This is the VOA Special English Development Report.

A market in Dakar, Senegal

In Senegal, some people receive medical coverage from large employers. Some buy their own insurance. But most Senegalese are uninsured, especially the poor -- a common story across Africa and elsewhere. If they get injured or sick, they must somehow pay the costs themselves, or go untreated.

The lack of health insurance is greatest among workers who deal in the informal cash economy. They include what Africans call "market women" -- women who sell produce and other food at local markets.

But a women's cooperative in Senegal is offering low-cost health insurance for market women. The coverage is offered through a credit union, part of what is called the Network of Programs for Urban and Rural Women.

More than twenty thousand women now pay into the insurance program. It pays for care at participating health centers. But it does not pay for conditions that existed before a person was insured, or for cancer, heart disease or H.I.V./AIDS.

Instead, the program is meant to help poor families deal with common health needs without having to borrow money.

The plan can insure as many as fifteen people in a family. Families can also get twenty-five percent off the cost of medicines. And pregnant women can get low-cost care through deals with several public hospitals and clinics.

Oulimatta Tigerre is an independent businesswoman. She sells vegetables and dried fish at a small wooden stand on a dirt road near Dakar, Senegal's capital. Her husband has been unemployed, and she worried that they could not pay the family's medical bills. Then she joined the credit union. The health insurance costs two dollars a month for her family of five.

She got sick while she was pregnant. The program, she says, paid all her hospital bills. And when her children get malaria, the insurance pays their bills. "This program is very important," she says, "because it saves us from the worry of where to get the money to pay the doctor."

Oulimatta Tigerre has used some of the money she saved from not having to pay hospital bills to expand her business.

But to have such satisfied members, experts say, a health insurance cooperative needs a large group of people. This is known as pooling risk. If the group is small, each member has to pay more, and that would exclude the poorest.

And that's the VOA Special English Development Report, written by Jerilyn Watson, with Scott Stearns in Senegal. I'm Steve Ember.