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Scaling up the economic life of PLHIV an Islamic microfinance approach by Khalid Ghailan


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Scaling up the economic life of PLHIV an Islamic microfinance approach by Khalid Ghailan

  1. Contents of the Presentation HIV/AIDS Socioeconomic impacts in Malaysia Microfinance as a potential tool Islamic Micro Finance Rationality Operational Model Recommendations
  2. Socioeconomic Impact of HIV/AIDS in Malaysia
  3. Total 2010 Prevalence 15- 49 = 0.5% 10% F 91,36240000 17.9 %AIDS3500030000 35%2500020000 HIV (13-29) AIDS1500010000 5000 0 < 2 years 2 - 12 13 - 19 20 - 29 30 - 39 40 - 49 > 50 years No Data years years years years years
  4. Been seen as a health issue rather than socioeconomic ThreatCost to mitigate HIV/AIDS outcomes and information in regards with socioeconomic impact of HIV/AIDS inMalaysia is very limited, despite its crucial guidance for related policies
  5. Quantifying strategic plans Morbidity/mortality Baseline Baseline estimates projection Socio-economic implications/costsWhat’s going What will happen on now next (if nothing changes) Cost of interventionValidate withsurveillance data/trend Impact of Alternative Morbidity/mortality intervention scenario Socio-economic projections implications/costs ‘What if’ interventions Strategic planning
  6. Socioeconomic impacts study in Malaysia - Hospital Cost Analysis - Household Survey
  7. Study LocationsData was collected from four different zones in the countryaccording to density of HIV/AIDS cases in each zone, based onSection of HIV/AIDS statistics for the last three years. STUDY LocationKL&SELANGOR JOHOR KEDAH KELANTAN
  8. Hospital Cost Analysis The principle of the costing approach General HIV/AIDS Top down data from in the 4 the 4 selected Bottom up selected hospitals, costing for hospitals (ALOS, excluding drug cost + drug prescribed in the hospital) No. of opt. Visits, No. of admissions, etc.)A combination approach of Top down & Bottom up costing methodsDrug cost data was extracted from 3585 HIV/AIDS patients’ records
  9. The estimated cost of health care services for HIV/AIDS patient per year in Malaysia. Cost of care for HIV/AIDS inpatient per day of stay. RM 364.83 Cost of care for HIV/AIDS per outpatient visit RM 138.64 CD4≤200 CD4>200 Inpatients Outpatients Outpatients Inpatients Outpatients Outpatients no ARVT with ARVT no ARVT with ARVTTotal cost perpatient per year 6,064.00 1,357.56 9,506.56 4,344.00 749.92 8,829.42
  10. Table (VI) The overall national HIV/AIDS health care provider cost break down for the year 2007 Description Cost Total inpatients cost of care in 2007 201,605,633.22 Total Outpatients cost of care in 2007 excluding ARVT 67,104,950.48 Total cost of ARVT for 6203 patients in 2007 50,332,692.75 Total provider cost of IP&OP care 319,043,276.456203 patients
  11. Household Survey Age (Male vs. Female) Age Group <13 13-19 20-29 30-39 40-49 50≥ Total female 0 .10% 12.50% 46.60% 30.70% 9.10% 100 % male 0 0 9.10% 44.09% 41.60% 5.30% 100 %
  12. Education
  13. Sexual Orientation
  14. How the infection was detected in the first place? Respondents latest CD4 count 75% are detected in health care facilities because of illnesses
  15. Mode of Transmission/Gender
  16. Cost of HIV/AIDS morbidity from household perspective
  17. Direct cost (out of pocket expenditure) The total estimated median of “Out of Pocket Expenditure” per year is RM 1080 (500 – 16480) which is almost 14.7% of patient’s median income a year RM 192 that is average household expenditure on health according to Malaysian national statistics 2007
  18. One household might have between 1 to 5 patientsunder the same roof and to mitigate the overexpenditure and affected household incomeFood, accommodation , qualifying plans &entertainment are respectively affected.
  19. Indirect cost (Productivity Loss) 41.1 % of the patients were heading their households
  20. Reasons of stoppage work
  21. Patients cost for the year 2007 Description Costing model CostTotal out of pocket Direct cost 72,612,720.00expenditure per yearTotal estimated productivity Indirect cost 287,364,839.40loss per yearTotal Direct + Indirect cost RM359,977,559.4 Representing 0.06% of Malaysian GDP in 2007
  22. The overall costHIV/AIDS in Malaysia has substantial economic impactas total estimated cost for the year 2007 was claimedabout RM 679,020,835.85 includes cost of healthcare provider, patient’s out of pocket expenditure andproductivity loss of patients 0.11% of the national GDP
  23. Socio demographic impacts
  24. Marital status Marital status Before currently before/currently Never Married 42.4 38.4 3.7% Married 44.4 35.4 9% Dev/Wed 13.1 26.3 13.2 Total 100.0 100.0 64.65 % are currently non married adults and their sexual behavior needs to be studied.
  25. Patients from households headed by non father are more than thosecoming from household headed by father. If infected fathers areexcluded,Chi Square Test showed the difference is statistically significant (P< 0.001 df (1) for n = 297).
  26. Children No. of children per HIV/AIDS patient who experienced marriage 61.7% Patient 1.9 childIn 2007 is 1179 AIDS related death with estimated No of orphan = 997
  27. Internal migration 1% Running away from the family to stay alone or with friends Are the whole Before detection after the detection family members (%) (%) staying together yes 59.6 45.8 no 40.4 54.2 Total 100.0 100.0
  28. Psychosocial impacts
  29. Current status of disclosure to family members and friends
  30. Hostility 21% Have heard about the patients intentionally harming others? 7.4% we can fine an excuse “it was not a crime or deviation” 1.3% are firmly supporting the righteousness of these activities. To support their revenge, anger, let others share the same feeling, feeling injustices, and self satisfaction were showed as the reasons.
  31. Impact on other household members61.7% of the respondents having children and amongthem 17.6% experienced neighbors prohibit theirchildren to play with patient’s children.Majority were indentified from Kelantan followed by Kedah, Selangor then JohorFurthermore, 10.1% have children left school fromKelantan and Kedah for various reasons.
  32. RecommendationsPsychosocial impacts monitoring data baseHIV/AIDS patients counselors & Mass media Trainingmodules A national research committee should beestablished to guide and direct prospectiveresearches with the view to fill the gaps ofknowledge in this field and to avoidunnecessary repetition of interviewing PLWAH
  33. Microfinance organizations can customize a specificpackage for the HIV/AIDS households especially forthe non ill members who can contribute in thehousehold income and leverage total earning. Thisadvantage would enhance their care and support andmight help to prevent most of the negativeconsequences.
  34. Introduction This section aims to propose an “operational model of Islamic Microfinance” that can extend financial assistance to the destitute HIV/AIDS patients so that their productive life can be illustrated by means of economic activities The implementation of this model may help to reduce productivity loss & enhance social protection of the HIV/AIDS patients and their families.
  35. Microfinance SystemMicrofinance:• Microcredit is a collateral free, solidarity(group) based lending programme for the uncreditworthy poor people. In this programme loan is provided to eradicate poverty through creating self employment. This system avoids any legal action and pays doorstep service to the clients. Besides it emphasizes on obligatory and voluntary savings. (Yunus 2011) It facilitates micro-loan, venture-capital, tiny-savings, micro- insurance and money transfer (IRTI-IDB 2007).
  36. Microfinance can play a vital role of easing the negativeeconomic impact on the HIV/AIDS affected household(Barnes, 2003). This provision can increase income and economic safety ofthe household extending productivity of the economicallyactive patients and it also enables the healthy members tobecome more productive (Parker, Singh and Hattel, 2000).
  37. Conventional Microfinance SystemWeakness:• Interest/ Riba From Islamic Perspective is the main weakness of conventional microfinance. (Clark, 2002; Segrado, 2005; Obaidullah, 2008) • Riba is detrimental to the social wellbeing as it causes unemployment rising cost of capital and consequently it contributes adverse affects on consumption, investment and employment • Marginal Efficiency of Capital (MEC) does not stand on the optimum level in the presence of Riba (Khan 1983)• The approach of the contemporary Microfinance is “financing based on repayment”• A trap of “borrowing-repaying cycle” that creates financial vulnerable condition (Diop, Hellenkamp and Servet 2007)• Solidarity and woman-only approach Conventional microfinance system can’t properly cope with the destitute HIV/AIDS patients because of sustainable rate of interest (Shankar 2007), Risk-averse attitude and group based lending method (Rosenberg 2002).
  38. Islamic Microfinance Islamic Microfinance can deal with the higher risk groups because it believes in mission and market based approach (Obaidullah, 2008) Diverse sources of capital (Sadakah/ donation, Waqf/ trust, and Zakah/ compulsory donation by the wealthy muslim) (Kaleem and Ahmed 2010). 4 principles such as 1) Completely free from Interest or Riba. (Borhan 1997) 2 ) Risk and Reward Sharing 3) Financial risks born solely with the IsMFI not with the borrowers 4) Loan to socially productive activitiesTherefore it could be presumed that Islamic Microfinance would be better fitted in financing the destitute people with HIV/AIDS.
  39. Family Based Lending Methodology Vs Group. Family based lending is more feasible Participation of the family members may contribute positively to the investment and create synergy As other member of the family will be benefitted from this type of financing they will be more concern and attentive to the patient. Instead of liability the patient could be considered as asset. Patient would feel more comfort, dignity and self-reliance Patient may feel lees or no stigma After demise of the patient, family member would be able to continue the loan scheme inheriting the assets earned by the patient. Family members would be more empathetic than the group members Thus family member will get an opportunity to perform their duty to the patient with greater convenience.
  40. Rationality• Better access to treatment• Maintain proper food / nutrition and accommodation• Minimize –ve impacts on other household members• Gain more care and support from other family members• Increase adherence to treatment• Increase adherence to drug rehabilitation• Decrease the feeling of anger ,revenge and hostility• Less psychological complications• practical approach to minimize stigma and discrimination• Application of Islamic financial tool might bring more religious institutes to learn more about HIV/AIDS and to help in more positive way “Islamic religious institutes are always asked to implement but not to be involved in the product development”.• Encourage health insurance companies to cover HIV/AIDS patients• Operationalize corporate social responsibility
  41. The Operational Model This model has been drawn based on the previous literature and our study on the economic impact of HIV/AIDS on the patients and their families in Malaysia. The model integrates: Islamic Microfinance (A conceptual Model) Destitute HIV/AIDS (Health Deteriorating Phases of the Patient ) Household Economic Portfolio (Economic Management Strategies of the Household)
  42. Conceptual Model of Islamic Microfinance for HIV/AIDS Source of Capital: Investor, Sadakah, Zakah, Waqf IsMFI Services Microcredit Micro Savings Micro Insurance Micro Equity Qard Hassan Charitable Trustee Activities Murabaha Financing with bai Bai (Mudarabah) BithaminAjil, Ijara, Bai Joint Venture Salam (Musharakah)
  43. Health Deteriorating Stages of the HIV/AIDSpatient Detection Revelation Recovering Complication Death
  44. Integrated Operational Model Reversible Mechanism and Micro- (CD4 500+) Stage 1 Disposal of Self-Insurance Equity Assets (CD500 to 300- ) Stage 2 Disposal of Productive Microcredit Assets (CD4 50-)Stage 3 Stage Charity Destitution Death1) Stages of Financing 2) Stages of Health Deteriorations 3) Stages of Adapting Strategies
  45. Organizational structure Retailing Production Stock Job Station HIV/ AIDS Microfinance Microfinance Screening Institution HIV/ Microcredit Mechanism AIDS Charity Rehabilitation HIV/ Centre Individual AIDS Enterprise Household
  46. Fundamental Issues Due to fungibility of financing , Conceptual Approach and Methodological Approach should encompass three level of analysis: 1) the Individual 2) the Enterprise and 3) the Household Standardizing a new criteria to measure up the poverty line of the HIV/AIDS patients Based on the Income and Expenditure levels Economic Portfolio of the Household with HIV/AIDS Patients of Malaysia Family Based Lending method Organizational Structure Shariah Compliance Regulatory and Management
  47. Impact of Income and Expenditure Effects on Household Consumption Expenditure (Gayle Martin) Householdconsumption drop in h/h expenditure expenditure h/h falling below poverty line h/h falling deeper below poverty line Poverty line Q1 Q2 Q3 Q4 Q5 Households divided into 5 income quintiles
  48. Borrower Issues Four basic issues are determined such as Identification, Measurement, Monitoring and Controlling (BNM 2007) Identification Borrower’s profile (Armendariz and Morduch , 2007) Who is the HIV/AIDS Patient (drug user, Brothel goer, sex – worker, transmitted from husband/wife/ mother etc) Current Stage of the Disease Destituteness/ Economic condition Expertise / Entrepreneurial Skills (determination of the scope of investment) Economic Activeness Family Status (Whether any other member of the family can participate in Islamic Microfinance or Crediting scheme) Track Record (Morals/ Credit Background)
  49. Borrower Issues(Con…) Measurement Ex-Ante and Ex-Post Ex-Ante Size of the Capital (Ehsan and Blake, 2008) Profit and Loss Sharing Ration (Variations based on Project and Profit) (Bacha,1997) Ex-Post Linear relationship between project and profit (Rickwood and Muride, 2000)
  50. Borrower Issues(Con…) Monitoring Ex-Post Hazard (Iqbal and LIewellyn (2002) Asymmetric information Superior information may lead a party to go against the interest of another The agent may conceal the profit level Usages of Loan (Beatriz Armendariz and Jonathan Morduch (2007) (Khalil, Rickwood and Murinde 2002) Overconsumption of prerequisites by the Mudarib Under reporting profit, risk avoidance and shirking of effort by the Mudarib Amoral entrepreneur may grasp higher profit margin than the agreed ratio(Ahmed 2002)
  51. Borrower Issues(Con…) Controlling Discretionary power Monitoring and contractual governance (Rickwood and Muride 2000) long term involvement with the project and higher risk exposure (Obidullah, 2007) Organizational Control
  52. Organizational Issues Risk Management Money Lending, Risk Taking, Risk Sharing, Risk leveraging Regulatory Framework Reinvestment of firm’s surplus growth (Aggarwal and Yousef, 2000) Code of Behavioral Conduct of the Islamic Financial Institute with the Destitute Patients Financial contract with a patient Loan Transformation to charity
  53. Other Issues: Non-Muslim Borrowers Non- Usages of Islamic Financial tools with non- Muslim Borrower Code of Ethics Code of Behavioral Conduct Shariah Compliance Investment Policy
  54. Industry based Business model Model 1: Cleaning Item (Retailing) Model 2: Fabrication (Production) Model 3: Stock Holder (Profit Sharing)
  55. Conclusion Existing Microfinance organizations like Amanah Ikhtiar Malaysia (AIM) can cater a specific package for the HIV/AIDS households The potentials of AIM Large in size and Capital (easy to economize the operating expenses) Operating all over Malaysia Higher access to poor and pro-poor Long experience of Microfinance Initiated certain Islamic Microfinance tool (Qard-al-Hassan) Trusted brand
  56. Thank You