Some of the biggest challenges facing Universal Health Coverage in India include lack of last mile connectivity of healthcare delivery, low public spending on health, poor accountability of the government towards community for mandatory healthcare services provided and high tolerance of the communities to low quality services / no services provided by the public sector.
In order to get closer to achieving Universal Healthcare, there should be a significant response from the government towards public healthcare, a responsive and responsible community to drive political commitment towards healthcare and also strategic collaborations with the private sector to leverage on their expertise in service delivery, management and quality. An exploration of partnerships outside of the healthcare sector that can potentially plug in the service delivery gaps as showcased by financial service providers (FSPs) delivering some significant aspects of healthcare must be undertaken. More particularly, the contribution of FSPs in providing health education and access to health products and linkages to health care services. Contribution of self help groups (SHGs) in community participation towards better sanitation, water and improving hygiene is significant.
The one-day conference held in Hyderabad, India on September 12th, 2013 and organized jointly by Microcredit Summit Campaign, Freedom from Hunger and ACCESS Health International was to explore options of integrating health into microfinance, to explore the role of microfinance in last mile connectivity and mobilizing community for greater engagement in healthcare. The first half of the conference focused on existing initiatives of microfinance offering healthcare- their experiences, achievements and challenges while the second half of the conference explored a few innovative health technologies that can improve efficiency of service delivery but needs to be embedded in the right delivery channels for optimum results.
The first panel comprised of existing Microfinance providers who delved into providing healthcare in their networks and beyond. Representatives from Equitas Microfinance Limited (operates a tele-medicine model in collaboration with Apollo Hospitals), Gram-Utham (NGO which is marketing and supplying ‘treated bed nets’ to prevent malaria through its financial network and also managing a previously non-functional government PHC), SKDRDP from
Karnataka (providing health insurance, health education with specific focus on nutrition and infection control), Society for Elimination of Rural Poverty, a community owned and managed program of Government of Andhra Pradesh, providing protection to the mother and child in the initial 1000 days of the child and Evangelical Social Action Forum (operating an Arogyamithra project and village screening initiatives for non-communicable diseases).
Most of these organisations have achieved considerable scale in providing healthcare services and have been recognized by the community for their work. Engaging with the community in providing healthcare and related services improves the marketability of the microfinance organisations as microfinance plus activities attract the community much more, besides helping the financial service providers to improve their microfinance program. A healthy community is able to focus better on their economic activities and repay loans without any default. Such microfinance plus engagements gives the organization a competitive advantage over contemporaries and also imbibes more trust within its client base.
Some of the broader ways in which microfinance networks can be leveraged for healthcare provision as discussed by the panelists are:
- Improving health seeking behavior through improved health education and awareness amongst self help groups;
- Financial provision and protection to the clients in terms of healthcare crisis. Access to money may determine access to health;
- Improving last mile healthcare service delivery especially for vaccines and product distribution;
- Community mobilization in health campaigns for clean water, sanitation and hygiene;
- Microfinance institutions can also act as points of data collection for more accuracy;
- Improved health indicators and health seeking behavior.
Challenges of introducing healthcare into microfinance
Introducing healthcare into microfinance has its challenges. Introduction of health as an agenda in the credit group meetings is cited as one of the foremost challenge. Healthcare provision by financial service providers is not a mandate and a small part of their overall operations, thus garnering resources to delve into these activities is a challenge. Also, influencing the policy makers, funders and investors to look at their work and support them through a more supportive environment is not very easy. Most microfinance organizations have an inherent social goal of livelihood empowerment through their endeavors, which makes it difficult for them to become channels of sale of commercial healthcare products and services. Availability of skilled staff remains a limitation and the company has to engage in hiring, training and building the capacity of existing staff is cost intensive. Only a limited number of services can be carried out by unskilled workers. In case of any discrepancies in healthcare provision, it can risk the reputation of the microfinance companies.
Using technology to improve healthcare delivery in remote areas
The second panel consisted of representatives from Biosense, Dimagi, Sharp and Neurosynaptics that essentially make innovative technology products to ease healthcare delivery even to remote and inaccessible areas. The challenge these companies face is often to get the right channels and networks to use these products. It was extremely interesting how some of these products could be used by the FSP providing a range of healthcare services. One of the biggest health innovation offered with technology is to mitigate the skilled labour problem to an extent. For instance, the Biosense product U-check used for measuring the blood glucose levels of a patient is easy to handle and unskilled and even uneducated people can interpret the results. This panel showcased potential technological products which could ease healthcare data collection and service delivery for both health program implementers and financial providers.
There is need for much deeper exploration, collaboration and understanding to channel the synergies of the financial service providers and healthcare. While there is immense latent opportunity, caution needs to be exercised and systematic quality checks on the kind of service provided need to be developed.
The forum has given a wide range of healthcare actors and stakeholders a glimpse of this collaboration but has also posed many questions and created a need for many such platforms to think about health beyond just the healthcare sector!