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TRANSCRIPT
Welcome to the first edition of the India
Health and Microfinance Community
Newsletter, a collaborative effort of the
Indian Institute of Public Health Gandhi-
nagar (IIPHG), Freedom from Hunger,
and Microcredit Summit Campaign
(MCS). This newsletter is a communica-
tion tool for the Indian community of
practice, and was a key demand from the
attendees of ―Linking Health and Microfi-
nance in India: Improving Incomes and
Promoting Universal Health Care Access
for the Poor.‖ The workshop, held in July
2011 in Ahmedabad, brought together
practitioners from the microfinance and
health sectors for the first time to exam-
ine the potential for linking health provid-
ers, MFIs and SHGs to reach many mil-
lions of the poor in India with essential
health services and greater protection
from the costs of poor health.
Philadelphia Children‟s Hospital Global
Health Symposium, USA, September 2011.
Evidence of the value of adding health to
microfinance, based on results from
Bandhan that improved child feeding
and maternal health, and from Ekjut’s
work with self-help groups (SHGs) that
significantly reduced infant mortality,
was shared with over 200 Global Health
practitioners at this annual meeting in
the United States.
Friends of Women‟s World Banking,
Patna, September 2011.
Five partners of Friends of Women’s
World Banking attended the workshop,
―Why Add Health to Microfinance?‖
facilitated by Soumitra Dutta, M.D.,
Freedom from Hunger. Two of the
partners are proceeding with developing
a health-protection program.
Volume 1, Issue 1, January 2012
India Health
and Microfinance
Community Newsletter
Inside this issue:
Sharing the Message
about Health and
Microfinance
1
A Report on the State
of the Field of
Integrated Health and
Microfinance in India
2
News from
Practitioners 3
Other Industry News
of Interest 4
Sharing the Message about Health and Microfinance
“The question is not,
„Should MFIs provide
health-related
services?‟ but rather,
which services and in
what manner? We
need innovative
approaches for inter-
sectoral collaboration
between MFIs and
the health sector.”
Keynote Address by
Ms. Ela Bhatt,
Founder SEWA
Key Themes from the Workshop
MFIs can help reduce access barriers
to health.
Start-up support will encourage and
help MFIs integrate health services.
Apex institutions, social investors and
donors, and microfinance networks
have an important role to play.
Research and documentation of best
practices will help advance the field.
Need a means to connect, convene
and share lessons and tools for best
practices in integrating health and mi-
crofinance.
Here is the link for the workshop pro-
ceedings. The full text of most presenta-
tions is available at this link.
Introduction
Researchers from IIPHG, Freedom from
Hunger, MCS and University of North
Carolina at Chapel Hill, USA, are
collaborating with other pro-poor
organizations to develop a more
comprehensive understanding of the
provision of health programs and
services by MFIs in India.
The report will outline the rationale for
combined services, document various
health products and services offered in
combination with microfinance, suggest
suitable know-how and technology to
expand the adaptation of integrated
services, present the social and financial
outcomes for clients and institutions,
and identify the challenges that must be
A Report on the State of the Field of Integrated Health and
Microfinance in India and Call for Assistance in Providing
Information on Credit-linked Health Program
Microcredit Summit Campaign Global
Summit, Spain, November 2011.
A workshop entitled, ―Why Integrating
Microfinance, Health Education and Other
Forms of Health Protection is Good for Your
Clients and Good for Your MFI, and How Can
You Incorporate It,‖ featured a commissioned
paper by Sheila Leatherman. Joy Marini of
the Johnson & Johnson Foundation
moderated the panel, which also included
Marcia Metcalfe, Freedom from Hunger
(USA); DSK Rao, MCS (India); Rosario Perez,
ProMujer (Latin America), and Shareran
Abed, BRAC. The Summit also sponsored a
full-day class on, ―Why Add Health to
Microfinance?‖ facilitated by Marcia Metcalfe
and DSK Rao.
Microfinance India Summit, Delhi,
December 2011.
A session entitled ―Health Plus
Microfinance—A Winning Combination for
MFIs and Clients,‖ was organized by DSK
Rao of MCS, featuring Priya Anant,
Access Health International; C.S. Ghosh,
Bandhan; David Gibbons, Cashpor; K
Paul Thomas, ESAF; and Amir U. Khan of
the Bill & Melinda Gates Foundation.
NABARD Workshop, Kolkata, December
2011.
Soumitra Dutta of Freedom from Hunger
along with staff from Reach India
facilitated a workshop, ―Why Add Health
to Microfinance?‖ for SHG partners of
NABARD.
Page 2 India Health
addressed to extend these services
effectively on a large scale. The report
will be beneficial for microfinance
practitioners, private and public health
providers, researchers, policymakers,
social investors and donors.
A key part of the report is filling an online
questionnaire accessible through this
link. While a significant portion of the
MFI community has completed the
survey, there are still MFIs that have not
responded. We request all MFIs that
have a health program to complete the
survey online. An offline questionnaire
can be obtained through contacting any
of the contacts listed at the end of this
newsletter.
SHG federation
meeting at Duni,
Rajasthan. Entry
point for integrating
community health
and hygiene
awareness issues
economic and social lives of the past
decade. Those living in rural areas have
not been spared—numerous cases of
hypertension and pre-diabetes have
been discovered during health checkups.
On the basis of recent surveys, the ICMR
estimates the prevalence of diabetes in
adults to be 3·8% in rural areas and
11·8% in urban areas (Lancet, October 5,
2005). The prevalence of hypertension
has been reported to range from 20–
40% in urban adults and 12–17% among
rural adults. India presently has the
highest number of diabetes cases and a
significantly increasing number of
cervical cancer cases. About 50.5% of
deaths in India occur due to non-
communicable diseases (NCD) like
diabetes, respiratory diseases, cancers
and cardiovascular diseases.
Bandhan, one of the fastest-growing
MFIs in India, has partnered with
Freedom from Hunger since 2006 to
integrate health in microfinance and pilot
evolution of evidence-based, health-
protection interventions for its members.
It has successfully scaled up its own
funding and is reaching out to more than
382,000 beneficiaries that include more
than 150,000 borrowers and their
families with health education, links with
healthcare services and access to quality
health products through community
volunteers known as SS.
Bandhan is planning with Freedom from
Hunger to integrate community-based
interventions to address common NCDs,
especially in rural areas. These are areas
in which NCDs highly affect the
livelihoods of thousands of Bandhan
clients and their families. Bandhan is
interested in researching pre-diabetic,
diabetic and hypertensive cases of
clients (and their families) above 40
years of age. Bandhan is looking for the
Research to analyze impact of credit
with health access on members of
SEWA and SKDRDP
IIPHG researchers have been awarded a
research grant from the Wellcome Trust
Capacity Building Programme to analyze
the effect of providing credit plus health
services for the members of the Self-
Employed Women’s Association (SEWA)
in Gujarat and for members of Shree
Kshethra Dharmasthala Rural
Development Project (SKDRDP) in
Karnataka.
Along with bachat mandalis (savings and
credit group) of SEWA, access to basic
health services for its members are
made available through Lok Swasthya
SEWA, a registered cooperative. SKDRDP
offers its SHG members a complete
protection plan against hospitalization
expenses and offers access to health
education through the JVK (Jnana
Vikasa) program.
A before-and-after comparison study with
a control group will aim to address
whether access to credit plus health
services has a differential impact on
institutional delivery and childhood
diarrhea, and its impact on client health
expenditures. An area served by credit
with health access from each MFI will be
selected as an intervention arm for the
study. A similar area served by the MFI,
but with no linked health intervention,
will serve as a matching control to allow
for assessment of the additional benefits
provided by the health intervention.
Reaching community to address non-
communicable diseases by MFI
Non-communicable diseases (NCDs)
have added to the woes of India’s poor,
who are already heavily burdened by
communicable diseases, affecting
News from Practitioners
Page 3 Volume 1, Issue 1, January 2012
Eye health
camp: Bandhan
collaborated with
Susrut Eye
Foundation to
provide free eye
exams to the
community,
identifying 36
patients with
cataracts and
referring them for
free surgery provided
by the Foundation.
Attendees of
“Linking Health and
Microfinance in
India: Improving
Incomes and
Promoting Universal
Health Care Access
for the Poor”
workshop
opportunity to screen clients for potential
high-risk factors and link them with
healthcare services as well as implement
health education and counseling.
Bandhan is looking forward to
collaborating with Freedom from Hunger
for technical support by developing a
joint project proposal to seek external
funding to initiate this as a pilot, with an
eye to scale up, the way it did for the
Microfinance and Health Protection
initiative.
Health programs can be low-cost and
sustainable for MFIs
An important question often voiced by
MFIs or SHGs considering the addition of
health care services is, ―How much does it
cost?‖ MFIs and SHGs face considerable
pressures for lean operations and to use
operating reserves only for those services
that will benefit clients or improve their
organizations’ work.
Recent cost studies conducted with two
new MFI implementers in Orissa by
Freedom from Hunger continue to add
weight to the argument that MFIs can
develop and operate health programs
that are low-cost, and with benefits to
the MFIs and clients. KAS Foundation
and Gram-Utthan both implemented
health programs over about an 18-month
period during 2009–2011. The average
cost of the program was about 100 INR
(US $1.89) per client.
This program created organizational
capacity to reach about 10,000 clients
during the pilot phase. Operating costs
were 5 to 8 INR (US $0.09 to $0.15) per
client per month, which is quite
comparable to a global study done by
Freedom from Hunger of five MFIs, in
which the monthly cost of health
program operations was about 6 INR (US
$0.11) per client. While costs will vary
from organization to organization, this
growing body of data strongly suggests
that MFIs can provide a range of health
services at very low cost and with
benefits to clients and the organizations.
Page 4 India Health
Other Industry News of Interest
National Rural Livelihood Project and its
focus on linking livelihood and health
Recognizing the fact that 78 percent of
rural households depend upon private
sources for treatment of illnesses, and
nearly 45 percent of rural households
resort to high-cost borrowing or sell their
productive assets to meet hospitalization
costs, the World Bank-funded National
Rural Livelihood Project (2011–2016)
intends to support the overall launch of
the activities of the National Rural
Livelihood Mission and create capacity
among the poor and particularly women
to enable last-mile service delivery for
health and nutrition. The project
proposed the following:
Developing a cadre of community resource
persons (CRPs) and health activists (HAs or
ASHAs) to work on promoting changes in
health-seeking behavior; propagating
preventive health issues, including hygiene
and sanitation issues at the community
level; ensuring 100 percent vaccination for
all pregnant and lactating mothers and
children (including infants); and acting as
bridge to the formal health-service delivery
institutions.
Village-level nutrition center to act as a
one-stop shop for delivery of
Reproductive and Child Health (RCH)
services, including vaccination and
routine health checks and for promoting
In Orissa, Freedom
from Hunger‟s
partner, Gram
Utthan, brings health
services directly to
poor rural
communities by
training credit group
members to serve as
volunteer “Medicine
Points.” These
women provide
health education and
consultation to their
neighbors and, with
the support of a
pharmacist, make
much-needed
prescription
medications
available to their
local community 24
hours a day.
behavioral changes such as breastfeeding and caring for newborns and
neonatals. A community resource person, para-nutritionist and a cook are
envisaged to manage and operate the nutrition center. A microcredit
product will be offered by the SHG federation to pregnant and lactating
mothers in case they need financing to pay for the meals at the nutrition
center.
The health savings account encourages the poor to save on a regular basis
during good times and incentivizes health savings by linking borrowing for
health needs (including emergencies) from the health-risk fund at nominal
interest rates and with easy installment payments. Both the health savings
and health-risk fund are maintained at the village and are exclusively for
health purposes.
IIPHG has entered into a knowledge partnership MOU with Gujarat
Livelihood Promotion Company Ltd (GLPC)
GLPC is the implementing agency for the State of Gujarat for Livelihood
Mission, named as MISSION MANGALAM, under National Rural Livelihood
Mission of Ministry of Rural Development, Government of India. The key
focus area of the MOU are to help GLPC in:
Capacity building of SHGs on different areas of community health, hygiene
and sanitation
Developing a sustainable health entrepreneurship model with SHGs in Gujarat
Support GLPC in addressing issues like malnutrition, cost of illness among SHGs.
Page 5 Volume 1, Issue 1, January 2012
Indian Institute of Public Health
Gandhinagar is an initiative of Public
Health Foundation of India to build
institutional capacity in India for
strengthening training, research and
policy development in the area of public
health. Contact: Somen Saha, Senior
Lecturer, [email protected]
Freedom from Hunger is an
international development organization
working in 19 countries across the
globe. Its value-added microfinance
programs are serving over 18 million
people in some of the poorest countries
on earth. Contact: Marcia Metcalfe,
Director, Microfinance and Health,
Soumitra Dutta, Program Manager,
India [email protected]
Microcredit Summit Campaign is a
global network of microfinance
practitioners. Their Financing Healthier
Lives Project aims to build a global
group of MFIs capable of providing
health education to their clients in a
sustainable manner to reach over a half
-million clients, affecting some 2.5
million family members. Contact: D.S.K.
Rao, Regional Organizer for Asia-Pacific,
Call for Action
The development of India’s Twelfth Plan provides a timely and unique
opportunity to take the global lead in a cross-sectoral strategy that combines
financial services with health protection to address persistent challenges of
reaching India’s rural poor with proven health interventions to improve the
health of mothers, infants, and young children, and to reduce the impact of
infectious and non-communicable disease. The High-Level Expert group on
Universal Health Coverage for India has recommended mechanisms to solicit
active engagement of civil society organizations (CSOs) to deliver information on
health care entitlements, campaign for UHC, and facilitate as well as coordinate
community participation activities. India is already a highly innovative
environment for innovations in integrating microfinance and community health.
It is high time that the communities of integrated microfinance and health
practitioners document, share, and advocate innovative best practices. This
community newsletter is a small effort in this direction.
You are welcome to submit an article to share with practitioners, a case study,
lesson learned, or an upcoming event by contacting Jessica Chin Foo at
Editorial Team