Health services

Poverty, hunger and poor health are all parts of a vicious cycle of deprivation. People who are hungry and sick are not able to meet their earning potential through productive and regular work. It’s a trap that can keep people poor, hungry and sick for generations. Providers of financial services tailored to poor people recognise this and appreciate that their clients often need other services as well, if they are to improve their circumstances.

The typical micro finance methodology of meeting in groups to process transactions provides an excellent opportunity for visiting officers to provide health and nutrition education. In particular the damaging consequences of HIV/AIDS mean that every opportunity should be taken to combat it. Since financial service personnel are not health experts, the material provided here is intended to help non-specialist officers communicate essential health messages to their clients.

Library Resources

resource title type year resource
Pro-Poor Financial Services for Rural Water Paper 2010

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Access to safe drinking water and to sanitation facilities is a pre-condition for achieving most of the Millennium Development Goals (MDGs). While it helps to reduce extreme poverty, food insecurity, and child mortality, it also has a positive influence on education, particularly for girls. Additionally, it reduces maternal mortality. Despite considerable progress in Asia, more than one billion people have no permanent access to safe drinking water, and more than two billion have no access to basic sanitation facilities. This scenario is particularly critical in sub-Saharan Africa, where more than 340 million people lack access to safe drinking water, and more than 500 million have no access to improved sanitation facilities.

Author Batz, F.; Lorek, S.; Majewski, J.; Lassenberger, C.
Publisher GTZ
Number of Pages 20 pp.
Primary Language English (en)
Region / Country Global, Africa, Eastern and Central Africa, Northern Africa, Southern Africa, Western Africa
Keywords Rural Finance, Financial Services, Water Management
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Financial Services to Improve Access to Water and Sanitation in Sub-Saharan Africa Technical Note 2008

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Achieving the millennium development goals, particularly, reducing child mortality (the fourth), and halving the proportion of people without sustainable access to safe drinking water (the seventh) requires significant improvements in access to safe water and basic sanitation. In Sub-Saharan Africa a water and sanitation crisis looms. Forty-four percent of the population does not have reliable access to safe water, and 63 percent remain un-served by sanitation facilities. Income poverty is also at a crisis stage. Some 72 percent of the population in Africa lives on less than US$2 a day and 41 percent suffers from extreme poverty on less than $1 a day. Despite the dire need and consensus on the goals, public funds for water supply and sanitation are drying up.

Marrying the financial with the water and sanitation sectors to make financial services available to low-income households and small-scale providers of water and sanitation services is a market-driven, market-friendly approach to resolving the credit constraint that is inhibiting the development of water and sanitation infrastructure in Africa. Depending on the situation, this approach: (1) promotes the provision of financial services directly to low-income households in order to enable their investment, (2) extends access to water and sanitation services to poor households by making financial instruments available to micro-, small-, and medium-size private operators, and/or (3) targets public funds more effectively to the extreme poor. Key strategies are: 1) closing the information gap that exists between the sectors at the policy and operational levels, and between service users and service suppliers; 2) supporting competition and financial viability in service provision in addressing policy challenges; 3) financial broadening by widening the range of financial products suitable for small-scale water supply and sanitation; 4) financial deepening by increasing the outreach and coverage of financial institutions to small-scale service providers and users; and 5) tight targeting of grant funding to the extreme poor and low-potential areas, and separating it from loans.

Author Biesinger, B.; Richter, M.;
Publisher GTZ and The World Bank
Number of Pages 4 pp.
Primary Language English (en)
Region / Country Global, Africa, Eastern and Central Africa, Southern Africa, Western Africa
Keywords Financial Services
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Microfinance and Health: A Case for Integrated Service Delivery Paper 2006

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World Bank sources indicate that more than 1 billion people live on less than a dollar a day worldwide. The Human Development Report 2003 states that out of 42 million people living with HIV/AIDS in the world, 39 million live in developing countries. The link between poverty and poor health is evident.

Poverty is a multidimensional problem requiring a comprehensive solution strategy. Microfinance institutions (MFIs) have emerged as an important strategy for poverty alleviation. Most MFIs focus on improving the poor people’s incomes. By ignoring health and education as important needs of the poor, ‘minimalist’ MFIs (financial services only) provide an incomplete solution.

This paper identifies the value of MFIs focusing on fulfilling other basic needs of the poor by incorporating ‘better health of clients’ as a primary goal. By doing so, MFIs can have a greater impact on poverty alleviation. Though this presents a challenge for MFIs in terms of financial sustainability, MFIs cannot ignore their clients’ health concerns. Health service provision strategies are outlined in the paper. MFIs must choose strategies appropriate to their internal and external context to balance social objectives and financial constraints. Poverty alleviation is successful only when all basic needs are fulfilled.

This paper highlights the necessity of incorporating health as a primary goal for MFIs and makes recommendations to take advantage of the MFI service model to provide comprehensive solutions to the problem of poverty. The recommendations are potentially transferable to education services, although further research is required.

The paper’s first section provides a brief description of microfinance and highlights the positive impacts on client, their families and the community at large. It then presents the case for focusing on the positive externalities (specifically health), including them in institutions’ primary goals. The second section offers strategies to accomplish better health and education. An example of a program incorporating health and credit services is provided. The analysis in this paper is meant to provide MFIs better understanding of client needs and how to (re)structure programs to increase impact addressing such needs.

Family Health and Literacy: A Guide to Easy-to-Read Health Education Materials and Web Sites for Families Document 2006

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This guide is designed to help integrate health and literacy education in family literacy programs. Resources are included that are deemed to be helpful to both family literacy teachers, and health educators and practitioners who work with parents with limited literacy skills. For teachers, there is a chapter on how to get started teaching health, which provides some context for how to include health topics in their curriculum. This includes ideas on how to introduce health, how to engage learners, how to enhance literacy and language acquisition using health, and how to collaborate with local health organizations. There are also listings of easy-to-read health information, lesson plans and teaching activities, online activities to use in class, and activities and games for parents and children to do together. Health educators and practitioners can also benefit from the easy-to-read health information, online activities, and ideas for collaborating, which include tips on communicating clearly with adults with limited literacy skills.

The health topics and types of materials listed here were chosen to meet the health information needs of parents in family literacy programs as identified by a national survey of family literacy teachers. All resources had to meet selection criteria developed with guidance from an advisory group of family literacy and health experts to ensure accuracy and appropriateness. Almost all of the resources listed are available for free online. Family Health and Literacy (2006) is also available online at www.worlded.org/us/health/docs/family.

The Marginal Cost of Integrating Microfinance with Education Using the Unified Approach Paper 2006

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Credit with Education is a methodology that integrates two services: financial and non-financial - where the fundamental purpose is to achieve a greater socioeconomic impact on its clients. This paper contends that credit is a very important resource to address obstacles related to poverty and an optimal instrument to achieve sustainability in any microfinance institution. However, the paper also notes, it is not sufficient – it argues that low income people, who are socially isolated, lack self esteem, have limited business experience, and have deficient health and nutritional conditions, need more than financial services. The living conditions of these people not only limit their possibility to become good clients, but also prevent them from developing the knowledge and skills to address their condition.

The paper suggests that while credit can make an institution sustainable, training consolidates its sustainability. Several experiences have demonstrated that non-financial services are closely related to satisfaction, loyalty, and indexes of client default. It is noted that the organizations that work with the Credit with Education services have demonstrated that through this integrated service, it is possible to render efficient educational services during the group borrower meetings. In this way, not only is the efficient use of resources achieved, but also the consolidation of an institution with social objectives.

In this paper, cost analysis and the results obtained from the credit with education service are examined. To this purpose, the successful experience of CRECER—a Bolivian institution that works with the unified service approach and has consolidated this service—is used. In the first part of the document, an analysis of the different forms of integrating education with financial services is presented. The second part consists of a description of the methodology used by CRECER, which allows a detailed understanding of the procedures used by the institution to provide the service. The third part presents a cost survey of the educational component - this survey was conducted by CRECER – and also sets out the method used for the cost estimate and the results achieved.

Finally, a series of conclusions are presented that go beyond the cost analysis. These include the author’s reflections and arguments related not only to the investments of financial services, but also to the results and impacts generated by them.

Author Isabel Rueda Fernández
Publisher CRECER, Bolivia
Number of Pages 24 pp.
Primary Language English (en)
Region / Country Global
Keywords Education, Non-Financial Services, Agricultural Microfinance
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From Microfinance to Macro Changes: Integrating Health Education and Microfinance to Empower Women and Reduce Poverty Document 2006

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This advocacy booklet calls for integration of reproductive health education with microfinance services in developing countries. It presents individual stories, case studies and dramatic findings to show the impact this combination can have on reducing poverty and improving individual lives. The booklet also offers eight concrete recommendations for action. The first section reviews the links between poverty, poor health and inequality. The next explores the effectiveness of microfinance as a poverty reduction strategy. The third section shows how combining microfinance with reproductive health education can yield greater benefits. The final section offers recommendations for promoting and expanding this strategic combination.

Author Watson, A, Dunford, C, Toure, A, Iskikawa, K, Daley-Harris, S and Awimbo, A
Publisher Microcredit Summit Campaign
Number of Pages 16 pp.
Primary Language English (en)
Region / Country Global
Keywords Agricultural Microfinance, Health, Poverty, Inequality
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Healthy Women, Healthy Business: A Comparative Study of Pro Mujer’s Integration of Microfinance and Health Services Report 2006

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Conventional wisdom among industry specialists is that microfinance institutions (MFIs) should specialize in financial services, leaving non-financial and human development services to other types of institutions. The logic behind this argument concerns financial self-sufficiency, as well as the dangers of overextending management and staff and diverting attention from an MFI’s core financial business. The argument assumes limited institutional capacity, the need for specialization, and the inability of human development services to cover their costs. While some microfinance institutions have provided financial and non-financial services successfully for a number of years, few have been able to convince the mainstream microfinance industry that they can offer both types of services effectively and on a sustainable basis.

This study grew out of Pro Mujer’s desire to more clearly understand and demonstrate the effectiveness and sustainability of its integrated microfinance and health services. It is based on data gathered in spring 2005. Pro Mujer is an international microfinance and women’s development organization originally founded in Bolivia. It has since expanded by creating four additional MFIs in Peru, Nicaragua, Mexico and Argentina, as well as a network support office, Pro Mujer International (PMI), in New York.

Pro Mujer operations began in Bolivia with a program that trained women’s groups in maternal-child health. The institution later introduced microfinance services, which became its central product line. Yet Pro Mujer realized that client health problems often led to problems with loan repayment, driving the institution to search for ways to integrate health interventions and financial services. After studying alternative methodologies for offering “one-stop” services to its clients, Pro Mujer decided to focus its health services on health education, primary preventive and curative healthcare. These services would be provided through health clinics established at existing Pro Mujer focal centers. After eight years of experimentation, Pro Mujer fully developed and rolled out its microfinance plus health service model. The demand for these services and their impact on clients led Pro Mujer to incorporate health services as a core MFI service and to formally include healthcare in its organizational mission.

Now three Pro Mujer MFIs currently offer a full range of microfinance and health services, as well as other human development services. While certain core characteristics define the Pro Mujer model, the organization has allowed its service delivery strategy to be adapted to local conditions in each country. This flexibility has led to three variations of direct and indirect service provision, which provide a basis for analyzing how different intervention strategies affect different outcomes, such as client satisfaction, development impact and financial performance. The study first examines the similarities and differences between health service strategies among the three MFIs and assesses how their clients and partners evaluate the benefits of these services. It then measures the financial performance of each model by segregating direct and indirect costs attributable to each service and assigning them in a systematic manner.

The study shows that Pro Mujer clients value the financial and health services that they receive. It also demonstrates that clients have improved their health knowledge and practices, and that they have better access to health services. Offering multiple services leverages Pro Mujer’s existing infrastructure, improves client loyalty and strengthens its competitive position in financial service markets. However, offering both financial and health services requires significant institutional capacity because the two programs have different management requirements.

The cost allocation exercise undertaken by this study provided Pro Mujer with detailed information to help manage its integrated services. Previously, Pro Mujer only allocated direct program costs to its health services. However, this practice simultaneously undervalued the operational self-sufficiency of its financial services and overvalued that of its health services. Following the exercise, Pro Mujer discovered that its health services could reach 142 percent cost coverage on the basis of earned income and donations, and up to 80 percent on the basis of earned income alone. The cost allocation also allowed Pro Mujer to calculate the full cost of its health services for the first time, which currently ranges from US$2 to US$9 dollars per client per year. The study concludes that integrated service models can have a positive and sustainable impact, but identifies a number of prerequisites and management issues that MFIs should consider before replicating an integrated service model or the attendant cost allocation exercise. Among other considerations, the feasibility of replication is determined by the commitment of management, institutional capacity, client demand and the operating environment.

This study is a valuable contribution to the difficult question of whether or not institutions can combine the delivery of financial and non-financial services in developing countries. It clearly illustrates the importance of developing a cost accounting methodology and provides a useful summary of advantages and drawbacks of different strategies. It is a highly recommended read for practitioners.

Author Junkin, R.; Berry, J.; Pérez, M.E.
Publisher Pro Mujer
Number of Pages 50 pp.
Primary Language English (en)
Region / Country Global, Americas, Central America, South America
Bolivia, Nicaragua, Peru
Keywords Credit Plus Approaches, Health Education, Microfinance Institution
Related Resources
Water for Life – Community Water Security Book 2005

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Water is essential for life. People, animals, and plants all need water to live and to grow. But in many parts of the world people lack enough water to stay healthy. Many people have to travel long distances to collect water. And often, the water that is available is not safe to drink.

If people do not have enough water for their daily needs, they face hardship and serious illnesses. And if the available water is not safe — because it is contaminated with germs, worms, or toxic chemicals — this can also lead to many illnesses.

When a community has a water supply that is accessible (easy to get to) and safe, everyone’s health is improved. If women are freed from the daily labour of carrying and treating water, the well-being of the whole family improves. Children grow healthier and have less of the diarrhoea disease that comes from contaminated water. And women and girls have more time to be part of community life and to go to school.

This booklet describes ways to collect, store, and conserve (save) water, and to protect and treat water so it is safe to drink. This booklet also helps to ensure water security (regular access to enough safe water) by raising community awareness about water problems, and by showing ways to organize for change.

The key topics within the booklet are usefully interspersed with a “story” that provides anecdotal evidence and case study examples of water related issues. Examples of some of the key topics covered are:

  • water security
  • health problems
  • water and HIV/AIDS
  • developing a plan for community water security
  • protecting groundwater sources
  • collecting rainwater
  • safe water transport
  • the Nicaraguan rope pump
  • safe water storage
  • how to make water safe for cooking and drinking
  • international law and the right to water
  • list of key words and where to get more information

The solutions offered here can be applied to small water systems anywhere. As long as all people have a say in how water is collected, conserved, and used, solutions can be found for even the most difficult problems.

Pesticides are Poison Document 2005

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Pesticides are chemicals used to kill insects, rodents, and weeds that might harm crops and people’s health. But pesticides also poison and kill other living things, including helpful plants, animals, as well as people. Pesticides can drift for miles from where they are applied and pollute the soil, the water, and the air.

In this book the word pesticide is used to describe all chemicals used to control pests. They include:

  • Insecticides – used to kill insects
  • Herbicides – used to kill weeds
  • Fungicides – used to control plant diseases
  • Rodenticides – used to kill rats, mice and other rodents

This booklet argues that pesticides are never safe but aims to assist farmers, plantation workers, and people who use pesticides at home to be as safe as possible. The booklet also provides information for those who want to return to traditional methods of agriculture to use safer methods of pest control, or farm without chemical pesticides and fertilisers.

Simple guidance is provided on pesticide safety under a range of scenarios and supplemented by useful illustrations within each topic. Examples of topics covered include, pesticide risk for children, how to reduce the risk of pesticide use, pest control at home, reading and understanding labels and environmental impacts.

The latter part of the booklet provides notes on starting a community education programme, including ways of conducting possible pesticide education activities.

The Family Nutrition Guide Book 2004

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The Family Nutrition Guide is a practical guide that aims to improve the feeding and nutrition of families in developing countries. It is primarily written for health workers, nutritionists, agricultural extensionists or other development workers who design nutrition education materials and activities and work with people at community level. It should also be useful to mothers or other caregivers who want to know more about family feeding, as well as anyone training health staff and other community-level workers.

The guide is divided into 11 topics that cover:

  • Why we need to eat well
  • Getting enough food
  • Making good family deals
  • Keeping food safe and clean
  • Food and care for women
  • Feeding babies aged 0-6 months
  • Feeding young children aged over 6 months
  • Feeding school-age children and youths
  • Feeding men and old people
  • Feeding sick people
  • Preventing and managing malnutrition

Each topic provides a summary of up-to-date technical nutrition facts that can be used to prepare various nutrition education activities and materials: face-to-face education sessions with families and other community-level groups; nutrition education print material or material for other media (such as radio talks); or training material for staff in different sectors who deal with family nutrition.

The nutrition facts of each topic are complemented by communication suggestions for people working directly with families and community groups. These suggestions describe the steps needed to prepare an education session, encourage participation and make the session more fun.

Author Burgess, A and Glasauer, P
Publisher Food and Agriculture Organization of the United Nations (FAO)
Number of Pages 52 pp.
Primary Language English (en)
Region / Country Global
Keywords Nutrition, Health
Related Resources
HIV/AIDS Prevention Education Guide for African Communities Guideline 2004

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This field guide, which is downloadable in two parts, is intended for use by community HIV/AIDS educators to assist them in talking with their neighbours about HIV/AIDS prevention and management – as such this is also a useful guide for lay educators.

The guide is broken down into fifteen lessons on HIV/AIDS prevention and the care of those affected. It is used by trained community HIV/AIDS educators on eight projects of the African HIV/AIDS Prevention Initiative of the Institute of Cultural Affairs (ICA). Each lessons is designed to answer questions people may have about HIV/AIDS and forms the basis for discussion about the importance of the information for the life of an individual, a family or a community.

The lessons, which are based on “HIV, Health and Your Community” by Reuben Granich and Jonathan Mermin, cover the following questions:

  1. Why do we need to fight HIV/AIDS?
  2. What is HIV? What is AIDS?
  3. What are the symptoms of HIV/AIDS?
  4. How is HIV/AIDS spread?
  5. How can I avoid being affected with HIV/AIDS?
  6. How can I practice safer sex?
  7. Does choosing safer sex conflict with common practice?
  8. Why are women at greater risk?
  9. How does the HIV test work?
  10. How can I have HIV/AIDS and live a healthy life?
  11. How can we care for someone with AIDS?
  12. What should a person with HIV/AIDS eat?
  13. What medical treatment is available for HIV/AIDS?
  14. How can the community respond to HIV/AIDS?
  15. What have we learned about defeating the epidemic?

Each lesson tries to emphasise four major points with accompanying illustrations to share with individuals and families, as well as suggested corresponding interactive conversation and optional activities for larger groups.

Microfinance and HIV/AIDS Brief 2003

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This short brief points out that the consequences of the HIV/AIDS virus are exponential, touching not only those infected with HIV/AIDS, but also depleting the economic and social resources of entire families and communities. Furthermore, it notes that in countries heavily affected by HIV/AIDS, microfinance institutions (MFIs) and the donors that support them are struggling to combat the impact of the epidemic on clients and MFI institutional viability.

The brief suggests that affected households can use financial resources as one way to protect and build their economic resources. But at the same time it argues that launching a financial intervention specifically to target persons with AIDS, would not be appropriate, given that financial services depend on the ongoing ability of clients to earn income. Instead, MFIs that operate in hard-hit regions can serve families and supporters of infected people and can benefit by planning for the institutional risk posed by HIV/AIDS. They can also build effective links to specialised providers of health and insurance services.

The brief is set out in four sections that attempt to answer the following questions:

  • How does HIV/AIDS affect poor households?
  • How can financial services best be used in communities grappling with HIV/AIDS?
  • How can financial institutions be effective in heavily affected HIV/AIDS areas?
  • What can donors do to support an effective microfinance response to the HIV/AIDS?
Living Well With HIV/AIDS - a manual on nutritional care and support for people living with HIV/AIDS Document 2002

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The manual highlights at the outset that malnutrition is a serious danger for people living with HIV/AIDS. Even at the early stages of HIV infection when no symptoms are apparent, HIV makes demands on the body’s nutritional status. The risk of malnutrition increases significantly during the course of the infection.

Good nutrition cannot cure AIDS or prevent HIV infection, but it can help and improve the nutritional status of a person with HIV/AIDS and delay progression from HIV to AIDS-related diseases. It can therefore improve the quality of life of a person living with HIV/AIDS. Nutritional care and support are important from the early stages of the infection to prevent the development of nutritional deficiencies. Many of the conditions associated with HIV/AIDS affect food intake, digestion and absorption, while others influence the functions of the body. Many of the symptoms of these conditions are manageable with appropriate nutrition.

The manual provides practical recommendations for a healthy and balanced diet for people living with HIV/AIDS in countries or areas with a low resource base. It aims at improving nutrition in a home-based setting. It is also applicable for people with HIV/AIDS in hospitals and other institutional settings, including hospices.

The manual consists of guidelines with accompanying information and explanations intended for use by:

  • Health service providers and other extension workers as well as those involved at the national and community level in the many different aspects of counselling and home-based care
  • Community-based organisations working with people with HIV/AIDS who need information for programming and counselling purposes
  • Planners in the health, social and nutrition services so they can develop national or local guidelines for nutritional care and support for people living with HIV/AIDS
  • International agencies that support national and community-based support programmes for people with HIV/AIDS

The manual also contains summary sheets that can be used as handouts, listing the main points for each key topic. These summary sheets and leaflets are designed for use by those people who are living with HIV/AIDS or who are caring for a person living with HIV/AIDS, who want to be better informed.

Author Food and Agriculture Organization and World Health Organization
Publisher FAO and WHO
Number of Pages 90 pp.
Primary Language English (en)
Region / Country Global
Keywords Nutrition, Health, Hiv/Aids
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A Microfinance Training Simulation: Client Risk and HIV/AIDS and the Challenges of Mutual Guarantee-Based Programs Document 2001

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This exercise is designed to stimulate thinking and discussion about how risks and costs are shared through mutual guarantee mechanisms used in microfinance. It illustrates that risks and costs are transferred to neighbors, friends, and the most economically active (but also poor) members of the community. Moreover, the lesson illustrates vividly how the risks and costs facing borrowers increases in an HIV/AIDS-affected environment, where households face extreme and often unanticipated changes in their financial capabilities and needs.

This training packet contains the following sections:

  • Section I provides a brief description of the Simulation: its structure, lessons, and required preparation.
  • Section II provides the trainer with important background information needed to prepare for the Simulation.
  • Section III describes how the Simulation is actually conducted: it outlines the facilitator tasks from start to finish, and provides a view of what happens in each round of play.
  • Section IV provides suggested information for the facilitator to use in introducing the Simulation, and then in leading a discussion after the Simulation ends.
  • Section V briefly describes modifications and extensions to the Simulation.
  • Section VI provides the “hardware” for the Simulation: instructions in preparing player envelopes, scripts for each part in the simulation, money templates needed to create the player envelopes, and the master math worksheet.
Author Special Unit for Microfinance (SUM) United Nations Capital Development Fund (UNCDF) and USAID Microenterprise Best Practices (MBP) Project
Primary Language English (en)
Region / Country Global
Keywords Microfinance Policy, Hiv/Aids
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Freedom from Hunger Website English (en)

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Freedom from Hunger  -  English (en)

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