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The report finds that insurance markets in Ghana, Kenya, Nigeria, and Rwanda are underdeveloped, with low penetration and significant 'risk-protection gaps' for households and SMEs. While government-led health insurance has increased overall uptake, private insurance remains focused on large corporate risks and compulsory lines, which often lead to irrational price competition and poor consumer value. The authors argue that the sector's role as an institutional investor is limited by short-term balance sheets and a lack of long-term investment instruments. To unlock the potential of insurance for development, the report proposes six imperatives: proactive policy leadership, a transition to risk-based supervision, driving innovation through better data and regulatory tools, re-engineering compulsory products, improving risk management for SMEs, and incentivising long-term savings to support capital market development.