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50 for 50: Bringing Health Insurance to Those Who Need It Most

By Richard Leftley

In 2004, Richard Leftley wrote a white paper outlining the severe risks the HIV/AIDS crisis presented for Opportunity International Trust Groups. He proposed a new, creative solution: very small insurance policies for Opportunity International’s clients. Originally, these microinsurance policies were designed to cover a client’s loan balance and, in some cases, funeral expenses, should a Trust Group member pass away.

This simple-but-revolutionary concept became MicroEnsure, the world’s first microinsurance agency, launched by Opportunity International in 2008. We are honored to hear from Richard as he describes pivotal moments for this remarkable program—and shares about the incredible impact it has had for families around the world. 

When I entered Devyani’s home, it was hard to ignore the depth of poverty. Her mud-floored shack in a crowded slum was made from sheets of plastic and sticks with barely enough room for her family to sit on the floor, let alone lie down to sleep. There was a noticeable absence of belongings—no pots and pans; no basic items you would expect to find in a home.

I was in Dhaka, Bangladesh, researching the risks these families living in poverty faced—trying to understand the disasters that could cause their precarious lives to fall out from under them. I had spent several days asking women like Devyani to describe the situations that caused them to spend money in unexpected ways following an emergency—and I posed the same question to her.

Without hesitation she started to tell me about how, a few weeks earlier, she had taken her youngest child to the hospital.

Her child had fallen sick with a fever and she had tried her best to help him recover—but after a few days using herbal medicine, she realized he was getting worse. Without any options nearby, she and her child walked ten miles to the nearest government hospital.

Getting treated was almost impossible. In Bangladesh, as in many countries, the public health system was extremely short on medical staff and resources. Patients often had to wait days to see a doctor, and even then, the drugs needed might not be available.

Devyani was getting increasingly concerned about her child as the hours turned into days, and still no doctor came to help. She remembered her neighbour telling her about a private hospital that was nearby and affordable, so she packed up and walked to the private hospital. They were willing to treat her child, but insisted on $5 paid up front before they would start treatment. 

Devyani knew she had to get the money to save her child, so she raced home and sold everything she had—all her pots and pans, and anything else she could find in her home. When even that was not enough, she was so desperate she sold herself. She explained to me that any mother would prostitute herself for a few hours to save her own child—they’d do whatever it takes. 

She rushed back to the private hospital the next day with the $5, but it was too late. Her child had died from the fever.

As Devyani finished her story, I felt rage welling up from deep inside me. I had spent the past several years listening to horrific stories, but Devyani’s loss struck me at my core. I hugged her and together we wept. 

I had spent years of my life building insurance solutions for people like Devyani, but health insurance had always seemed too expensive and too difficult. It felt impossible to cover some of the risks that these families faced, and even in the best circumstances, health insurance is extremely hard to do well. It’s fraught with operational risk and open to fraud from multiple sources. The idea of finding a sustainable way to provide the poorest with health insurance frankly terrified me. 

But in that moment, standing in that hot, smelly shack, I knew I faced a simple choice: I could continue to see health as too great a mountain to climb and apologize to women like Devyani for the rest of my life—or I could face one of my biggest fears and attempt to develop a product that would provide a safety net for those who need it most.

While I was certain I would probably fail, I made a promise that day to Devyani that I would at least try. I would aim to find a way to provide health insurance for others like her.

I thought back to my early days at Opportunity International in 2001, developing the first microinsurance products to protect against accidents and property damage. I remembered a family I met in rural Zambia who explained to me how they worked their way out of poverty, but then disaster would strike and they would lose everything. They likened their experience to a game of “Chutes and Ladders”—and in those early days, they challenged me to help put a safety net in place that would stop their fall following a setback.

I had spent the better part of my career building these safety nets—and Opportunity International had made it possible. They invested in a young entrepreneur with big ideas, and thankfully they let me make hundreds of mistakes along the way. I was stubborn, Opportunity and its supporters were faithful, and over time we developed models that worked for our clients.

Together, we built the foundation of the microinsurance industry.

The same risk-taking mentality that had driven my earliest endeavours at Opportunity kicked in following my fateful meeting in Bangladesh. Over the next few years, we made numerous attempts to develop health insurance for the low-income sector—all of which ended in failure due to claims being higher than premiums, issues with fraud, or operational processes too complex for our clients to understand.

Every time we failed, though, I would remember my promise to Devyani—and that sense of helplessness I had felt when she told me her story. And so we picked ourselves up and tried again. And again. And again.

After several years and countless failed attempts, we found a model that worked: a simple product we called Hospital Cash. Instead of leveraging ID cards, a hospital network, or paperwork about a patient’s treatment, Hospital Cash simply pays out a lump sum to the customer when they have been in hospital for 48 hours or longer. It is simple and easy to understand, and claims can be paid within a few days—and it costs only $0.50/month for a person to be covered.

Best of all, it works for the families that need it most.

It works for people like Halidu, a junior high school teacher in Ghana. When Halidu came down with a bad cold, he first tried to deal with it at home, just like Devyani had. But when it wouldn’t go away, he decided to seek medical advice—and discovered he had typhoid. Unlike Devyani, Halidu had Opportunity’s health insurance, so he was successfully admitted to the hospital for three days for treatment. 

After being discharged from the hospital, he filed a claim; a few days later, he received his payment. Now, he is back in the classroom—healthy, and without a financial burden to carry.

It is such a different result from Devyani’s story.

One day, I hope to return to Bangladesh to find Devyani. I would love to tell her how we fulfilled the promise made all those years ago to find a product that helps provide a safety net for those facing health shocks. I would love to tell her that her child did not die in vain, but that her story lit the fire that helped force me to find a solution. She inspired me to fight my fears and overcome the seemingly insurmountable hurdles in my way, and now, tens of millions of clients in Africa and Asia go to bed at night knowing that if something happens, they have a safety net that will catch them. 

Richard Leftley served as the Founder & CEO of MicroEnsure for 15 years, providing insurance to over 60 million customers around the world. In 2020, he became the Executive Vice President of the Micro Insurance Company, which was formed by the merger of MicroEnsure and STP Group, where he leads the company’s outreach to new partners and markets. He is a pioneer in the provision of digital insurance in Africa and Asia and a global leader in creating and implementing financial services distributed through partner banks, mobile networks, mobile wallets, and e-commerce partners.


Each week for the next 50 weeks, we will share a piece of Opportunity's history—major or minor, sobering or inspiring. We have gotten to where we are today by facing some of the world's greatest challenges, with you by our side. Please join us in celebrating the many significant moments that have built the foundation on which we will embark on our most audacious vision yet: ending extreme poverty.

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