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CIDR’s 2010-2014 Strategic priorities

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Health Insurance and Social Protection 

Strategic positioning

Social security needs of urban and rural workers in the informal sector are barely being met. To meet needs for health, accidental death and disability insurance, and reduce the vulnerability of African populations in the informal sector, it is necessary to create, negotiate, and implement microinsurance schemes.

Inevitably, national health insurance systems will first cover public employees and the formal private sector. They will struggle to reach informal workers. Commercial insurers looking to expand their client base will want to reach out to the informal sector. To do so, at least initially, they will have to partner with microinsurance experts.

By 2014, the Health and Microinsurance Department aims to distinguish itself among public and private stakeholders as a microinsurance expert with experience reaching rural and urban informal workers and participatory governance know-how.

It will develop strategies to integrate participatory microinsurance schemes into universal health insurance. It will diversify its know-how to cover risks such as accidental death and disability insurance. It will build capacity of permanent staff and develop long-term partnerships with the mutual movement in the North and South.

Moreover, the Department will scale up its intervention capacity at a national level, by supporting existing mutuals and developing new expertise in health reinsurance.

To expand health insurance, quality of care must be improved. Therefore, the Department intends to hone its expertise, contracting public health services and partnering with service providers specialized in health services management. It will promote private, socially oriented health care capable of carrying out the mandate of public services in regions where it supports microinsurance schemes. It will partner with institutions providing technical assistance to health care service providers and will implement programs to develop health services and micro health insurance in tandem.

The Department will adopt a regional strategy to coordinate and maximize impact of its programs throughout West Africa (Benin, Burkina Faso, Côte d’Ivoire, Guinea, Senegal and Togo). A regional coordination unit will be set up in East Africa (Kenya, Uganda and Tanzania).

Strategic priorities

a. Professional management for micro health insurance schemes

The Department will capitalize on the lessons learned from managing mutuals and actuarial risk to develop centers to promote and manage micro health insurance schemes.

These Promotion and Management Centers (PMC) will ensure the technical management of micro health insurance programs for mutuals, private insurers and others. They will also offer a range of services including new product development, actuarial management of risk pooling mechanisms and premiums and claims management. Existing mutuals will have priority to claims management services, which involve purchasing health care (negotiating care packages, procedures, fees and contracts with health care providers); but private insurers and other health care funding schemes may access these services as well.

Private insurers are increasingly prospecting new markets by developing microinsurance products for the informal sector. Lacking knowledge of the health risks in this population, they often seek out technical partners. Delegating management functions to the PMCs is one way to meet their needs. The Department will partner with these insurers to help them develop services adapted to new markets. Together, they will build a new distribution and management model for microinsurance products, perhaps allowing policyholders to assume some product management functions (marketing, distribution, etc.).

b. Diversified funding and financial models

Co-funding is one way to increase risk coverage and cover the expenses and intermediation costs of micro health insurance schemes. Microinsurance programs should be able to take advantage of the expected increase in funds for microinsurance and reinsurance opportunities in the years to come.

A strategy to diversify funding resources will be set up for each country. It will define how funds should be used based on the characteristics of each funding source (type of funding, timeframe, funders’ objectives).

Different types of financing will be used depending on the context:

- Funds from local, regional or national institutions. Creating financial linkages between microinsurance schemes and universal health insurance is a way to access reliable and sustainable public resources.
- Funds from mutual networks in the North. This type of financing is particularly well adapted to mutual networks in West Africa and francophone countries in the South. It can be incorporated into the communication strategies of some mutual organizations in the North.
- Funds from nationals living abroad. The idea is to organize immigrants living in France to help fund mutual health networks in their home countries. This option, although politically sensitive, is attractive for certain donors.
- Funds earmarked by local businesses as part of their communication and social responsibility strategy. This type of funding requires a critical mass of large companies willing to publicize their efforts to help salaried and non-salaried workers.

Re-insurance can help health insurance programs consolidate both technical and financial performance. Self-financed reinsurance will be proposed to existing mutuals to mitigate risk. Subsidized reinsurance will be integrated into marketing strategies of new programs or products. Developing these different types of reinsurance might require the creation of a specialized structure.

The Department will seek out the necessary skills to professionalize existing reinsurance arrangements and create new ones better suited to mutual and microinsurance schemes’ changing needs. It will conduct an exhaustive needs assessment and study the possibility of creating new reinsurance arrangements between mutual networks in different countries, to better mitigate external risks, such as epidemics and inflation.

c. Promote, with other stakeholders, quality health care adapted to the specific needs of microinsurance schemes

Expansion of health insurance is limited by high priced, low quality health care services. The Department will adopt strategies that involve health insurance programs in efforts to improve the performance of contracted health care providers.

It will negotiate with public health services and perhaps implement derogatory measures to improve quality of care: performance bonuses for staff, diversification of drug suppliers, etc. Depending on the openness of public institutions, mutuals may be invited to participate in the governance of public health services.

The Department will encourage the private sector to offer top-notch health care in conjunction with mutuals. Although a clear separation between health care providers and insurers is necessary, mutuals must be able to negotiate with suppliers to keep their products attractive, without compromising the viability of private care providers.

d. Incorporate micro health insurance models into national social protection schemes

The ongoing health sector reforms in English- and French-speaking countries may be an opportunity—or a threat—depending on how microinsurance will be incorporated into universal health coverage. The Department will develop efficient strategies to integrate micro health insurance programs into national social protection schemes.

To influence policy, it will build alliances with practitioners sharing a similar vision. It has already done so with the National Federation of French Mutuality (Fédération Nationale de la Mutualité Française), and will continue to implement this partnership strategy with other mutuals. The Department will suggest forming a consortium to encourage synergies and strengthen negotiation power. These alliances will lead to national programs designed to promote member-based health insurance. In many countries where the Department operates, the context is increasingly favorable for setting up national and/or regional schemes to improve quality of care and coverage. The Department will develop partnerships with institutions that have expertise in this area.

Department staff will participate in consultative bodies on national and international health insurance policies (ILO, CGAP, World Bank, etc.). A communication strategy will be developed to address private sector players in view of diversifying partnerships.

Efforts will be made to actively contribute to the formulation of national policies. The Department will dialogue regularly with competent authorities as well as monitor ongoing reforms and participate in working groups.

Attached documents

Publié le Wednesday 15 September 2010, by CIDR

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