Feasibility of health insurance schemes in West Africa

This short paper was written by Gerrit de Vries, ICCO programme specialist on Healthcare, as part of a course with the Royal Tropical Institute (May 2007). The paper is quite relevant as ICCO is further developing its work on health insurance via the HIP, Health Insurance Platform, set up in 2006. Other HIP members are: other NGOs, Ministry of Foreign Affairs, insurance companies and knowledge institutes.

The paper – "Feasibility of Health Insurance Schemes in very low income countries: focus on four West-African countries" explores the feasibility of (community) health Insurance in very low income countries.

It is based on a literature review. Studies of four West African countries - Ghana, Burkina Faso, Guinea-Conakry, and Senegal - were gathered to provide evidence related to the topic. Evidence from these four countries was analysed focusing on financial feasibility, enrolment, and administrative capacity.

The conclusion of the paper is that community health insurance is an important way to finance health care and improve access in low-income countries, as well as to provide financial protection. However health insurance, and more specifically community health insurance, will only be feasible provided a few aspects are taken into account:

• Administrative capacity of the schemes should be improved, e.g. by providing technical assistance or other forms of capacity building.
• Ownership of the schemes has to be taken seriously.
• Schemes are developed bottom-up. Small, localised schemes should first be established and working, before trying to scale up to regional or national levels.
• Measures are implemented to avoid moral hazard and adverse selection. It was shown that such measures, such as co-payments and probation periods, are easy to implement.
• Measures are taken to enrol even the poorest of the poor. Such measures can include more flexible payment systems, e.g. not paying at once but in several instalments, or (partial) exemptions for the poorest.

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The synopsis was prepared by Justine Anschütz to help make ICCO sponsored 'research' more accessible

Baseline study on conflict transformation

This 2007 study by Irma Specht assesses the strengths and weaknesses of ICCO's work on Conflict Transformation in Africa and the Middle East. It provides a baseline for ICCO and its partners to improve their work on country specific Conflict Transformation and to measure its impact at local, provincial, national and international levels.

The purpose of this baseline study, as formulated in the TOR is to:

1. Provide a systematic and critical overview of ICCO's current efforts and results in the field of Conflict Transformation in Africa and the Middle East. This overview should pay special attention to the efforts and results of faith based organizations.
2. To make an inventory of the indicators used by ICCO and its partners and to suggest improved indicators for monitoring our future efforts in the field of Conflict Transformation in the period 2007-2010.

The study is based on ICCO country files from Burundi, DRCongo, Uganda, Liberia, Sudan and the Middle East. Two locations, Israel/Palestine and Karamoja in Northeast Uganda were visited for in-depth field research.

Interesting features of the study

Chapter 2 gives an overview of literature on conflict transformation. Chapter 3 gives a list of possible indicators for conflict transformation (output and outcome/impact level). The author has found that impact indicators are often missing in ICCO funded conflict transformation projects.

In Chapter 4 (assessment of ICCO's partners and ICCO-funded activities) the author found that the conflict analyses were often too short and not detailed enough. She recommended that the capacities of ICCO partners to look further and deeper by built up, even if they are addressing a local conflict solving direct causes. Also she recommended that the conflict analyses are more based on a consultative process with partners in the South.

The author states that in some ICCO funded projects there is too much stress on seminars and conferences. Section 4.3 provides a list of possible conflict transformation activities.

The author evaluated the partners she visited in Uganda and Israel/Palestine regarding their work on three levels main leves of Conflict transformation:

• Behaviour (e.g. violence, destruction, versus peaceful coexistence, dialogue)
• Attitudes/perceptions (e.g. hatred, mistrust, suspicion versus faith, trust)
• Structural causes (e.g. inequality, marginalization, corruption versus development, justice and equality for all citizens)

According to the author, ICCO and its partners especially need to reinforce their work on the structural causes. She considered one of the strengths of current approaches to be ICCO's ability to work across religious barriers and to play a role in reconciling people from different religious backgrounds.

The concluding chapter elaborates on the role of religion, gender and youth in conflict transformation. The report ends with recommendations for conflict transformation strategy of ICCO and for organisational restructuring.

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The synopsis was prepared by Justine Anschütz to help make ICCO sponsored 'research' more accessible

Adding value in Kyrgyzstan agriculture

This 2007 report by Eugene Ryazanov for ICCO and Helvetas examines how farmers, processors, and traders in Kyrgyzstan can set up a win-win situation in the fruit and vegetable production and processing sectors.

The booklet aims to analyse added value at different stages of the chain and possible ways of cooperation and business development of all the actors and supporters involved and it can also be used as a reference for market information. The main readers of the booklet are expected to be people involved in development cooperation working with agricultural producers, processors and traders.

The booklet is based on experiences gained in the Local Market Development Project in Kyrgyzstan, funded by ICCO and Helvetas Kyrgyzstan. The first phase of the project lasted from 2005 to 2006, the second phase from 2006 to 2008. The project focuses on 4 'oblasts' (districts), includes 10 value chains and targets 2000 farmers, mainly marginal and disadvantaged groups like resource-poor farmers, ethnic minorities and women.

The booklet contains three chapters. The first chapter analyses added value in eight selected value chains related to crops grown in Kyrgyzstan, namely: early potatoes, late potatoes, wheat, raw fibre cotton, ginned cotton, oil and cake, tomatoes, cucumbers and cabbages.

The second chapter focuses on ways of increasing added value at different stages of the value chain: at farmer, processor and trader level.

The third chapter has some recommendations on effective approaches and possible tools for the development of value chain actors. The provided approaches and tools are those that have actually been used by the Local Market Development Project and its partners for several years in Kyrgyzstan.

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The synopsis was prepared by Justine Anschütz to help make ICCO sponsored 'research' more accessible

Microfinance systems in the Philippines

This October 2006 country study of microfinance in the Philippines was conducted by Ma. Piedad S. Geron in the context of MICRONED, an alliance of ICCO, Hivos, CORDAID and Oxfam/Novib around microfinance activities.

The study is structured in the following way: Chapter 1: The Philippines: general overview, geographical, economic growth, population and employment, poverty situation; Chapter 2: The Philippine financial system, types of financial institutions; Chapter 3: The Philippine microfinance sector, about the microfinance policy environment, the demand and supply of microfinance services, donor support to the microfinance sector, priority needs and support gap to the MFIs ; Chapter 4: Meso-level support to microfinance, about the meso level supporters, needs and support gaps at the sector level; Chapter 5: Conclusion and recommendations, regarding three types of support: to clients of microfinance services, to the MFI sector, to networks, associations and federations

Table 3 in Section 3.1 presents some key policy measures on microfinance taken in the Philippines:

In Section 3.2 (Demand and supply of microfinance services) it is stated that demand not always matches supply. Most microfinance service suppliers prefer to provide services to those already engaged in some form of entrepreneurial activity. So many poor do not have access to microfinance. Very few MFIs provide start up funds for clients. Women comprise more than three fourths of the clients of microfinance institutions in the Philippines.

The study gives information on the three major types of institutions involved in microfinance in the Philippines: microfinance NGOs, cooperatives, and banks (rural and thrift banks). It presents their activities, total loan portfolio and number of clients. It also provides some judgement on their maturity and quality of operations. In the Philippines NGOs serve the highest number of clients and have the largest portfolio.

In Section 3.3 (Donor support to the microfinance sector) Official Development Assistance for microfinance is addressed and the portfolio of Dutch institutions in microfinance in the Philippines is presented, including amounts invested by Cordaid, ICCO, OxfamNovib, Rabobank Foundation, FMO, Oikocredit, and DOEN Foundation in 2002-2005.

In Section 3.4 (Priority needs and support gap to the MFIs) the kind of current donor support is summarised and gaps for future support are identified:

• Assistance in developing new products that meet the changing demands of current and prospective clients;
• Using technology based systems (e.g. use of cellphone based technology in payments and use of Personal Digital Assistant in recording loan payments) in lending operations;
• Development of savings products appropriate to the needs of the poor;
• Provision of insurance and microinsurnace services;
• Provision of services to accommodate Remittances from Overseas Filipino Workers;

The study also provides a description of various meso level supporters (section 4.1), such as associations of banks engaged in microfinance, federations of cooperatives, and training service providers, involved in promoting best practice, acting as lobby group, providing capability building to their member-institutions. It identifies needs at this meso level as well, for example (section 4.2):

• Improving the credit information system for microfinance clients
• Improving financial literacy among users of microfinance
• Development of a microfinance database and indicator system for monitoring purposes

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The synopsis was prepared by Justine Anschütz to help make ICCO sponsored 'research' more accessible

'Forgotten and marginalized' - Displaced persons in Khartoum

This February 2006 report - 'Forgotten and marginalized' - Displaced persons in Khartoum: One year after the peace agreement' was written by Rik Delhaas for ICCO.

Sudan has experienced the worst population displacement in the world: six million internally displaced persons (IDPs) out of a total population of 37 million people. Two million of the internally displaced persons live in official IDP camps, squatter areas or relocation sites in and outside the capital Khartoum, in northern Sudan. This report explores the situation of these two million IDPs, one year after the government of Sudan and the southern rebel movement SPLM/A signed a Comprehensive Peace Agreement.

The report is based on previous research and some interviews. It is not set up as a research report, in the sense that it does not include a research question or clear information about the methodology used. The last part is more like a pamphlet, urging the Sudanese authorities and international donor community to take certain actions. ICCO has used it for its lobbying efforts. The report provides some interesting figures and illustrations, among others a map of IDP camps in Khartoum State.

The findings in this research suggest that the administration of Khartoum State has not just economic motives for demolishing and relocating the IDP-camps. It also uses relocations as a method of discouraging people from legitimately settling themselves in Khartoum. The government of South-Sudan, in turn, lacks sufficient influence in northern policies and thus cannot interfere. It furthermore has electoral interests in having the southern IDPs returned to their places of origin in the South. Apparently, none of the authorities care for the welfare of IDPs living in and around Khartoum.

As a result of continuing demolitions and relocations to sites far outside Khartoum the situation of these IDPs has deteriorated. In all the camps, sufficient basic services such as health-clinics, water-facilities, latrines and job opportunities are lacking. Many IDPs have lost their jobs, because they cannot afford transport costs to Khartoum. Child malnutrition and mortality are high among the IDPs. Additionally, IDPs are prevented from organizing themselves and from collectively demanding improvement of their situation. In short, circumstances in the camps around Khartoum are dire. Even the IDPs in Darfur are better off, according to Special Representative of Secretary-General Jan Pronk.

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The synopsis was prepared by Justine Anschütz to help make ICCO sponsored 'research' more accessible

Performance and impact monitoring support to local market partners in Ethiopia

This 2006 report by Ben Haagsma is from a mission of IC/Consult to Ethiopia to assist two organisations -SHDI and NGO Cereal Banks Consortium- to improve their monitoring systems and their baseline studies.

SHDI provides capacity building of agricultural cooperatives and unions, while the NGO Cereal Banks Consortium helps farmers to set up cereal banks. Both organisations focus on promoting access to markets for small producers.

The report is structured in 7 chapters: Chapter 1 introduced the background and objectives of the mission; Chapter 2 clarifies terminology, monitoring for proving and improving, formal and informal monitoring; Chapter 3 provides the outcomes of a joint workshop; Chapter 4 gives detailed information on the systems of the Cereals Bank Consortium; Chapter 5 outlines monitoring systems of SHDI; Chapter 6 contains reflection and discussion; while Chapter 7 outlines some next steps.

In Chapter 2 the author presents some perceived differences between monitoring to 'prove' something (accountability) and to 'improve' something (learning). For example a survey can both provide average values, e.g. average amount of potatoes produced per year, and extreme values, the range from the lowest to the highest amount. The author argues that the average is most interesting for proving/accountability, while the extreme values are more interesting for improving/learning.

The report contains some interesting feedback on the content of questionnaires (sections 4.3 and 5.4) and on sample sizes for surveys (section 3.8).

Section 6.3 provide some interesting insights on the importance of participation in monitoring, both of target groups and within NGOs themselves.

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The synopsis was prepared by Justine Anschütz to help make ICCO sponsored 'research' more accessible

Transforming youth gangs into civil society organisations in Central America

Sarah Dobbe of CIDIN recently wrote a paper on "Transforming Youth Gangs. The Possibilities of Transforming Youth Gangs into Civil Society Organisations" (November 2005).

The main research question she asks is: "How can youth gangs in Central America be transformed into civil society organisations, and what lessons can ICCO learn from this analysis?" The report answers this question through answering the following sub-questions:

• What are the processes behind the formation of youth gangs and the occurrence of gang violence?
• What are civil society organisations?
• How do youth gangs differ from civil society organisations?
• How can these differences between youth gangs and civil society organisations be reduced?
• What recommendations can be made to ICCO with regard to transforming youth gangs into civil society organisations?

The study is structured around 4 chapters: Chapter 1: Introduction, research questions, methodology; Chapter 2: Fiction meets Reality (perceptions of youth gangs); Chapter 3: How to continue (transformation of youth gangs into CSO's); Chapter 4: Recommendations.

Section 2.2 analyses some of the important processes behind the formation of youth gangs and the occurrence of gang violence. Section 2.3 describes how youth gangs are perceived with regard to violence, and what implications this has on gangs, youth and gang violence. The popular views on youth gangs and gang violence are contested by describing alternative ways to look upon gangs. It is also described where these popular perceptions originate from.

Chapter 3 looks at how youth gangs differ from civil society organisations (CSO's) and how these differences can be reduced. The most important existing intervention strategies are analysed in the light of reducing these differences, and their potential in facilitating the transformation of youth gangs into CSO's. Section 3.3 suggests what is needed to make the transformation happen; the author also provides some recommendations to ICCO.

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The synopsis was prepared by Justine Anschütz to help make ICCO sponsored 'research' more accessible