After the Gold Rush: Advancing Health Outcomes with Microfinance
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1 After the Gold Rush: Advancing Health Outcomes with Microfinance Thierry van Bastelaer Abt Associates USAID Mini-University September 30, 2011 SHOPS is funded by the U.S. Agency for International Development. Abt Associates leads the project in collaboration with Banyan Global Jhpiego Marie Stopes International Monitor Group O Hanlon Health Consulting
2 Why Link Heath and Finance? Support financial instruments that reduce or spread out out-of-pocket payments for health care: Financial protection Access to quality health care Leverage grassroots financial structures to advance health outcomes
3 What is Microfinance? Financial services for low-income clients Small, regular amounts Reaching at least 120m people with savings, insurance, remittances, loans Loans: little or no collateral; joint or individual liability Reliance on horizontal and vertical social capital, regular meetings Provided by MFI NGOs, banks,
4 Why Focus on Microfinance for Health? Controversy Most powerful anti-poverty strategy ever invented? The New Loan Sharks? Microfinance is finance No controversy Focus on women and low-income families Field presence Regular meetings, small financial transactions Pre-existing trust Very large captive market
5 What are Opportunities for Health? Health messages Health products Treatment and referrals Health finance: Health savings Health loans Partner-agent model of micro health insurance
6 Microfinance and Health: How does Pro Mujer s Model Work? Woman wants a loan for her small business Joins or forms a group of women who want the same and whom she trusts Comes to Pro Mujer where group is finalized and members guarantee each other s loans Direct contact with a group of asymptomatic women at high risk of suffering from chronic conditions Courtesy Pro Mujer 6
7 Microfinance and Health: How does Pro Mujer s Model Work? Each woman starts out with small loan for her business Group comes to Pro Mujer offices where they repay loan, receive training, access health care With each successive loan the woman can take out more money Low opportunity cost: one-stop shop. Information, incentive, convenience Follow-ups and access to more health and finance training Courtesy Pro Mujer 7
8 Pro Mujer Nicaragua Cost: US$ 2.40 per month P A C K A G E Education Diagnosis Consults, Counseling, Referrals 1. Reproductive health 2. Maternal health 3. Domestic violence 4. Cervical and breast cancer 5. Diabetes 6. Hypertension 7. Adolescent sexuality/pregnancies 8. Respiratory diseases 9. Diarrhea and GI diseases 10. Seasonal problems 1. Blood pressure measure 2. Blood test 3. Body mass index 4. Urine test 5. Glycemia 6. PAP smear 7. Clinical breast exam Additional Services (Fee-for-Service) 1. Colposcopy 2. Pregnancy tests/mac 3. Ultrasound 4. Others TBD by market/collaborations 1. Medical consults and counseling 2. Diagnosis, treatment, follow-up 3. Referrals to specialists at discount prices 4. Discounts on medications/treatments 5. Others TBD 6. Referrals/collaboration w/ public sector Courtesy Pro Mujer 8
9 CARD (Philippines) Health education Health micro-insurance loans Linkages to health providers and medicines Bandhan (India) Health education Health loans Health products and health provider linkages RCPB (Burkina Faso) Health education Health savings and health loans Courtesy Freedom from Hunger 9
10 Partner-Agent Model of Micro Heath Insurance Aligned incentives: MFIs Insurers Clients All the makings of a win-win-win solution Fully consistent with sustainable/profitable business models of both types of organizations
11 Examples Bancosol-Zurich in Bolivia: 15,000 members SKS-ICICI in India: 1.5m - defunct? Basix-Royal Sundaram in India: 1.8m First Microfinance Bank-New Jubilee in Pakistan: 150,000 CARD-PhilHealth in the Philippines: 14,000 Faulu-Pioneer in Kenya: 3,000 KWFT-NHIS in Kenya: 30,000 SEAP-HCI in Nigeria: 5,000
12 A Promising but Fragile Model Powerful model, but very delicate Must successfully address same issues as any other health insurance product, plus a few more Needs careful and precise calibration Needs constant monitoring and adjustments But the payoff can be enormous for insurers, MFIs, and low-income families
13 Convergence of Microfinance and Health: Win-Win-Win-Win Health Care Providers MFI MFI Clients and Families Community Opportunity to expand reach and market share More dependable income flow Low cost or marginal profits Competitive advantages Healthier clients Social mission Improved health knowledge and behaviors Improved access Greater financial protection Lower instance of and spending on illness More rational use of health services Courtesy Freedom from Hunger 13
14 SHOPS is funded by the U.S. Agency for International Development. Abt Associates leads the project in collaboration with Banyan Global Jhpiego Marie Stopes International Monitor Group O Hanlon Health Consulting
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