One of my summer projects was the evaluation of a health insurance system at a small health clinic in Kuwde, Togo. In exchange for a 75% discount on general medication and a 50% discount on pregnancy medication, residents of the mountain village could pay 1800 CFA (the equivalent of ~3 USD) for a full year of coverage for them and everybody in their household. When I arrived, participation in the system was scarce, with only 10 families out of a possible 150 enrolled. Two other students and I were tasked with finding out why registration in the insurance system was so low and evaluating whether the system was still practical.
To do this, we worked closely alongside two lovely village doctors: Odile Koriko and Basile Beyaki. They were cooperative and friendly, answering all our questions as we delved into the project in the first few weeks. They also organized interviews for us so that we could talk with people who were previously enrolled in the system, but dropped it, as well as those who were still enrolled at the time. This allowed us to see clearly why people joined in the system in the first place and discover why some left later on.
My teammates and I had several valuable insights about humanitarian work throughout the progression of the project. For example, a constant theme of our discussions was sustainability. How could we mold the system in such a way that it was sustainable and would not cost the health clinic too much money? Despite our altruistic desire to make medicine as inexpensive as possible, we knew that a system that gave out free medication was not sustainable because of how the health clinic interacts with other NGOs and with the Togolese state. We wanted to make the system accessible to everyone, but we also could not simply increase the discounts and slash the entry fee.
Through our experience, we were able to experience firsthand the bevy of different factors that make humanitarian aid complicated and sometimes inefficient. Yet at the end of the project, I was very pleased with the nature of our work and our findings. We got an inclination for why people were not joining the system, and we made the adjustments we thought necessary for the system’s sustainability as well as its accessibility. However, I think the most valuable thing that we got from the experience is that we were humbled. We were able to see with our own eyes how, despite our good intentions and abilities, we were very limited in our capacity to contribute towards solving the global problem of lack of access to healthcare. We saw that, as Duke students, we couldn’t save the world. But we could make a difference.