 There are many ways in which a scheme can often become a financial disaster.  Firstly, when rural insurance is developed, the risk pools the insurance organize from are often smaller, leading to a decreased risk pool.  This puts the insurance organization at an immediate disadvantage, as the ability to pay out for all care needed is decreased when the risk pool is smaller.  In addition, these sorts of systems, when not developed properly, may allow people to move in and out of the system with relative ease, meaning a person can pay for coverage when they need it (say when a woman becomes pregnant) and stop participating when they are in relatively good health.  In other words, these people will only be adding stress to an already small risk pool, further hurting the financial viability of the organization.  This problem can be fixed, usually through a waiting period during which the person is paying into the pool but not able to utilize services, but these sorts of decisions should be made before a rural insurance scheme is implemented.  
	Another contributor to the failing of so many of these sorts of schemes is the administrative stress of developing such schemes.  For smaller schemes like these sorts of rural insurance organizations, administrative costs are high, owing to the reduced funding pool, and the high administrative needs.  For instance, most administrators must negotiate rates with providers, set premiums and collect premiums from members, and coordinate recruitment into the scheme.  As a result, administrative costs and fees often further hamper the organization's viability.  In addition, the premium fees are often set on the basis of how much the members can pay rather than on the costs of provision of care.  This means that the administrators must develop a package of services that are covered and decide what is excluded.  These sorts of issues mean that administration of these insurance schemes really need qualified, experienced administrators that are often lacking in these rural areas.  A poorly-run scheme with staff that is not up to the task likely will eat up potential funds with administrative fees.
	A third likely reason for the failing of so many rural insurance schemes is the lack of government support that would help such a setup to thrive.  Generally, donor-funded schemes will need to become independent at some point after insurance scheme has been established and the initial donor has pulled out.  Due to the various high costs and issues described above, many schemes will likely find themselves unable to pay for all utilized services at some point after this.  If the government has also been a stakeholder in the development process, they might be able to subsidize the insurance scheme or provide some funding to keep the organization running.  If not, in many cases, the insurance scheme may find itself unable to continue running.
	Having looked at some of the reasons for the high failure rate of these rural insurance schemes, what can be done when developing the scheme make it more likely to succeed? 