FULL TITLE: Why Offer Integrated Microfinance and Health Services: An Introduction to Health Education, Health Financing, Healthcare Linkages and Health Microinsurance ROOM: Lenana Hall FACILITATED BY: Freedom from Hunger Ms. Myka Reinsch Sinclair (USA) Dr. Mahamadi Cissé (Burkina Faso)

1. Why Add Health Services to Microfinance
Freedom from Hunger
April 2010

2. Session 1
Welcome and Introductions
1

3. Social Performance Pathway
2

4. Introductions…
With others from your organization, interview another organization
asking the questions below. After a few minutes the others will interview
you.
You will then have one minute to introduce them and their organization
using what you have learned.
Who are you reaching out to?
What services are you providing to them?
What are the ultimate changes you want to see
in their lives?
3

5. Session 2
Workshop Purpose and Objectives
4

6. Session 3
Discussion on Client Health Challenges
and How Microfinance and Health
Protection Addresses Them
5

7. A Quote to Consider…
In the 2002 World Bank study, Dying for Change, illness was the most
commonly cited reason for “a downward slide into poverty… ahead of
losing a job, which took second place”.
Turn to someone near you and discuss this:
Reflecting on this quote, what is your experience with the effects
of illness in the lives of your clients?
6

8. A Perspective to Consider…
To confront health challenges Freedom from Hunger suggests that…
―Ideally the over 3,000 existing microfinance institutions worldwide could
provide and infrastructure or platform for reaching the poor through a
coordinated combination of services. MFIs recognize the need, hear the
demand and have a vested interest in cultivating a healthy, successful
clientele with strong microenterprises.‖*
Turn to the same person and discuss this:
 What do you think about the proposed role of MFIs in this quote
given the challenges you have identified?
 What, if anything, has your organization done to deal with the
health challenges of your clients?
*Adapted from: How microfinance can work for the poor: The case for integrating microfinance with
education and health services by Dunford et al. 7

9. Microfinance and Health Protection
Definition:
Microfinance and health protection is the use of the microfinance
platform to provide MFI clients with access to crucial health-
related information, financing, care and products.
8

10. Questions for Further Reflection:
You already discussed a bit some of what you have seen among your
clients concerning their health challenges and what you have done about
them.
Before discussing some ways that the MAHP program has worked with
partners to deal with client health problems take a minute to think to
yourself about the following:
In addition to any information you have now about the health needs of
your clients, what additional information would you want to know about
their health needs to provide services or products to meet these needs?
9

11. Session 4
Four Health Protection Approaches
10

12. Four Approaches to Health Protection
Developed by MFIs in Response to Clients’
Needs
11

13. Bandhan Case Study
12

14. Session 5
Health Protection Products and
Services Developed by MFIs
13

15. Cohesive
Microfinance
+
Health
Packages
14

16. PADME (Benin)
Cohesive • Health education
Microfinance • Health product
+ distribution
Health
Packages
15

17. PADME (Benin)
Cohesive • Health education
Microfinance • Health product
+ distribution
Health
Packages
Bandhan (India)
•Health education
•Health loans
•Health product
distribution
•Informal linkages
to health providers
16

18. PADME (Benin)
Cohesive • Health education
Microfinance • Health product
+ distribution
Health
Packages
RCPB (Burkina Faso) Bandhan (India)
• Health education •Health education
• Health savings •Health loans
• Health loans •Health product
distribution
•Informal linkages
to health providers
17

19. PADME (Benin)
Cohesive • Health education
Microfinance • Health product
+ distribution
Health
Packages
RCPB (Burkina Faso) CARD (Philippines) Bandhan (India)
• Health education •Health education
•Health education
• Health savings •Health micro-
•Health loans
insurance loans
• Health loans •Health product
•Preferred provider
distribution
linkages
•Informal linkages
•Access to
to health providers
affordable drugs
18

20. PADME (Benin) CRECER (Bolivia)
Cohesive • Health education • Health education
Microfinance • Health product • Mobile doctors
+ distribution • Health loans
Health
Packages
RCPB (Burkina Faso) CARD (Philippines) Bandhan (India)
• Health education •Health education
•Health education
• Health savings •Health micro-
•Health loans
insurance loans
• Health loans •Health product
•Preferred provider
distribution
linkages
•Informal linkages
•Access to
to health providers
affordable drugs
19

21. Cohesive
Microfinance
+
Health
Packages
20

22. Four Approaches to Health Protection
Developed by MFIs in Response to Clients’
Needs
21

23. Four Approaches to Health Protection
Developed by MFIs in Response to Clients’
Needs
22

24. Session 6
Health Education – A Key Approach
23

25. What Makes Freedom from Hunger’s
Education Unique?
• Relevant for clients
• Focused on Behavior Change
• Enjoyable
• Easy to Use
24

26. Key Characteristics of
Freedom from Hunger’s Education
Delivery Channels  Field agents of MFIs or NGOs deliver sessions during
regular meetings of Credit, Savings or Self-Help Groups
Module Components  Facilitator’s Guide that field agents use to facilitate sessions
 Trainer’s Guide that a trainer uses to train field agents
Number of Sessions  Approximately 7 sessions per module
Length of Sessions  30 minutes
Session Structure Sessions use the following structure:
Review previous session
Share new knowledge/skills
Analyze new knowledge/skills in depth
Apply new knowledge/skills and commit to action
Methods that Create  Stories, visual aids, small-group work, role-plays, games,
Dialogue demonstrations, small- and large-group discussions
Measures of Success  Measurable objectives for each session

27. Available Education Modules
26

28. Session 7
Costs and Benefits of Selected Health
Protection Services
27

29. Savvy MFIs are adding health
services in order to improve
their own profitability.
28

30. Health services can create Net Benefits for MFIs
Income-generating health services for MFIs:
• Health education (in conjunction with village banking)
• Health loans
- Health savings (potentially)
• Health microinsurance premium loans
• Health product distribution
Non-income-generating health services for MFIs:
• Health education (parallel approach)
• Linkages to health providers
- Mobile health providers
- Referrals to health providers

31. Gallery Walk: Sample Cost-Benefit Description
Cost to MFI Benefit to MFI Cost to Client Benefit to Client
 Additional time  Interest earned on  Additional time  Lower instance of
Financial
for field agents. microfinance loans spent in a credit or disease leads to
covers the separate meeting. savings of money
marginal cost of and time away
education. from
microenterprise.
 Demonstration that  Improved health
financial
MFI cares about knowledge and
Non-
clients—boosts behaviors.
MFI reputation and
marketing.
30

32. Reflection on the Cost and
Benefits of Health Protection Products/Services
With others from your organization (or, if you are the
only one from your organization, with another person)
discuss the following two issues:
 What did you find useful from the perspective of your
organization?
 What are your general questions/concerns you have
given everything you have seen?
31

33. Session 8
Market Research – A Key First Step to
Developing Health Protection Products
and Services
32

34. Microfinance and Health Protection Services
(Sample Development Process and Timeline)
33

35. Purpose of Market Research in the Development
of Health Protection
To better understand the health care environment within
which you are operating and to identify the health needs of
current, and potential, clients.
34

36. Characteristics of Market Research
 It seeks to explain underlying reasons for behaviors and
beliefs
 It utilizes dialogue-based methods to develop a deep
understanding;
 It enables participants to discuss sensitive topics; and
 It accommodates illiteracy through use of verbal and visual
data-collection techniques.
This and the following pages reprinted from Market Research for Microfinance and
Health Protection How-to Guideｩ2009 Freedom from Hunger. 35

37. Types of Health Data Generated Through Market
Research
Types of Market Research Data Uses of Market Research Data
 Common illnesses  Inform the design of health-related
financial services, such as health loans
 Frequency and cost of treating illness and savings.
and disease
 Household financial impact of illness
 Preventive and coping strategies  Inform the design of linkages to health-
service providers, such as establishing
 Availability and accessibility for clients reduced prices for clients with local
to various types of local health care) health-care providers.
doctor, medicines, hospital)
36

38. Market Research Tools
Tools Purpose of the Tools
 Discuss impact of disease on the household finances
 Discuss what clients know about preventing and treating local
Focus Group Discussions
common illnesses.
 Examine challenges clients face in accessing local health services
 Determine how clients currently pay for health care and the challenges
they face about paying for health-related expenses.
 Identify illnesses and disease that affect clients’ repayment capacity
In Depth Interviews
(MFI Management)
 Assess the extent to which client illnesses affect the MFI’s financial
performance
Participatory
Rapid -Appraisal
 Identify where the community goes for different health services, and
(Health care-seeking
which health providers and institutions they trust or value and why
behavior maps)
37

39. Session 9
Action Planning – Next Steps for
Developing Health Protection Products
and Services
38

40. What are your reactions
to our discussions today and
what do they mean for
your institution?
39

41. Developing Next Steps for Your Organization
Health protection approaches to explore:_______________________
________________________________________________________________
Who What By When
(what is needed to implement,
Next Steps Needed (who is responsible in my MFI (by when do we need to
i.e. information, materials,
to accomplish this step) accomplish this step)
technical resources)
40

42. Closing Remarks
41

43. “You know well that we are poor country
people. Agriculture is not flourishing like
before due to the capriciousness of the
climate. Our spouses thus do not have
enough financial resources and the
family income is weak. With the
conditions where life is expensive or
where it is already painful trying to have
enough to eat, we have to invest our
small incomes in health and this is even
more punishment. We don’t have a
great way to get to the hospital, but if
someone can give us ideas on how to
prevent disease, we will apply these tips
and save our children and ourselves.”
--PADME client, when asked her
opinion on the health education

44. “ When you go to the market in the
morning you never know what will
happen, but when you have the
health savings and can get a health
loan, you have the security of
knowing that if you have a problem,
you will be protected.”
–RCPB client
“ Neither health savings nor health loans have
created extra work for staff. The health
savings accounts do not present more
challenges or difficulties than any other
financial products at RCPB.”
–RCPB branch directors

45. “ I joined CARD because they
have many benefits; my favorite
benefits are the health benefits”
-Roselyn, CARD client
“ Had I not received this health loan from
Bandhan, I would have lost both my sons
as well as my asset... Bandhan brought
back light in my family and I am obliged to
spread this message of my immense
benefit….”
--Bandhan client

46. Microfinance and
Health Protection
(MAHP)
Myka Reinsch, Special Advisor, MAHP
myka@freedomfromhunger.org
Mahamadi Cisse, Regional MAHP Manager
mcisse@freedomfromhunger.org
www.freedomfromhunger.org
www.ffhtechnical.org