India Health and Microfinance Community Newsletter

Transcription

1 India Health and Microfinance Community Newsletter Volume 1, Issue 2, June 2012 Introduction Welcome to the second edition of the India Health and Microfinance Community Newsletter, a collaborative effort of the Indian Institute of Public Health, Gandhinagar, Freedom from Hunger, and the Microcredit Summit Campaign. Sharing the Message about Health and Microfinance How do the poor in India deal with medical emergencies? Many low income families in India currently face financial difficulties in overcoming medical emergencies in the absence of quality public heath care facilities. As a recent note from Microsave states, poor people in India cope with medical emergencies by using their savings; borrowing from Self Help Groups, acquaintances, or moneylenders; and pawning or selling their assets. These strategies to deal with major health shocks create an increased financial pressure for poor families, and leave them in the vicious cycle of poverty. MFIs can play an important role in responding to this pressure by offering a health financial product specifically designed for these target populations. For example, health financial products such as health savings or health loans would free up household savings for purposes like housing and education. Furthermore, MFIs can bridge the gap for these families to access affordable healthcare with health microinsurance that offers claims reimbursement, free hospitalization, free or low cost surgeries, and network hospitals. For these schemes to be efficient, the MFI must ask its clients what they need and develop appropriate products to address those needs. Gram Utthan s effort to sustain their village health volunteers (VHVs) through livelihood activities Gram Utthan, an NGO-MFI in Odisha, is actively engaged in the health integration process using microfinance and health protection (MAHP) strategies covering about 10,000 clients across 103 villages. In each village there is a village health volunteer (VHV) who is responsible for conducting health education in the community, managing medicine points, which is a drug store in each VHV s home and visiting homes in the village to identify health issues from follow-up and referrals. For each health education session a VHV gets Rs. 25 (50 cents) and on an average earns Rs. 78 ($1.56) per month for selling "It is heartening to know that the microfinance community is responding to an urgent need of the poor, especially in India where the magnitude of poor people needing healthcare is enormous. Dr. Jaime Aristotle B. Alip, Managing Director, CARD Inside this issue: Sharing the Message about Health and Microfinance News from Practitioners Forthcoming Paper on the State of the Field in India 1 3 5

2 Page 2 India Health and Microfinance Community Newsletter Community Health Volunteer offered free polio vaccination for all children 5 years and under health products from the medicine point. Gram Utthan thinks this is not enough to sustain the VHVs for the kind of work they do. They find that unless they earn about Rs ($20) per month, it is difficult to retain the VHVs in their present role. In this context, Gram Utthan developed a strategic plan with Freedom from Hunger s support, to identify three relevant livelihood activities for the VHVs with detailed costing to ensure that they begin to earn Rs per month. These livelihood activities are grocery (which will be extended with medicine point ), goat rearing, and vegetable cultivation. Gram Utthan researched the feasibility of each livelihood activity, including forward and backward market links as well as the present skill set of the VHVs and their family members. Each VHV will be selecting one of the three livelihoods. They will get a loan of Rs. 10,000 from Gram Utthan to begin their business, and the costing shows that within 3 to 6 months the profit will be Rs per month. These livelihoods will not affect their work as VHVs since each month they spend 2 days in health education and 1 hour each day for 5 days a week on home visits. Freedom from Hunger has decided to provide Gram Utthan with a loan of Rs. 250,000 ($5000) to start with 25 VHVs as a pilot. This is the first time that Freedom from Hunger will provide a loan to one of its partners in India. What do SHPIs need to do to ensure successful health integration? Following the success of the Microfinance and Health Protection Program (MAHP) by different MFIs in India with support from Freedom from Hunger the challenge has been to take the lessons of MAHP to the self-help promoting institutions (SHPIs). SHPIs are responsible for forming self-help groups (SHGs) primarily for economic activities, using the savings mode and linking them with formal banks for credit. These institutions can be instituted by the government (e.g., health, Social Welfare sector, livelihoods, or panchayats) or NGOs, which are supported by NABARD, (Rashtriya Mahila Kosh or National Women s Fund of the government), and national or international development agencies. Freedom from Hunger focuses on NGO- SHPIs as well as SHG federations--which are either formed and nurtured by NGOs or by the government--to add health to the SHG platform in a similar way it is done with MFI credit groups. SHPIs in India have different features compared to non-bank financial institutions (NBFC) MFIs. SHPIs have less control over the SHGs compared to the MFIs over their credit groups since the former do not provide direct credit but link the groups with banks (or other financial institutions). As a result, the SHGs are not regular in their meetings and are less disciplined than MFI credit groups. In comparison to MFI credit officers, SHG animators are less regular in organizing meetings and do not always have a very definite agenda. SHPIs do not generate any revenue out of SHG formation, and SHPI funders cover only administrative costs related to forming and nurturing the groups. Whereas MFIs have revenue they can invest back in the MFI to cover the cost of non-financial services like health, SHPIs cannot cover such costs unless there is external funding support or there are income generating activities. For this reason, cost sharing during the pilot in health integration and sustaining beyond the pilot (including scale up) is a

3 Volume 1, Issue 2, June 2012 Page 3 big challenge. Within this context, Freedom from Hunger has initiated a partnership with West Bengal Voluntary Health Association (or WBVHA, a network to reach 19 SHPIs), Nidan (an SHPI in Bihar), and Reach India (NABARD partner in West Bengal). In order to mitigate the challenges as mentioned above, Freedom from Hunger has taken the following steps: Selected those partners of WBVHA which have some income generating activities and those who are willing to cover the cost at the field level. This is also true for Nidan and NABARD News from Practitioners Microfinance Programs as a Means for Delivering Reproductive Health Information and Services The US-based international organization FHI 360 is implementing an innovation in health education to clients in partnership with the Network of Entrepreneurship and Economic Development (NEED) in Uttar Pradesh. FHI 360 is providing technical assistance in the content and delivery of training to 35 community based outreach workers called Village Health Guides (VHGs) covering 70 villages. NEED s VHGs were trained to deliver a series of bi-monthly reproductive health information sessions over a period of 8 months and also assist in accessing reproductive health services based on a locally-developed referral resource directory. The sessions will cover the potential benefits of family planning (FP), the various options for realizing fertility goals, and referrals for family planning methods (due to restrictions on who can provide FP methods VHGs cannot directly distribute FP products). The primary objective of this innovation is to assess whether the provision of partners. Focused on areas for the pilot where the groups are old and strong and the animators visit twice a month. Selected those SHPIs which have strong expertise in nurturing the SHGs in order to ensure better outcomes of the health interventions and promote sustainability. these reproductive health messages are associated with a programmatically meaningful increase in family planning use among members of nongovernmental self-help groups (SHGs) or joint liability groups (JLGs) in rural Uttar Pradesh. This research design is a prepost single group design, and the indicators of success examined are method uptake, increased awareness of options, client satisfaction, and VHG satisfaction. These reproductive health sessions will continue until June 2012 when end-line data will be collected. The goal is for the messages delivered by VHGs to complement the outreach efforts of the government community-based workers like the Accredited Social Health Activist (ASHAs) and Auxiliary Nurse Midwife (ANM) serving these same villages. The cost of resources used to support the intervention will also be documented to assist other microfinance organizations to assess the feasibility of sustainably replicating this approach in their programs. Please contact Sharmistha Basu of FHI 360 at sbasu@fhiindia.org for further details. Potable water supply, Community Health Volunteer emphasize the importance of using safe water for cooking and drinking Bandhan, home visit by Community Health Volunteer

4 Page 4 India Health and Microfinance Community Newsletter Photos: Andrew Aitchison / Ashden When receiving the 2012 Ashden International Gold Award, SKDRDP s Dr. Heggede explained that Our vision is from darkness to light and for energy for all which of course must be sustainable energy and the poor must be partners in this process. The Health and Microfinance Alliance In January 2012, the Microcredit Summit Campaign and Freedom from Hunger announced the formation of a global alliance, with support from Johnson & Johnson, to leverage our technical expertise and communications platforms to build support for and expand the practice of integrating microfinance and health. (See the news release here.) The Health and Microfinance Alliance provides access to an international team of microfinance, health, development practitioners, researchers and policy makers working with microfinance organizations around the world to implement and test innovative approaches to address poverty. Independently and collaboratively, the two organizations are working with numerous institutions in India, as well as in other countries, to help these institutions add health protection to the range of services they provide to clients. These services include, Health education on prevention of HIV/ AIDS, TB, malaria, as well as on basic nutrition and treatments for childhood illnesses; Linkages to health care providers and products; and Health financing such as health loans, health savings, and health microinsurance. Using India as a demonstration of what can be achieved globally, the Health and Microfinance Alliance is currently disseminating methodologies, tools, and products to build the capacity of 28 institutions serving India s poor. By continuing to innovate, and aggressively replicate successful interventions, over the next 5 years the Alliance expects to: Reach 3.7 million microfinance clients in India with integrated microfinance and health protection services that can improve health and financial security for themselves and their families and are sustainably delivered. Engage a more diverse community of practitioners that includes many more influential actors from the health, selfhelp, and financial sectors, as well as policymakers, researchers and donors and expand the work beyond India. To learn more about the Health and Microfinance Alliance, download the flyer here Ashden International Gold Award to Shri Kshethra Dharmasthala Rural Development Project The Shri Kshethra Dharmasthala Rural Development Project (SKDRDP) in South India is an implementing partner for the Health and Microfinance Alliance. SKDRDP is actively providing education to rural women on women's health. They are also a prime example of the vital role a well-run microfinance organization can play in meeting the energy needs of the poor. On May 30th, Dr. D. Veerendra Heggade, President of SKDRDP, and L.H. Manjunath, Executive Director, received the prestigious Ashden International Gold Award for SKDRDP s outstanding work on contribution in microfinance and sustainable energy. The Karnataka-based NGO provides affordable loans to families in the area, helping them buy life-enhancing renewable energy systems such as biogas plants, solar home systems, cookstoves and family-scale hydro plants. Key to the success of this highly replicable programme are self-help groups that help people plan their household needs, save money and make informed choices on what energy products they buy. So far SKDRDP has provided nearly 20,000 energy loans, benefiting around 82,500 people. This is yet another example that SHG model is an efficient platform for integrative services.

5 Volume 1, Issue 2, June 2012 Page 5 Forthcoming Paper on the State of the Field in India Inspired by a July 2011 gathering of leaders in Ahmedabad, India to discuss integrating health and microfinance, Freedom from Hunger, the Indian Institute of Public Health, Ghandinagar, and the Microcredit Summit Campaign will publish a report entitled, Integrated Health and Microfinance: Harnessing the Strengths of Two Sectors to Improve Health and Alleviate Poverty in India A Report on the State of the Field of Integrated Health and Microfinance in India, The purpose of this report is to inform and educate policy makers, practitioners, donors and social investors, and other stakeholders about the potential of combining microfinance and health in the Indian context. We hope it will catalyze dialogue and debate and encourage further support and exploration of integrating microfinance and health as a low-cost approach to improve health and productivity of the Indian poor. 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, ssaha@iiphg.org This report will provide an overview of the rationale for microfinance and health from the perspective of each sector, what we have learned from a scan of the landscape, and examples of integrated activities that represent the promise of the field. The report will be released in Delhi, on June 28. If you are interested in attending please contact Jessica Chin Foo at jchinfoo@freedomfromhunger.org. 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 jchinfoo@freedomfromhunger.org. Editorial Team 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, mmetcalfe@freedomfromhunger.org or Soumitra Dutta, Program Manager, India sdutta@freedomfromhunger.org 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 more than 500,00 clients, affecting some 2.5 million family members. Contact: D.S.K. Rao, Asia Regional Director, dskrao@microcreditsummit.org