European Microfinance Week 2021

PRESENTATION

This session discussed the paper ‘The First Wealth is Health’, presenting the landscape of inclusive health care and the factors for success that the European Microfinance Award 2021 (EMA2021) evaluation process identified.  EMA2021 sought to highlight organisations and programmes that facilitate access to quality and affordable health care for low-income communities.

The paper’s lead author Sam MENDELSON started off by briefly setting out that good health (care) matters, as it helps prevent that other metrics or progress are constrained. Good health care allows education to play its role in opening new opportunities; it allows people to earn, invest and employ others, and lets groups and societies prosper. The combination of typically volatile and precarious incomes and the absence of high-quality universal health care means that low-income communities not only need access to health care, but also the ability to pay for it.

Paying for health care is a two-fold problem, he continued. Accessing and affording quality health care may be an insuperable barrier. In addition, even for those who are treated and recover, the financial burden of the health shock can cast a shadow for years after. This is the health and poverty trap faced by the poor, Mendelson explained; the consequences of low-quality or inaccessible health care for those on low, volatile, and precarious incomes, and in countries without a universal health care safety net to catch them when they are in need.

The financial inclusion sector can play an indispensable role in both helping households plan day-to-day medical spending and smoothing health-related financial shocks. This can be done by using financial services, such as savings, credit, insurance (life, credit life, hospitalisation, incapacity, etc.) as well as hospital vouchers and remittances. This can be combined with non-financial services, such as education/awareness-building, screenings, preventive treatments, and distribution of health products.

Against this background, the seven semi-finalists of the EMA2021 were presented. The seven semi-finalists being: Al Amana Microfinance from Morocco; ASEI from El Salvador; Avanza Sólido from Mexico; CARD from the Philippines; Friendship Bridge from Guatemala; Microfund for Women from Jordan; and Pro Mujer Argentina. A comprehensive and detailed account of each of these organisations and their programmes can be found in the publication ‘The First Wealth is Health’.

Mendelson shared how the complexity of providing health care stems from three levels of need: First, countries’ health care systems, capacity, resources, and priorities vary. Second, groups – children, men, women, migrants, the elderly, remote communities – all require unique and specific care. And third, no two people are the same, and everyone has their own individual health needs or challenges. That means that effective health care has the difficult task to be both general and specific at the same time.

Although the programmes of the semi-finalists represent a diverse range of health care initiatives, three general approaches emerged when studying the initiatives, said Mendelson. These approaches, by which financial services providers can increase access to affordable health care, are:

1. Preventing and treating illness;
2. Mitigating the risk of health shocks;
3. Delivering health care to those who need it most.

DISCUSSION

After the presentation, Mendelson, Chiara PESCATORI and Olga BIOSCA discussed what they found most interesting, innovative, and replicable about the specific programmes. Common factors for success to achieve this were further discussed in this session.

A first factor mentioned is the reliance on partnerships and linkages. As health care is outside the core expertise of a financial services provider, there is a need to work together. Who the right partner is, depends on the financial product and non-financial services being provided and to whom. Second, access to health care for vulnerable communities is always going to require a focus on the particular needs of women. Third, understanding structural barriers and designing health care initiatives in a way that is culturally sensitive, language-appropriate, client centric and empathetic is crucial to expanding access. Another success factor discussed was the high level of integration of education and awareness building into an initiative. Innovating with technology was also mentioned (example: e-consultations), as it allows health care to be brought to more people at lower cost. Finally, integrated and holistic models are more likely to be successful: combining multiple financial and non-financial products and services.

Pescatori pointed out that, in addition to these factors, it is important to have a plan and a clear long-term strategy. This requires ongoing monitoring of the progress you are making. As needs might change overtime, it is important to monitor this, and be ready to adjust activities when necessary. In addition, Biosca pointed out that the finalists of the EMA2021 are all initiatives that are well-embedded in communities, having assessed and continuing to assess what clients’ needs are. A good health care program is not about access only, it is also about understanding culture and context. This is crucial as health is also about creating trust to use the services, which is best done from the ground up.

Lastly, Pescatori shared two other initiatives that did not make it to ‘The First Wealth is Health’ paper but were worth mentioning due to their innovative nature and the inclusion of strong digital components. The first one is Shelf Life, which aims to take the burden and risk of inventory off local pharmacies in Nigeria and Kenya. Through technology, analytics, capital, and expertise, it manages forecasting, quality assurance, fulfilment, and inventory management via a subscription service. Pharmacies sell Shelf Life-supplied goods on consignment through a pay-as-you-sell program.

The other initiative is The Medical Concierge Group, which operates in Uganda, Kenya and Nigeria. It was founded by medical doctors and a pharmacist and has been delivering telemedicine and digital health solutions since 2012. They work in close partnership with health professionals to guarantee 24/7 access.