An incomplete promise

An incomplete promise

The poor cannot afford to be sick and when sick, most often, they cannot afford to get well. Poverty and sickness, an old saying goes, marry into the same family. Microfinance, many believe, can break this vicious cycle. While it may seem obvious that the integration of microfinance with primary health services and health education affect family health and consequently human development, empirical evidence for this relationship is only just emerging.

Development agencies are primarily influenced by evidence-based research and dominant development paradigms. They wait till enough evidence has emerged for any programmatic innovation. The idea of integrating services, even those that may seem essential but whose integration lacks empirical evidence, is then often disregarded. Recent studies on microfinance and the integration of primary health services have shown extensive benefits in the area of family health. Though still new, these case studies from Bangladesh and Latin America have empirically assessed the impact of microfinance on health and compared it with the integrated impact of microfinance and health education. The rationale for such integration is simple. Clients in microfinance, most often women, play multiple roles: breadwinner, mother and wife. The health of the client (and her family unit) influences her ability to earn and repay loans and, therefore, ensures the sustainability of the programme.

Hence, the idea that poverty alleviation can be tackled without integrating health education or services is deeply flawed. You cannot bring any long-term change in poverty statistics if you cannot assure the poor access to clean water, sanitation or basic nutrition or at least provide them health education to safeguard themselves. Contrary to popular perception, the poor worry a great deal about their health—but often don’t know of the necessary precautions to safeguard themselves. If given through a critical channel such as microfinance, it will be absorbed effectively. Women —the largest group of microfinance beneficiaries—are most likely to integrate this in their lifestyles. In most cases catastrophic health expenses are the single biggest reason for long-term poverty and debt. If microfinance—or, for that matter, any development programme —does not focus at least partially on health education or services, alleviating poverty is merely a shifting goal.

It is hard for microfinance purists to believe, but poverty reduction and benefits of microfinance are impossible to achieve unless we focus on improving the health of the poor. This intriguing and critical relationship between health and microfinance underscores an old debate in development: to integrate or not?

The answer is anything but simple. We can wait for the one-stop solution which will affect everything in five years and bring an unimaginable number of people above the poverty line. A line, if one may point out, drawn arbitrarily by a group of people. Every few years, we learn that millions have now risen above this critical line. The questions to ask are: Are those just above the line so much better than those just below it? How long will they stay there without services such as health and education? And how does any programme talk of development without integrating human health?

One can understand apprehensions about how integrating too many services leads to a dilution of the core mission of the programme. However, unless we integrate at least health services that affect project results in the long term and human development in its essence, we will continue to have results of the poverty line variety. Our inability to achieve any long-term or significant impact on poverty alleviation is linked to our inability to tackle the basic needs of those under that poverty line. Only then can they miraculously climb over this imaginary line and stay there.

Chapal Mehra is a New Delhi-based researcher and writer on health and development issues. Comments are welcome at