Integrating Microfinance and HealthBenefits, Challenges and Reflections for Moving Forward

Sheila Leatherman, Professor of Health Policy and Management

Gillings School of Global Public Health, Univ. of North Carolina

Freedom from Hunger

Christopher Dunford, Marcia Metcalfe, Myka Reinsch,

Megan Gash and Bobbi Gray

Remarks

• Why add health programs to microfinance

• What can be done to meet basic health needs• What can be done to meet basic health needs

• How; a look at the evidence for “ what works”

• Summary; how can we move forward

Why Integrate Microfinance and Health ?

�Opportunity to reach hundreds of millions globally

3500 MFIs - 190 million clients; incl. 43 mil. very poor families

�Illness (w/cost) is barrier to progress out of poverty�Illness (w/cost) is barrier to progress out of poverty

Evidence is strong and compelling

�Microfinance – is a vast distribution channel for

proven, simple, and low cost health interventions

How essential are health educ./services in helping very poor clients to move and stay above the $1.25 a day threshold?

-Health spending can be a high portion of household annual income ; 22 percent in Bolivia and 67 percent in Burkina Faso*

-Average of 17% of clients reported use of their business loan for health *

-In W. Africa; clients spent up to 30% of income on malaria *

-India; Annually 24% of all those receiving medical treatment fell below the poverty line because of high cost ( 20 million people)

What can we learn from institutions that have been most successful in this area?

*Freedom From Hunger data

WHAT must we do to improve health?

Access Barrier;Financing

Access Barrier;Good

Information

Access Barrier;Appropriate health services and products

Client Need or Barrier Examples of programs

Information

and knowledge

• Health education

• Health promotion and screening

• Trained community volunteers

Availability of effective

Health products/ services

• Direct delivery of clinical care

• Health fairs /health camps

• Linkages with/referrals to providers• Linkages with/referrals to providers

• Community pharmacies/dispensaries

• Loans to health providers

• Micro franchising health-businesses

Financial ability to pay • Loans for medical care ( indiv./gp)

• Health Savings ( indiv/gp)

• Health microinsurance/prepaid care

Microfinance and Health

What works ? What are best bets?

1. Global evidence review of literature

2. Case Studies; ex. BRAC, Pro Mujer2. Case Studies; ex. BRAC, Pro Mujer

3. Microfinance and Health Protection (MAHP); Freedom From Hunger demonstration (Gates funded);

5 MFIs in India, Bolivia, Philippines, Benin and Burkina Faso

Microfinance-Health Integration

What is being done?

(89 MFIs, 2009)

% of MFIs providing

Health program

Health education

79%

Referrals

23%

Direct health services

delivery 22%

Contracts w/health

providers

20%

Health micro-

insurance

20%

Health promotion

events

16% 8

Evidence of Impact ;

Health education combined with MicrofinanceLeatherman et al, WHO Bulletin, 2010

• Reproductive Health

• Primary care for children

• Nutrition/Breastfeeding

• Diarrheal illness• Diarrheal illness

• HIV Prevention

• Gender based Violence

• Sexually Transmit. Infections

• Malaria

• Tuberculosis

Interventions with Positive BenefitLeatherman et al, Health Policy and Planning, 2011

HealthKnowledge

Behavior change

Use of health services

Increase health system capacity

Positive health outcome

Health

educationX X X X

Trained

health

workers

X X X X xworkers

Linkages

w/

providers

X X X

Loans to

health

providers

X X X

Goal Where ? Intervention ? Result

Improved access

to health services

BRAC/ Bangladesh +

CRECER/Bolivia; health

fairs

Pro Mujer/Nicaragua

primary health care

•In 2010 -reaching over 100

million with health services

•24% receiving health service

never had medical care before

•Increased pap smears for

cervical cancer from 36% to 95%

Ability to

afford care

Bandhan/India; health

loans

• 33% would have delayed

treatment without the loan

• 62% felt able to afford other

necessities (food, education)

Better health

outcomes

Ekjut/India;

Participatory health

education and planning

•30 % reduction in newborn

mortality

•> 50% in maternal depression

Integrating Microfinance and Health

Benefits Multiple Stakeholders

• Benefits to the microfinance provider– Business benefits, ex. competitive advantage , retention of clients

– Healthier and financially more stable clients

– Achievement of social mission

• Benefits to Clients, households and communities – Financial protection

– Better health access, knowledge and behaviors

– Improved health status and productivity

Potential to contribute to health is clear

The microfinance sector offers a unique opportunity

to address critical health needs of the poor

So how can we move forward?So how can we move forward?

What are the barriers and how can they be addressed?

How do we identify “ the best bets” among health programs?

What mechanisms are needed for shared learning?

How can we speed the process of adoption and scale up?

THANK YOU

The EndThe End

Cost data; the question of sustainability

MFI Program annual cost

Per client

MAHP Programs; Philippines;

Gov’t insurance and PPP

Burkina Faso; savings/loans

Bolivia; health fairs

Cost to institution

avg direct 0.29 $

avg indirect 1.59 $

Bolivia; health fairs

India;

health educ and products

Pro Mujer Health educ & clinical

services

Cost to client 29.00$

Health Education-INDIA

•KAS Foundation

•MCS Campaign ( 4 MFIs)

Credit with health

education ( CwE)

Health education

Cost to institution

1.20 $ ( first year only)

1.91 $

Ekjut (India): Participatory health education and action

planning

Randomized Control Trial (Population of 228,186,

half assigned to treatment, half to control) Control Treatment

Change in NMR (per 1000 live births) +9.5% -32%

Change in still births (per 1000 births) -9% -31%

Change in early NMR (0–6 days) +12% -37%Change in early NMR (0–6 days) +12% -37%

Change in late NMR (7-28 days) +2% -20%

17

Other key findings:

•NMR reduction not associated with increased care-seeking or

health- service use.

•Home care practices showed significant improvement.

•Costs per newborn life saved = $910; Costs per DALY $33