Title Registration Form Campbell Collaboration Social Welfare Coordinating Group

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1 Title Registration Form Campbell Collaboration Social Welfare Coordinating Group 1. Title of review (Suggested format: [intervention/s] for [outcome/s] in [problem/population] in [location/situation] Example: behavioural therapy for reducing violence among adolescents in institutions) The Impact of Microinsurance on Economic and Social Outcomes for the Poor in Low- and Middle Income Countries 2. Background and objective of this review (Briefly describe the problem and the intervention) Economic crises, natural events, and social shocks are main hindrances to escaping the cycle of poverty. Many development efforts, for instance microfinance projects, offer ways to escape poverty. However, the limited ability of the poor to cope with risks and economic shocks resulting from these risks reduces the potential effects of such efforts. More so than the rich, the poor cannot cope well with illness, death of the bread winner, death of livestock, loss of property, droughts and crop failure. The poor need risk management and the development sector has increasingly recognized this over the last decade. Protecting the poor against life s uncertainties is a priority to fight against poverty and thus an important component to reach the Millenium Development Goals. Financial protection schemes have been made available to low-income people not traditionally covered by insurance to reduce their vulnerability to unexpected and potentially catastrophic life shocks. Collectively referred to as microinsurance, these schemes can cover loss or injury to health, property, crop, weather, and life. Microinsurance is the use of insurance as an economic instrument at the micro (i.e. smaller than national) level of society. Protection is provided in exchange for regular premiums proportionate to the likelihood and severity of the risk involved. Insurance functions on the concept of risk pooling, and likewise, regardless of its small unit size and its activities at the level of single communities, so does microinsurance. Microinsurance links multiple small units into larger structures, creating networks that enhance both insurance functions (through broader risk pools) and support structures for improved governance (i.e. training, data banks, research facilities, access to reinsurance etc.). This mechanism is conceived as an autonomous enterprise, independent of permanent external financial lifelines, and its main objective is to pool both risks and resources of whole groups for the purpose of providing financial protection to all members against the financial consequences of mutually determined risks. 1

2 The field of microinsurance is experiencing tremendous growth, with microfinance units, government agencies and private insurance companies serving as providers. Policy makers in governments, national and international development agencies, and the civil society are considering whether investing in policies and programs supporting microinsurance is worthwhile. This decision needs to be answered in the light of the potential impact microinsurance can achieve. A number of studies have scrutinized the impact of microinsurance on the poor, however there is no comprehensive review of these studies. This review seeks to answer the following questions: Do microinsurance programs achieve impacts on beneficiaries and their households? Further, if programs do achieve positive impacts, what are the common contexts or mechanisms these successful programs share? We will answer these questions by conducting a systematic literature review on the impact of microinsurance. To date, only one systematic review in the domain of microinsurance has been conducted. In 2004 Björn Ekman published a systematic literature review of the impact of micro health insurance schemes. Ekman s research question was limited to whether voluntary, not-for-profit, health insurance products impact resource mobilization and financial protection for the poor in low-income countries. Ekman s review uncovered strong evidence that community-based health insurance provides some financial protection by reducing out-of-pocket spending, moderate evidence that such schemes improve costrecovery and weak to no evidence that these schemes effect quality of care or the efficiency with which care is produced. The field of microinsurance has considerably grown since Ekman s review; different insurance schemes include life, funeral, death, crop, weather, property, and health insurance. There is a push within the microinsurance field and the policy level towards composite products that cover a range of these risks. Our review will cover studies conducted on the range of microinsurance products available and determine whether the lessons learned in Ekman s review apply to other microinsurance products (life, credit, etc.) and what new learning can be shown in the field of health insurance. The results of the review will identify the impacts of microinsurance in several outcome dimensions. Our preliminary screening suggests that microinsurance products can improve access to health care, equity in access to care, financial protection and thus support poverty eradication, and changes in gender relations. Our review will separately identify impacts in these dimensions and identify research and knowledge gaps. Targeted efforts can then be taken to fill these gaps and further support policy makers and microinsurance providers with evidence on the most effective ways to positively impact clients, households and communities. 3. Define the population (Who is included and who is excluded?) The target population includes poor people living in low and middle income countries (LMIC). We define being poor by either earning half the average income (proxy of Gross National Income (GNI) per head used as reference) of a LMI country s population or by living below a poverty line of $2 USD per day (Purchasing Power Parity) 2

3 4. Define the intervention/s (What is given, by whom, and for how long? What are the comparison conditions?) The intervention is microinsurance. Microinsurance is the protection of low-income people against specific perils in exchange for regular premium payments proportionate to the likelihood and cost of the risk involved. As with all insurance, risk pooling allows many individuals or groups to share the cost of a risky event. Microinsurance may include insurance for: life, health, property, funeral, crop, weather, or livestock. 1. Life Insurance: covers the policyholder and his/her family on the event of death and disability. The policy pays death benefits only if the insured dies during the term. There are 4 main types of life insurance: a. Term Life: provides a set amount of insurance coverage over a specified period of time, such as one, five, ten, or twenty years. The policy pays death benefits only if the insured dies during the term. b. Whole Life: cash-value policy that provides lifetime protection. c. Endowment Life: payable to the policyholder if living, on the maturity date stated in the policy, or to a beneficiary if the insured dies before that date. d. Credit Life: repays the outstanding balance on loans in default due to the death of the borrower. 2. Health Insurance: provides coverage for health care related costs linked to illness, injury and medical treatment. Health policies offer many different options and combinations; policies include insurance for losses from accident, medical expense, disability, or accidental death and dismemberment. 3. Property Insurance: provides coverage against loss or damage of assets. 4. Funeral Insurance: provides benefits to cope with the high costs of funerals. 5. Crop Insurance: agricultural insurance that covers crops against perils such as hail or fire. 6. Weather Index Insurance: agricultural insurance based on the measurable occurrence of a specific peril. Benefits linked to an objective index and if the index trigger is met or exceeded, clients receive a payment, with no need to calculate individual losses. The payment is a function of cover purchased rather the actual loss suffered. 7. Livestock Insurance: agricultural insurance that covers against loss of livestock owned by the policy holder(s). 5. Outcome/s (What are the intended effects of the intervention? Primary and secondary outcomes should all be mentioned.) 3

4 Studies must measure and report changes in the economic or social circumstances of insured and noninsured persons, their households, the enterprises they run, or the communities they live in. There are no standardized impact measures yet in the domain of microinsurance. The review will accept measures which satisfy pre-defined quality criteria (to be developed in the protocol). Outcomes include financial status, access to health care, quality of care, gender roles, family relationships, and other social or economic outcomes. One of the very objectives of this review is to list the impact dimensions (outcomes) which have been subject to study so far. 6. Methodology (What types of studies are to be included and excluded? Please describe eligible study designs, control/comparison groups, measures, and duration of follow-ups.) Studies will be eligible for inclusion if they include parallel cohorts of insured and uninsured persons, assessed at one or more points in time. Eligible studies include randomized controlled trials, cluster randomized trials, and quasi-experiments. Quasi-experiments must provide information on baseline comparability of the cohorts and use statistical controls or matching to adjust for baseline differences. Ideally, inclusion of subjects into the cohorts will be random or quasi-random (e.g., from a list of beneficiaries). Intensive interview and ethnographic studies will be included in the narrative of the review if they shed light on microinsurance outcomes. 7. Review team (List names of those who will be cited as authors on the final publication) Lead reviewer This is the person who develops and co-ordinates the review team, discusses and assigns roles for individual members of the review team, liaises with the editorial base and takes responsibility for the on-going updates of the review There should be at least one co-author Name: Ralf Radermacher Title: Affiliation: 1. Micro Insurance Academy, India 2. University of Cologne, Germany Address: 246 Sant Nagar, East of Kailash City: New Delhi State, Province or County: NCR Postal Code: Country: India Phone: Mobile: Name: Dr. Iddo Dror Affiliation: Micro Insurance Academy Name: Kari Zabel Affiliation: Micro Insurance Academy Name: Sowmiya Ashok Affiliation: Micro Insurance Academy Name: 4

5 Affiliation: 8. Roles and responsibilities Please give brief description of content and methodological expertise within the review team. It is recommended to have at least one person on the review team who has content expertise, at least one person who has methodological expertise and at least one person who has statistical expertise. It is also recommended to have one person with information retrieval expertise. Please note that this is the recommended optimal review team composition. Content: Ralf Radermacher, Iddo Dror Systematic review methods: Statistical analysis: Ralf Radermacher, Iddo Dror Information retrieval: Kari Zabel, Sowmiya Ashok, Ralf Radermacher, Iddo Dror 9. Potential conflicts of interest (E.g., have any of the authors been involved in the development of relevant interventions, primary research, or prior published reviews on the topic?) The Micro Insurance Academy is an independent think-tank in the domain of microinsurance. It is funded by donors to carry out research and develop material to assist in the creation of microinsurance schemes. MIA is supporting communities to launch their own schemes; however, at the time of this review no MIA assisted scheme has gone live and thus no MIA assisted scheme is part of the review. In previous publications of MIA also negative processes and outcomes of microinsurance were documented, stressing MIA s desire to contribute to knowledge creation in the sector. No conflict of interest exists. 10. Support Do you need support in any of these areas: methodology and causal inference, systematic searches, coding, statistics (meta-analysis)? Support on developing the procedures for methodology and causal inference as well as statistics (metaanalysis) would be appreciated. Someone to review the systematic search protocol is also appreciated. 5

6 11. Funding Do you receive any financial support? If so, where from? If not, are you planning to apply for funding? Where? For this study no funding is being received. The work is funded by the resources of the charitable trust, which are mainly donations from Misereor or for commissioned studies. 11. Preliminary timeframe Approximate date for submission of Draft Protocol (please note this should be no longer than 6 month after title approval. If the protocol is not submitted by then, the review area is opened up for other reviewers): The first draft was submitted on 14 January We intend to submit a revised draft not later than 20 September Title registration approval date: 28 August

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