'More health for the money': an analytical framework for access to health care through microfinance and savings groups

Microcredit Membership and Self-Reported Healthcare Autonomy among Bangladeshi Women

Participation in microcredit programs has so far received widespread research and policy attention in the context of health and empowerment among Bangladeshi women. However, not much is known regarding the relationship between participation in microcredit programs and healthcare autonomy (HA) among women. In the present study, we analyzed two nationally representative surveys (Bangladesh Demographic and Health Survey 2004 and 2014), to assess the relationships between MC membership and HA among adult women (n = 29163), while adjusting for various sociodemographic correlates. Self-reported healthcare decision-making autonomy was assessed by asking whether or not the participant had final say on her healthcare. The findings revealed that between 2004 (20.9%, 95%CI = 19.8, 22.0) and 2014 (14.1%, 95%CI = 13.3, 15.0), the proportion of women reporting HA decreased significantly, despite considerable improvements across several socioeconomic indices, including higher education enrollment and labor market participation. Between 2004 and 2014, the percentage of microcredit borrowers decreased for Grameen (18.9% vs. 10.7%) and BRAC (7.9% vs. 7.4%), while it increased for BRDB (0.9% vs. 7.0%). A multivariate regression analysis revealed that Grameen Bank membership was positively associated with reporting HA in both male- (OR = 1.16, 95%CI = 1.09, 1.23) and female-headed households (OR = 1.44, 95%CI = 1.13, 1.85). A positive association between microcredit membership and HA was also observed for BRAC (OR = 1.33, 95%CI = 1.20, 1.47) and BRDB (OR = 1.18, 95%CI = 1.09, 1.29), but in the male-headed households only. Further analysis indicated that membership with Grameen bank was the most important predictor of HA, followed by BRAC, BRDB, and ASA, with the degree of importance varying substantially between male- and female-headed households. In conclusion, these findings suggest the potential of microcredit programs to promote healthcare autonomy among Bangladeshi women and provide insights for further research, as to why certain programs are more effective than others.

Examining the evidence of microfinance on non-communicable disease health indicators and outcomes: A systematic literature review

Microfinance has emerged as an effective approach to address health outcomes, particularly infectious diseases and maternal and child health. However, there remains a significant knowledge gap about microfinance and Non-Communicable Diseases (NCDs). This review synthesises current evidence on microfinance and NCDs, including NCD-specific modifiable risks, health-seeking behaviour, and financing mechanisms of adults using microfinance services. Studies were identified through a systematic search of seven electronic databases, extracted for full-text screening, and analysed using a narrative analysis. A total of twelve articles that covered thirteen countries and four global regions were included in the review. Variations in study designs and reporting in the articles limited the ability to draw strong conclusions about microfinance and NCDs. However, the review revealed that microfinance may reduce modifiable risk factors, promote health-seeking behaviour, and reduce out-of-pocket health expenditure and catastrophic health expenditure related to NCDs. One study, however, found microfinance to be associated with negative effects of higher waist circumference, BMI and obesity rates. Overall, the review helped to identify the current gaps in knowledge, and highlighted the need to focus future research and publication on the use of microfinance to target NCDs of the poor.

Perceived Usefulness of a Microfinance Intervention on Health Awareness and Practices in Nepal

Background

Economic constraints may lead to poor health among people from the developing world. Microfinance has proven to be useful in improving health outcomes elsewhere, but it still remains a neglected issue in Nepal. This study aims to assess perceived usefulness of the microfinance on health awareness and practices among different ethnic groups of Nepal.

Method

A community-based cross-sectional study was conducted in four districts of western Nepal. A total of 500 microfinance clients representing different ethnic groups (upper caste, aadibasi and janajati, and dalit) were selected by using systemic random sampling. Health awareness and practices among different ethnic groups were compared by logistic regression after adjustment for age, level of education, sex of household heads, occupation, and place of residence. Since participants were asked about their health awareness and practices, before and after microfinance intervention, during a single interview, there was a strong possibility of recall bias with respect to their preintervention awareness and other measures.

Results

Microfinance intervention positively influenced self-reported health awareness and practices among different ethnic groups in Nepal, which was highest among the upper caste group (77–92%, rate ratios around 1.7–2.6), followed by the aadibasi/janajati (60–76%, rate ratios around 1.4–1.8) and dalit group (33–52%, reference group). Self-reported awareness about environment and sanitation, family planning methods, and available health services at local level improved from 11.2 to 69.2, 9.2 to 65.0, and 3.8 to 59.8%, respectively, among the clients after microfinance intervention (p < 0.001). Similarly, the practices of eating nutritious food/balanced diet, drinking safe water, using toilet, immunizing the children, and regularly visiting the healthcare facility were improved from 4.2 to 63.8, 12.6 to 66.8, 15.2 to 70.4, 15.8 to 73.8, and 3.6 to 61.4%, respectively (p < 0.001).

Conclusion

Despite lack of control group and potential recall bias, this study reports positive effect of microfinance on self-reported health awareness and practices among different ethnic groups of Nepal. This finding supports further implementation and evaluation of equity-based microfinance to improve health and economic conditions of Nepalese people.