Leatherman, S., Metcalfe, M., Geissler, K., and Dunford, C. (2012). Integrating microfinance and health strategies: examining the evidence to inform policy and practice. Health Policy and Planning, 27, pp.85–101.Link to Source
Headline Findings: a summary statement
Few high-quality studies are available on the effectiveness of programmes that integrate microfinance services and health programmes. However, current studies show benefits in diverse health areas, and this evidence supports further delivery and evaluation of integrated programmes.
The authors included 17 studies, which they categorised into three design types: studies using pre- and post-intervention measurement in both treatment and control groups (12 studies) studies comparing post-intervention measures in treatment and control groups (four studies), and studies comparing pre- and post-intervention measures in the same group (one study). The studies covered a wide range of health interventions (including health education and health promotion, direct provision of health services, and loans to health providers to improve capacity and infrastructure). Most of the studies were conducted in South Africa (five studies), Bangladesh (four studies) and Uganda (three studies), with the remaining studies conducted in Ghana; Ethiopia; Dominican Republic; Malawi, Guatemala and Thailand; and Honduras and Ecuador.
Implications for policy and practice
Although the authors did not find a large number of high-quality studies, they concluded that current evidence tends to support integrating microfinance and health services.
Microfinance with health education: The majority of studies found that microfinance services combined with health education improved client health knowledge. This was the case both when service staff delivered education during regular education sessions and when community health workers delivered education during community outreach. Studies also found improvements in self-reported health practices and behaviour (for example, reproductive health, malaria and gender-based violence), use of health services (including preventive services, such as vaccination and cancer screening), and health outcomes (in diverse areas including diarrhoea, tuberculosis and sexually-transmitted infections).
Health financing: The authors found few studies on the effect of health financing on use of health services. A study of a health micro-insurance programme in Uganda found that participants were less likely than non-participants to delay seeking medical care, while an integrated programme in Bangladesh found that increased capacity for health-related spending led to increased use of formal health-care services.
Building community capacity for health services: The authors found two studies evaluating programmes to provide microloans and business-skills training to private health providers, which led to improved facilities and pharmaceutical supplies and to increased numbers of clients.
Implications for further research
Most of the studies assessed programmes that provided health education or promotion to change knowledge and behaviour. The authors advocate for the trial and evaluation of a broader range of programmes, such as programmes to improve ability to pay for health expenses, access to health workers, access to health-related services and access to health insurance.
Microfinance institutions provide low-income populations with financial services, including credit, savings and insurance. Illness is often a key reason for families becoming or remaining poor. Therefore, some microfinance institutions have also begun to offer health-related programmes such as health education, health-care financing (such as health loans), health micro-insurance or delivery of health services.
To review the evidence on the effect of combining health interventions and microfinance services on health-related outcomes, such as health knowledge, health behaviour and health status.
The authors included a wide range of study designs assessing the effect of offering programmes that combine microfinance services of any kind with health programmes (such as health education, microloans to health providers or access to health-related products such as pharmaceuticals and mosquito nets) on a range of health outcomes, including changes in health knowledge and health behaviour, access to health resources and public-health infrastructure, health status, and burden of disease (at the population level). Selection criteria for inclusion included a clearly defined research design with objective evidence and a focus on one or more organisations delivering integrated services. The authors excluded studies that assessed the impact of microfinance services alone on health.
The authors searched 10 electronic databases, including PubMed, ScienceDirect and Embase; they also obtained articles from colleagues and industry websites, and they searched for studies that had cited included studies. The authors included studies published in peer-reviewed journals, in English, with no date restrictions. They extracted data from articles meeting the selection criteria, with a focus on study design, outcomes and limitations and wrote a narrative synthesis.
The review uses appropriate methods to reduce risk of bias through clear criteria for study inclusion and a relatively comprehensive search strategy. However, the review has several major limitations. The search may not be entirely comprehensive, as the search of the grey literature appears to be limited. The authors do not report any criteria used for assessing risk-of-bias, nor the results of such assessment. Thus, the assessment of study limitations appears predominantly based on type of study-design. The authors do not report whether two researchers independently extracted data from the included studies. Finally, the authors conduct vote-counting analysis based on direction of effect, without reporting full effect sizes for the included studies. This does not allow the reader to assess whether the reported effects were statistically significant and whether they were substantively relevant.