1. Integrating Microfinance and Health
Benefits, 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

2. 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

3. 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

4. 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

5. WHAT must we do to improve health?
Access Barrier;
Access Barrier;
Good
Financing
Information
Access Barrier;
Appropriate health services and products

6. Client Need or Barrier Examples of programs
Information • Health education
and knowledge • Health promotion and screening
• Trained community volunteers
Availability of effective • Direct delivery of clinical care
Health products/ services • 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

7. 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

8. % of MFIs providing Microfinance-Health Integration
Health program
What is being done?
Health education
(89 MFIs, 2009)
79%
Referrals
23%
Direct health services
delivery 22%
Contracts w/health
providers
20%
Health micro-
insurance
20%
Health promotion
events
16% 8

9. 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

10. 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
capacity
Health
X X X X
education
Trained
health
X X X X x
workers
Linkages
w/
X X X
providers
Loans to
health X X X
providers

11. Goal Where ? Intervention ? Result
Improved access BRAC/ Bangladesh + •In 2010 -reaching over 100
to 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 delayed
afford care loans treatment without the loan
• 62% felt able to afford other
necessities (food, education)
Better health Ekjut/India; •30 % reduction in newborn
outcomes Participatory health mortality
education and planning •> 50% in maternal depression

12. 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

13. 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?

14. THANK YOU

15. The End

16. Cost data; the question of sustainability
MFI Program annual cost
Per client
MAHP Programs; Philippines; Cost to institution
Gov’t insurance and PPP avg direct 0.29 $
avg indirect 1.59 $
Burkina Faso; savings/loans
Bolivia; health fairs
India;
health educ and products
Pro Mujer Health educ & clinical Cost to client 29.00$
services
Health 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 $

17. Ekjut (India): Participatory health education and action
planning
Randomized Control Trial (Population of 228,186,
Control Treatment
half 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