MicroSaveAfrica, of four health insurance programmes representing the four general models of insurance provision. Two of the programmes are still in the testing phase, while the other two have more than
three years' experience with their products. The programmes attached to MFIs all chose to create an institutional barrier between the insurance programme and the microfinance activities, citing issues of
capacity and risk. Only one programme had significant reserves, but two of the others were taking steps to improve cost coverage. The article describes design features to avoid adverse selection, fraud
and moral hazard. What the programmes charged for insurance, and what coverage was provided varied considerably between programmes. Topics such as the relationship between the specific product and the client's
willingness to pay for it are critical to the issue of surplus generation with these programmes, and require further research. A very high dropout rate was seen in three of the programmes related to a universal
lack of client understanding of the benefits of risk pooling. The ease with which clients could save their premiums was also an important consideration. In early testing of one programme, no evidence was
found that access to quality health care has any impact on client performance with a related MFI. Finally, health insurance is a very complex business activity and great care should be taken by any MFI
considering starting a programme.