The Micro Insurance Academy: Helping Communities Manage Risks from the Ground Up
Location
The MIA is offering unique step-by-step stewardship to understand the benefits of insurance, to design context-relevant solutions, to act as “barefoot insurers” of own risks.
About You
Location
Project Street Address
Project City
Project Province/State
Project Postal/Zip Code
Project Country
Your idea
Year initiative/program began:
2007
Field of work
Banking/Financial Services
If Field of Work is "Other" please define in 1-2 words below (and explain in detail in the entry form):
Service / Activity focus (If "other" please explain in entry form)
Delivery Method
Year organization founded (yyyy)
2007
YouTube Upload
Project URL
Positioning of your initiative on the Mosaic of Solutions™ diagram:
Which of these barriers is the primary focus of your work?
Non-affluent are not valued customers
Which of the principles is the primary focus of your work?
Leverage the stake individuals have in financial success of the group
If you believe some other barrier or principle should be included in the mosaic, please describe it and how it would affect the positioning of your initiative in the mosaic
This field has not been completed. (333 words or less)
Name Your Project
The Micro Insurance Academy: Helping Communities Manage Risks from the Ground Up
Describe Your Idea
The MIA is offering unique step-by-step stewardship to understand the benefits of insurance, to design context-relevant solutions, to act as “barefoot insurers” of own risks.
Innovation
What is your signature innovation, your new idea, in one sentence?
The MIA is offering unique step-by-step stewardship to understand the benefits of insurance, to design context-relevant solutions, to act as “barefoot insurers” of own risks.
Describe what makes your idea unique—different from all others in the field.
A key component of our intervention involves helping resource-poor communities create and design microinsurance products that meet local needs, priorities, and willingness to pay. This is accomplished through a comprehensive series of studies and workshops to train, coach, and assist communities in developing relevant and cost-effective micro insurance systems and processes.
Our project explains the value proposition of insurance. Based on field data, we design tools which demystify insurance for resource-poor communities. One example is CHAT, a game-like tool allowing members to jointly define the benefit package that covers their needs. Unlike most microinsurance products, it is neither mandatory, nor linked to a savings product.
Our project gives clients the ability to cover items that are typically excluded from microinsurance products (such as maternity, drugs etc.).
Our project uses local management and ownership, along with “en-bloc” group affiliation (all household members) to combat the challenges posed by moral hazard and adverse selection.
This combination of elements is innovative, and to our knowledge never before implemented elsewhere.
How do you implement your innovation and apply it to the challenge/problem you are addressing?
We provide poor communities with the knowledge to promote an insurance package that combines access to healthcare services with underwriting healthcare risks; a package unavailable to the poor today. The MIA focuses on an integrated approach for that encompasses tools and training to:
1. Mobilize people to create MIUs
2. Empower communities to govern MIUs
3. Empower MIUs to develop sustainable operations
By providing communities with the knowledge to develop affordable healthcare, the MIA minimizes the financial vulnerability they face when illnesses arise.
Do you have any existing partnerships, and if so, how did you create them?
The Micro Insurance Academy believes that there is strength in numbers both at the community and partner levels and we strive to harness this collective power. Our partners include organizations of all sizes whose commitment to sustainable healthcare reflects our own.
The MIA always works with partners (NGOs, MFIs, etc) helping them to understand the features and solutions that micro insurance offers, and capacitating them to implement as many of the functions as possible within their target grassroots communities. Not only is this in line with our core principle of Subsidiarity, but it also allows us to utilize local expertise, such as understanding the local languages or political contexts, to enhance our innovation based on the local realities.
Together with the local partners, we create a process, and design products, that meet their needs, priorities, and willingness to pay. This is accomplished through a comprehensive series of local workshops with the communities to train, coach, and assist them in developing relevant and cost-effective systems and processes.
In which sector do these partners work? (Check all that apply)
Citizen sector (nonprofits, NGOs) , Private sector , Public sector (government).
Impact
Provide one sentence describing your impact/intended impact.
We empower communities to protect their livelihoods using the exciting financial tool of microinsurance and help reduce their financial vulnerabilities through relevant solutions.
Please list any other measures of the impact of your innovation.
The impact of our innovation has many dimensions. Our innovation saves lives through increasing access to health insurance and providers by underserved communities throughout India.
Resource-poor people will also be protected from the financial burden associated with unexpected and unmanageable health expenses.
Local community members will be empowered to take on roles and responsibilities they may not have thought possible, and gain skills in vast new areas.
We train local researchers and local insurance executives at the village level to take over many of the functions that are traditionally done by insurance companies.
This ensures that the community is empowered to take control over their future, and become fully self sustainable within a 5-year time horizon. Moreover, our innovation will result in faster claims processing, reduced instances of fraud, mobilize local resources, and improve democratic governance at the local level.
Does your innovation address and/or change banking regulations?
No, our innovation is completely managed by the local communities
How many people does your innovation serve or plan to serve? Exactly who will benefit from your innovation?
Our innovation has the potential to reach thousands of poor and underserved people in the developing world. The beneficiaries of this innovation are people living in poor communities throughout India and beyond. MIA’s model of providing the infrastructure for local communities to engage in their own micro insurance schemes is self sustaining and will continue to reach communities well after the initial project has come to an end.
This Entry is about (Issues)
Sustainability
Financing source
How is your initiative financed (or how do you expect your initiative will be financed)?
In the MIA model, the local insurance schemes are sustainable from the very first day of operation. As all associated costs are covered by the premium, the community can be assured of their health insurance scheme long into the future. Additionally, the management of the scheme fund is set up to collect between 3-5 percent of the premium into a reserve fund, which can be used for advisory services as and when required. When the community needs to revisit the specific benefits of their insurance package, these reserve funds can be accessed to pay for a consultancy or a recalibration of actuarial costs.
If known, provide information on your finances and organization:
Audited accounts available on request.
The MIA currently has some 30 staff and volunteers in its Delhi office, with another dozen or so part time collaborators across the world.
What are the main financial barriers and how do you plan to address them?
Getting the data required to adapt the CHAT metrics is a very costly and intensive effort. The steps involved include the design of survey tools, cognitive pre-test and analysis, household surveys, key informant interviews, focus group discussions, and rigorous statistical and actuarial analysis for the adaptation of the CHAT tools to the local language and context. To address this challenge, we are engaged in a multi-year research project aimed at developing a cost effective methodology to design better health insurance products.
Aside from financial sustainability, how do you plan to grow the initiative?
We plan to expand the initiative through advocacy at the grassroots and international levels. We incorporate an awareness building campaign into our project to generate knowledge among rural communities on the benefits of participation in micro health insurance schemes. This campaign includes street games, radio advertisements, and other mediums appropriate to the audience. In addition, we advocate on the global arena through our participation in international conferences, a growing web presence, and partnerships with donors and NGOs.
The Story
Please select one
What was the motivation or defining moment that led to the creation of this innovation? Tell us the story.
Years of my efforts to develop top-down systems through which governments would deliver equitable and efficient health insurance for all have had few results. The frustration that most people at base of the pyramid (BOP) in low-income countries cannot afford to pay for healthcare required a personal paradigm shift. This project is that new paradigm.
If poor people are to pay a premium, they insist on a compelling why-to-buy proposition that is relevant to their daily priorities. These priorities are context-specific. Yet, insurance business today is based on few “one-size-fits-all” products, with most of the premium covering distribution/advertising, commissions, and high profit margins. This needs to be converted to customized solutions and low margins, with most of the premiums covering risk.
As insurance makes sense only when it is trusted, I shifted action from commercial settings to embedding the process in existing trusted social structures at grassroots level, based on transparent governance by the people for the people. The insurance industry does not offer this trust-base at BOP. Therefore, we had to set up a new entity to support the expansion of the new paradigm at BOP.
The personal voyage from being with the UN to working at grassroots level started with conceptual work (and a book), on to juxtaposing with evidence (through surveys, analysis, feedback from grassroots and publications) and then action: establishing the Micro Insurance Academy, to train grassroots communities to govern their process of insurance. As this microinsurance action is scaled, we will add links to reinsurance.
Please provide a personal bio of the social innovator behind this initiative.
David Dror has been involved in development of social health insurance worldwide for many years, notably with ILO; he is the originator of the Social Re concept linking microinsurance to reinsurance.
Dr. Dror is Professor of Health Insurance at Erasmus University Rotterdam MC (Institute of Health Policy and Management). He has published extensively on microinsurance, health economics and insurance in India and elsewhere; to view many publications click here
a) Please identify the individuals that your innovation benefits (Please check all that apply)
Producers , Consumers , Holders of assets.
b) Do you help the people you serve to buy goods or services using financial innovation? If so, how?
People are socially embedded creatures who buy goods and services by reference to what others do. We build on this logic to develop health insurance.
Health insurance essentially should convert unexpected and unaffordable health costs to affordable and expected transactions. This can be done best by pooling risks and resources of large groups. Hence we launch micro health insurance units that enable communities to buy services in ways that single individuals cannot do on their own. Contracting services and negotiating prices of healthcare is complicated.
We pursue this objective in steps: We obtain the information needed to create context-relevant actuarial and cost estimates. We enable grassroots communities to prioritize the services they will insure by running simulation exercises (called CHAT: Choosing Healthplans All Together). We enable grassroots communities to govern the business-process of insurance, through training and by providing access to IT tools.
This enables the poor to enjoy the benefits of health insurance, by converting out-of-pocket spending on healthcare to more financially efficient premiums
c) Do you help the people you serve to sell goods or services using financial innovation? If so, how?
Yes, we help people at the base of the pyramid to access insurance services, and thus reverse the dictum that “the poor are uninsurable”. Everything we have been doing is about financial innovation beyond microfinance.
Microfinance is usually limited to savings and credit. Insurance offers more financial benefits to the poor than mere savings or credit; yet, the offer of insurance products to the poor is derisory, and in fact the poor have almost no access to relevant and affordable insurance today.
By identifying groups that already enjoy their members’ trust through previous community-based activities, and offering them our step-by-step stewardship (through initiation workshops, followed by training and technical assistance) first to understand the benefits of being insured, then to implement context-relevant micro insurance solutions, and to act as “barefoot insurers” of their collective risks.
We offer a broad range of services of financial literacy, followed by mutual insurance that benefits the entire group, and thus inclusive access to risk management that strengthens existing groups
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Comments
A great idea Iddo. It's not specifically mentioned in the competition information and so I was wondering what provision/possibility is there for gaining industry support - and thereby reduced financial risk - through obtaining reinsurance for the premiums?
Hi Jeremy, and thanks for the spot-on question.
Industry support, specifically around reinsurance is indeed a crucial part of the overall long-term sustainability of the model, and something we are actively working towards.
The concept is not new to us; the seminal “Social Re” book, published in 2002, dealt with that specifically, and you’ll find the reinsurance model (and much more) available for free download here
If you’re in the mood for something shorter than a 500+ page book, I recommend the following publications by our team, all available for free download from our website's publications page:
David M. Dror: Reinsurance and Other Facilities for the Indian Micro Health Insurance System. FORTE Insurance Journal, Special Issue on Micro Insurance, 2006
David M. Dror and John Armstrong: Do Micro Health Insurance Units Need Capital or Reinsurance? A Simulated Exercise to Examine Different Alternatives. The Geneva Papers on Risk and Insurance - Issues and Practice, Vol. 31, No. 4, 2006.
David M. Dror and Thomas Wiechers: The Role of Insurers and Re-insurers in Supporting Insurance to the Poor. Chapter 5.4 in Churchill C. (ed.): “Protecting the Poor: A Microinsurance Compendium”, Geneva, ILO, pp. 524-544, 2006.
David M. Dror, John Armstrong and Vijay Kalavakonda: Why Micro Health Insurance Schemes Cannot Forego Reinsurance. Journal of Insurance and Risk Management (special issue on micro health insurance), Vol. 4, No. 7, 2005.
Hope this answers your question, and feel free to revert with any additional questions on any aspect of the model – the more critical debate we have, the better we can refine our approach – so thanks again for your question!
Best wishes,
Iddo
In India there are so many cultures and languages. How are you planing to reach all those people? unless of course you speak Hindi, Sanskrit and 30 other Indian dialects fluently :)
Hi Amitaibu,
Yes, you are right - there is a real need to customize the solutions to the local context. Luckily, we do just that... we design our training materials (including games, videos etc.) in a way that they can be easily translated into the different local languages in India (and surrounding countries).
But the real issue is this one: we always works with local partners, and so our role is to empower these local partners to support their communities. This is in line with our core principle of subsidiarity. As such, we need not speak all these languages ourself - it is enough that a handful of people from the community (or grassrootsNGO active in that community) speak English, Hindi, or whatever language we do speak. We train them as trainers, provide them with all training materials, and provide technical assistance as needed. The community then takes on the ownership of the programme - and they always speak their own language!
Hope this answers you question, and thanks for having taken the time to write to us!
Iddo
Hi Iddo,
I remember in 2005 when I had the privilege and opportunity to work with Dr. David Dror on developing a fund-raising strategy for the Micro-Insurance Academy (MIA).
That interaction and experience gave me a bird's eye view into the complexity of offering micro-insurance services to low income communities, how different it really is from 'micro-finance' and yet how easy it is to confuse the two.
First of all, let me congratulate you and Dr. David Dror on having come this far in implementing this great and much needed innovation for a country like India. I'm most impressed with the level of professional & technical skills that MIA brings to this endeavour coupled with the commitment to making beneficiary communities the central stakeholder in the process.
However, I'm left wondering about one aspect.
I understand, ultimately MIU are about reducing health-expenditure related financial burden on low-income communities by offering them insurance which they can avail to access health care.
But I wonder if there are just not enough hospitals offering maternal care and other services, or for that matter not enough doctors, in rural areas, then how far can health insurance go.
From your experience so far, how do you see the utility of micro-health insurance vis-a-vis availability (or non) of basic health care services to the rural low-income communities where you have been operating and beyond?
Thanks and all the very best in taking this initiative to new scales !!!!
Inderpreet
Hi Inderpreet,
Great to hear from you - and a special thanks to you –one of the IOMBA stars that helped with the initial fundraising efforts!
You raise a valid question – the provision issue – especially in rural India where access to healthcare still leaves much to be desired. I am actually about to board a plane to one such location as I type these lines, so would invite some of my colleagues to answer more in depth, but here’s my quick reply:
First, I must stress that the MIA deals with health financing, not with health provision. As important as that area is, we must draw a line and make sure we do not experience a mission drift into the provision realm. There are many great organizations active in this field, and there are some interesting recent developments on primary care delivery in rural India, so we can partner with such organizations, but will not take on this role directly.
Then, India had no dearth of medical practitioners. In fact, it is the number 1 exporter of medical doctors in the world. Stroll in any Indian metro, and you’ll never be far away from a doctor’s clinic. So why is there insufficient supply in rural areas? Well, perhaps the issue is that providers are afraid that the rural poor can’t pay them enough to make it worth their while. So, it is quiet plausible that once one pools resources and creates a solvent demand, the supply will quickly follow. We are seeing first evidence of this, for instance, in districts that have been selected for inclusion in the governments recent RSBY insurance scheme – both by public and private providers – so health financing may indirectly solve (at least partly) supply-side issues.
Finally, our approach puts communities at the center of the process, and it is they who decide on the benefit package. The issue of perceived quality remains their decision, and who is better equipped to decide what local provision is perceived as “best available” then the clients themselves? So, the likelihood of a benefit type that does not have sufficient supply deemed as “best available” being included in the packages is quiet low. Resource-poor households are already spending on health - sometimes in double digits as a % of household income – and often it is the 2nd largest expenditure after food. In this context, we focus on helping them spend their money more efficiently – not on deciding for them what “quality” is.
I am sure others will have much to say about this issue – so thanks for having started this important exchange!
Hi Iddo
Sounds really interesting and very worthy, though I must admit that I am very unfamiliar with the dynamics of it. My question was about succession. Obviously the bio of the key person has been asked for and provided, though I wonder whether one has to think and be ready to talk about a succession plan to assure the sustainability of the program.
Best of luck with it, Martin
Hi Martin,
Thanks for taking the time to read and post - much appreciated.
Succession is an important issue, at several levels. So many times, when the social entrepreneur, or visionary behind the initiative moved on, the organization faces a severe challenge, sometimes even stopping work altogether. As the younger half of a father-son combo, I can only smile and say that this isn't necessarily the case here... Not just because of me, but because of my other senior colleagues who are part of "the next generation" (such as Ralf Radermacher and others) who are actively involved in shaping the MIA's vision and action. We really work as a collective team, and as such, succession planning and sustainability are probably less of an issue for us than for other organizations. A second, related matter is that the MIA, a global organization set up in India, will groom local leadership to take over the Indian chapter of the MIA in time for our main thrust of international expansion, schedule to take off in 2010.
But to me, sustainability doesn't stop at the top leadership level. I mentioned in an earlier post that subsidiarity is a core principle we follow. This means that we seek to empower "barefoot researchers" and "barefoot insurance executives" at village level to take over many of the functions that are traditionally done by insurance companies. This is done with the aim of lowering transaction costs, battling market failures such as adverse selection and moral hazard, but also to ensure that the community is empowered to take control over their destiny, and become fully self sustainable within a 5-year time horizon. Down the road, this would do much for sustainability, and will be the real "succession plan" of the MIA.
Best regards,
Iddo
Hi Iddo --
It is really great to see the MIA having progressed so much and only in about a year!
I wonder about a specific part of how MIA operates, i.e. the CHAT.
As I understand it, CHAT is the methodology that you use in order to harness community knowledge about the health insurance cover it may need, this in the context of sharing knowledge with the community about the nature of insurance, per se, and building its capacity to design and manage its own insurance products ...
Are there challenges in making this methodology work (for example, language and culture raised by Amitabu, but also community dynamics and personalities - often hard to predict)? If so then how are you addressing them??
Thank you!
Hi Nadejda
You are absolutely right that CHAT enables communities to leverage their knowledge of their context into the design of insurance packages that are relevant for them, at a price they would be willing to pay.
Are there challenges? Sure. For one, getting the data required to adapt the CHAT metrics is a costly and very intensive effort, and involves steps such as design of survey tools, cognitive pre-test and analysis, households surveys, key informant interviews, focus group discussions, not to mention the rigorous statistical and actuarial analysis that follows before the adaptation of the CHAT tools to the local language and context can take place. However, the results, are simply fantastic – in many ways, CHAT is a real “disruptive innovation” demystifying insurance for resource-poor communities, thus contributing to awareness, understanding, and acceptance of this important financial tool.
Incidentally, we are currently engaged in a multi-year research project to find ways to simplify this process and reduce the associated costs. This is a WOTRO-Funded Research Project on Development of a New Cost- & Time Effective Methodology to Upscale Demand for Health Insurance among the Poor in India. The overall goal of this four year research project is to upscale demand for micro health insurance among grassroots groups in India by developing a cost- & time effective methodology to design better HI products. You can read more about this here
If you’re interested in knowing more about CHAT in the context of microinsurance, I would suggest the following Resources:
Our Changemakers entry about CHAT from July 2007
A 5-minute video of CHAT, available at http://www.youtube.com/microinsurance
The following publications, available from free download from our website’s publications page:
Iddo Dror: Demystifying Micro Health Insurance Package Design - Choosing Healthplans All Together (CHAT). Microfinance Insights. Vol. 4, September 2007
Marion Danis, Erika Binnendijk, Sukumar Vellakkal, Alexander Ost, Ruth Koren and David M. Dror: Eliciting Health Insurance Benefit Choices of Low Income Groups. Economic and Political Weekly, VOL 42 No. 32 August 11 - August 17, 2007.
David M. Dror, Ruth Koren, Alexander Ost, Erika Binnendijk, Sukumar Vellakkal and Marion Danis: Health Insurance Benefit Packages Prioritized by Low-Income Clients in India: Three Criteria to Estimate Effectiveness of Choice. Social Science & Medicine, Vol. 64, No. 4, 2007.
And of course, you can always write me directly from more info, or continue the discussion here.
Thanks for adding to the discussion, and best wishes,