Figure 5: Savings Groups and Risk of Anemia among Children in Southern Mali
Note: These two maps compare the predictive geographical risk of anemia in children aged 1−4 years against the reach of savings groups in southern Mali under Oxfam America’s Savings for Change program.
Source: R.J. Soares Magalhães and A.C.A. Clements, 2011, “Mapping the Risk of Anaemia in Preschool-Age Children: The Contribution of Malnutrition, Malaria, and Helminth Infections in West Africa,” PLOS Med 8(6): e1000438, doi:10.1371/journal.pmed.1000438; and J. Ashe, with K. Jagger Neilan, “In Their Own Hands: How Savings Groups Are Revolutionizing Development,” paper presented at the 17th Microcredit Summit, Merida, Mexico, September 3−5, 2014, http://17microcreditsummit.org/wp-content/uploads/2014/08/Savings-Groups-overview-for-MicroCredit-Summit-English-Jeff-Ashe-07-31-2014.pdf.
2015 Grama Vidiyal Campaign Commitment
“Sticking to its original mission, [Grama Vidiyal] reaches clients beyond the credit lines through its entire gamut of services—focusing on health, environment, social skills, etc. A double bottom-line approach with the right balance of fiscal performance and positive social impact is key to the microfinance’s success.”
— Sathianathan Devaraj, chairman and managing director, Grama Vidiyal, IndiaThe Campaign Commitment from Grama
- organizing 720 health camps for clients and screening 300,000 members;
- providing health education to 80,000 client families; and
- helping 800,000 clients with its Free Meals program.
Microfinance providers that map the challenges faced by their clients who struggle often find that household health-related challenges form one of the primary causes of business failure. A sick proprietor cannot run a business, and a severely sick child can deplete accumulated family assets with payments for medical care.
Health providers that map the usage rates of their health services often find that large sections of the country do not avail of their services. In many cases, these are the same areas where microfinance providers operate.
Comparing maps, like those in figure 5, can help pinpoint where to implement an integrated health and microfinance program. Loan officers and savings group facilitators can be trained to deliver educational messages to women about health issues, such as nutritional foods to consume in order to prevent or treat anemia.
As MFIs participate in the goal to eliminate extreme poverty by 2030, they will need to develop strategic, coordinated partnerships with other sectors to help address the many dimensions of poverty faced by their clients, especially as it relates to healthcare. MFIs can provide some health services on their own (e.g., health education and health financing products). To reach scale with health services, however, they will also need to partner with others who provide direct health services, health insurance, and healthcare products.
When it comes to addressing healthcare needs of microfinance clients and their families, there is much for us to learn from the last 15 years pursuing the MDGs. Evidence from a series of studies published in 2014 by the World Health Organization (WHO) identified success factors for achievements in maternal and child health (MDGs 4 and 5). One of these studies shows that 50 percent of the reduction in the mortality of children under five years of age resulted from “health-enhancing investments in other sectors.” These factors include improvements in safe drinking water and sanitation, increases in women’s incomes, reduction of fertility rates, and increases in children’s school enrollment. This is good news for MFIs and other financial service providers with a mission to improve their clients’ lives. Their efforts to improve women’s outcomes plus their efforts to develop cost-effective integrated health and microfinance interventions have potential for important follow-on effects. Unsurprisingly, these studies credit a strategic, coordinated approach across sectors for the gains seen in MDGs 4 and 5.
A recent study conducted by the Microcredit Summit Campaign in collaboration with MAVIM, a partner implementing integrated health and microfinance services in India, shows an improvement in awareness and positive behavior change regarding healthy habits practiced to prevent non-communicable diseases, such as diabetes, hypertension, and cancer. For example, MAVIM showed that awareness by its SHG members about consumption of fruits and vegetables increased from 46 percent and 83 percent, respectively, to 98 percent (for each); and their change in patterns of consumption nearly doubled from 42 percent at baseline to 81 percent at the end line.
In addition, the provision of health-related services can improve an MFI’s relationship with its clients, who greatly value these services. A longitudinal impact study of Bandhan’s health program from 2008 and 2013 reported important improvements in health outcomes for mothers and children alike, such as increased breastfeeding rates and greater use of oral rehydration solutions for treatment of diarrhea. It also reported high satisfaction levels with the health program: “Clients repeatedly expressed that they felt as though Bandhan cared about their health.” These are some of the specific responses:
- 77 percent of the 36 participants interviewed qualitatively in 2013 (five years after the start of the program) felt positively about their involvement with Bandhan.
- 64 percent of participants would not be able to cover medical expenses with their current finances if they faced a major illness, but they were willing to use a Bandhan health loan if necessary.
- 17 percent of participants reported having taken out a health loan, but many who did not seek a loan expressed concern over their ability to repay it.
- The health education forums “were the most valuable part of the program, while others highly valued the services and knowledge of the SS” (Swastha Sahayikas, health product distributors).
The Campaign has worked to help cultivate partnerships between MFIs and health providers over the past five years. As part of these efforts, our “Healthy Mothers, Healthy Babies” project in the Philippines aims to deliver health education via group meetings and increase access to maternal healthcare through health fairs. CARD and Freedom from Hunger set a target to provide training with their “Healthy Pregnancies Make Healthy Communities” initiative to more than 600,000 women by the end of 2015. They met that target early and are on track to reach 1 million women by the end of the year. CARD is also working with the Microcredit Summit Campaign to mobilize strategic partnerships among MFIs, health providers, government agencies, and local funders (e.g., family foundations and CSR divisions within corporations) in order to secure an ongoing support base for a consortium of 21 MFIs called MFIs for Health.
Figure 6: The Celebrity Couples of Maternal and Newborn Survival
Source: L. Greenslade, 2014, “Partnering beyond the Health Sector for Maternal and Newborn Survival,” PowerPoint presentation (New York, NY: MDG Health Alliance)”
Leith Greenslade, vice chair of the MDG Health Alliance, refers to these uniquely powerful partnerships across sectors as “celebrity couples”—pairs of interventions that have a proven correlative relationship to leverage their respective impacts. They are the secret to achieving the MDGs and, by extension, the SDGs. As Leith explains, “If we know that we can accelerate achievement of health goals for women and children by investing in toilets, contraception, education, roads, electricity, water, and women’s incomes, why don’t we see more partnerships beyond the health sector? Why do single disease (e.g., AIDS) and single intervention (e.g., vaccines) investments still proliferate? Why are we not building health systems that harness the power of these cross-sector relationships?”
Figure 7: MFIs Offering Health Products and/or Services
(December 31, 2009−December 31, 2012)
Figure 8: Types of Health Products and Services Offered
(December 31, 2011, and December 31, 2012)
The microfinance sector has an opportunity, by making this a key strategic piece of service design and delivery, to improve the lives of their clients. MFIs occupy a critical place in between the healthcare demand and supply, enabling them to play a role in creating linkages between the two. They meet with millions of low-income women in rural areas every week and have built relationships of trust with their clients; enabling them to provide health education, health financing to clients, and linkages to health providers at a reduced cost.
Our data show greater numbers of MFIs taking on this challenge. In figure 7, almost half report providing health education to their clients, with significant percentages also providing health insurance and other non-financial health services (see figure 8).
Freedom from Hunger—a leader in designing integrated health and microfinance solutions, with which we work in India and the Philippines—and its network of 30 MFIs currently reach nearly 3 million families around the world. In India, 19 Indian MFIs reported in a survey in 2012 that nearly one in four of their clients—3.9 million families—had access to a health program in 2011.
The health-related services provided or coordinated by MFIs take many forms:
- Health education: offered via short lessons in groups meetings covering healthy habits and disease prevention techniques
- Health fairs: bring health professionals together to provide health screenings for microfinance clients and their family members
- Health financing: provides health insurance, health savings accounts, and emergency health loans
- Telemedicine: allows MFI branch offices to provide health screening through a computer video link with a hospital
- Local community health workers: trained and financed by MFIs.
Financial service providers: By providing health financing and education, and by linking with health providers, the microfinance sector improves knowledge, effects positive behavior change in relation to health, and helps families afford curative and preventive healthcare. Further, it addresses both a shortage of health providers through the provision and coordination of their own community health workers in these vulnerable communities, as well as the problem of distance by bringing healthcare closer to such communities.
Government health ministries and other health providers: Linking with MFIs with extensive outreach will expand access and usage of health services. Health shocks and the resultant expenses are the primary reason families fall into—or sometimes back into—poverty. Therefore, the delivery of health services and health-related financial tools by MFIs or direct linkages to local health actors represents a key pathway out of extreme poverty for their clients.
|← Previous: 2015 Report > The Next Wave||Next: 2015 Report > Infographic: Integrated Health and Microfinance →|
Table of Contents
- Executive Summary
- Where’s the Map?
- Global Data Show Diverging Paths
- Integrated Health and Microfinance
- Saving Groups
- Graduation Programs
- Agricultural Value Chains
- Conditional Cash-Transfer Programs
- Digital Finance
- Read the Full Report (Coming soon!)
- Get Your Copy
- Français (Coming soon!)
- Español (Coming soon!)
- Arabic (Coming soon!)