Message-ID: <Pine.3.89.9607031250.A4972-0100000@gwis2.circ.gwu.edu> Date: Wed, 3 Jul 1996 12:19:27 -0400 From: James Macinko <mailto:jmacinko@GWIS2.CIRC.GWU.EDU> Subject: Microenterprise for health - meeting highlights To: Multiple recipients of list DEVEL-L <mailto:DEVEL-L@AMERICAN.EDU>
Microenterprise Development for Better Health - Expert Meeting HighlightsWashington, DC- On June 11, 1996 the Society for International Development Health and Development Workgroup, in collaboration with the GW Center for International Health and the National Council for International Health held an expert meeting on Microenterprise Development for Better Health Outcomes. The purpose of the meeting was to explore the areas in which microenterprise development and health interact, and to identify practice guidelines that would facilitate the interaction between the two sectors. The meeting was attended by 60 individuals who represented International Organizations, NGOs, academic institutions, and individuals from the financial, health, microenterprise and community development sectors.
It was agreed that there is a natural fit between microenterprise and health programs. Particularly when speaking about women, improved economic opportunities can lead to empowerment and, if combined with education, improved investments in family health. For example, a representative from FINCA pointed out that their village banking programs focus exclusively on providing credit and saving services. However, in their programs in Uganda, FINCA staff had to deal with the issue of AIDS education, if only to enhance the chances of survival for bank members. Save the Children representatives found that it was natural to add credit activities to heath education activities in many of their programs.
Participant discussion centered on the fact that although there seems to be a complementarity between the two sectors, there exists very little information on the impact of microenterprise development programs on health and human development and vice-versa. The evidence that does exist is largely anecdotal in nature. Participants were concerned about the many types of microenterprise development strategies and the myriad of mechanisms for linking income generation with health. They expressed a need for more "how-to" information stressing practical lessons that can be used in the field.
In response to some of these questions, the GW Center for International Health distributed a recent article that provides a conceptual model for evaluating the health impact of microenterprise programs. In addition, two groups, the GW Center for International Health, and Freedom From Hunger were able to discuss results from evaluations and on-going studies and indicated that each is conducting more complex field research projects, the results of which should be available within the next few years.
In addition to identifying issues for further discussion and research, participants identified a number of lessons learned from their own programs and research:
1) There is a continuum of thought on mechanisms to provide economic development opportunities to the poor, and a great variety of approaches to link such mechanisms to improved health. Although many organizations have experimented with combining income generating activities such as microenterprise support with health education and/or services, little has been done to document which strategies are most effective in terms of improved health, financial and institutional sustainability, and cultural appropriateness.
2) It is important to determine the appropriate public/private mix when entering into a microenterprise/health program. Market forces need to be utilized to assure the financial viability of savings and credit programs, and borrowers should be free to invest their loans in whatever enterprise they feel will be most productive. At the same time, health promotion activities may need to be subsidized through government or other sources; although borrower's increased income may allow them to purchase more health services, and may therefore be able to contribute to local health systems development.
3) Finally, other questions and concerns were raised about the possible negative effects of microenterprise support programs on family health. These include the risk of microenterpreneur's (mostly women's) time being devoted to expanding their business thereby limiting the amount of time they can spend with their families. Other concerns included addressing how taking on increased responsibilities such as adding credit programs to health programs affect the financial and institutional health of the implementing organization i.e. are health NGOs really cut out for the banking world, and are credit and savings programs really equipped to adequately address health concerns? One option being explored by several organizations is to develop a partnership between health and microenterprise development organizations that serve the same clientele. In this way, each organization can provide its clients with the services it is best designed to provide. Nevertheless, if the linkages between increased income and better health are not made explicit, it is doubtful that these partnerships will achieve their maximum potential.
The meeting called attention to the fact that although better health may improve the economic performance of microenterpreneurs, and increased income can enhance the possibilities for improved health, there exist mitigating factors which may enhance or impede these relationships. A strong multidisciplinary research effort among NGOs, research organizations and community-based organizations in the health and microenterprise sectors is needed to identify best practices to achieve lasting improvements in health and human development in the developing world.
-- James Macinko is co-chair of the SID Health and Development Workgroup and International Health Associate at the George Washington University Center for International Health.
July 3, 1996