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For $4 a year, a family in the village of Kuwdé, in northern Togo, can sign up for health insurance at a local medical clinic. This system, created by Duke students in 2009, is a win for both sides. Insured villagers save money when purchasing medicines, while the clinic makes money from the transaction. Today, enrollments are up—more than fifty families are insured—but this was not the case in the beginning. This essay follows the ups and downs of the insurance scheme, suggesting reasons for lagging enrollment in the early years of its creation. A long-term hope is that this...

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