Microfinance Does Health Care

> Posted by Elisabeth Rhyne, Managing Director, CFI

I was recently asked to give a talk at the University of Pennsylvania’s 8th (!) annual Microfinance Conference. This year’s theme, “Microfinance Beyond Its Roots” set me in search of ways in which the microfinance industry is moving into areas beyond its original microcredit core. Of course, this process has been going on for a long time, and so there are many topics to choose from.

I decided to look at health care, partly because, as every staff member of a microfinance institution knows, health setbacks are one of the most frequent sources of repayment problems among low income clients. As they learned about the health vulnerabilities of their clients, microfinance organizations began to invest in experiments, bringing their businesslike approach to bear on a challenge that is often dealt with in heavily subsidized, non-market ways. Today, many of these programs have matured and grown, even as new ideas are being tested.

I looked among the organizations belonging to the Microfinance CEO Working Group, and I found that nearly all have something exciting going on in health care. Approaches include some combination of direct health care service provision, health insurance coverage, and education. Many are using technology as a means of reaching people at scale and low cost.

The meetings associated with group lending provide a convenient and cost-effective platform for health services, and adding a health component to group microcredit is probably the earliest and most widespread model. Health education was perhaps the starting point, as pioneered by Freedom from Hunger and also implemented by Opportunity International. Today the services often reach farther (while health education continues to be important). ProMujer, for example, directly employs nurses and other health practitioners to staff fixed and mobile clinics available to ProMujer members. They focus on maternal and reproductive health, as well as screening for the chronic diseases that are increasingly major health issues in Latin America. Hundreds of thousands of women get access to health care through ProMujer’s efforts.

Health insurance is another area of important advances. As one of many examples, Women’s World Banking, working with Microfund for Women in Jordan and Zurich Financial Services, developed a hospital insurance program, Caregiver, that pays hospital fees and a share of lost income when a client is hospitalized. I find it revealing that Caregiver does not try to cover every health need. It focuses on a specific range of services prioritized in a particular market – the costs associated with hospitalization. From looking at all these initiatives, I conclude that selecting a limited range of high-priority needs to address is part of what enables programs to cover their costs and thus be scalable and sustainable.

Stepping beyond microfinance clients, Opportunity International, together with local insurer ELAC and Airtel mobile operator, provides life and health insurance free to Airtel subscribers in Ghana. This program applies what Opportunity has learned about microinsurance since it created MicroEnsure a decade ago, to benefit all Airtel users.

Grameen Foundation is also using mobile technology as a health care tool. Here’s an elegant application of its MOTECH platform, which connects directly from providers to patients: One of the challenges of chronic disease treatment is making sure patients take their medication on schedule. For HIV positive patients in India, MOTECH sends an automated phone message every morning asking, “Have you taken your medicine this morning? Press 1 for yes, 2 for no.” If the patient answers no (or doesn’t respond), MOTECH calls again in half an hour. No response triggers escalating interventions, including contact from the health care provider. These messages increase compliance and keep patients healthy.

Accion’s Venture Lab is also investing in mobile technology as a health care tool, through Mera Doctor, in India, which offers subscribers 24/7 access to a phone consultation with a doctor, together with health insurance and discounts on drugs.

I’d like to know more about all of these efforts – like how many people they are reaching, how sustainable they are, and what the program designers have found to be key success factors. I think the numbers may be surprisingly large. Freedom from Hunger, for example, is working with about 25 MFI partners around the world reaching a combined total of over 2.6 million women with multiple-benefit health packages.

What I am fairly certain about is that these programs all benefit from their connection to microfinance. In some cases, the connection is direct: you must be a microfinance client to receive the services. In others, however, the connection is indirect: in the knowledge the microfinance organizations have gained about low income clients and in their experience building sustainable social business models.

Image credit: ProMujer

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