by Lynne Davidson Jarrell
Lynne has graciously volunteered to summarize the posts under Theme Six, from her perspective rather than mine. Note that she points to the posts relevant to each topic she covers (the numbers are hyperlinks). Each post on this blog is assigned a unique number in chronological order of posting, and all the posts for each theme are listed by number and title on the right side of this page under “View by Theme.” Next, I will discuss what Theme Six means for Freedom from Hunger. Then on to Theme Seven!
Is there evidence that microfinance providers can impact the health and nutrition practices of their clients? The summary of evidence here focuses on those programs that bring together these two services—financial services alongside health education. While a case might be made that one organization with one staff cannot possibly do justice to these vulnerable clients when they are asked to be experts in two very different endeavors (the unified model), one might also argue that for microfinance to work, the clients must have the ability to address their own health issues, and it is therefore in the interest of all parties that health education is provided along with financial services, and that it is done in the most efficient manner.
Freedom from Hunger’s Credit with Education is one such unified model. Research of Credit with Education programs in Ghana and Bolivia found, in Ghana, significant improvement across a range of health and nutrition practices, and those improvements were greater than those found in Bolivia (post 66). The greatest improvements in knowledge and practice were for exclusive breastfeeding in Ghana; participants in both countries reported significant improvements in how they fed or breastfed the study child (when compared to older siblings). The larger improvements in Ghana can be attributed to the quality of education implementation. In Bolivia, there had been disruptive staff turnovers and other challenges in the implementation of the program. Those in Bolivia who received good-quality education had improvements much like those observed in Ghana.
Also in Ghana, a randomized trial measured changes in knowledge, attitudes and behaviors pertaining to malaria at two rural banks that provided malaria education (post 67). The research showed that those who received the education were more likely to recognize that mosquitoes alone cause malaria, more able to describe the transmission process compared to other groups, and more likely to know that pregnant women and children under age five are most vulnerable to malaria. Further, almost all who received the malaria education knew that insecticide-treated nets (ITNs) were the best protection against malaria, half owned a mosquito net and 11 percent owned an ITN (and were more likely to own an ITN than others were). Women of reproductive age who had received the education, and their young children, were more likely to be sleeping under an ITN and twice as likely to have re-treated a mosquito net in a last six months. And almost 90 percent of those who received the education said they shared those messages with others in their community.
A majority of the studies in a review of 17 articles (post 68) found significant improvement in client health knowledge when microfinance services were combined with health education, whether this was provided by microfinance field agents at group meetings or by trained community health workers. Several of these studies found improvements in self-reported health practices related to leading causes of morbidity and mortality among the poor (e.g., diarrhea). One study in Malawi, Thailand and Guatemala (post 68) found that with education, there were significant increases in the percentage of women seeking care for signs of sexually transmitted infection and seeking primary care for child health. Other studies found increased utilization of preventive services, including vaccinations in the Dominican Republic and cancer screening in Honduras and Ecuador. Some found that providing health education alongside microfinance services meant improvements in reproductive health, prevention and primary care for children, child nutrition and breastfeeding, child diarrhea, HIV prevention, domestic abuse/gender-based violence, tuberculosis and sexually transmitted infections.
And a study in Uganda indicates that microfinance participants with health insurance were less likely to delay seeking care for malaria than those without, and a higher number of those without insurance were admitted to the hospital (an indicator that those with insurance had greater success in preventing illnesses from becoming serious).
Data were collected from five Microfinance and Health Protection (MAHP) programs in India, Benin, the Philippines, Bolivia, and Burkina Faso using client interviews, focus-group discussions, interviews with staff and healthcare providers, and reported MFI financial indicators (post 69). The analysis also included a randomized, controlled trial in Benin. In all five programs, clients received health education for the prevention and management of illness. Clients reported high levels of satisfaction with the services and said that they would recommend the services to others.
In the India MAHP, researchers found significant improvement of knowledge about maternal health, care of newborns, child-feeding and management of diarrhea (but not for hand-washing). In the Philippines, women reported saving more money for health-related expenses. In Benin, villages receiving health education learned more and made more productive use of what they learned than villages with financial services alone. These improvements in health practices extended to the general population in those villages. (This “spreading-the-knowledge” effect was also seen in India.)
Clients in these MAHP programs also benefitted from links that were developed to local healthcare services, as well as health-savings products. Some of the results included greater access to healthcare providers and greater affordability of those providers. In Bolivia, 24 percent of health fair attendees had never before seen a medical provider; and both in Bolivia and Burkina Faso, clients reported higher use of preventive services.
Logic suggests that microfinance clients in the poorest communities are not well-suited to fully benefit from microfinance services if they are ill or if their time is required to care for family members who are ill. These studies provide evidence that linking microfinance services to health-related services (especially education, but perhaps also more tangible benefits such as links to providers and financial products directed at health insurance, savings or loans) may provide a synergy of benefits. At least we can say with some certainty that microfinance clients who have received health education or other health-related services know more about relevant health issues and are more likely to have some health benefits because of that knowledge. I wonder now if there is research to show how those improvements in health translate to more productive use of microcredit services.