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.