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Centre International de Développement et de Recherche (CIDR)

About the Project
Project Name: 
Health Product diversification and improvement of institutional efficiency of the schemes
Type of Facility Project: 
Innovation Grant
Country of Operation: 
Guinea
Region: 
Africa
Project Thematic Focus: 
Insitutional models and business processes
Product: 
Health
Type of Risk Carrier: 
mutual or community-based
Type of Distribution Channel: 
Mutuals, community-based organizations
Project Description: 

The project seeks to improve the existing MHO sustainability by diversifying the products they offer. The first phase will implement a mandatory coverage for maternity at the village level as well as a mandatory accident and illnesses coverage for children at school. In a second phase, the MHO will expand the scope of their activities and target formal workers.
A second objective is to improve the quality and efficiency of health care by implementing performance based on contracts with health care providers.
Eventually, the project will strive to improve the MHO' efficiency by strengthening their information system and marketing strategy.

Consortium Members: 

Established in 1999 as part of a health insurance programme by CIDR, l'Union des Mutuelles de Santé de Guinée Forestière (UMSGF), is a regional network that governs and provides technical services to 35 MHO in Guinea. UMSGF has been providing microinsurance products for 8 years with CIDR support. Currently covering about 22 000 people in the 3 districts of Lola, Nzérékoré and Yomou, UMSGF offers a voluntary family health package that covers primary health care and hospitalizations.

Beneficiaries: 

CIDR expects to reach 21,000 women through the maternity coverage and 50,000 school children with the accident and illness coverage.

Lessons from the Project
Learning Agenda: 
  • What is the value of basic health insurance for the rural poor and especially of maternity coverage?
  • To what extent can the poor benefit from health insurance in the context of inadequate health services infrastructure?
  • What are key strategies for sustainability of MHO? Is a product diversification strategy sufficient? What are other ways to improve efficiencies and stabilize MHO financial performance?
  • What are the specific mechanisms to reduce adverse selection, moral hazard and frauds?
  • What is an efficient marketing strategy to promote these kinds of products?
  • How an innovative group product, as village based maternity coverage, could boost the current individual products?
Emerging Lessons: 
  • Covering delivery costs only in case of complications does not seem sufficient to guarantee the product’s attractiveness and have an impact in terms of public health. On the other hand, covering all antenatal visits does not make it possible to define a product that is affordable to families. External sources of financing need to be secured.
  • In the context of the mandatory product at village level, it is important to think about effective population counting methods to obtain sufficiently reliable data at a reasonable cost and reduce the risk of fraud.
  • It is important to take family size into consideration in determining premiums for group products.
  • Better estimation of the time needed for premium collection would have made it possible for better planning of the collection process.
  • The school product is easy to implement, especially in schools located near a health facility.
  • Subscriptions to the school product were facilitated by the involvement of the Ministry of Education’s representative.
  • Full payment of the fee by parents at the start of the school year is problematic, especially because it is combined with the payment of enrolment fees.
  • Village size and the credibility of elected officials are determinant factors with regard to village affiliation.
  • Villages in which community projects are being carried out seem more disposed to subscribing to the safe motherhood product.
  • The school product is very attractive to both parents and teachers.
  • Quality of care determines the attractiveness of health insurance products.
  • The coverage of ANVs and the training of village birth attendants make possible an increase in the number of deliveries attended by medical personnel, emergency transfers to hospital and caesarean deliveries, although the indictors overall are still below the national average.
  • The safe motherhood product’s biggest impact was the reduction of maternal mortality.
  • The technical equilibrium of health products heavily depends on medical inflation. In the context of limited pay capacity, a major increase in medical costs places the viability of microinsurance health products in jeopardy.
  • The strategy of including coverage of primary health care in the health-care package did not pay off: it did not have the desired effect on membership and was costly to the network.
  • Distance from the health centre is a determinant factor in terms of consumption: the closer a beneficiary is to a health-care structure, the more frequent the number of visits.
  • The school product has great potential as a viable product.
  • For the moment, the safe motherhood product is not cost-effective and seems to require sustained external funding to break even.
  • The diversification of products renders the task of mutual managers more complex and makes procedures more cumbersome.
  • With time, a mutual structure heavily dependent on volunteers and the leadership of elected officials shows its limitations.
  • The community model is not always synonymous with good governance.
  • The population’s financial capacity remains a genuine hindrance to the development of mutuals.
  • The sparse funding of mutual activities by donors does not make it possible for the Union to have a coherent development strategy.
  • The strategy of contacting organized groups has not yet borne fruit, with only one group out of 25 visited being interested.
  • After ten years of activity, the mutual model in Guinea has difficulty in identifying the economic model that will allow it to achieve sustainability. At this stage of the project, it is becoming apparent that the product diversification strategy alone will not make it possible to ensure the mutual Union’s viability.
Key Performance Indicators: 

Learning Journey: 
Learn more about the lessons that CIDR is learning in this project.
About the Organization
Relationship with the Facility: 
Innovation grantee
Country of Head Office: 
France
Region : 
Europe
Type of institution : 
Non government organization
Participation in Microinsurance: 
Consulting support
Organizational Overview: 

Centre International de Développement et de Recherche (CIDR - International Centre for Development and Research) is a non-governmental organization (NGO) created in 1961. It aims to strengthen the capacity of local institutions and microentrepreneurs in the informal economy of a dozen African countries, by promoting microfinance, service enterprises, territorial development In several of these countries, CIDR is also involved in supporting mutual health organizations (MHO).

Microinsurance activities : 

More about the Organization
Websites: 
CIDR
Quotes: