Women, health and inclusive insurance: mainstreaming gender into microinsurance

Women tend to be the primary decision-makers when it comes to managing household health. Yet nearly a billion women are excluded from financial services and women make up 70% of those living in absolute poverty.

The latest Microinsurance Network Expert Forum brought together Lisa Morgan, Technical Officer at the ILO's Impact Insurance Facility, Zainab Saeed, Head of Market Research and Product Development at Kashf Foundation in Pakistan and Gilles Renouil, Director of Microinsurance for Women's World Banking (WWB). Greg Scully, International Advisor at the US Treasury’s Office of Technical Assistance moderated the discussion.

Lisa Morgan linked gender mainstreaming to the Sustainable Development Goals (SDGs) - particularly SDG 5: empowerment of women and SDG 3: healthy lives for all. Gender and sex are not the same thing and many women are at the centre of a complex set of relationships between poverty, health, work and financial inclusion. Women are more likely than men to work in the informal economy where they are unprotected by labour laws and social protection, and they have less access to loans, credit and savings.

When it comes to healthcare, women need products which compliment government universal healthcare (UHC) plans. Women are disproportionately impacted by the lack of healthcare cover both for themselves and their children, and ill health can trigger other expenses typically not covered by UHC, such as loss of income, cost of medicines, or transport to and from hospital. Lisa urged financial services providers (FSPs) to adopt a holistic approach by bundling together a number of different healthcare products and services - in this way gender will be mainstreamed throughout the offer.

There are a number of barriers to increasing women’s financial inclusion: poor understanding of gender dynamics which can create inappropriate products; female customers in the informal sector are hard to reach; changing financial relationships in the household can lead to violence or divorce. Product development must be approached with care - key lessons include good market research to understand women’s religious, cultural and health issues; using technology to overcome barriers; mainstreaming of gender in all products; training gender-aware staff; and creating women-friendly products.

Gilles Renouil presented the case of Latifa Subah from Jordan, a businesswoman with a child to look after. When Latifa fell ill, spending two days in hospital meant two days’ loss of income, a dilemma typical of women across the world. Women face three main barriers to healthcare: psychological (women tend to ignore early symptoms and delay seeking medical advice); infrastructure (public or private hospital? how far is it? how good are the doctors? what will it cost?); and financial (women in the informal economy have limited access to social security or insurance - for example, 42% of women in Egypt said they cannot afford to seek medical help). Furthermore, there are hidden costs to illness such as transport, diet, bribes (to get into hospital) and loss of income, which can be double the actual medical expenses.

In response, ten years ago WWB and the ILO created ‘Caregiver’ - a health insurance product which is meaningful (women can use the per-hospital-night fixed cash payment for any purpose such as medicine, school fees or loan repayment); relevant (no exclusions) and affordable (low premiums). More than two million lives (>50% women) are now covered in four countries. Caregiver empowers women, said Gilles, in four areas: material (manage income better and avoid debt); cognitive (understanding of insurance benefits and greater financial literacy); perceptual (stronger sense of self-confidence); and relational (improved position in the household). Financial products, if designed thoughtfully, can impact the lives of women clients in many ways.

The Kashf Foundation success story in Pakistan was presented by Zainab Saeed. Poverty is the biggest barrier to accessing healthcare, she said, and loss of income and being forced to sell assets during ill health has a long-term developmental impact on households. 1.57 million people are now covered by Kashf’s maternity and non-maternity products. Benefits include coverage for the entire family, no exclusions, cash and cashless options, income loss stipend for the main breadwinner, ambulance transport and a free annual health camp. Although coverage is split roughly 50/50 male and female, women make 70% of claims and receive 72% of the total claim amount.

Zainab listed key success factors: design (client-centric, mandatory, the right insurance partner, flexibility and staggered premium payments); commitment (management and team buy-in, large number of panel hospitals, the right head office structure) and innovative marketing (Kashf used social theatre performances, financial education and training to raise awareness of the need for health insurance). Kashf also run gender sensitisation programmes for men who become ‘champions of change’ in their communities.

Other challenges to emerge during the Q&A included the need for the private sector to support government UHC; the limitations of tele-health and digital health products, especially for many women who do not have smartphones; the need to involve women in testing and developing new products so they trust them and spread the word; and using behavioural economics to incentivise women - for example, by rewarding women for going to their health check-ups.

The entire discussion is available to all MiN members here in the members’ portal. Look out for details of our next Expert Forum in December!