Senegal 2010

This research project is an impact evaluation of the role of insurance literacy and liquidity constraints on the demand of health microinsurance, provided by community-based health insurance schemes (CBHIS) in Senegal. It involved the collection of first-hand data and the implementation of a randomized field experiment.

Public health funding in Senegal has been stable over recent years while overall per capita health expenditures have been increasing in the same period. The shrinking of the state’s ability to meet health care needs makes it unable to provide universal insurance for its population. This has led to the emergence of many community-based health insurance schemes in Senegal. These schemes vary in design and implementation but they are all not for-profit organizations based on voluntary participation and underpinned by concepts of mutual aid and social solidarity at the community level. Despite their benefits, in some areas there remain low take-up rates.

The main research objective was to evaluate the roles of lack of knowledge of these CBHIS and lack of financial literacy amongst locals. We also investigate the effect of marketing techniques that alleviate the potential financial barriers to entry.

Together with Philippe LeMay-Boucher, Olivier Dagnelie and Michel Tenikue, I designed and organized the survey. I was the main coordinator and supervisor of the project on the field.

In summer 2010, we developed a partnership with GRAIM (Groupe recherche d’appui aux initiatives mutualistes) a Senegalese NGO promoting the work of local CBHIS active in Thiès.

We collected data on 360 randomly selected households across the city and obtained information on each household member’s religion, level of education and health problems (sickness and chronic diseases). We also gathered information from the head of household concerning work, income, and a number of other factors pertaining to trust, risk aversion, and discount rate evaluation.

Our randomized experiment implemented consisted of providing an insurance literacy module offered by the GRAIM on health microinsurance and specifically on CBHIS unctioning (and the differences across various MHOs active in the city of Thies), together with notions on saving, risk and insurance. After the insurance literacy training was completed and independent of this assignment, households were split into three randomly chosen sub samples and each subsample received an additional marketing treatment in the form of one of three vouchers alleviating the economic barriers to entry CBHIS.

In order to carry out our survey, we employed twelve local, independent and qualified enumerators who conducted the survey in local language (wolof). All enumerators had previous experience with surveys and field work and received 2 days training in survey design and questionnaire administration by the research team. We had the pleasure to work with: Ndeye Seyni Kane, Moustapha Diop, Hamet Diallo, Marie Tall, Hadyatou Diallo, Magatte Ndiaye, Abdoullaye Fall, Awa Sogne Gueye, Fatima Ndiaye, Yvonne Faye, Blandine Nogoye Faye, Marième Ciss.

Acknowledgments

This work was supported by the International Labour Organization (ILO) Microinsurance Innovation Facility; the Fonds National de la Recherche du Luxembourg and the Carnegie Trust for the Universities of Scotland. We thank the GRAIM in Thiès, Ndeye Seyni Kane for her help during our field work and Joe St Clair.