Linking health and microfinance is the goal of an opinion piece by Leatherman and Dunford in the current Bulletin of the World Health Organization. While they recognize the real and potential stumbling blocks of equitably and honestly serving the 155 million household worldwide that are serviced by more than 3500 microfinance institutions, they also see evidence that microfinance can have a positive health impact.
Where it occurs, the link between health and microfinance occurs through an organized health education component during member meetings and through individual loan counseling. Areas that have seen positive health outcomes include child nutrition, diarrheal disease control, HIV prevention and malaria, among others.
The malaria example cited by Leatherman and Dunford is a Freedom from Hunger Foundation (FFHF) project in Ghana. The project researched the effect of malaria health education on microfinance clients by comparing them with a group of clients receiving education on diarrheal diseases and a group of non-clients. By the end of the project a greater proportion of the malaria group …
- had appropriate malaria knowledge
- identified groups most vulnerable to malaria
- reported that insecticide-treated nets (ITNs) provide the best protection against malaria
- agreed that pregnant women should use ITNs
- had improved knowledge of malaria complications during pregnancy
- owned at least one bed net
- reported at least one child or woman of reproductive age sleeping under a bed net
- increased in ITN ownership and use
Those who did not have nets complained of both cost and access. Â Learning sessions alone could account for knowledge changes listed above, but not necessarily the behavior change. Although FFHF does not claim so directly, the authors set the stage for one to hope that improved living standards afforded by microfinance enabled some to use their knowledge and obtain nets. Otherwise, there would be less reason to justify coupling health education and microfinance.
An indigenous microfinance group in Orissa, India also has tackled malaria. BISWA (Bharat Integrated Social Welfare Agency), a nongovernmental organization tried three interventions with their microfinance self-help groups (SHG): 1) health education on ITN use, 2) health education with free nets, and 3) health education on ITNs that encouraged use of microfinance money to but nets. Nearly 60% of SHG members offered the opportunity to buy ITNs through micro-credit did purchase at least one net, and the majority of those were bought on credit.
Knowledge and access to credit may not be the only factors at work in changed health behaviors. The FFHF group concludes that, â€œWhen MFIs provide culturally sensitive education and support to poor women, they not only improve health but also empower women by enhancing their self-confidence and promoting their status in households and communities.â€
This hints at what Bamidele has defined as personal agency belief. Personal agency is the multiplication of locus of control and perceived self-efficacy, and he used it as a measure of entrepreneurial spirit of participants in microfinance enterprises in Nigeria. Members of credit societies had greater personal agency beliefs than non-members. This may be why Deji found that, â€œMembership of cooperative societies is very significant to favorable adoption behavior of women farmers towards agricultural innovations, hence should be encouraged as a strategy for improving the agricultural productivity and livelihoods of the women farmers.â€
The FFHF project acknowledged that during the span of intervention their project did not affect malaria treatment behaviors. Finance of course makes a big difference in treatment seeking by poor people as pointed out by Chuma and colleagues. The poor in Kenya used borrowing from friends and relatives and getting medicines or care on credit as major coping strategies. Purchase of medicines on credit from drug shops was also identified as a common practice by Rutebemberwa et al. in Uganda.
Microcredit services may make access to malaria medicines more reliable with a combination of knowledge, financial resources and enhanced personal agency belief â€“ this is an idea that deserves further research.