The role of microfinance-based self-help groups in improving health behaviours and outcomes of the poor in India

Abstract

Introduction: Despite an intense national discussion in India during 2010 – 2012, progress towards universal health coverage (UHC) has stalled. Coverage of the entire population is still a challenge, especially effective coverage of the poor. Through the mechanism of microfinance-based self-help groups (SHGs), poor women and their families are provided not only with access to finance in a way that is understood to improve livelihoods, but also in many cases with a range of basic health services. With 93 million people organised nationally, SHGs provide an established organised network that can potentially be used to extend health coverage. Through a combination of quantitative and qualitative research approaches, this thesis aims to explore the potential for existing microfinance networks, using SHGs with attached health programs, to contribute to improved health coverage for the poor.

Methods: A mixed-methods approach was used to address the study aim. A review of published evidence on the role of microfinance programs in improving health outcomes was conducted. This was followed by analysis of a national survey dataset to assess the impact of the presence of an SHG at village level on key health indicators at the individual level. Finally, a mixed methods study to assess the effect of combining a health program with microfinance-based SHGs was undertaken. This mixed methods study comprised two rounds of surveys to collect pre-test and post-test data with matched comparison groups and subsequent qualitative investigation to better understand the interconnections between SHGs, health programs and health.

Results: The presence of SHGs was associated with significantly higher odds of women delivering their babies in an institution, feeding colostrum to their newborns, having knowledge of modern family planning methods and using family planning products and services. Additionally, the inclusion of a health program within microfinance-based SHGs was associated with further improvements in health behaviours, including facility-based deliveries, feeding newborns colostrum and having a toilet at home. However, the SHG health program led to no significant reduction in diarrhoea among children and no effect in reducing household money spent on health care.

Conclusion: Capitalising on SHGs with health programs to improve the health of poor women and their families is an avenue worth investigating further. These established organised networks of SHGs provide an administrative apparatus to more effectively reach poor women and their families with essential health programs. Public health planners could leverage SHGs to increase the proportion of the population enjoying health coverage and make progress in relation to financial coverage and utilisation of existing publically-financed health protection schemes, although a lot more work is needed to optimise these possibilities.