European Microfinance Week 2021

Gabriela ERICE welcomed the participants and panellists. This year’s theme of the annual European Microfinance Award focuses on access to affordable and quality health care among low-income communities. The Award is co-organised by e-MFP, the Luxembourg Ministry of Foreign and European Affairs – Directorate for Development Cooperation and Humanitarian Affairs and the Inclusive Finance Network Luxembourg.

One of the aims of the Award is to reward excellence. The winner receives a prize of EUR 100,000, and the two runner ups get EUR 10,000 each. The winner would be announced in next day’s ceremony.

The second aim of the Award is to play an inspirational role through the collection and dissemination of the most relevant practices for replication by others. Erice then introduced the new publication ‘The First Health is Wealth’, authored by e-MFP’s Sam Mendelson. This publication gathers practices and factors of success identified throughout the selection process of the Award, highlighting remarkable strategies, interventions and results, and features case study profiles of the ten Award semi-finalists. This year’s Award received 43 applications and, to be a finalist, applicants had to pass through three selection rounds.

The plenary started with Micol GUARNERI, one of the consultants supporting the Award process, who provided an overview of the landscape of needs and initiatives identified in the selection process. She started first with the needs, which can be grouped. First is access to affordable quality care; second is the financial support required to gain that access; third is accurate information. Access barriers can be structural and cultural or gender-specific. Financial barriers are not only the costs of care, but can also extend to a loss of income during treatment. Patients often borrow from MFIs to cover these costs.

WHO estimates that more than 200-300 million people spend more than 25% of their household budget on health care, a substantial part being pushed back into poverty because of that. And then there is the information hurdle: people need to be informed on both preventive and curative health care in order to make informed decisions. As to the second hurdle, financial institutions can play a direct role, by lending for health expenditure and scheduling repayments in line with the capacity of borrowers. Some go beyond lending and offer insurance packages or derivates such as vouchers and special health savings products. Insurance is often offered in partnership with specialized corporations and can offer all-round cover, in and outpatient schemes and specific coverage of selected treatments. Payment options also vary: from reimbursement to vouchers to general periodic premium payments. Then there are specialized products such as maternity loans and emergency/ambulance loans. Other services offered are discounted treatment costs, direct access to medical specialists or health education, often forming part of a more overall package.

Erice added that, compared to other years, in this edition of the Award the offering of non-financial services played a key role in the different initiatives. The e-MFP publication is structured via 3 different approaches that have emerged from the selection process, according to the needs that have been served and the services being offered. Asked to identify the major success factors that she came across in the assessment process for the award, Guarneri addressed some, which depend on the nature of services offered. In insurance it seems to work to simplify all claim processing and compensation processes. Overall two main success factors can be identified: appropriate design of services that includes tailoring to specific needs and circumstances, and the capacity of the FSP to ensure the quality of services offered by the health care providers.

Guarneri also presented the three finalists, starting with CRECER in Bolivia that started in 1990 servicing rural women through a village banking approach. Cervical cancer is the most prominent form of cancer affecting young rural women, and the leading cause of death among young women in Bolivia. CRECER introduced a (self) diagnostic and prevention methodology in cooperation with public and private care providers. Together with the Ministry of Health, intensive training and education activities were designed that reached beyond women and targeted communities as well. The applied gender-sensitive approach was highly effective and appreciated.

Dreamlopments was formed in Thailand in 2015, as a social enterprise with a particular focus on servicing three million migrants predominantly from Myanmar, through the Migrant Fund (M-FUND), which is a low-cost, not-for-profit health insurance. Since 2019 the fund is also active across the border, to offer health protection to border communities. It enrols paid community workers to run the programme in the villages. Access to health care is arranged through a network of hospitals and clinics. Services are available in various languages and costs are covered for many health care plans for all members, most of whom are women. An important feature of this programme is its demonstrated capacity to serve a hard-to-reach population of unregistered migrants.

The third finalist was Fonkoze from Haiti which is a family of three organisations: the MFI, the non-profit Foundation, and the support Foundation in the USA. Haiti ranks low on nearly all global health rankings and particularly challenging is the infant and children mortality rate which prompted Fonkoze in 2015 to start ‘Boutique Santé’ which are small informal shops offering health information and basic services, including screening and referrals. The Community Health Entrepreneurs who own the boutiques (often at the heart of a community) are Fonkoze credit clients, and all women. They are supported by Fonkoze’s Boutique Santé team, which includes nurses and other professionals. They offer basic services such as screening and first aid, but also sell over the counter medicines and other essential health, nutrition and hygiene products. In addition, they offer health education services. Critical to its success is the continued quality control, and a main feature is the replicability of the boutique model.

DISCUSSION

At this point the floor opened for the three finalists, kicking off with the question why they decided to serve the health care needs of their clients. Viviane ROMERO pointed to the challenge of having very high cervical cancer rates in Bolivia which could not be ignored; hence the strategy to add health to financial services, especially in view of the historical poor performance of the public health sector. Second, their mission goes beyond financial products, and forced them to look at the well-being of poor women from a more holistic perspective. They chose cervical cancer as an intervention area as it is so wide spread. In addition, targeting one particular issue helped them to remain focused and specialised, taking out the risk of spreading scarce resources too thin, which would reduce impact.

Carine ROENEN, representing Fonkoze, explained that offering health services was triggered by the growing inability among clients to service loans, as a result of health-related incapacities affecting overall performance. Second, clients asked for it; they wanted Fonkoze to help them deal with health expenses.

Nicolas DURIER of Dreamlopments from Thailand, a trained doctor, then explained how they started by observing a small organisation offering health services to the migrants in border areas. That programme was fully donor-supported and at risk due to declining support. The organisation had to start looking for sustainability, so they picked up from there with the migrants, had a feasibility study done indicating good prospects, launched the M-FUND, and grew since then.

Erice saw a similarity in all finalists serving very vulnerable communities and developing a business model around it. Critical common characteristics that were identified among the three finalists are: a predominantly rural setting; solidly established microfinance operations; dedicated and institutionalised community focus with a clear gender lens; the pursuit of quality and convenience, also in non-financial services; and, good cooperation with heath providers and government agencies.

In that sense, the finalists have shown that the combination of financial and health services can really reach and serve those who are most excluded from the health and financial systems. However, each of these initiatives is marked by a high level of uniqueness, showing that success cannot be just imported, but rather comes from adaptation to local needs and context.