Microfinance as a vehicle for promoting health and intersectoral action on Health: a case from Ghana
This case study focuses on the role of two MicroFinance institutions (MFIs) in Ghana, the Freedom from Hunger MFI initiated in 2006 and Grameen Ghana MFI initiated in 2003. Both integrate health programmes within MFIs to improve social, economic and health outcomes in low income women, integrating inputs from finance, health, agriculture and other economic sectors. Grameen Ghana has added use of mobile phones for community health within a rights based framework, to provide information to women and track delivery of services. The scale of MFIs globally and in Ghana and the debate on their health benefit motivates the case study.
Both schemes in Ghana were initiated by international NGOs working with national partners and implemented through highly decentralized local self-governing credit associations with support from local field agents. While attribution of cause is difficult, an evaluation of one of the MFIs found improved incomes and health behaviours compared with control groups. The MFIs were found to strengthen women's self-esteem and confidence and to support health care uptake. Positive features were found to be the field agents and community health workers that connect women to local systems; links made to health services; participatory health literacy processes amongst MFI members; and clear agreements on roles and accountability in partnerships. Shortfalls were identified. MFIs need to integrate explicit measures that generate social advocacy on gender norms, target structural determinants of women's health and build accountability of service delivery. Business expansion meant longer working hours and limited time for the family and the pressure not to default on loans led to stress, asset depletion and wider debt in some MFIs. It is proposed that greater attention be given to real-time monitoring of MFIs that integrate health goals and processes and that the women involved in their design have a stronger voice.