Private insurance products hardly exist for the rural and urban poor and in cases where they do exist they are not affordable for them. Public Social Insurance Services are mostly insufficient and exclude people working in the informal sector. Nine out of ten people in Sub-Sahara Africa therefore do not have any access to health or accident insurance. They have to pay tremendously high fees for treatment, medical care and hospitalisation out of pocket. Especially those people living below the poverty line (more than 40% in Sub-Saharan Africa) have to take out loans, dissolve their savings or sell essential resources to pay for their treatment. Therefore, many are not in the position to make use of the required services at all. In fact, many people fall into poverty due to illness and treatment costs.
For decades now the World Bank and IMF -- a bit like loan sharks in poor neighborhoods -- have held out fat loans for poor countries. The price for accepting those loans was accepting neoliberal ideology, and privatizing public services.
The loans also weren't usually tracked very carefully, so that they became a corrupting influence for government officials who became fat and retired to Switzerland on them.
So government services were cut, including health care. The money was ineffeciently spent, and then the loans came due -- forcing a further cut in social services. Including health.
And now a German professor has a research project going for how "access to proper insurance for all can be reached successfully" -- through micro-insurance. Same as we have here!
All according to plan.