Elizabeth Carosella, International Program and Business Development Manager for Partners for Development, explains the organization's microfinance model to address the devastating link between poverty and poor health in developing nations.

1. Combattingthe Vicious Poverty
& PoorHealthCycle:
Integrating Health and
Microfinance
Presented by: Elizabeth Carosella
Partners for Development
June 2014
www.pfd.org

2. Partners for Development (PFD)
• PFD is a U.S.-headquartered NGO that
works to improve quality of life in
partnership with vulnerable &
underserved populations.
• True to our name, we partner with
and build the capacity of local
organizations to design, implement
and monitor development programs
in Africa, Asia and Eastern Europe.
• Core practice areas: public health,
agricultural development, enterprise
development, and microfinance.
Capacity building is part of everything
we do, and we integrate programs to
the greatest extent possible.
www.pfd.org
• We are working in multiple
regions of Nigeria, having
maintained an integrated
program there since 2000.

3. The Poverty-Poor Health Cycle
• 100 million people fall below the poverty line each year due to
large or unexpected health expenditures. Many of those already
living in poverty continue to go untreated because they cannot
afford to seek health care.1
• Poverty leads to poor health. High costs of transportation, services
and commodities prohibit the poor from accessing care.
• Poor health leads to poverty. Families are forced to sell productive
assets to cover healthcare costs.
• In much of the developing world, both are correlated with low levels
of education and cultural norms that further impede women from
accessing a range of services.
1. “USAID’s Global Health Strategic Framework: Better Health for Development.” USAID. 2012 – 2016.
www.pfd.org

4. Women are at the Center
• With urban migration
(primarily men), women have
more household
responsibility, yet face
deteriorating earning
potential due to limited
access to financial services.
• Poor, rural women are already
at increased risk of maternal
health complications,
malnutrition, and a range of
diseases including HIV/AIDS.
www.pfd.org
• According to the World Bank,
“maternal deaths are both caused
by poverty and are a cause of it,
with the costs of childbirth often
the single biggest cause of casting
a family into poverty.”

5. Intertwined Challenges
Perspective Challenge
Health • Costs of clinical care, drugs, and transportation to health facilities are
prohibitive
• Financial burden of illness leads to reductions in women’s and children’s
health and education
Financial • Clients’ redirection of loan capital to cover health-related costs
• Reduced productivity when a client or family member is sick or disabled.
• Delays in loan repayment
• Inability to repay loans resulting in default
• Poor performance of clients’ businesses
• Poor attendance at microfinance group meetings, undermining of
the solidarity of the microfinance client group.
Reaching
the very
poor
• Health service outreach to the poor is a significant challenge, especially
for stigmatized issues
• Questions about the effectiveness of microfinance in reaching the
poorest of the poor, rather than the “economically-active poor”
www.pfd.org

6. Mutually Reinforcing
Components
• FROM A FINANCIAL PERSPECTIVE:
• Healthier clients more economically productive, better able to
repay loans, more likely to repeat loan cycle
• Decreased likelihood that clients divert capital away from
productive purposes to cover health costs
• Increased attendance at group borrower meetings
• Increased client loyalty and boosted market share for MFIs
www.pfd.org

7. Mutually Reinforcing
Components
FROM A HEALTH PERSPECTIVE:
• Incorporating access to finance enables clients to overcome
major cost barriers to service access.
• Regular access to the poor, increasing the ability to extend service
outreach.
• Regular group meetings are service delivery platforms for
education, training, and dialogue
• Creates unique spaces to foster social and behavioral change.
• One-on-one meetings between borrowers and credit officers are
opportunities for individualized exchanges, and even direct
service provision.
• Regular community-based and context-appropriate meetings
engages male partners as well as community and religious
leaders
www.pfd.org

8. Growing Body of Evidence
• MICROFINANCE INCREASES DEMAND FOR CLINICAL CARE
• Microfinance, without integrated health services, increases the demand for
formal healthcare among women (Nanda 1999).
• INTEGRATED HEALTH FINANCING APPROACHES STRENGTHEN SYSTEMS
• Clients enrolled in a micro-insurance scheme implemented through MFIs,
“credit and savings organizations,” and traditional groups in Ghana were
more likely to seek treatment for malaria before hospitalization became
necessary (Blanchard-Horan 2007).
• SUPPLY-SIDE INTERVENTIONS IMPROVE PERCEPTIONS OF QUALITY OF CARE AND
HEALTH-SEEKING
• Improvement in clients’ perceptions of quality of care provided by private
midwives who received business skills training and MFI loans in Uganda.
(Agha et al. 2004).
• Positive impact of microloans to local private medical clinics, coupled with
business skills training. Clients were more likely to seek care when facilities
were well-stocked, clean, and conducive to private interactions (Seiber and
Robinson 2007).
www.pfd.org

9. INTEGRATED APPROACHES PROMOTE SOCIAL AND BEHAVIOR CHANGE
MkNelly and
Dunford (1999)
Improvements in maternal and child health (MCH) through unified delivery of
village banking services and child-survival education in Bolivia and Ghana
Barnes et al. (2001) 32% of women who received education regarding HIV/AIDS prevention through
microcredit groups practiced at least one HIV/AIDS prevention method,
compared to only 18% among non-clients in Uganda
Hadi (2002) Increased knowledge of pre- and post-natal care among participants in an
integrated microfinance and health program in Bangladesh
Smith (2002) Link between higher levels of healthcare and participation in an integrated
microfinance and health education program in Honduras and Ecuador
Dohn et al. (2004) Higher rates of vaccinations, use of health facilities and public health
knowledge among community members participating in an integrated
microfinance and MCH program in the Dominican Republic
Ahmed et al. (2006) Significant increase in vaccine acceptance rates among borrowers and their
families as part of, an integrated program for women’s financial empowerment,
health and education
Pronyk et al. (2006)
and Kim et al.
(2007)
Integrated microfinance, intimate partner violence, and HIV prevention
program reduced the risk of IPV and improved women’s empowerment in
South Africa
De la Cruz et al.
(2009) and Sherer
et al. (2002)
improvements in infectious disease prevention practice through integrated
microfinance and health education programs, including malaria, sexually
transmitted infections (STIs) and HIV/AIDS.
Metcalfe et al.
(2011)
incorporating education related to financial planning for health and use of
health services increases preventative health service uptake
www.pfd.org

10. Areas of Potential Impact
Micro-
finance
• Increased clientele base
• Greater market share
• Client loyalty
• Marketing niche
• Stronger loan performance
• Likelihood of repeat borrowing
Health • Nutrition and breastfeeding
• Maternal Health
• Access to clinical care
• Reproductive Health and Family Planning
• Infectious diseases (HIV/AIDS, Sexually
Transmitted Infections and Malaria)
Cross-
cutting
issues
• Financial inclusion
• Household economic strengthening
• Women’s economic empowerment
• Gender and normative change
www.pfd.org

11. PFD’s Integrated Health &
Microfinance Program in
Nigeria
• Over 10 years of partnership with the
Packard Foundation
• Goal of reaching large numbers of
women of reproductive age through
microcredit borrowers circles to
educate and inform them about
reproductive health, family planning,
and preventative methods to ensure
safer pregnancies and deliveries.
• Delivered information on family
planning and appropriate pre- and
post-natal care to more than 112,000
women to date.
www.pfd.org

12. Geographic focus:
• Benue
• Bauchi
• Edo
• Kaduna
• Nassarawa
• Sokoto
www.pfd.org

13. Integrating Health and
Microfinance: PRI 2009 - 2012
• Program related investment (PRI) from the Packard
Foundation in 2009 to promote reproductive health and family
planning.
• Initial capital investment of $1.5 M to MFI partner LAPO
• As of 2012, this yielded $18.7 M in loans to 76,000 Nigerians
• 95% female borrowers
• Average loan size is $244
www.pfd.org

14. Components
• Delivered information on family planning and appropriate pre- and
post-natal care to women through regular borrower meetings
• Broadened the traditional understanding of family planning.
• Menu of services included safe motherhood, post-abortion care,
testing and treatment of STIs, pre and antenatal care.
• Stressed education of service providers AND community members
• Holistic approach that also included “edutainment”
• “Male motivators” and engaging religious leaders
www.pfd.org

15. Findings
•Increased health knowledge and application
•Increased demand and utilization of health services and
commodities
•Increased money management/ business skills
•Improved and extended outreach and community mobilization
•Improved commodity management and record-keeping
•Positive effect on secondary beneficiaries
www.pfd.org

16. Household Impact
• Beneficiaries in Bauchi saw a clear connection between an
increase in financial well being and better health care
• Women’s increased decision making authority in the home
• Husbands’ financial burden decreased
• Children attending school more consistently and families
providing children with more nutritious food.
www.pfd.org

17. Thank you!
www.pfd.org