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Usaid presentation v13


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  • Double check…
  • Lack of differential pricing makes it hard to attract range of people Highlights the cultural shift from social movement to business that is sustainable
  • Note that this is the example from Bembereke, and highlight that decision-making process is working well…. \\Coordination
  • Illustrate that this is a sucessful example from MFI… annual- maybe kill the numbers? Replace with success factors : tipping point, salaried, etc. add back in coop slide?
  • Example from Uganda-Case studies of ways this was improved… MTN/Ecobank example…
  • Linkages to national policy and planning- more clear
  • Transcript

    • 2. Agenda Overview of research approach and interviews Professional structures of mutuelles in Bembèrèkè and Sinendé Customer feedback on value proposition of mutuelles Next Steps
    • 3. University of Michigan MAP Team: Abt Associates, Benin University of Michigan MAP: Multi-disciplinary Action Projects  Interactive learning experience pairing teams of students with global organizations to solve real problems  Team comprises multiple disciplines and industries: travel, consulting, development, marketing, healthcare Our Sponsor: Abt Associates  Key research question: How do mutuelles boost the adoption rate in rural communities in Benin?  Length of project: 7 weeks— 4 on-site in Benin, 3 synthesizing and performing research in Ann Arbor Michigan
    • 4. Bios Matt Preeti Sander SusanSource
    • 5. Problem Statement Since RAMU’s announcement in October 2011 mandating universal health coverage, the mutuelles have been brought to the spotlight as the model for universal coverage in Benin. However, the limited uptake suggests problems with the value proposition that must be addressed, and steps need to be taken to professionalize the mutuelles in order to make them a scalable business able to accommodate universal coverage. How can the mutuelles become self-sustaining, scalable enterprises? Source
    • 6. Mutuelles Health Insurance is a prevalent model throughout Westernand Central Africa Uganda, Ghana, Senegal examples…Source
    • 7. Despite having been launched more than 10 years ago, mutuelles inBenin have limited uptake• 5-8% adoption of mutuelle in most communities in Bembèrèkè• 10% in areas with mutuelle scolaires1• Sinendé adoption is much lower, 1-2% in most communities (more prevalent in Sinendé centre)• Of mutuelle members, only ~20 percent also pay for hospital insurance through the Union Source
    • 8. Thus far, we completed field research and synthesized our findings from Bembèrèkè and Sinendé Phase complete Field Deliver Project Research Synthesize Follow-on recommendatioImmersion and Research Research nsMarch 9-16 Interviews March 31-Apr 2 April 1-23 April 24-27 March 17-30
    • 9. Key research questions and interviews completed…..Accomplishments from the field:• Interviews with Union leaders of Bembèrèkè and Sinendé• Sessions with 4/10 mutuelles in Bembèrèkè and 3/4 mutuelles in Sinendé• Interviews with 64 community members (27 members, 37 non) across both communities• Additional visits to 2 health centers, and 1 Hospital (includes interviews with 2 nurses, 1 doctor, and 2 hospital admin) 98 Source interviews total
    • 10. There are three areas where the mutuelles need to professionalize: Capacity building Capabilities • Decision- making/controls Value Proposition • Data aggregation • Cost • Succession • Services offered planning • Healthcare quality • CultureSource
    • 11. Adoption in Benin has been slower than other countries, and recentnational health legislation has brought mutuelles center stageSource
    • 12. The value proposition of mutuelles currently does not attract a large percentage of the population, even in well-managed areas Details to follow Standard mutuelle offering Adoption rates Mutuelle: 2400  5-8% adoption of mutuelle in most CFA/member communities in Bembèrèkè Union: 3000/house Cost hold  10% in areas with mutuelle scolaires1  Sinendé adoption is much lower, 1- 2% in most communities (more prevalent in Sinendé centre)  Of mutuelle members, only ~20 Value percent also pay for hospital Basic coverage of Propositio Health center is insurance through the Union illness & n primary provider prevention Services Quality of Offered CareSource: interviews in Bembèrèkè and Sinendé
    • 13. While premiums are affordable for individuals, certain groups can not meet current price point for mutuelle membership Issue Opportunity At highest risk, Offer basic Indigent but unable to coverage to the population afford full poor at a lower coverage cost? Most families can Offer an incentive Large only afford 4-5 for large Families beneficiaries households (6+ regardless of members)? actual family size Create flexible Seasonal Inconsistent payment plan income annual earnings that allows earners make it difficult to farmers to match pay monthly premiums to income?Source: interviews in Bembèrèkè and Sinendé
    • 14. Offer multiple basic plans to meet varied consumer needs while avoiding adverse selection  Plan Offerings could include:  large-household incentives or plans to generate incremental income  a range of offerings to cover specific illnesses (malaria, pregnancy and infant care, hernias, etc.)  Example of success: Vaccination coverage provided by government for children up to age 5 Advantages Challenges  Attract a large, un-tapped segment of  Is it necessary to make it equitable the population  Increased risk for higher payout  More members sooner decreases  Daily operations more complicated for consumer pain point with mandatory mutuelle volunteers plan  Additional education would be required  Potential to increase the risk pool for staff and consumers  Generates incremental income for  Adverse selection the mutuelle  How to keep people committed for  Creates affordable option for families longer than one year – contracts? who wouldn’t otherwise join  Could cannibalize existing full-plan  Attractive to groups who don’t members typically join (e.g. men  hernias)  Need to conduct cost analysis to  Offers low-risk introduction to determine pricing mutuelle servicesSource: interviews in Bembèrèkè and Sinendé
    • 15. Our observations from Bembèrèkè and Sinendé isolated barriers limiting functional capacity and effectiveness of the mutuelles de santé Details to follow Checks and • Lack of decision making balances autonomy • Financial accountability degrades consumer trust • Need for professional liaison Organizational on care issues Role specialization structures • Specialized training for outreach & management Organization • Co-op versus agency structure design • Constraints of volunteer relianceProfessionalization • Dispersed communities make Fee collection distance a problem • Lack of urgency to pay • Infrastructure for accountability Operational Technical • Lack of ability to aggregate efficiency Administration and use data to improve • Ineffective sales force Outreach • Tie-ins with larger communitySource: Interviews education issues
    • 16. Post withdrawal from involvement in Sinendé, PISAF’s role in management and strategic planning has not been filled by local operations  The model is not self-sustainingFunction PISAF Mutuelle PISAF GAP 2006-2010 s/Union 2011+ S 2011+ • Since 2011,Research & set mutuelle X X strategicpremiums planning andEnsure meeting cadence with all X X financialparties present oversight have lapsed forConduct financial audits X X Sinendé, creating issuesAddress inconsistencies in X X withmedical care given(medical accountability ofcounselor) the mutuelles to the communityMaintain relationship between X Xhealth centers and mutuelles • Currently noCollect premiums & process X structure existsclaims about Union andConduct outreach X X Mutuelle for issue escalationRaise and address mutuelle X & supportissues at the Union level andabove
    • 17. Checks and Balances: organizational structure needs to support a self sustaining model Case Example Proposed decision model based on Necessary checks Bembèrèkè performed by Hospital Union Manager • Financial Audits of Union Level premiums collected and bill Executive Manager payment Board Auditing for • Liaison with health oversight care providers for Administrative Surveillance Council on contracts and committee Operations, issue resolution General Controls, • Perform data Assembly and aggregation and healthcare audits Strategy • Facilitate execution of strategic plansSource: interviews in Bembèrèkè and Sinendé
    • 18. Fee Collection: Neighborhood network of mutuelle agents to collect premiums and conduct outreach Case Example Problem addressed: Distance of villages to the mutuelle makes fee collection and outreach difficult, and volunteers spend most of their time returning 2-3 times per house to collect premiums. Benefits: • Reduces dependence on volunteer administration structure • Eliminates expense and time traveling to distant villages • Encourages local entrepreneurship Assessing the Numbers • Trusted member of the local community is the face of (example): the mutuelle Challenges: • Requires significant financial controls to prevent fraud • i.e. Use stickers instead of stamps to track membership • Critical mass of membership required for sustainability • interviewsSource: PAPME Director interview, mutuelle Unclear fit to existing volunteer-based structure
    • 19. A Mobile Money infrastructure would help revamp the current fee collection system to induce growth and financial stability Case ExampleCurrent System Central Village Members Mutuelle Multiple visits for Volunteer single collection by family 5,000 Cash PaymentMobile Money MembersSystem Central Village Local Mutuelle Volunteer Agent Limited displacement Via Phone House Mutuelle Bank Source: Mobile Money for the Unbanked, GISM 2010
    • 20. Professionalization of data aggregation and analysis could create a platform for future connectivity between mutuelles Individual identification Data aggregation at Succession planning: numbers Union level passing down - Information tracked by - Enables performance management knowledge beneficiary evaluation of mutuelle - Creates a plan for - Enables tracking of results to Union goals sustainable operations for enrollment fees and care - Ability to stage mutuelles in the future by the individual interventions promptly - Promotes continuity & - Makes future reciprocity -Financial accountability consistency for day-to- between regions feasible through regular audits day operations - Builds skills in the communitySource: interviews in Bembèrèkè and Sinendé