard to develop and formulate policies that could lead to a sound financial
environment facilitating development in infrastructure, modern education, industrial
productivity, and employment.
One of the key problem arise to provide financial security to the poor and vulnerable. They are
the ones who are “Financial Excluded”, i.e. in which the poor and vulnerable groups of people
are excluded from financial services like credit, savings, insurance, etc., and so financial
inclusion, is considered. And for strong financial development of the economy it is seen as a pre-
requisite to alleviate this poverty.
Financial institutions today compete to deliver services to these previously unbanked people.
This workforce comprise the informal work-force and farmers. This is the population that is
highly vulnerable to trouble times like:
 health shocks
 life loss
 livestock loss
 catastrophic events
 Agricultural loss, etc.

Here is when the Micro Insurance comes to scene.

The draft paper prepared by the Consultative Group to Assist the Poor (CGAP) working group
on micro-insurance defines micro-insurance as:
“Microinsurance is the protection of low-income people (those living on between
approximately $1 and $4 per day) against specific perils in exchange for regular premium
payment proportionate to the likelihood and cost of the risks involved.”

6|Page
According to Dror and Jacquire (1999)
“micro” refers to the level of society where the interaction is located, i.e. smaller than national
schemes, and “insurance” refers to the economic instrument like self-help schemes for social
health insurance. Virginia et al. (2012) define it as an arrangement that offers financial protection
to the poor against specific risks, in exchange for premium payments. Moreover, it differs from
general insurance on the grounds of transaction sizes, products, regulation and target audience.
The informal and unorganized sector as defined by IRDA includes:
(i) self-employed workers such as agricultural labourers, beedi workers(beedi an unfiltered
cigarette made by rolling tobacco in a dry leaf of a particular plant; it is an inexpensive substitute
for cigarette used mostly by the poor smokers), brick workers, carpenters,
cobblers, construction workers, handicraft artisans, handloom workers, lady tailors, leather and
tannery workers, street vendors, primary milk producers, rickshaw pullers, salt growers,
sericulture workers, sugarcane cutters, washerwomen, working women in hills, or such other
categories;
(ii) informal sector includes small scale, self-employed workers typically at a low level of
organization and technology, with primary objective of generating employment and income, with
heterogeneous activities, with the work mostly labor intensive, having often unwritten and
informal employer-employee relationship;
(iii)economically vulnerable or backward classes persons who live below poverty line; and (iv)
other categories of persons include persons with disabilities and who may not be gainfully
employed, as well as persons who tend to the disabled.

7|Page
Insurance in India: A historical perspective
In India, insurance has a deep-rooted history. Insurance in various forms has been mentioned in
the writings of Manu (Manusmrithi), Yagnavalkya (Dharmashastra) and Kautilya (Arthashastra).
The fundamental basis of the historical reference to insurance in these ancient Indian texts is the
same i.e. pooling of resources that could be re-distributed in times of calamities such as fire,
floods, epidemics and famine. The early references to Insurance in these texts have reference to
marine trade loans and carriers' contracts.
Insurance in its current form has its history dating back until 1818, when Oriental Life Insurance
Company[3] was started by Anita Bhavsar in Kolkata to cater to the needs of European
community. The pre-independence era in India saw discrimination between the lives of
foreigners (English) and Indians with higher premiums being charged for the latter. In 1870,
Bombay Mutual Life Assurance Society became the first Indian insurer.
At the dawn of the twentieth century, many insurance companies were founded. In the year 1912,
the Life Insurance Companies Act and the Provident Fund Act were passed to regulate the
insurance business. The Life Insurance Companies Act, 1912 made it necessary that the
premium-rate tables and periodical valuations of companies should be certified by an actuary.
However, the disparity still existed as discrimination between Indian and foreign companies. The
oldest existing insurance company in India is the National Insurance Company, which was
founded in 1906, and is still in business.
The Government of India issued an Ordinance on 19 January 1956 nationalizing the Life
Insurance sector and Life Insurance Corporation came into existence in the same year. The Life
Insurance Corporation (LIC) absorbed 154 Indian, 16 non-Indian insurers as also 75 provident
societies—245 Indian and foreign insurers in all. In 1972 with the General Insurance Business
(Nationalization) Act was passed by the Indian Parliament, and consequently, General Insurance
business was nationalized with effect from 1 January 1973. 107 insurers were amalgamated and
grouped into four companies, namely National Insurance Company Ltd., the New India
Assurance Company Ltd., the Oriental Insurance Company Ltd and the United India Insurance
Company Ltd. The General Insurance Corporation of India was incorporated as a company in
1971 and it commence business on 1 January 1973.
The LIC had monopoly till the late 90s when the Insurance sector was reopened to the private
sector. Before that, the industry consisted of only two state insurers: Life Insurers (Life Insurance
Corporation of India, LIC) and General Insurers (General Insurance Corporation of India, GIC).
GIC had four subsidiary companies. With effect from December 2000, these subsidiaries have
been de-linked from the parent company and were set up as independent insurance companies:
Oriental Insurance Company Limited, New India Assurance Company Limited, National
Insurance Company Limited and United India Insurance Company Limited.

8|Page
The Micro insurance: History
In India, a few micro-insurance schemes were initiated, either by nongovernmental organizations
(NGO) due to the felt need in the communities in which these organizations were involved or by
the trust hospitals. These schemes gained pace partly due to the development of micro-finance
activity, and part of it is mandatory obligation as se t by IRDA (IRDA 2000). As a result, we can
see, micro-finance institutions (MFIs) and NGOs are negotiating with the for-profit insurers for
the purchase of customized group or standardized individual insurance schemes for the low-
income people. Although the reach of such schemes is still very limited their potential is viewed
to be prominent.
The insurance regulatory and development authority (IRDA) defines rural sector as consisting of
(i) a population of less than five thousand,
(ii) a density of population of less than four hundred per square kilometer, and
(iii) More than twenty five per cent of the male working population is engaged in agricultural
pursuits.The categories of workers falling under agricultural pursuits are: cultivators, agricultural
labourers, and workers in livestock, forestry, fishing, hunting and plantations, orchards and allied
activities.
The social sector as defined by the insurance regulator consists of (i) unorganized sector (ii)
informal sector (iii) economically vulnerable or backward classes, and (iv) other categories of
persons, both in rural and urban areas.
The rural obligations are in terms of certain minimum percentage of total polices written by life
insurance companies and, for general insurance companies, these obligations are in terms of
percentage of total gross premium collected. It is important to highlight few points
First, the social and rural obligations do not necessarily require (cross) subsidizing insurance.
Second, these obligations are to be fulfilled right from the first year of commencement of
operations by the new insurers.
Third, there is no exit option available to insurers who are not keen on servicing the rural and
low-income segment.
Finally, non-fulfillment of these obligations can invite penalties from the regulator. In order to
fulfill these requirements all insurance companies have designed products for the poorer sections
and low-income individuals.

9|Page
Products and Implementation Models

Micro-insurance comprises different products like:

1. Health
2. Life
3. Crop and
4. Livestock insurance

Implementation models include:

1. Full-Service Model
2. Partner-agent model
3. Provider-driven model and
4. Community-based model

The project work specifically focuses on the contribution and financial sustainability of
Community based model.

10 | P a g e
 LITERATURE REVIEW

11 | P a g e
Features of Microinsurance
According to Institute of Actuaries of India, Microinsurance is predominantly defined as:

• insurance accessed by low‐income people

• provided by a variety of institutions
• run in accordance with generally accepted insurance Core Principles
• funded by premiums
• a financial service, besides savings, credit and cashless payments which
the poor use to manage their risks
• Insurance targeting those that are “ignored by mainstream commercial
insurance and social insurance schemes” that is, “persons who do not have
access to benefits” often because they are not part of the formal sector or
have no access to benefits normally provided through formal employment.
• closely linked with other financial services via clients,products, insurers,
intermediaries, policy decision makers, regulation and national strategies
• a strategic tool for different development agendas (pro‐poor financing,
agricultural and rural development, social security development,
mitigation of climate change)

12 | P a g e
IRDA guidelines

According to Access to Insurance Initiatives,

On 13th March 2015, the Insurance Regulatory and Development Authority (IRDA) India
introduced the revised Microinsurance Regulation (2015) which supersedes the existing
regulations introduced in 2005. Withdrawal of all existing microinsurance products which do not
meet the stipulations of the new regulation was to be done by January 2016.

The new regulation makes a number of important amendments including to the guidance on
product development, adjusting the risk coverage levels, permitting more entities to distribute
microinsurance products and the training of microinsurance agents and their specified personnel.
It also introduces a change in the existing compliance norms for insurance companies which had
been established under the Rural and Social Sector Obligations (2002). Of particular note is the
introduction of a new product category called micro variable life, a hybrid product category
which offers the customer the benefit of systematic contribution with term insurance coverage.

With respect to distribution, the new regulation enlarges the current range of institutional
intermediaries to include Reserve Bank of India (RBI) regulated Non-banking Financial
Companies, District Cooperative Banks, Regional Rural Banks and Urban Co-operative Banks,
Primary Agricultural Cooperative Societies registered under the Cooperative Societies Act, and
Business Correspondents who have been appointed in accordance with the RBI Financial
Inclusion Guidelines.

In connection to training, the new regulation specifies a mandatory training period of 25-hours
for individuals employed as micro insurance agents (”agents and their specified persons”).
Individuals selling non-life products to micro and small enterprises now need to undergo an
additional 25 hours training. In addition, every micro insurance agent or sales person needs to
undergo refresher training for half of the specified mandatory training time at the end of 3 years.
In terms of risk coverage levels, the new regulation sees an increase in the maximum limits
across previously specified risk coverage levels. The earlier limits ranged between INR 5,000
(approx. USD 78) and INR 50,000 (approx. USD 780) depending on the type of product. The
new limits are set as follows: for life INR 200,000 (approx. USD 3,100), for non-life INR
100,000 (approx. USD 1,560) and for group health INR 250,000 (approx. USD 3,900). This
should enable insurers to target consumers across the lower middle income segment, which
remains presently largely uninsured on account of the unattractive (low) coverage limits and
poor access.
The new regulation also sees the introduction of a new product category, Micro Variable Life
Insurance Products, a hybrid insurance solution comprising of systematic contributions with
term insurance cover. This product has a lock-in period of five years during which policy
surrenders are not allowed, but partial withdrawals may be permitted.
Lastly the new regulation no longer recognizes policies sourced as part of social security
schemes as microinsurance, and prohibits insurance companies from including them as part of
their reporting on their rural and social sector mandatory targets.

13 | P a g e
Financial Aspects: Pricing

As with conventional insurance, the main objective in pricing microinsurance products is to

derive rates that will sufficiently cover all costs and generate a “fair” return for all partners
involved. In the absence of permanent subsidies, even not-for-profit programmers must produce
a surplus to finance future growth and to build up contingency reserves for unexpected claims
fluctuations not covered by reinsurance.
In general, premium rates should be set so that the actuarial present value of all premium
collected over the duration of coverage will be sufficient to fund the expected present value of
future claims and expenses incurred on the same block of business and still generate a
“modest” surplus. In theory, the projected interest income should also be part of the present
value calculation. Since the effect of interest increases with product duration due to mathematics
of compounding, it is not as significant for pricing short term products, especially those without
a savings component.

Main concern arises as interest income is usually minimal, setting the premium rates
correctly is paramount because it is usually not possible to revise them until renewal nor
is it very prudent from a marketing perspective to increase rates shortly after launching a
new product. Even if the insurer realizes the premium is insufficient after a few weeks,
insurance regulations in most countries prevent rate increases for existing insurance in
force. Premium rates can only be revised once an insurance policy term ends and it is up
for renewal. This poses a serious risk (not only in microinsurance) for longer duration
products and is one of the main reasons why short term insurance durations are still
predominant in microinsurance.

What can be the Consequences of gross pricing errors:

It is important to understand the possible consequences of errors in the pricing of a
microinsurance product. These errors affect not only the financial results of the provider, but also
the emerging microinsurance market.
If the premium is set too high:
 Low take-up will likely result because the market perceives the product as unaffordable and
constituting poor value for low-income households with limited financial means. If take-up is
low and does not increase over time, the required scale is not achieved and sustainability cannot
be attained.
 Anti-selection often increases because an over-priced product will only attract clients who
continue to see value in it, i.e. those more likely to claim. Lower risk insurance buyers will
gravitate towards better value products if these are available or they may not buy insurance at all.
If the premium is set too low:
 Premiums collected will not be sufficient to cover claims and other expenses, leading to poor
financial outcome for the provider.
 Large price increases may be required in the short term to correct inadequate pricing and
maintain solvency. As a result, many of the current customers will not renew their coverage.
Furthermore, the market will likely lose confidence in the microinsurance provider. This
happened to Karuna Trust in India which provided a highly subsidized health insurance product
in order to achieve wide market participation quickly. However once the subsidy was removed,

14 | P a g e
he renewal rate abruptly dropped to 10 per cent. The impact of large price increases would
likely be similar in most other contexts.
 Insolvency (in addition to unsuitable product design and/or poor operational implementation)
may lead to the discontinuation of the product. As a result, the target population may turn away
from insurance as a financial risk management tool and regaining their trust may take as long as
a generation. Adapted from Churchill et al, 2012, chapter 21, for new products, a good strategy is
to calculate the rate as accurately as possible and then build in a modest margin (10-20 percent)
to make sure that there is only a slim chance of future rate increases. If the
calculated rate turns out to be near correct, this strategy will permit faster surplus build-up.
Furthermore, it will allow for a benefit increase after ample surplus build-up which will be very
positively received by the market.

After realizing that premium rates are insufficient, some programs introduce restrictive measures
such as sub-limits or waiting periods to reduce claims costs rather than raise rates. These may be
applied to all business in force in some cases (such as some mutual) or only to new sales. While
this not desirable it may be more palatable than raising rates in certain situations. As stressed in
Box 2.3, setting rates correctly is essential. Inadequate rates could threaten the solvency of
smaller programmer especially if they are still new and with few resources. On the other hand, an
overpriced product will normally lead to lower sales volumes than projected, especially when the
purchase decision is voluntary, and when the premium is of a magnitude that seriously competes
with other spending decisions of low income earners. Lower sales in turn may cause expense
overruns – that is, the actual expenses incurred by the insurer and other participating parties in
developing, distributing and administering microinsurance exceed the corresponding premium
components projected to cover these expenses.

15 | P a g e
 OBJECTIVE OF THE STUDY

16 | P a g e
The idea of the project is to understand the community based implementation model of
insurance.
The idea arise from a curious question:
o Why a sizeable population of the society lacks the self-reliance despite the high financial
sector development?
o What are the key features of Micro Insurance, Community based in particular?
o How community based model is helping in sustainability?
o What other things can be involved for achieving financial sustainability and thus high
future growth for this model?

The project is an attempt to concentrate on the aspects of micro-insurance to propose it as an

innovative dimension of financial inclusion in developing countries. The motivation of the
research idea dwells on its huge potential of managing risks of poor with grounds up approach in
the developing countries.

17 | P a g e
 METHODOLOGY

18 | P a g e
All the data and information has been collected by doing library research, magazines, articles,
visiting bank’s official websites and various other web pages.
The following systematic study was done to understand and contribute to the topic:
Chap 1: The Problem and the Target groups: Why microinsurance is different
Chap 2: Assessing the Impact of Community Based Programs
Chap 3: What should be the Qualitative and quantitative standards?
Chap 4: What are the best possible indicators to assess Microinsurance scheme’s financial
and sustainable aspects?
Chap 5: The Reinsurance
Chap 6: The Conclusions Drawn.

Chap 7: Recommendations

19 | P a g e
 MAIN REPORT

20 | P a g e
 Chapter 1: The Problem And The Target Groups: Why Microinsurance Is Different?

Problem1: How can we define Microinsurance precisely?

According to Dror and Piesse (2014): “The definition of microinsurance can be split into its two
aspects: Firstly, what constitutes insurance and secondly, what is micro in microinsurance.”
What constitutes the Insurance?

From business perspective: Insurance is a contract, represented by a policy, in which an

individual or entity receives financial protection or reimbursement against losses from an
insurance company. The company pools clients' risks to make payments more affordable for the
insured. Insurance policies are used to hedge against the risk of financial losses, both big and
small, that may result from damage to the insured or her property, or from liability for damage or
injury caused to a third party.

In general Insurance is a concept which involves a contract under which an insurer shall pay
specific pre-defined compensation when financial damages are caused by pre-defined cost-
generating events, in exchange for up-front payments of a premium by the insured. In principle,
the premium should reflect the fair cost of the risk transferred from insured to insurer, and the
calculation should be based on the magnitude and the frequency.

We can see Insurance as a trade off between an unaffordable (or large) loss, which is uncertain,
and an affordable loss, which is certain (the premium). Friedman and Savage (1948).

Insurance thus primarily aims to “smooth” fluctuations in the income of the insured that are
caused
by exogenous, unpredictable changes.

Quoting Dror and Piesse (2014) :

“The assumption underlying this smoothing is that

the insured gains utility from experiencing two years of average consumption
rather than experiencing one year of starvation plus one year of excessive
consumption. A common explanation for the utility gain is that excessive
consumption does not increase happiness, or what economists call utility, as much
as starvation lowers it (Gruber 2007, 317). “

21 | P a g e
What is the Micro?

The “micro” can be explained from different viewpoints, each leading to different definition.

We can define “micro” in terms of:

1. The financial status of the target population.

2. The feature of the product.
3. The characteristic of the process in which schemes are created.

In general if we see the financial status of the target population, the common definition is that
Micro insurance is the insurance for low-income people. But the problem here arises how can we
tell the people are poor enough to qualify for the microinsurance? The answer is, it differs from
country to country.

The feature of the product, however, looks at the product point of view. Main requirements for
MIUs, as understood in this sense, are that they are simple, affordable, and located close to
its members. (Dror and Piesse (2014)). Thus, it aims at understanding microinsurance as per the
premiums and benefits of the product.

Coming to the characteristic of the process in which schemes are created, the focus is on the
subsidiarity. Dror and Jacquier (1999) characterize it as voluntary, group-based, self-help
insurance.

However the term “micro” never implies that it cannot be replicated to meso and macro levels. In
fact the success of the microinsurance sector is based primarily on its outreach, its sustainability, and
how it can actually benefit to all.

India was the first country to seriously define microinsurance products within its regulatory framework,
referring to microinsurance as insurance offerings with claim payments less than Rs 50,000 (IRDA 2005).
New revised guidelines were issued in 2015, as mentioned earlier in the project.

----------

22 | P a g e
Problem 2: The Challenges Involved.
To accelerate the outreach and sustainability there are few dimensions in which microinsurance
should evolve and be competitive.
1. The Regulation
Regulation is required and will have an impact on how insurance is sold, bought, and distributed
at bottom of the pyramid. It is important to have an adequate legal frameworks to facilitate the
practice of microinsurance.

2. The Technology
Technology always plays the prominent role when some new and innovative way is sought to
provide the outreach to the rural areas, and also to analyses the risk and profitability of such
sachems. Automated techniques, the rise of Internet and mobile technology is a game changer.
3. Risk Management
The next is the professional understanding of the risk, actuarial pricing of the products and —
financial Analysis of the products and its performance.

-----------

Problem 3: The Target Population

Since targeting low-income people is usually considered a core characteristic of microinsurance, the
problem arises to identify what income is the “low income”. And once that is defined the problem further
arises the identification of population with this low income, which is complex and costly.

Poverty headcount ratio at national poverty lines (% of population) in India.

21.9% 2011
29.8% 2009
37.2% 2004
45.3% 1993

We can further see the state wise distribution of GDP which also tell us the complex assessment of actual
“Low-income” definition.

23 | P a g e
24 | P a g e
Why is pricing microinsurance different?
As mentioned, microinsurance is not insurance business as usual. All along the value chain of
microinsurance, innovation is required to overcome the constraint of dealing with a relatively
unknown and inaccessible market. Buying behavior needs to be mapped and understood to
overcome lack of understanding of insurance among the low income population.
Listed below are some of the main differences between insurance and microinsurance. All of
these will impact the tasks of the pricing specialist: (P Wrede, C Phily, ILO)
Client focus
Even more so than in other markets, client perspective must be at the centre of microinsurance
activities to ensure acceptance of insurance as a risk-management tool. To build demand,
products have to be designed to match client needs in term of risks to be covered, affordability
and timing of premium, simple claims procedures, minimal underwriting, and processes designed
to enhance accessibility to clients.

Scarce data
While there is a rapidly growing interest, in most countries there are only a few microinsurance
providers or none at all. This limits available industry experience data for pricing. In some
countries, even mainstream insurance data is not available due to lack of insurance market
development which further limits the potential of using comparable products to serve as a pricing
benchmark. Aside from limited data in such countries, microinsurance providers are rarely able
to count on guidance from reinsurers who until recently lacked interest in supporting
development and reinsuring microinsurance markets. The pricing specialist has to be both
creative and cautious in developing rates in

Need for an affordable premium

Reaching the low-income market means designing accessible products since financial
accessibility is a key to unlocking demand. With high budget constraints and low purchasing
power, insurance is not the first consumable need for low-income households therefore it stands
to reason that microinsurance premiums need to be low, especially in a context of no subsidies
(the usual case). On the other hand, development and delivery costs may be higher per unit of
insurance than for traditional business. Much of the market is rural and remote with no access to
bank accounts which impacts the cost of setting up an effective distribution network. Efficiency
is one of the key requirements to solve this challenge.
Traditionally, actuaries have a tendency be very conservative in a context of limited access to
data. While if it is important to set a fair price for the providers, premium level and client value
have to be very attractive for low-income markets. Actuaries need to overcome their tendency to
overload premiums.

Limited access to dedicated pricing software

The use of common pricing tools (such as MoSes and Prophet) is very rare in microinsurance.

25 | P a g e
Pricing specialists will have to develop their own pricing models mainly using tools such as
Microsoft Excel and Access. This is preferred by many anyway who view the pricing tools in the
market as “black boxes”.

Importance of processes
It is also important to bear in mind that processes are part of the microinsurance package. The
way insurance is marketed and distributed, the way that premiums are collected and so on, has
significant impact on premium adequacy.
In microinsurance, even more than in conventional insurance business, processes will
significantly impact pricing and penetration rate. The pricing specialist has to carefully consider
the impact of process design to ensure an attractive offer.

Innovative distribution model

Unlike traditional insurance, which relies on brokers and agents for sales, the whole distribution
process is often re-engineered for microinsurance. To contain costs, microinsurance providers
must delegate the functions of the insurance value chain to the party that can deliver it at the
lowest cost. Partnering with institutions which already have a footprint in the target market,
especially if they already carry out financial transactions, is often considered a good way to
reduce transaction costs. Some examples of potential delivery channels are microfinance
institutions (MFIs), retailers, affinity groups and utility companies. This approach is commonly
referred to as partner-agent delivery.

26 | P a g e
 Chapter 2: Assessing the Impact of Community Based Programs

Community-based health insurance is an emerging and promising concept, which addresses

health care challenges faced in particular by the rural poor. The results of a study by Johannes P.
Jütting show that in poor environments, insurance programs can work: Members of mutual
health organizations have a higher probability of using hospitalization services than nonmembers
and pay substantially less when they need care. Furthermore, the analysis revealed that while the
schemes achieved to attract poor people, the poorest of the poor remained excluded.
In the research paper published in , Bull World Health Organ vol.80 n.8 Genebra Aug. 2002, by
Michael Kent Ranson: One thousand nine hundred and thirty claims submitted over six years
were analysed to study the impact of community based health insurance.
Objective was to assess the Self Employed Women's Association's Medical
Insurance Fund in Gujarat in terms of insurance coverage according to income
groups, protection of claimants from costs of hospitalization, time between
discharge and reimbursement, and frequency of use.
Major findings were:
 Two hundred and fifteen (11%) of 1927 claims were rejected.
 The mean household income of claimants was significantly lower than that
of the general population.
 The percentage of households below the poverty line was similar for
claimants and the general population.
 One thousand seven hundred and twelve (1712) claims were reimbursed:
805 (47%) fully and 907 (53%) at a mean reimbursement rate of 55.6%.
 Reimbursement more than halved the percentage of catastrophic
hospitalizations (>10% of annual household income) and hospitalizations
resulting in impoverishment.
 The average time between discharge and reimbursement was four months.
 The frequency of submission of claims was low (18.0/1000 members per
year: 22–37% of the estimated frequency of hospitalization).

27 | P a g e
 The paper concluded that:
 The findings have implications for community-based health insurance schemes in
India and elsewhere.
 Such schemes can protect poor households against the uncertain risk of medical
expenses.
 They can be implemented in areas where institutional capacity is too weak to
organize nationwide risk-pooling.
 Such schemes can cover poor people, including people and households below the
poverty line.
 A trade off exists between maintaining the scheme's financial viability and
protecting members against catastrophic expenditures.
 To facilitate reimbursement, administration, particularly processing of claims,
should happen near claimants.
 Fine-tuning the design of a scheme is an ongoing process — a system of
monitoring and evaluation is vital.

The crucial thing that comes from the paper is the tradeoff between the financial viability and the
protective cover of members. Quoting the paper:

“Balancing service to the poor with financial viability

The fund faces a challenging trade off. On one hand, it is committed to serving the poor, which
translates into low premiums and a target population for which the frequency of illness, and thus
hospitalization, may be relatively high. On the other hand, the fund's administrators expect it to
remain financially viable. To date, this trade off has not been a problem for the fund, largely
because the low rates at which the fund is used (along with the small external grant from the
German Development Cooperation) have meant consistently high rates of cost recovery. “

Similar were the findings of other paper analyzed.

Group/ Community insurance is favored in microinsurance because it:
 Has lower administration costs since the group can normally perform some of the administrative
tasks at a lower cost than the insurer; for example, collecting and encoding enrolment data of
group members;
 Normally offers coverage with minimal individual underwriting, especially if coverage is
mandatory;
 May have lower distribution costs, if the group acts as an effective aggregator of a large enough
number of risk units. However, aside from cooperatives and MFIs, there are not many natural
groups in existence in the low income market, since, for example, fewer people are formally tied
to an employer, or are members of a club or professional association;
 May have lower claims costs, if the group serves to reduce adverse selection. High take up is
required to achieve this, and the group membership must be based on objective criteria other than
the common desire to seek insurance coverage.

28 | P a g e
 Chapter 3: What should be the Qualitative and quantitative
standards?
Impact assessment in microfinance has received more attention than in any other area of
enterprise development. It is now generally accepted that impact assessment is a critical
element in further improving micro-finance services and promoting innovation. Existing
impact assessments have made an important contribution to understanding some of the
complex interactions between microfinance interventions, livelihoods and different
dimensions of poverty reduction and empowerment. There remains nevertheless a
considerable gap between the potential contribution of impact assessment and the
practical usefulness of existing findings.
What is basically qualitative and quantitative assessment: the difference?
Approach Quantitative Qualitative
Epistemological  Post positivist:  Interpretivist:
background and deductive understanding
forms of knowledge procedures, subjective and
probabilistic law contextual

Research problem  What and how much  How and why does
and research impact for impact occur/
question whom? not occur:
 Hypothesis-testing mechanisms and
theories of change
 Discovery-oriented:
What
unintended and
unexpected
impact occurs?
Data analysis  Calculation and  Interpretation and
statistical particularization /
generalization analytical
 Assess impact along generalization /
predefined exploration
and externally  Understand and
imposed indicators represent
 Tables and numbers the target group’s
perception
of meaning, existence
and
significance of impact
 Rich and thick
description
Advantages and disadvantages of Qualitative assessment:

29 | P a g e
The Advantages:
• Issues and subjects covered can be evaluated in depth and in detail.
• Interviews are not limited to particular questions and can be redirected or guided by researchers
in real time.
• The direction and framework of assessment can be revised quickly as soon as fresh information
and findings emerge.
• The data in qualitative research depends on human experience and this is more compelling and
powerful than data gathered through quantitative research.
• Complexities and subtleties about the subjects of the research or the topic covered is usually
missed by many positivistic inquiries.
• Data is usually gathered from few individuals or cases therefore findings and outcomes cannot
be spread to larger populations. However, findings can be transferred to another setting.
• With this type of research, the researcher has a clear vision on what to expect.
The Disadvantages:
The quality of research is heavily dependent on the skills of the researcher and can be easily
influenced by personal idiosyncrasies and biases of researchers.
• Rigidity is more difficult to assess, demonstrate and maintain.
• The quantity of data makes interpretation and analysis time-consuming.
• Qualitative research is sometimes not accepted and understood especially within scientific
communities.
• The presence of researcher in the process of data gathering is unavoidable and can therefore
affect or influence the responses of subjects.
• Issues on confidentiality and anonymity can pose problems during presentation of findings.
• Findings can be time consuming and difficult to present in visual ways.

Some guidelines for qualitative assessment:

Dos
• Familiarize yourself with your
questions as much as possible in
advance
• Listen and pick up on cues
• Ask follow-up questions based
on what you are hearing; use the
participants’ words where possible
• Encourage participants to share
anecdotes and specific experience—
avoid generalities
• Allow silences and accept pauses
as natural; break the silence only if
the respondent seems stuck
• Feel free to laugh and appreciate

30 | P a g e
 humor
• Monitor body language
• Catch discrepancies and try and
seek clarification
Don’ts
• Ask leading questions (where the
question contains hints or leads to
answers)
• Make judgmental comments
• Interrupt the respondent or try to
control the conversation.

On the other hand Quantitative has its advantages and disadvantages: The advantage is that when
the research data is collated because it’s simply based on numbers it’s a lot easier to collate and
place together into a form of chart. Also when it comes to placing it into graphs and charts it’s a
lot easier to read, because if it’s placed into a pie chart it’s exceedingly simple to read. However
with advantages always come disadvantages. One of the disadvantages is that because it’s all
based on figures, it’s not always up to date. It’s usually in constant need of updating because
numbers change.

A good example quantitative data being used is on programs such as Family Fortunes, because
that shows answers are usually based on a surveys being taken. Where they will ask 100 people 1
question and list the top 5 answers. It’s also always used in programs such as the News where
they will go out on the street and ask a selection of people closed questions that are can be
always answered with using yes or no or using a liker scale.

They also use quantitative research not just in television but in films as well. In the film Super-
Size Me it gives quantitative research results at the beginning such as that over 100 million
people are obese in and that the state of Virginia is in the top 3 most obese states in the United
States of America. This research is presented to the audience by animations and cartoons. I
believe that this is easily interpreted by the audience because in essence they makers of the film
have tried to simplify their findings. A program where the use quantitative research the most is
Match of the Day when they are showing a live football match. It’s used most because their
researches have to analyses the match and come up with the percentages of things such as
possession and shots on target etc.

31 | P a g e
Chapter 4: What are the best possible indicators to assess Microinsurance
scheme’s financial and sustainable aspects?
According the paper by Conor Doyle and Pradeep Panda, The key problem faced by the
evaluator is
choosing a set of indicators that illuminate the most important elements of the intervention and
will form a cohesive story of the whole from a limited number of pieces.
They suggest to start with placing indicators into one of three levels:
 Process indicators are metrics that examine the extent to which
a scheme has run in the manner expected or the success of
a scheme in reaching operational targets. They examine the inputs
made into the operation of the scheme, i.e., internal aspects of
scheme administration that can be considered to be largely under
the control of the staff working on and managing the insurance
scheme. In the insurance context, process indicators might include:
the proportion of a local population who have been contacted by
an insurance education campaign, the proportion of insurance clients
to whom claim forms have been pre-distributed, or the proportion
of claims processed via correct formal channels.
 Outcome indicators examine the extent to which the operation of
the scheme has been turned into a tangible and direct short- or midterm
result. They often examine external changes in the behaviour
or situation of those covered by the scheme that are a direct result
of the scheme being in operation. In a health insurance context, the
average reduction in out-of-pocket (OOP) expenditures on inpatient
(IP)
care is a commonly-used indicator in the outcome category.
 Impact indicators examine the extent to which the scheme in question
has
led to long-term effects. These are often external effects of the scheme
that are indirectly facilitated, but not directly caused by it. To return
to the health insurance example, an impact indicator might be the
reduction in the number of individuals falling below the poverty line
due to the costs of an inpatient care episode.

32 | P a g e
The study suggests 3 basic types of indicators:
The qualitative indicators:
 Patient’s feelings as to whether money was well spent,
 Administrator’s opinion as to why number of patients has changed,
 Member’s statement as to why he/she joined the insurance scheme
The quantitative indicators:
 Amount of money spent on IP services
 Number of people who have visited a hospital
 Number of individuals who have joined an insurance scheme.
The Hybrid indicators:
 Patient’s rating of quality of care along a 5-point scale
 Ranking of a set list of reasons why number of patients might
have changed
 Ranking of a set list of reasons as to why a scheme has been
joined

33 | P a g e
 Chapter 5: The Reinsurance

As per Wikipedia:
Reinsurance is insurance that is purchased by an insurance company (the "ceding
company" or "cedent" or "cedant" under the arrangement) from one or more other
insurance companies (the "reinsurer") directly or through a broker as a means of risk
management, sometimes in practice including tax mitigation and other reasons described
below. The ceding company and the reinsurer enter into a reinsurance agreement which
details the conditions upon which the reinsurer would pay a share of the claims incurred
by the ceding company. The reinsurer is paid a "reinsurance premium" by the ceding
company, which issues insurance policies to its own policyholders.
Microinsurance network defines reinsuarance as:
Reinsurance is an arrangement according to which an insurance company, the “reinsurer,”
commits to provide compensation to an insurance company, the “insurer” for all or part of the
risk under a specified group of insurance policies issued by the insurer.
Reinsurance reduces the insurer’s risk exposure and can also be a useful source of funding and
actuarial experience. This practice may help to stabilize the profits and protect them against
strong fluctuations in financial results from year to year. Reinsurance enables small insurers to
share the risk with other operators located in other regions or abroad by pooling the risks
sufficiently, as the risk is mutualized among many insurers.
One common and relatively simple type of reinsurance is stop loss, in which the reinsurer covers
the total claims above an agreed value on a group of policies.
Despite the many potential advantages of reinsurance arrangements, they are often absent from
microinsurance programmer. This can be due to the low involvement of reinsurers in the
microinsurance space but also is reflective of the limited risk that many microinsurance policies
hold (with very small claims benefits spread over large numbers), which diminish the need for
reinsurance in some types of policies.

34 | P a g e
Analyzing the famous paper by, Dror, Duru, Lamure (2002):

Microinsurance units can play a valuable role in operating health insurance schemes for people
excluded from national health systems. The strength of microinsurance is rooted in social capital
and communities' capacity to adapt insurance techniques to specific conditions, thereby
overcoming classical problems inherent in the principal-agent relationship. Two key weaknesses
relate to the units' small size, which limits the population across which risks can be spread,
And their members' low income, which limits the amount of financing that can be mobilized in
poor communities. The solution to the first problem lies in reinsurance. The solution to the
second problem lies in subsidies and strengthened links to national programs for health care
financing and delivery.

Now the question comes how the microinsurance models can be sustained?

Sharing risks between insurance carriers is common practice in the insurance

Industry, regardless of the size of insurers. Social health insurers in most industrial countries
operate under "pay-as-you-go" financing, which transfers all deficits to the population at large.
Micro insurers cannot operate this way because loading deficits onto few members can
encourage withdrawal from affiliation because of limited ability to pay. Nor can micro insurers
count on unlimited deficit financing from external sources. Hence, micro insurers need a
different solution. This section examines the causes of micro insurers' financial instability and
looks for ways out of this dilemma.

“Under the basic contract between each micro insurer and its reinsurer, the
Micro insurer pays the reinsurer a periodic premium. In return, the reinsurer
Pays the micro insurer for costs exceeding a specified reinsurance threshold. The
Fundamental assumption here is that the client micro insurers' business results
Can fluctuate around a mean value. Thus, in "good years" (when costs are below
The mean), the micro insurer will run a surplus (compared with the mean), and
In "bad years" (when the costs exceed the mean) the micro insurer will run a
Deficit (compared with the mean). These fluctuations stem, to a great extent,
from the micro insurers' small membership and claim load. The extent of
fluctuations
can be estimated by applying statistical laws, if the probability of events
and their average cost are known. However, no one can know whether the surplus
in good years will cover the deficit in bad years, or that good years will
precede bad ones, such that the micro insurer always has enough reserves to
cover deficits. Therefore, if the micro insurer wishes to lower its financial risk
exposure to the mean cost, which is much more predictable and affordable, it
has to obtain an alternative source to cover these mean costs. This is what the
reinsurance offers to do.”

35 | P a g e
 Chapter 6: The Conclusions drawn

Analogous to the terms microfinance and microcredit, microinsurance refers to insurance

products
specifically targeting low income markets. In developing countries, the majority of the
population lacks
insurance, mainly because they are engaged in economic activity outside of the formal sector
which is the
traditional target of mainstream insurers. Microinsurance is however still a type of insurance
since it is a
mechanism of risk pooling by its purchasers who seek protection from various types of risks.
While microinsurance is governed by the same insurance principles as traditional insurance (see
Box 2.1)
the low income market (LIM) has very different product and servicing needs. Therefore there is a
need to
rethink design, delivery, and management of this emerging industry to make it accessible to
intended
markets.
There are many definitions for Microinsurance, e.g.
 In India, microinsurance is defined based on coverage amount and term of policy, for
both general and life microinsurance products. The maximum coverage amount is 50,000
rupees (INR) for term life and INR 30,000 for any other products.
 In Peru, a preliminary regulation defined microinsurance on the basis of coverage
amount. The revised version states that “microinsurance is an insurance product that
protects the low income population against losses due to either life event or asset losses.”
Some microinsurance requirements are listed, such as the necessity for the product to
cover the need of the target population and the necessity to provide simple
documentation.
 In the Philippines life microinsurance is defined as a product targeting low income
markets with cover not to exceed 500 times the daily minimum wage for Metro Manila.
Providers must adhere to a set of service standards such as a maximum time limit for
paying claims.

36 | P a g e
However there are seven basic principles of insurance that must be there to qualify a risk as
insurable risk for the very minimum:
1. The event must be random (i.e. occur purely by chance). In the case of a microinsurance
programme,this implies that the covered event must not be influenced in any way by the insured
household. This usually requires some controls to prevent this from happening.
2. The loss must be definite in terms of timing and amount- This implies that the benefits and
theconditions under which a claim for benefits can be made must be very clearly defined and
understood at the onset, for the benefit of both the insured household and the insurer.
3. The loss must be significant. It would be uneconomical, for example, to insure petty losses
that do not cause hardships for the household since this would be too costly to administer.
4. The rate of loss must be predictable- it should be possible to estimate the loss rate for each
covered risk before launching the product, so that an equitable premium rate can be set with
reasonable confidence. As discussed in the guide, this is why a programme should gather
operations data as soon as possible. In the beginning, the rates of loss have to be estimated from
national statistics or from experience of other programs (which may have different
characteristics).
5. The loss must not be catastrophic to the insurer. This has two dimensions a) a single loss of
an insured should not devastate the program; this implies that the benefits should be limited and
that the size of the programed needs to include a “large” number of participating households; and
b) Catastrophic events (i.e. a single co-variant event) must be either excluded or “reinsured”.
6. A “large” number of persons (or assets) with similar risk characteristics must
participate.
Essentially this means that the insurance program needs to enroll a sufficiently “large” number of
households for each particular risk event, and there is a reasonably similar probability of the risk
event
affecting each household. This requirement is grounded in mathematical statistics and is
necessary for stable financial results of an insurance programme. The small premiums of the
many insured households finance the losses (claims) of the few that are affected.
7. Premium rates must be affordable otherwise it is not an accessible financial service. For this
to be possible, the probability of the risk event occurring must be very small, the amount of
insurance coverage must be limited, and insurance delivery has to be efficient.
An important supplementary principle is the addition of loss prevention measures to
microinsurance product design and delivery which are meant to lessen the chance and degree of
loss before it happens.

o Policy frameworks are often not favorable to microinsurance market development.

o Policymakers’ awareness and know‐how on microinsurance is low.
o Limited Supervisory capacity impedes them being proactive.
o Coherence among different policy areas is weak.
o There are mandate crossings between government agencies.
o Fiscal burden on premiums and intermediation hinders demand.

37 | P a g e
 o Subsidies can impede market based solutions.
o General customer protection frameworks and financial literacy
o Work often do not include insurance or low‐income customers.
o Microinsurance is highly vulnerable to gross pricing errors.

o There are important measures that are to be taken for assessing the impact of the
microinsurance schemes.

----

Pricing specialists are also expected to:

 Set or build and continuously review a risk model which matches the target population risk
profile and calculate accurate risk pricing. This activity may imply segmenting the target
population into groups facing different risk patterns.
 Define financial projections which are the backbone of any insurance business plan. The
pricing
specialist should help management by setting different projected scenarios.
 Set the claim control mechanism to mitigate anti-selection, fraud and moral hazard, and
continuously assess the evidence to detect any deviation of the experience vis-à-vis the pricing
assumptions.
 Continuously monitor and extract relevant information from experience, to ensure timely risk
mitigation strategies and proper understanding of the portfolio.

38 | P a g e
There are still huge number of people potentially excluded from insurance marketSource :
World Bank

39 | P a g e
 Chapter 7: The Recommendations
(From the best practices around the world)

1) Guidelines for indicators by Karla Henning and Andreas Landmann:

o Outcome: Risk taking behaviour
(1) Indicator: Productive investment as percentage of total income of the household
(2) Indicator: Total amount of loans taken
(3) Indicator: Total amount of savings.
o Outcome: Risk management strategies (ex-ante)
(1) Indicator: Total amount of savings
(2) Mount of liquid assets.
(3) No. of income sources per households
o Outcome: Reliance on informal risk sharing networks
(1)Indicator: Total amount of borrowing for shock-related
Expenditures from informal networks.
2) Risk-minimising’ credits for the ultra-poor. The very poorest, who are most exposed to risk,
do not often take advantage of micro financial services, or a fortiori of microinsurance; and
yet,
precisely because they are most exposed to shocks, they are most in need of support services
–essentially fulfilling an insurance function, as above - which may help them smooth
consumption. The Bangladeshi NGO BRAC (formerly Bangladesh Rural Advancement
Committee) sought to break into this vicious circle by providing under its IGVGD (Income
Generation for Vulnerable Groups Development) and CFP (Challenging the Frontiers of
Poverty) schemes for ultra-poor single women24, first providing food aid on its own, then
requesting that a part of that food aid be converted into small cash savings, then linking the
savings to training in a low-capital low risk enterprise (such as poultry raising, goat-keeping,
small-scale fish-farming or sericulture), and then finally for those who wished to receive
providing conventional microfinance loans.
3) 2 Emergency loans from ‘village banks’. The Bolivian NGOs Promujer and CRECER (which
cater for a lower stratum of the population than any others in the country)25 practise a
‘village bank’ model, in which training, maternal and child health and legal advice services
are provided alongside group credit for those desiring them. They also offer an emergency
loan facility. Essentially this loan facility (known in Bolivia as a cuenta interna or ‘internal
account’) functions like a rotating savings and credit association—it takes a fortnightly or
monthly subscription from clients, which goes into a common pool from which, in case of
need such as a sudden income shock, members are entitled to draw emergency loans
supplementary to their existing borrowings, if approved by a vote of the members of their
borrower group.
4) Micro-savings schemes. Savings, classically, enable the ‘protection’ function of insurance to
be performed by enabling the low-income household to draw on a cash reserve, rather than
an insurance policy, at times of crisis. As described in Hulme, Barrientos, and Moore (2007),
microsavings remain a neglected element in microfinance, historically of great importance
since the nineteenth century as an instrument by which poor households buffered themselves
against shocks, and in the twenty-first century, at least in potetial, fulfilling the role, since the
consequences of shocks are worst for the poorest, as a highly progressive component of the
microfinance operation.

40 | P a g e
5) Loan-savings linkages. In a number of countries, NGOs, which are the dominant form of
microfinance organisation, are not authorised to take savings deposits, which as discussed
above represent the least risky mode of contact with the financial system. Consequently, in
the assumed absence of microinsurance, individuals who wish to receive financial services
are obliged to take loans, and are not able to protect themselves by savings against the risk of
decapitalisation caused by the combination of overborrowing and external shock (see Hulme
et al. 2007). One important potential way around this problem is by the formation of linkages
between microfinance NGOs and banks or nonbank financial intermediaries

Adding the recommendations of Simon Russell, September 12th, 2014. To tap the huge
potential of microinsurance with long term financial sustainability:

 Collaborate with local partners. This is particularly necessary for global carriers, who
are unlikely to have experience with sub-economic consumers. Again, local partners with
existing distribution networks and customer bases/ audiences will help bridge this gap.
 Understand your customers and, in particular, the risks they face. Because customers
are likely to be first-time insurance buyers, information will likely be scant. The
participation of government agencies or non-governmental organizations will help solve
this challenge. Analytics and big data will also play a growing role in this area.
 Innovate, innovate, and innovate. Every business needs to be innovative, to be sure, but
the need is acute in order to overcome the challenges. Coming up with ways to develop,
distribute and market products in these markets is a tall order, and strategic thinking will
have to generate ideas that are truly “outside of the box”. Insurers cannot allow
themselves to have fixed ideas about what insurance is, how it works or with whom to
partner.
 Focus on agility. Agility is the flipside of innovativeness. For one thing, it’s likely that
several iterations will be needed before a product is perfected; for another, the needs,
preferences and means of the consumers are constantly evolving—these are after all
economies that are often growing rapidly and socially evolving thanks to rapid
urbanization. Operational simplicity will be vital in delivering agility in this high-volume,
low-cost scenario, but also in keeping costs down.

To conclude, community-based health scheme that aims to strictly target the poor could improve
equity and financial viability by seeking subsidies from government or donor agencies. Subsidies
may, however, not be sufficiently reliable or sustainable. Alternatively, a socially oriented
community-based health scheme could seek to broaden membership to include wealthier
populations, but would ensure equity by indexing premiums to income and enabling equal (or
better) access to care among the poor. For voluntary community-based health insurance schemes,
this would require a high degree of social solidarity among members.

I would recommend that insurers should be more than willing to apply innovation and agility:
both are qualities that are going to play increasingly important roles in all insurance markets.

41 | P a g e
 “In short, microinsurance is an opportunity to tap into a valuable new market, and one that is
growing, what it requires from the insurers side is persistence and a stable financial indices.”

42 | P a g e
 REFERENCES

43 | P a g e
 1. Preker, A. S., Carrin, G., Dror, D., Jakab, M., Hsiao, W., & Arhin-Tenkorang, D. (2002).
Effectiveness of community health financing in meeting the cost of illness. Bulletin of the
World Health Organization, 80(2), 143-150.
2. Dror, D. M. (2007). Why'One-Size-Fits-All'Health Insurance Products are Unsuitable for
Low-Income Persons in the Informal Economy in India. Asian Economic Review, 49(1).
3. Dror, D. M., & Jacquier, C. (1999). Micro‐insurance: Extending Health Insurance to the
Excluded. International social security review, 52(1), 71-97.
4. https://en.wikipedia.org/wiki/Insurance_in_India
5. Ahuja, R., & Guha-Khasnobis, B. (2005). Micro-insurance in India: trends and strategies
for further extension. ICRIER paper.
6. Dror, D. M., & Piesse, D. (2014). What is microinsurance ?
7. Wrede, P., & Phily, C. PRICING FOR MICROINSURANCE A TECHNICAL GUIDE
8. Jütting, J. P. (2004). Do community-based health insurance schemes improve poor
people’s access to health care? Evidence from rural Senegal. World development, 32(2),
273-288
9. Ranson, Michael Kent. (2002). Reduction of catastrophic health care expenditures by a
community-based health insurance scheme in Gujarat, India: current experiences and
challenges. Bulletin of the World Health Organization, 80(8), 613-621. Retrieved May
16, 2016, from http://www.scielosp.org/scielo.php?script=sci_arttext&pid=S0042-
96862002000800004&lng=en&tlng=en.
10. Mayoux, L. (2001). Impact assessment of microfinance: Towards a sustainable learning
process. EDIAIS Application guidance note.
11. Bonnevay, S., Dror, D., Duru, G., & Lamure, M. (2002). A model of microinsurance and
reinsurance. D. Dror, D. and A. Preker (eds): A new approach to sustainable community
health financing, 153-186.

44 | P a g e