Integrating Microfinance and HealthBenefits, Challenges and Reflections for Moving Forward

Sheila Leatherman, Professor of Health Policy and ManagementGillings School of Global Public Health, Univ. of North Carolina

Freedom from HungerChristopher 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

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

WHAT must we do to improve health?

Access Barrier;Financing

Access Barrier;Appropriate health services and products

Access Barrier;Good

Information

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

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 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 providingHealth 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 Microfinance

Leatherman et al, WHO Bulletin, 2010

• Reproductive Health• Primary care for children• Nutrition/Breastfeeding• Diarrheal illness• HIV Prevention• Gender based Violence• Sexually Transmit. Infections• Malaria• Tuberculosis

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

Health

Knowledge

Behavior change

Use of health services

Increase health system capacity

Positive health outcome

Healtheducation

X X X X

Trained health workers

X X X X xLinkages 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?

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 End

Cost data; the question of sustainability

MFI Program annual costPer client

MAHP Programs; Philippines; Gov’t insurance and PPP Burkina Faso; savings/loansBolivia; health fairsIndia; health educ and products

Cost to institutionavg direct 0.29 $ avg indirect 1.59 $

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 institution1.20 $ ( first year only)

1.91 $

Ekjut (India): Participatory health education and action planningRandomized 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 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