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Sharing Examples of Microfinance Plus Health Services

install_kdid
October 4, 2010 11:50 pm

Let’s Get Started

The first question we’d like to consider is about the provision of health services and products by MFIs, and to see if we can identify some examples of where MFIs and health providers are working together to provide health services and products.

Freedom from Hunger has developed a graphic that we use to describe the needs of clients and the types of products and services that an MFI can provide to respond to those needs.

 MAHP Diagram

What other types of products and services or examples are there of organizations integrating some type of  health service with their financial service offering?  

What examples do we have of private or public health providers linking with MFIs to reach MFI clients and their families?

Comments (38)
Oct 6, 2010   12:14

Dear all

It is my great please to share our experience in health education with micro credit clients in state of Tamil Nadu, India.We have started this health education training in the year 2007.

2007-2008Nearly we have trained 20 field workers and each field worker delivered the lessons to 150 women

2008 -2009 we have trained 15(new) field workers. each field worker  in turn delivered a lesson to 150 members. (totally end of 2009 we had 35 field workers)

By 2010 we have additional 36 field wokers trained. So totally we have 71  field workers (both old and new)This year (2010 -2011)we  have propoosed to reach 8500 cllients

Health education is very important for clients. It is important to deliver health lessons.Then the women will taake care of themselves as well as the family especially the children.

In health education we will assess the impact of the training through pre and post test. In pre test we will analyse the knowledge level iof the client and after training the knowledge level also analysed. The analysis will show that befroe the training knowledge is very low an after the training the knowledge is high.

Health education is very systameatic and lessons delivered in a systamatic way. Lesson pattern is very particiapatory.

Thank you

Jasmine

PIONEER TRAD 

Oct 6, 2010   09:30

Star Microfin Service Society (SMSS) is a sustainable MFI operating in two backward districts of Andhra Pradesh, South India. It was formerly Star Youth Association (SYA), an NGO, working in various development activities, including microfinance. Since …… it has converted itself into a Non Banking Finance Company (NBFC) and serving 35000 clients, most of whom are very poor.

SMSS implemented a pilot project on integration of health education with microfinance during 2007-08, with technical support from Freedom From Hunger and Microcredit Summit Campaign (MCS). 40 field workers facilitated lessons on a) HIV/AIDS Prevention and Management b) Integrated Management of Childhood Illnesses and 3) Women’s Health to more than 6000 clients.

Women clients love to participate in the lessons. They enjoy the non-formal and participatory methods used during facilitation. They like the group discussions and role plays. Evaluation studies by external evaluators have shown significant improvement in the knowledge levels of clients on the above health topics.

Field workers also enjoy facilitating lessons. They get to learn a lot of new things on health. Though they visit 5 to 6 centers every day, they facilitate lessons for only one or two centers, as they do not have time to cover all the centers every day with lessons. Our Management has noticed that field workers are now an improved lot, with better articulation skills, than before.

Realising the numerous benefits of integration, our Management has decided to mainstream health education into our microfinance operations. We have now expanded health education. More than 50 field workers are now trained to facilitate health lessons. Topics, such as, a) Infant and Child Feeding b) Healthy Habits and 3) Malaria are added. More than 8000 clients are being covered.

In the next two years we propose to cover all the existing clients with all the 6 lessons.

We provide health loans. We also have an innovative product known as “Loan on Phone” to meet the emergency needs of clients, which are mostly related to health.

We will be happy to diversify integration and take it to a different level by expanding to health services and products. We would like to learn from the successful efforts of other MFIs in providing health services and products.

M.Hanumantha Reddy,
Operations Manger,
Star Microfin Service Society (SMSS),
Central Office - Velugodu (K),
Kurnool (DIST), A.P,INDIA.

Oct 6, 2010   07:01

Dear All

We are working for health awareness programme for our clients. We have started this in our organization since February 2010. Currently we are covering 9,000 client of our 600 centers.

One experience which we want to share here that we have started this programme as a pilot project in our organization, some of our clients has listen about it and requested to provide the same to them also to our senior officials.

As to stared it in all over the company, we have decided that every trained staff will be trained her colleague to facilitete the lessons, so we can cover our maximum clients

Even some of new clients joined our organisation to be aware and change their life.

Regards,

Sushmita

Cashpor Micro Credit, India 

Oct 5, 2010   15:12

One of the examples I shared earlier was about testing out health education with youth in India. In this program, health education was provided to existing self-help group members who were asked to invite their adolescent daughters and daughters-in-law. There was not a direct financial product provided to youth, so it's not a perfect example for providing an integrated microfinance-health product to youth. There is a lot of momentum right now in providing financial education and financial services to youth, but are there any examples of organizations providing financial services and health protection services to youth specifically? I know there are some examples of microinsurance being provided to youth, but that's often through schools. Any examples of youth-focused integrated financial and health services?

Bobbi Gray

Freedom from Hunger

Oct 5, 2010   10:43

One of the great benefits of bringing microfinance/microenterprises and health services together is the synergy created through unity. Each organization in a health service/microfinance alliance gains access  to clients that were not previously reachable. This forum not only offers the chance to communicate prior wins, but it is also a means of finding new and innovative partnership opportunities.

Who and where are there individuals that you think could benefit from your organization's services, but that you are unable to reach?

Are there other complementary organizations already serving those customers?

Are there clients of your organization that you believe would benefit from a particular service that your organization is not able to or does not currently provide?

Where do you see opportunity for synergy between microenterprises and health services?

Oct 5, 2010   12:35

pepper you make a point which echoes with my biggest learning in 20 years of facilitating partnerships in extreme - but sustainable - innovation linking in to above zero-sum games grassroots networks play http://www.normanmacrae.com/netfuture.html ; sometimes the dream internal partnership can only get liberated from a silo (top-down rules) culture by choosing an external partnership to have this catalytic impact;

I have found this to be particularly so in trying to get global professions to help reform each others compound risks; very timely to be reminded of this as I am interviewing yunus tomorrow in dhaka as part of my annual tracking with him of game rules of how collaboration partners make impossible goals become possible ; I am a huge fan of microcreditsummit as it seems to be the Yes WE Can space where unthinkable partnerships reforming economics are born http://grameeneconomics.org

Oct 5, 2010   10:36

I work with Caring and Living as Neighbors (CLAN), www.clanchildhealth.org , an Australian NGO that works with families who have children with chronic conditions in resource poor countries. CLAN has a small pilot microfinance program in Indonesia where local parent support groups manage a small pot of money that they can lend to member parents to set up a small home-based businesses that will allow them to earn more money to better pay for the health care and medications their children require.

So far, they have had an excellent repayment history. The parents have used the funds to buy things like tools or sewing machines. We hope to be able to expand this program in the future.

Kelly R. Leight, J.D.
Vice President
Director, International Chronic Care Clinics
Caring and Living as Neighbors (CLAN)

Oct 5, 2010   10:59

Kelly,

Excellent example!

What are the leading chronic diseases that the children in Indonesia face? How and what kind of information do these affected familiies received to combat these illnesses? Are there preventative measures that you believe could reduce the frequency of these illnesses?

Regarding your expansion plans, do you see expanded health services as a valuable complement to your efforts? I wonder if any one in the group can offer insights or advice on how CLAN can help its members "better pay for the health care and medications their children require."

Thank you for sharing. We appreciate your participation and hope that you all will continue to join us as we expand on these issues over the next two days.

Pepper Whaling

 

Oct 5, 2010   16:25

CLAN is a very small program, but the only one I know that is working specifically with children with chronic conditions. Unfortunately, none of the countries we work in track chronic disease frequency data. This is one of the big problems. Data is often collected on communicable diseases, but not non-communicable, long-term conditions. Endocrine disorders, cardiac disorders, developmental disabilities, chronic renal diseases, neuromuscular disorders, epilepsy,  pediatric cancer and genetic disorders are rarely systematically tracked on a country-wide basis. In many cases, these children are never diagnosed, and they simply die. Some of these disorders may benefit from preventative measures, but many do not. They are present in all societies, but the plight of children in developing nations with chronic conditions receives little play on the international stage. They are dwarfed by the overwhelming problems of infectious diseases, sanitation and hunger. But the situation is just as dire, especially to the families and children so affected.

CLAN focuses on optimizing healh care services, access to medication and equipment, and patient education and support. Microfinance is a complement to these services, rather than the other way around. So, we are looking for ideas and partners to help us expand this aspect of our program. let me know if you can help!

Kelly Leight

globalchildrenshealth@gmail.com

 

Oct 5, 2010   08:16

As morning rises on the east coast of the Americas, we would like to take a moment to acknowledge and thank our colleagues in Asia, Africa and Europe for the great comments and questions received so far. We've heard from individuals from CARD MRI's Development Institute; Indian Institute of Public Health Gandhinagar; valuetrue.com; AKAM and others. Feedback has touched on health camps, women's health,  diarrhea prevention, health loans, prepaid health services, community-based funds, health product sales, de-addition programs and more. 

So let's keep the conversation going, we want to hear from you. So tell us,

What examples can you share about private or public health providers linking with MFIs to reach MFI clients and their families?

What other types of products and services or examples are there of organizations integrating some type of  health service with their financial service offering? 

Oct 5, 2010   10:51

Warm greetings from chilly Chicago! As the Lead Facilitator to The SEEP Network HIV & AIDS and Microenterprise Development (HAMED) Working Group, I greatly appreciate participating in this discussion on integration and the opportunity HAMED has to put together a discussion summary. Integration is at the core of the HAMED mission and objectives, which are anchored by The SEEP Network Guidelines for Microenterprise Development in HIV & AIDS-Impacted Communities, hereafter referred to as The Guidelines.

The SEEP Guidelines are in essence an integration toolkit that target MED and HIV programming, cross-sector partnership, and key strategies to integration. The Guidelines are composed of three separate books that each speak to MED professionals, health professionals, and the donors/policymakers who help drive the course of integration. You can download the three books and related supplementals here: http://www.scribd.com/document_collections/2636850 The SEEP Network has developed a model for poverty eradication, which is provided below (from the HAMED Brochure which you can find in Recommended Resources).

The challenge with HIV & AIDS is that often people/households affected can jump from one tier of poverty to the next for periods of time due to the cycle of sickness. Through holistic and comprehensive programming that aims to establish a strong community safety net, individual households can work together to lift themselves out of poverty and increase their livelihood security response. HAMED has held similar on-line discussions over the years that address the issue of integration and seek examples, lessons learned, and key strategies.

We have also put together a case study series Climbing the Ladder to Integrated Programming which highlights an innovation in the field and tracks its progress from Emerging Initiative to Promising Practice to Best Practice. Some of the projects we have showcased include a very interesting Community Grants Scheme by Save the Children in Mozambique (http://www.scribd.com/doc/38021304/Better-Choices-for-Children-Community...) and a Child Savings project by Aflatoun (also in Mozambique) which is very soon to be published. From cash transfer to a more non-traditional savings intervention, there is a diverse array of financial services offered by HAMED Member Organizations to communities affected by HIV & AIDS to alleviate the economic burden of the disease. Several of you have provided some very interesting examples from the field that may be eligible for consideration for the HAMED case study series. We are accepting abstracts through the end of the month. For more information, please refer to the HAMED Brochure that is available for download in the Recommended Resources.

One important lesson that we have learned at HAMED over the past few years addresses one of the potential outcomes of this 2-day discussion in formalizing a working definition of integration. Within the SEEP Network, most of our contributing members are from the microfinance world. Often the integration that we are in effect working with is the integration of financial services with vulnerable populations (such as those affected by HIV & AIDS or Orphans & Vulnerable Children). In our experience, our greater challenge is finding MED programs that successfully integrate with health services/treatment/intervention, so I am particularly interested to read your examples.

Furthermore, I pose a question to the MFI participants who are working with health interventions…I work with blindness prevention which aims to prevent the world’s blind population from doubling to 75 million and to prevent the low vision population from increasing to 250 million by 2020. The majority of blindness is preventable or restorative, and most unattended cases are in the developing world. The economic loss is a great burden to local communities, and the low vision or visually impaired in the developing world or often without proper assistance to live independently. We are particularly interested in linking regional blindness prevention programs to microfinance interventions and offer vocational training to the visually impaired to help them achieve their livelihood security. I would welcome any suggestions or recommendations of MFIs, particularly from India and Latin America. Thank you!

Kristen Eckert

Oct 5, 2010   13:15

Kristen and others are invited to contribute as well:

There have been some great examples shared here already about providing microfinance to vulnerable populations, such as those infected or affected by HIV/AIDS. So far, most of Freedom from Hunger's examples of linkages between HIV and microfinance has been around the provision of HIV/AIDS education focusing on the prevention of and testing for HIV/AIDS. I also know that World Vision (I think that's the other organization) has been using the same module we've been using, but it's only in the past year that we've received results from testing out this module using randomized control evaluations. The first one we tested out a single compact session on HIV prevention, stigma, testing, etc. with a self-help promoting institution in West Bengal with SHG members (women only) and their adolescent daughters and dauther-in-laws. We found that both mothers and daughters had significantly better knowledge (such as ways you can or can't contract HIV), they were more likely to talk to a spouse (if married) about HIV, more awareness about condoms and where to get tested for HIV compared to the control groups (those not getting HIV education).

In addition to this evaluation, our partner PADME who has already been mentioned here also conducted HIV/AIDS education and we found very similar results; however, here, there was an interesting twist. Groups who had allowed men to join, had better knowledge and behaviors (similar to those I mentioned above) compared to groups that were women-only ---when comparing the groups that got education to control groups not getting any education. At a minimum, we have some confirmation that microfinance institutions can deliver very sensitive education, such as HIV and facilitate important improvements in knowledge and behaviors.

Given this information, I wonder whether you or others in the HAMED working group or elsewhere have any experiences with the use of HIV/AIDS education in the programs where you're developing financial products for HIV vulnerable populations or whether there are other examples where there has been some sort of linkage of clients to testing facilities or the rapid diagnostic tests that can be easily conducted in the field? At one point, we explored the idea of "practicing" the rapid tests as part of the education, to see whether ease of use at a non-threatening time might get clients to seek testing out when they felt necessary. In any case, is anyone aware of any other examples where there have been more integration of HIV education, testing, services, etc in addition to financial services developed specifically to assist HIV infected or affected peoples?

-Bobbi Gray

Freedom from Hunger

Oct 5, 2010   15:15

You will generally find amongst HAMED members that their projects advocate for further integrating HIV education and reducing stigma to better serve the targeted population. 

Last year, HAMED collaborated with the SEEP Practitioners Learning Program (PLP), which highlighted four different kinds of integrated HIV/MED programs. Sinapi Aba Trust (SAT) formed an alliance with Planned Parenthood Association of Ghana (PPAG) with the goal of improving the well-being of SAT clients through quality health services related to HIV & AIDS, together with microfinance services.

Specific objectives of the partnership included: intensifying education and awareness efforts for SAT clients;  offering voluntary counseling and testing for HIV & AIDS; educating clients on stigmatization and discrimination against people living with HIV & AIDS; providing care and support for HIV & AIDS-affected people; and playing a leading role in advocacy to support people living with HIV & AIDS.

Partnership activities SAT and PPAG conducted a range of activities to serve the clients of both organizations. These activities included: a three-day capacity-building workshop on HIV education and prevention for clients of both partners; voluntary counseling and testing in four SAT branches; ongoing support for infected persons, referrals to clinics for treatment; and creation of a support group for HIV-positive clients. Some 564 clients at four program locations participated in the workshop; 150 clients participated in voluntary HIV testing; and fifteen people were registered for follow-up support and care, such as counseling, transportation allowance, and nutritional support.

Challenges

1. Providing one set of services leads to the provision of other services. Awareness raising and testing services often lead to the need for other services. For example, when SAT and PPAG learned that some clients tested positive for HIV, they wanted to offer medication and support services. Thus, a partnership formed with a limited scope may find itself wanting to offer or make linkages to further services. Sinapi Aba and PPAG have worked together to ensure that follow-up services such as health referrals and support groups are available, but these options will not always be possible.

2. One-off programming and funding limits opportunities for expansion. Although the partnership has been successful and Sinapi Aba would like to continue to offer HIV & AIDS prevention training, its efforts to reach more communities are constrained by inadequate funding.

Lessons learned

1. Participatory planning leads to stronger results. The SAT-PPAG alliance ran smoothly because both partners were actively involved from the outset of the program. The two organizations held consultations, roundtable discussions, and gathered input from the other partner when drafting and finalizing the memorandum of understanding (MOU) and the work plans of the partnership.

 2. Anonymity concerns related to HIV are more easily addressed with a partner organization. Guaranteed privacy meant that MFI clients were willing to come forward for testing and treatment. If SAT had offered the training itself, it is unlikely that clients would have been willing to be tested, for fear that a positive result might result in them being turned away for future loans.

You can read more about this project and the other partnership models from HAMED and PLP here: http://www.scribd.com/doc/38021315/Partnership-Planning-Conference-Synth....

Oct 5, 2010   15:56

Thanks for this interesting example.  the challenge of one service leading to another certainly spans this whole approach as MFIs consider whether and how to add health services. Increased health knowledge is designed to lead to changed behaviors, some of which will likely create demands for better access to quality services, and then also to a need for means of financing those services.  Another example of this is with CRECER in Bolivia where there is a relatively high incidence of cervical cancer.  Women received education on the need for regular PAP testing.  In some cases, tests were available in local public clinics, but quality issues created problems with service quality and especially with the women getting results.  CRECER's response was to contract with private providers (private physicians and with Marie Stopes program) to bring quality tests and prompt reporting directly to the community.  Women got tested, but then some needed follow-up.  So CRECER's response was to develop formal referral relationships with physicians and clinics where women could receive quality services at negotiated prices.  In cases of serious illness, health loans were also available to help finance at least some of the care needed.  ProMujer (also in Bolivia) has developed a very successful cervical cancer screening program and they actually provide much of the testing and follow-up in their own facilities.

So how far to go?  MFIs are not health organizations or providers and cannot possibly meet all of the health needs of their clients and with limited resources need to focus on most important needs.  CRECER had years of experience with education, so the addition of referral and financing methods were based on an established and sustainable foundation of integrated education. 

In the case of SAT it seems as if there was an opportunity for early partnering where SAT's access and knowledge of client need could be combined with PPAG's know-how around education and provision of services and achieve an outcome where everyone gained.  SAT managed to improve its ability to help some of its most vulnerable clients, clients were able to access testing and important services, and PPAG was able to reach new clients for its services. 

So given this "triple win", what is driving concerns about continuing or even scaling the program to reach all of SAT's clients, and perhaps taking to other MFIs in Ghana as well?   What are the costs involved for scaling this to new clients?  Is this an efficient way for PPAG to reach its target population? And if not, why?

 

Marcia Metcalfe, Freedom from Hunger

 

Oct 7, 2010   09:20

Dear Colleagues,
Thank you all for this interesting discussion. There is no doubt that the poor would benefit greatly from an integrated service, which also provide a ‘cost-effectiveness’ advantage to service providers.
*Particularly the group lending approach, with weekly/monthly ‘regular’ meetings, provides a good platform for this. Essentially, financial services create a strong ‘bondage’ between service provider and service receiver clients -- which is not common in many other sectors. That is, the MFI has its money out in the hands of the poor, which they have to monitor very closely. On the client side, they also cannot avoid the meetings to know what is going on with other members’ business performance since they co-guarantee each other. So the weekly/monthly contact is a real one, and cannot be missed by either side ….. In many rural areas, this meeting is perhaps the only meeting that very poor people have the chance to see ‘officers’ from outside. So when clients come to the group meetings to discuss on credit and saving, on group dynamics, etc they also want to present all kinds of issues and problems they encounter while running their business and managing their livelihoods, seeking solutions from the ‘officer’, or at least for him/her to take the information to whoever can provide a solution. The issues can be agricultural, health, drought, wild animal, etc, etc. Also this is, in most cases, the only chance that they can hear about what is going on in towns, in politics, etc. ….. Hence, perhaps it is correct to label microfinance an ‘entry point’ to rural development, where other services can be integrated.
*At ACSI/Ethiopia, we have started a good initiative on this (before I leave the MFI about a year ago).  This has been supported by the Packard Foundation, USA. Health and other organizations that work at the grass-root serving similarly poor people can use the meetings to deliver their messages, give small trainings (about 20-30 minutes – mind client time!), announce what kind of services they give, demonstrate their facilities, etc. But many organizations may not be able to come to every microfinance forum, in which case they give training to MFI staff on some ‘basics’ (e.g on HIV/AIDS, etc) and the MFI staff can do the orientation to clients at every regular meetings; clients will also have the information where they can go to and contact for detailed information and actual service. ‘Model farmers’ (on health, etc) can demonstrate at such meetings. In some cases (but unfortunately only few!) teachings on health by a professional health workers are recorded on cassette, and without the need of the health officer, clients at their group meetings can enjoy listening to the tape while settling their repayments or doing their savings. (This applies where there are tape recorders in the Branch office). How poor clients appreciate this!!
*So yes, microfinance provides a real opportunity not only to reach poor people who previously did not have the financial service opportunity, but also to serve as a platform for other services, leading to the achievements of the MDGs. And there are good innovative initiatives in many cases. But are they ‘scaling-up’. May be NOT. I think there are some real problem. First, those sectors (in this case health and microfinance) need to have a ‘shared vision’ toward reaching and serving the poor cost effectively and ‘sustainably’. If, for example, such service providers are simply getting their funding from a donor and therefore are not worried about such things as ‘cost-effectiveness’ or sustainability, or if there is no close monitoring of their performance, the integration will face a real challenge. On the microfinance side, many of them with their simplified approaches (often a direct copy or replication of the Grameen group lending modality) they have already managed to enable many poor people to ‘access finance’, and most would have the interest and motive to just go ahead with this established or ‘standard’ system. Such ‘integration’, even if they can be convinced about the potential benefit, would require them to exert some ‘additional efforts’ with clients (including staff training, etc). So many MFIs may NOT (and actually do NOT)see this as a top priority. Who can then push the integration? Can some type of Smart subsidy apply here? This is actually the case particularly where clients have few opportunities for alternative financial service provider than the present MFI. Where there is a competitive atmosphere among MFI, perhaps providing ‘integrated’ service can enhance the ‘competitive’ position of the MFI, and therefore the MFI can be convinced to introduce such approach without such a ‘smart subsidy’. And this can offer a sustainable way of integrating.
 
Rgrds
 
Getaneh Gobezie
Independent Ruralfinance Consultant

Oct 5, 2010   12:45

Kristen,

Thank you for this comprehensive post. In terms of linking your program with microfinance, could you share more about how your program works? Does it consist mainly of educational programs or are there direct services provided? I ask only from the short experience Freedom from Hunger had with linking women entrepreneurs with a "business-in-a-box" program to provide simple eye exams and then help assist in purchase of corrective lenses. These types of innovations are those we've been following closely, particularly when looking at linking MFIs or their clients with particular health protection services. How would the work you're doing differ or how is it similar? That might help see better linkages or opportunities for your services. 

-Bobbi Gray

 Freedom from Hunger

Oct 5, 2010   13:57

We work to build comprehensive eye care systems to fight the major causes of blindness and care for blind and visually impaired person through supporting high-quality, sustainable projects that deliver eye care services, train personnel, develop infrastructure, and/or provide rehabilitation and education in underserved communities. While education is a key component of all our projects, our financial priorities focus on direct services and local capacity-building within each eye care system. Comprehensive eye care is fundamental to all our projects; while community health volunteers often work at a grassroots level to dispense eyeglasses and provide education, their service should be linked to trained eye professionals within a referral network. We are now expanding our priorities to low vision education and rehabilitation. 90% of blind or low vision children do not attend school and the unemployment rate amongst their adult counterparts ranges from 75-90%. The World Blind Union estimates that visually impaired people can be as much as five times more likely to be unemployed than the general public, often due to misperceptions. We will be looking to organizations to provide training and business planning assistance, mentorship and subsidies or microloans to help individuals start their own business. It should be further clarified that we will be working already with a targeted population within a comprehensive, regional blindness prevention program. This would mean the beneficiaries, blind and low vision transition-age youth and adults, will already be served and assisted by the eye care system. So, we are specifically looking to see if microfinance could fill the gap between comprehensive eye care and self-sufficiency and social independence. Please let me know if you seek any additional clarification.

Kristen Eckert

Lions Clubs International Foundation

Oct 5, 2010   11:22

Kristen,

Thank you for your posting. Impressive work on behalf of the SEEP network and HAMED.

Are there any other organization out there who also face the issues of blindness among their clients? What have you experienced as a best practice for preventing/fighting blindness in the communities you serve? What kinds of integration do you see around this issue?

We welcome your comments and encourage you engagement with others who share similar health/financial concerns.

Pepper

Oct 5, 2010   08:23

What about examples of MFIs providing various types of health care financing?  For example, CARD MRI (who posted here earlier) has developed a linkage with PhilHealth, the national health insurance plan of the Philippines.  CARD enrolls MFI clients, provides premium loans that ensure continuous enrollment over a 12 month period, and then remits quarterly premiums to PhilHealth.  RCPB in Burkina Faso is providing a health savings product that is linked to a low cost health loan when needed.  Clients use health savings for more routine health needs and have access to health loans for less frequent and higher impact illnesses.  And finally, both Bandhan (India) and CRECER (Bolivia) provide health loans to their clients.    Aree there other examples people can share about how MFIs help their clients finance health care services?

Oct 5, 2010   19:05

1) Faulu in Kenya has an arrangement with insurance company Pioneer that is very similar to the CARD/PhilHealth arrangement that Marcia describes.  They lend the amount of the insurance premium and recover the loan as part of their regular reimbursement schedules.

Elsewhere in Nairobi, Jamii Bora is running its own health insurance scheme without involvement of an insurer (or reinsurer).   They edge against risk by making this insurance compulsory for all their borrowers, but they are definitely going against lessons learned that suggest that microfinance institutions are better off focusing on savings and credit only, leaving insurance to companies who know how to design and price the products--and which have the resources to withstand non-idiosyncratic shocks.

Can any of the participants to the Speaker's Corner contribute their own experiences about MFIs that self-underwrite their health insurance product--and lived to tell the tale?

2) As far as health savings go, we found that the poor find them very attractive--and easier to comprehend than the concept of insurance.  Yet, when insurance is available, they will often prefer spending, say, 2,000 Kenyan Shillings on an insurance policy that opens access to much larger coverage through pooling than to spend that 2,000 Shillings to pay for service--even if they realize that insurance premium is not recoverable if no claim is submitted.  Do participants to the Speaker's Corner have access to information or data that confirms or contradict this finding in other countries?

Thierry van Bastelaer, PhD
Principal Associate/Economist
International Health
Abt Associates Inc.

Oct 5, 2010   07:03

Please find a program we tested to change mindsets and provide loans to HIV+ve persons.  

While working in eastern DR Congo, we found that there were many HIV +ve persons who had given up on life and were getting ready to die. Their families had also taken away their children as they feared transmission of HIV/AIDs, which made them mentally weak and destitute. We encountered these HIV+ve persons in the corridors of clinics and hospitals and also in the premises of convents and churches.

In 2003, we had established Advisory Centres for Better Living (ACBL) to provide a package of services (Please read the package of services at: http://www.changemakers.com/system/files/Advisory%20Centres%20for%20Better%20Living%20%28CCMV%29.jpg) including access to MicroFinance services to recover and reintegrate families that were left out by MFIs as they were considered the “non-entrepreneurial poor”. Our staff decided to carry out the following in order to test if we could also recover the HIV+ve and contacted the hospitals and convents to send them to the ACBL offices.

We presented the package of services that was available at the ACBL centres and questioned them on their happiness/contentment levels. Most of them said that they were less than 25% happy as they had lost everything including their homes and children.  When we questioned them on their ability to take loans, invest in small economic activities (SEAs) and pay them back in a month’s time, most of them cried, saying that they were too traumatized to do any activity and were only waiting to die. However, we noticed that there were a few who were silently digesting the information we provided and started asking questions. We tried to convince the HIV+ve that their inactivity and mental state were major causes of accelerated deaths, but that they could live longer until they were ready to die if they wished, by accepting their condition, challenging themselves to live longer by establishing a purpose and objective in life. (i.e. objective of earning sufficiently to take care of themselves and purpose of getting their children back)

We then told the HIV+ves who were waiting to die, to separate from the others who were asking questions as we could not recover loans from those who had planned to die and were thinking negatively.

We continued our discussions with the group of HIV+ves who were questioning us. We demonstrated the manner they could identify their talents/likes (which made them innovative and creative) and invest in SEAs which could enable them to have an income (buying and selling fish/banana’s, keeping small tables, preparing and selling bean cakes etc), provided them guidance to form groups and take first loans of $10 each, and pay them back on a weekly basis. We also visualized the manner they could demonstrate their capacity to earn sufficiently to their family members and entice them to bring back their children. (After two months, most of the HIV+ve who obtained loans were earning more income than their families and some children were returned)

Evaluating the program after a few months we found that there were some of the HIV+ves who were using their loans for consumption rather than investment. We established a format to engage them to invest loans in SEAs and demonstrate tangibly their enhanced living conditions before receiving their second loans. The format can be viewed at:  http://www.changemakers.com/system/files/CCMV%20Assessment%20and%20Pre-Engagement%20for%20impact-Goals%20pg%201_0.jpg

The group for HIV+ves who were not willing to take loans observed the progress being made by those who received the services from the ACBL centres and joined the program in the third month. We enabled around 500 HIV+ve persons recover and reintegrate with their families. We plan to replicate the program wherever there is a need. 

 

There were some HIV+ve persons who improved their health and also some who became trainers to carry on the message.

Thank you,

Sunimal Alles,

Consultant Conflict prevention, MicroFinance, MicroEnterprise, Livelihoods, and resettlement of displaced/refugees

C/O The TIDY Centre,

Sri Lanka.

www.TIDYcentre.com  

Oct 5, 2010   08:44

Dear Sunimal,

Thank you for sharing this experience.  It is fascinating and quite inspiring.  I noticed that there was a registration fee of $1.  Did this amount cover all of the training, or did particpants pay per session?  Also what was the total number of people or families reached with this program?  It is very exciting to see that the program also encouraged replication by training participants to share with others. 

 

Two other questions:  What other dimensions of client impact are you measuring and what have you found?  And what advice would you have for others who might want to replicate this in other areas or regions? 

Many thanks for this good work!!

 

Oct 6, 2010   00:21

Dear Marcia,

The registration fee of $ 1, was paid by everyone that requested any form of service from the ACBL centers. The $1 covered the first interview to identify talents/strengths: (Please read the interview sheet we used at:   http://www.changemakers.com/system/files/Goals%20and%20Talents%20identification%20format%20CCMV_0.jpg )  and was able to cover the costs for orientation towards the most appropriate and feasible SEA (based on market surveys and the talents/strengths/likes of the client/HIV+ve person) The $1 also covered most of the small business management, new technologies and marketing training as it was carried out within the ACBL. However, those who requested longer term training such as sewing and motor mechanics were covered by the project, and were limited to the duration of the project.  The loans were provided at an interest rate of 1% per week and the loans were paid back in four to eight weeks. The salaries of the staff of the ACBL centres were paid from the interest earned and from the registration fees. The total number of families that we reached by the program was around 5,000 (the setting up of the ACBL centres and recovery of HIV+ve persons was a part of a program titled MicroFinance for Rehabilitation (MFR)

In response to your questions related to client impact:   

In addition to the “Pre-engagement for impact-goals” format we developed (http://www.changemakers.com/system/files/CCMV%20Assessment%20and%20Pre-Engagement%20for%20impact-Goals%20pg%201_0.jpg),  we also developed a matrix to measure the enhancement/change of assets and livelihood security which enabled us to monitor their transcendence of becoming “not poor” by ranking them at the start as either: a) Very Poor (VP), b) Not So Poor (NSP),  or c) Non Poor (NP). The format we developed for DR Congo was based on one we developed in Cote d’Ivoire and was published by the MicroCredit Summit in 1999 and Updated in June 2000 by Anton Simanowitz: the matrix we developed in Cote d’Ivoire can be read on page 33 of the following document:  http://www.microcreditsummit.org/papers/povertypaperH.pdf

Based on the above matrix, we developed an impact evaluation system which was presented at the Results Inc. Annual Conference in Washington in 1999. The results of the impact measurement in Cote d’Ivoire revealed that access to small loans to develop SEAs was able to enhance assets by 500%. The baseline can be read at:  http://www.changemakers.com/system/files/Baseline%20of%20CI%20program%20June%201998.jpg  And the impact table can be read at:    http://www.changemakers.com/system/files/Impact%20of%20CI%20program%20Oct%201998.jpg

Advice and guidelines to replicate the program/process: We have refined the process of setting up ACBL centres since 2003. We now recommend that facilitation sessions be carried out to establish Committees for Better Living (CBL) with emerging leaders in any area where there is lack of access to resources for enhancing livelihoods (including access to health services), before establishing centres, as some areas may need Value chain Associations and Producer Organizations, some ACBL centers and others Production and Service centers. Please refer to a power point presentation titled “Guidelines to recover and strengthen communities in RRA and post conflict2” that was sent as an attachment to speakerscorner@microlinks.org to access the refined guidelines.

Thank you,

Sunimal Alles,

Consultant Conflict prevention, MicroFinance, MicroEnterprise, Livelihoods, and resettlement of displaced/refugees

C/O The TIDY Centre,

Sri Lanka.

www.TIDYcentre.com 

Oct 5, 2010   07:57

Dear Sunimal Alles

 

How fascinating. Great work for an MFI to do.

 

When Star Microfin Service Society (SMSS), People's Mulitpurpose Development (PMD), Mclevy and Pioneer Trad, the four microcredit practitioners started facilitating lessons on "HIV/AIDS: Prevention and Management" in South India, significant changes came in the thinking, attitude and practices of clients and their families.

 

The above 4 practitioners used the training material of Freedom From Hunger (www.freedomfromhunger.org)

 

The health lessons were facilitated through non-formal, participatory education, following adult learning principles. The lessons were full of stories, role plays and group discussions, facilitated by MFI field workers, in which MFI clients participated enthusiastically.

 

The entire topic on HIV revolved around the sad story of one woman, who was HIV infected for no fault of her's. The participating women became so emotional, that they firmly decided that they would never allow themselves, or any body in their family or community to suffer the fate of the woman in the story. The lessons made participants to "think", "feel" and "act".............

And all participants completely changed their attitude towards HIV+ve persons. They became so accommodating to them. Went out of their way to help them to lead a normal life...

 

D.S.K. Rao

Oct 5, 2010   06:02

Dear Somen,

where can I read your working paper on MFIs in India with health intervention?

Thank you & kind regards

Peter Wrede

Oct 5, 2010   07:45

Peter,

I'm not sure if you've seen these or not, but if you are interested in research related to MFI's in India who have initiated health intervention initiatives you may want to review the "Recommended Resources" section of this discussion's Web page under the "Quick Links" section (to the right). A couple of the documents you may find of interest are:

1. The "Financing Healthier Lives": http://microlinks.kdid.org/sites/all/modules/pubdlcnt/pubdlcnt.php?file=http://www.microcreditsummit.org/papers/Adv_Doc_2009_English.pdf&nid=3004

2. The "Microcredit Summit Campaign Consulting Report" http://microlinks.kdid.org/sites/all/modules/pubdlcnt/pubdlcnt.php?file=http://microlinks.kdid.org/sites/microlinks/files/gcontentadmin/files/SMR-Microcredit_Summit_Campaign-Consulting_Reportv1.pdf&nid=3004 

Pepper Whaling

UCLA/MCS SMR Research Team

Oct 5, 2010   04:30

On behalf of Freedom from Hunger India office, we did a pilot study with one of the largest and fastest growing MFI in India called Bandhan to integrate relavant health interventions with the objective of reducing family health expenses of the clients. Due to paucity of my time at the moment I may not be able to describe all the important health interventions but would like to highlight on the issue of linking MFI clients with health service providers that has great potential as I found.

Govt. Health department had been grappling with the covearge of Tuberculosis / suspected cases esp. in the rural areas for early diagnosis, treatment and follow-up esp. in the state of West Bengal where we did the pilot with Bandhan. Through proper communication and conviction on the potentail network that MFI groups (with consistent meetings every week) has, the state TB control office agreed to offer Bandhan to open up microscopy centres for sputum examination, send the cases, provide medicine through DOTS approach and ensure follow-up with all technical and initial captial assistance from the government. This is what I think a 'win-win' situation as such partnership would ensure proper treatment among the TB cases in clients' families (affecting health cost and hence micro-business) as well as the govt. ensuring its own succes of covearge and statistics. This happened in 2007. Unfortunately it did not materialse due to local polotical reason but this showed a great potentail to link with health providers by the MFIs to address the health needs of its clinets so that they can concentrate with their economic activities to improve their livelihood

I will post more examples when my time permits

Soumitra Dutta

Freedom from Hunger India representative

 

Oct 5, 2010   05:20

Thank you Soumitra

FFH project implemented in Bandhan in East India is a great example of succesful public-private partnership.

MFIs can provide health related services very efficiently. Be it health education, health services or making available health products. No other agency has the advantage of working closely with  groups of women, who are by and large very poor. And the biggest advantage of MFIs is that these groups meet very regularly and frequently (mostly weekly meetings). And field workers of MFIs who are generally school educated boys and girls attend these meetings routinely.

It is found that these field workers are very effective change agents. And through their involvement, MFIs could provide health related services very cost effectively. Minimum training to these youngsters is enough to make them good facilitators and change agents. And they are able to do it with very little effort, along with the financial services

D.S.K.Rao

Oct 5, 2010   01:44

Good morning.

 

What other types of products and services or examples are there of organizations integrating some type of  health service with their financial service offering?  

There is one organisation in Karnataka which has been linking a powerful alcohol de-addiction program to all its microfinance borrowers and their families.  This is a very important service because of the following:

1. Alcoholism is rampant amongst the poorer sections of society; reasons are many and include "we need the alcohol to help us go to sleep after a hard day's work", "we have no work to do, and alcohol helps us forget our worries"......

2. Alcoholism is costly for the family in two ways : eats into their sparse money, and causes health and social problems.

 

There is another which tried to set up clinics where all its microfinance borrowers and their families could get subsidised medicines and free doctor's consultation.  But this did not go forward as the expectation from the clients was very high, and they expected ALL treatment to be free and at their doorstep.  They were not willing to go to the specified hospitals for surgeries, etc.


Oct 5, 2010   03:09

Dear friend   May be you are referring to SKDRDP in the west coast of Karnataka. They are running for years now a alcohol de-addiction program very successfully. and there are many others who are trying health services.   To have an idea about which MFI is providing which type of health related support (health education, health products and health services), go to the following link to read the paper  "" Linking health to microfinance to reduce poverty" by  Sheila Leatherman a & Christopher Dunford   http://www.who.int/bulletin/volumes/88/6/09-071464/en/index.html   In addition, nearer to you, there are two NGOs in Tamil Nadu and one MFI in AP which are doing fantastic work on systematic integration of health education into microfinance.

    D.S.K. Rao

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