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Integrating Micro-insurance for Families into Agricultural Cooperatives

Community-based health insurance services will be integrated into existing agricultural cooperatives to reduce financial barriers to health services. Training and education for cooperative members will be expanded to influence norms and practices to support healthy nutrition, disease prevention and hygiene at home. Parents will have cash available, and insurance mechanism to pay for child health care, with basic health, nutrition and hygiene components offered through membership to existing agricultural cooperatives.

Photo of Claire Espey
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This idea is founded on the principle that wealth is a primary, fundamental determinant of health and early child development.  Despite economic indicators of macro-economic progress, the Democratic Republic of the Congo (DRC) is among the poorest countries in the world with a life expectancy of 48 years where 72% of the population living below the poverty line – the same level as 2005-2007.  Malnutrition is chronic amongst a large part of the population and has been on the rise since 1995 with families spending 62% of their income on food.  Rural farmers are particularly affected, as 80% of rural farmers are considered to be living in poverty.  Child health indicators in DRC are similarly dire, as one of every ten children born in DRC will not reach the age of five.  In relative terms, the DRC is one of six countries that together bear the burden of 50% of the worlds’ maternal mortality, the third largest contributor to mortality for children under five after India and Nigeria. 
In response to these challenges, Eastern Congo Initiative (ECI) provides resources and funding through grant-making and capacity building for Congolese-led community-based organizations in the region working in economic development and maternal and child health (MNCH).  Since 2010 ECI has partnered with rural farmers and local organizations to improve the quality and quantity of crops (such as coffee and cocoa) and to integrate conservation and rural agriculture to revitalize local markets and household economic stability.  In the health sector, ECI partners with local organizations that focus on mothers, children under five and infants by supporting the development of community-based preventative healthcare systems and practices. ECI also works to convene health partners to promote local promising practice interventions that can be scaled and replicated through increased investment.
With this project, ECI aims to extrapolate lessons learned from our existing MNCH programming to integrate in our economic development programs as a component of the agricultural cooperative services.  Wealth is fundamentally and causally linked to health and early child development, and will be addressed as we apply such innovative proven concepts as the insurance collectives to increase impact and sustainability of reinforcement to agricultural cooperatives.
Children under five in DRC are getting sick and dying from known causes that could be prevented if parents had the cash on hand to pay for preventive and curative health services (pneumonia, diarrhea, malaria, malnutrition). Payment for health services is a great challenge in the Kivus in particular, as they are transitioning from humanitarian to development context they must find simple, sustainable and fast solution to pay for consultations and essential medicines.  Low levels of income, lack of savings and payment mechanisms, and low prioritization of existing household resources on health (prevention, care, nutrition, and hygiene) lead to low health service utilization and poor health outcomes.   Parent’s must have the cash on hand and recognize the importance of spending it on health at appropriate times. 
ECI’s financial, technical and administrative support to agricultural cooperatives has successfully boosted technology, managerial know-how and investment to improve agricultural practices and raise revenue for local farmers.  Cooperatives are community-based commercial enterprises that exist to collectively pool resources for farm investment and leverage the voice of many to negotiate fair prices.  As individuals, farmers often lack the resources and knowledge to invest in their farms and access markets, however when resources are pooled, quality and quantity of their production is likely to improve. Farming households pay annual dues to cooperatives that provide agricultural training, access to value-added technology, and eventually, a stable market.  Members farm their own plots, but gather monthly in groups of approximately 20 households for trainings.  After the harvest, which happens generally once or twice a year, the cooperative should purchase the crop yield of members and sell the collective yield at fair negotiated price.  General assemblies bring together members of the cooperative to determine profit distribution. In addition to reducing cost of production and increasing farmer’s incomes, cooperatives are also tasked with contributing to social wellbeing of their members.  
Building from these achievements, we propose to integrate a successful community based insurance model to pool risk and facilitate couple’s payment for maternal and child health services.  ECI has supported HEAL Africa’s Safe Motherhood program on Idjwi Island in S. Kivu since its 2012 inception, having also previously supported a similar intervention in Masisi territory in N. Kivu.  The Safe Motherhood program has created over a thousand solidarity insurance groups in the region, more than 70 percent of which are still in operation and independent of HEAL. These health insurance groups are formally registered groups of couples (10 - 25), who gather monthly to pay the membership fee (less than a dollar a month) and regulate requests and demands for pooled maternity funds.  Whenever a pregnant woman goes to the health clinic for reproductive health services, prenatal care or delivery, the insurance group pays half the bill. This model will be expanded to include health services for children under five. 
Lessons using behavior change communication for health promotion will be added to existing training events for couples registered in the agricultural cooperatives.  These will include essential family practices such as those related to:
  • Water and Sanitation (hand washing with soap, latrine use, point of use water treatment)
  • Insecticide treated bed nets for kids and pregnant women
  • Oral rehydration salt home treatment of diarrhea
  • Safe sex
  • Family planning
  • Healthy nutrition for pregnant women and kids, use of iodized salt
  • Breast feeding for first six months
  • Danger signs for newborns and pregnant women
  • Prenatal visits and health center deliveries
  • Child wellness visits and birth registration
  • Vaccination for kids and pregnant women 
In order to address causes of malnutrition, farmers will also learn good agricultural practices to grow nutritious food for household consumption through intercropping or kitchen gardens.
  1. How to make cooperative registrations more inclusive (expand from from individual members to households)?
  2. How to increase women’s participation in cooperatives?
  3. How can we understand and influence parent’s decision-making for spending income?
  4. How can we ensure that demand doesn’t exceed the funds available in common piggy bank for health insurance?
  5. How to set a reasonable monthly fee given the expansion of services covered from mothers to include children?
  6. How to encourage parents to prioritize food security and healthy diet for their children?
  7. How to formalize village banking for collective use (including health insurance)?
  8. How do we bring technology into this idea (communications, financial transactions, transparency, etc)?

Who will benefit from this idea and where are they located?

An existing ECI partner cooperative association members and their families: Tufaidike coffee cooperative in Bweremana in N Kivu (228 members divided into 23 sub-groups. 52 members are women) [Updated Jan 29, 2015]

How could you test this idea in a quick and low-cost way right now?

ECI is already working with existing partners Tufaidike and have prototyped our model to enhance cooperative capacity and build out national and international value chains for increased revenue. Local partner HEAL Africa has already prototyped the health insurance collective model and community health promotion through Safe Motherhood program, supported by ECI. ECI will support the collaboration of these partners and integrate health insurance into existing cooperative networks. We plan to first reinforce capacity of these cooperative structures, expand membership to members’ spouses, integrate health insurance and GAPS for growing nutritious food for HH consumption. The principle assumption is that collectivity around income generation also applies to health spending. This assumption could be tested through focus groups with cooperative members to discuss shared interests, and learn about how couples make decisions about health for their children. We would also need to ensure that service quality meets community expectations, and verify that finance factors among the most significant barriers to accessing health services.

What kind of help would you need to make your idea real?

We would like OpenIDEO community feedback on methods for testing our assumptions and for piloting the concept. Would be great to get expert advice from health economist to discuss best practices for finance mechanisms in rural contexts. We want to know best practices for integrating health in economic cooperatives. And advice for how to measure health impact of economic investment.

Is this an idea that you or your organization would like to take forward?

  • Yes. I am ready and interested in testing this idea and making it real in my community.
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Attachments (2)

ECI 0-5 Q&A 20_12_14.pdf

Q&A Amplify team - first 5 questions answered

ECI 0-5 Q&A 6_1_15.pdf

Q&A Amplify team - questions on womens participation and recruitment strategies answered


Join the conversation:

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Photo of Adam Reterski

Love the idea! Congatulations for passing through the refinement section. This is my favourite idea so far!

Photo of DeletedUser


This idea is very good with multiple benefits for the individuals involved and for the local economy. To add to this, have you thought about expanding the idea by including support in existing public areas that can advertise and inform the idea to the community such as hospitals and schools. Also congratulation on making it this far with the idea!

Photo of Musa Innis

Congratulations on getting so far in this challenge!!
I think the idea is pretty cool and would work although if there were slight additions such as getting the children and parents involved in the farming as it would keep them active and build stronger relationships.
If there was also a reward system to help motivate them, and get extra space to farm or certificates/medals for the best or most crops.

Also I think if you could gather some children and parents for exapmple in a primary school to take part in your activity that would be a nice way to test it out. You could also split up the children and parents into small groups to farm in different places and then come together twice a year for the progress.

I hope your team gets further in the challenge and good luck!!

Photo of Chioma Ume

Hello Claire! We've been having early childhood experts take a look at the ideas in Refinement and we'd like to share some of their feedback with you: Some things to consider include ways to ensure women's access and control over funds. I will be critical to consider whether there are other things beyond money that prevent access (e.g. distance or quality of services), so that parents want to access the groups and see the returns of investing in the insurance schemes. We like the idea of using the group meetings for behavior change communication. Your team might consider how to make this engaging for participants and the right amount of information to share at session to maintain interest.

Photo of Lwala Community Alliance

This is a really good question and we would love to hear insight from the DRC. In our experience in Kenya distance to care, service and provider quality, and difficulty paying are all competing challenges for rural clients.

Photo of Chioma Ume

Thanks for the comment, Lwala. Are there any insights about how to overcome these challenges from your experience in Kenya that might be helpful to Claire and her team?

Photo of Claire Espey

Thanks so much Chioma and Lwala! We have scheduled some informal key informant interviews with cooperative members this week to understand the context in Kirotche and Katana health Zones. From HEAL Africa's experience on Idjwi island, however, we know that significant barriers to accessing maternal and child health care there do include finance, geographic distance and poor road conditions, as well as quality of care. This is why HEAL's Safe Motherhood program incorporates components to support health zone supervision and management, to supplement essential meds and equipment, and to train nurses, as well as reinforcements to the existing referral system from traditional birth attendants to bring women into clinics, in addition to addressing the demand side of services (through insurance cooperatives and behavior change communication for essential family practices). It's a really important point though that you both make - we will address these assumptions about access in our upcoming prototype. We do welcome any insights from Lwala Community Alliance experience. Cheers!

Photo of OpenIDEO

Congratulations on making to the Zero to Five Challenge Refinement list, Claire! We love how this idea addresses a really practical issue for parents – having money to access basic services. It’s great to see you collaborating with members of the OpenIDEO community and the list of what you would like assistance with is very helpful. You mention that to gain user trust the services that they access must be considered valuable? How will you work to change behaviours and ensure that health services accessed by the collective are of good quality? How will you decide which services will be eligible for families to access the money? Educating the collectives around early childhood health is a great idea – which organization will be be leading that effort? What challenges do you anticipate as you merge these two ideas? To articulate how your idea would work for a member of the collective, we’d encourage you to fill in a User Experience Map and share it with our community We’d also like for you to think about how you could test an aspect of this idea by creating a quick prototype. Check out tips for Refinement for some tools to help you get started.

Photo of Meena Kadri

Great to see you've uploaded your responses, Claire! We look forward to seeing your User Experience Map when you're ready. We also hope you'll find the time to look over other ideas in Refinement and post questions, feedback and suggestions. There are some great conversations going on to strengthen our collective impact – and we'd love to have you join in with your experience and perspectives.