International Development Journalism Competition: Microinsurance and its role in healthcare
On the sixth floor of DKV insurance in Barcelona, I watch Carlos Martínez shuffle through his schedule. An appointment is hard to get with the Director of the Department of General Services at one of the largest and most profitable health insurance companies in Europe.
Approximately 6,000 miles away in Quito, Vinicio Villalba, Director of the Intermón Oxfam mission in Ecuador is no easier to pin down for an interview. Working in the non-profit sector of one of the poorest countries in South America, his hands are full.
So what links these two very different figures and their seemingly unrelated roles and sectors? Well, an interesting project that illustrates how and why multinational private enterprises can and should deploy their expertise and knowledge in the world of development.
The story starts with an Italian priest and activist based in South Quito named Padre José Carollo. His dream of giving universal medical care to a community with scarce economic resources was realised in the form of Un Canto de Vida, a Hospital constructed two years after his death in 2007. Through Carollo's Funcadión Tierra Nueva (FTN), the hospital was able to offer health care services for the local community with the help of microinsurance.
Like the under-fire microcredit industry, microinsurance aims to offer a financial product - taken for granted in the developed world - to the poor of underdeveloped countries. In the case of FTN, members are covered by a medical insurance policy linked with the hospital protecting them for $2 a month. It is all made possible as the foundation acts as a non-profit cooperative which pools members' payments, ensuring there is enough to cover the predicted costs.
The only thing missing is the technical expertise to ensure fully comprehensive and legal insurance coverage. This is where the corporate social responsibility arm of DKV insurance in Spain was called upon by a Spanish collaborator at FTN. Carlos Martínez from DKV explains, "Our role was to design a health insurance product [for the FTN cooperative] attentive to all the needs of this population." In the case of FTN and the hospital it was, "A product specifically adapted to the most frequent illnesses and diseases in the area."
The project was a success and thanks to a team of three insurance experts sent regularly from Spain to Quito, a suitable model was developed and monitored voluntarily by DKV to, according to Martinez, "periodically ensure, its economic sufficiency and guarantee its sustainability."
Those covered by the scheme now receive medical attention for anything from vaccinations to childbirth, both of which require special attention in a country which suffers from some alarming health statistics. WHO publications show the level of maternal mortality at more than double the regional average while the prevalence of Tuberculosis, for example, is almost triple that of neighbouring countries.
The microinsurance scheme successfully offered protection from these ills to around 3,000 members, alerting the attention of Vinicio Villalba of Intermón Oxfam, the Spanish speaking arm of Oxfam International.
Villalba and Oxfam had been engaged in various projects in the region of Tungurahua, also in poverty stricken South Quito, with another local healthcare foundation, Fundacion Alli Causai (FAC); Kichwa for "good life." Focused on rural health issues in one of the poorest regions in Ecuador, they planned to construct a hospital in the year 2000. The project was never completed due to spiraling costs which were exacerbated by 94% inflation during the worst economic crisis in the history of Ecuador.
"This is how the necessity to seek alternative financial resources to complete the hospital was born," explains Villalba. He adds that the state's failure during this period "marked the start of the relationship between Intermón Oxfam and DKV," the latter of which were already engaged in the country.
Villalba called upon Martínez and DKV and funds were soon provided to aid the completion of the hospital. Later, after the working relationship had been established, came "the idea of putting DKV's expertise in health insurance at the disposal of FAC in order to design a system of microinsurance for indigenous families and rural communities in the province of Tungurahua."
A similar system as before was replicated and by 2009 previously vulnerable people were being protected through the affordable, community-based, non-profit microinsurance scheme that FAC offered. Oxfam, DKV and FAC managed to fill a vacuum left by the broken public institutions of a struggling state. Where public institutions had failed to offer sufficient protection in a developing country, private but cooperative enterprise succeeded.
Since then Ecuador has recovered somewhat from its crisis and has maintained a level of stability in recent years. Improved institutions have returned and found a strong legacy left behind by the community hospital and its microinsurance access scheme.
The project, which Villalba admits would not have been possible without the help of DKV, has not just protected members of the scheme but has altered the perceptions about health entirely. "It has succeeded in changing practices of hygiene among children, families, schools and other public sectors which has been a fundamental element in the prevention of diseases." Furthermore, "Emphasis has not just been on the prevention of diseases and illnesses but also on innovating the methods and quality of curing as much in primary health as in secondary health care in the hospital, providing a quality service at accessible prices."
It seems that DKV's corporate social responsibility program has made real and lasting change in South Quito. It has successfully transferred existing knowledge and expertise, encouraging the development of healthcare where it is needed most.
However, Villalba thanks the company's attitude more than their "know how". "DKV has understood the focus on rights that Intermón Oxfam works with. It has demonstrated commitment to a 'Southern' country, helping poor people fight for their rights and achieve a quality of life and level of dignity that strengthens their roles as citizens."
On a final return to DKV I wonder if I can detect a sense of duty being fulfilled. "It's not a duty, but an opportunity," their expert in corporate social responsibility, Daniela Toro, tells me. "Health is our business but it is also where we can make a difference." She draws on DKV's "competence, expertise and knowledge," in its field, highlighting that these put them in good stead to contribute through "social investment". She adds that when a company chooses to take advantage of its position in this way, "participation in a joint enterprise can be magnificent."
This feature was written for the Guardian International Development Journalism competition before 13 June 2011.