Transcript of "Sheila Leatherman, Why Integrating Microfinance, Health Education, and Other Forms of Health Protection"
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• 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 poorclients 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 belowthe poverty line because of high cost ( 20 million people)What can we learn from institutions that have been mostsuccessful in this area? *Freedom From Hunger data
WHAT must we do to improve health? Access Barrier; Access Barrier; Good Financing Information Access Barrier; Appropriate health services and products
Client Need or Barrier Examples of programsInformation • Health education • Health promotion and screeningand knowledge • Trained community volunteersAvailability of effective • Direct delivery of clinical care • Health fairs /health campsHealth products/ services • Linkages with/referrals to providers • Community pharmacies/dispensaries • Loans to health providers • Micro franchising health-businessesFinancial 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 literature2. Case Studies; ex. BRAC, Pro Mujer3. Microfinance and Health Protection (MAHP); Freedom From Hunger demonstration (Gates funded); 5 MFIs in India, Bolivia, Philippines, Benin and Burkina Faso
% of MFIs providing Microfinance-Health IntegrationHealth program What is being done?Health education (89 MFIs, 2009)79%Referrals23%Direct health servicesdelivery 22%Contracts w/healthproviders20%Health micro-insurance20%Health promotionevents16% 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 Benefit Leatherman et al, Health Policy and Planning, 2011 Health Behavior Use of Increase Positive Knowledge change health health health services system outcome capacityHealth X X X XeducationTrained X X X Xhealth xworkersLinkages X X Xw/providersLoans to X Xhealth Xproviders
Goal Where ? Intervention ? ResultImproved access BRAC/ Bangladesh + •In 2010 -reaching over 100to health services million with health services CRECER/Bolivia; health •24% receiving health service fairs never had medical care before Pro Mujer/Nicaragua •Increased pap smears for primary health care cervical cancer from 36% to 95%Ability to Bandhan/India; health • 33% would have delayedafford care loans treatment without the loan • 62% felt able to afford other necessities (food, education)Better health Ekjut/India; •30 % reduction in newbornoutcomes Participatory health mortality education and planning •> 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?
Cost data; the question of sustainabilityMFI Program annual cost Per clientMAHP Programs; Philippines; Cost to institution Gov’t insurance and PPP avg direct 0.29 $ Burkina Faso; savings/loans avg indirect 1.59 $ Bolivia; health fairs India; health educ and productsPro Mujer Health educ & clinical Cost to client 29.00$ servicesHealth Education-INDIA•KAS Foundation Credit with health Cost to institution education ( CwE) 1.20 $ ( first year only)•MCS Campaign ( 4 MFIs) Health education 1.91 $
Ekjut (India): Participatory health education and actionplanningRandomized Control Trial (Population of 228,186, Control Treatmenthalf assigned to treatment, half to control)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%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 17
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