NextBillion - An Initiative of the William Davidson Institute at the University of Michigan

Some of the biggest challenges of universal health coverage in India have been the lack of “last mile” connectivity of health care delivery, low public spending on health, poor accountability of the government concerning mandatory health care services provided and high tolerance of citizens to low-quality services/no services provided by the government.

In order to get closer to achieving universal health care, there should be a significant effort by the government toward public health care, a responsive and responsible community to drive political commitment toward health care and also strategic collaborations with the private sector to leverage their expertise in service delivery, management and quality.

An exploration of partnerships outside the health care sector ? partnerships that can potentially plug in the service delivery gaps, as showcased by financial service providers (FSPs) delivering some significant aspects of health care ? must be undertaken. In particular, FSPs have helped provide health education, access to health products and links to health care services. The contribution of self-help groups in community participation toward better sanitation, water and improving hygiene is also significant.

The one-day conference on Sept. 12 in Hyderabad, India, organized jointly by Microcredit Summit Campaign, Freedom from Hunger and ACCESS Health International (the author’s employer), was to explore options of integrating health into microfinance, the role of microfinance in last-mile connectivity and mobilizing the community for greater engagement in health care.

The first half of the conference focused on existing initiatives of microfinance firms offering health care ? 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 need to be embedded in the correct delivery channels for optimum results.

The first panel was composed of microfinance providers who delved into providing health care in their networks and beyond. It included representatives from Equitas Microfinance Limited (which operates a telemedicine model in collaboration with Apollo Hospitals), Gram-Utham (an NGO which, through its financial network, is marketing and supplying “treated bed nets” to prevent malaria, and also managing a previously non-functional government primary health centre), SKDRDP from Karnataka (providing health insurance and health education with a specific focus on nutrition and infection control), the Society for Elimination of Rural Poverty (a community-owned and -managed program of the government of Andhra Pradesh, providing protection to mothers and children in the first 1,000 days of their life) and the Evangelical Social Action Forum (operating an Arogyamithra project and village screening initiatives for non-communicable diseases).

Most of these organizations have achieved considerable scale in providing health care services and have been recognized by the community for their work. Engaging with the community about health care and related services expands the reach of the financial service providers and helps improve the marketability of their microfinance organizations. A healthy community is better able to focus on economic activities and repay loans without defaulting. Such engagement gives organizations a competitive business advantage and also builds more trust among clients.

Some of the broader ways microfinance networks can be leveraged for health care provision, as discussed by the panelists, are:

• Healthier behavior through improved health education and awareness among self-help groups.

• Financial provisions and protection for clients in the event of a health care crisis. Access to money may determine access to health.

• Improving last mile health care service delivery, especially for vaccines and product distribution.

• Community mobilization in health campaigns for clean water, sanitation and hygiene.

• Microfinance institutions can act as points of data collection for more accuracy.

However, introducing health care into microfinance has its challenges. One of the foremost challenges cited is introducing health as an agenda item in the credit group meetings. Health care provision is not a mandate of financial service providers and is only a small part of their overall operations, so garnering resources to delve into these activities is a challenge. Also, it is not easy to influence policymakers, funders and investors to look at and support their work. 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 health care products and services. Availability of skilled staff remains a limitation and the company has to engage in hiring and training, building the capacity of existing staff, which is cost intensive. If there are problems in health care provision, it can risk the reputation of the microfinance companies.

The second panel consisted of representatives from Biosense, Dimagi, Sharp and Neurosynaptics, which essentially make technologically innovative products designed to ease health care delivery even to remote and inaccessible areas. The challenge these companies face is often to get the correct channels and networks to use these products. It was extremely interesting to hear how some of these products could be used by the FSPs to provide a range of health care services. One of the biggest health innovations offered with technology is to mitigate the skilled labor 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. The panel showcased technology which could ease health care 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 health care. While there is immense latent opportunity, caution needs to be exercised and systematic quality checks should be developed on the kind of service provided.

The forum gave a wide range of health care actors and stakeholders a glimpse at this collaboration but also posed many questions and created a need for many such discussions about health beyond just the health care sector.

Rohini Rao is a program manager for public-private partnerships at ACCESS Health International.

This blog originally appeared on the Center for Health Market Innovations website.