How important is health? In the lead up to World Health Day, Opportunity's Asia Health Program Director, Jessica Carter, speaks about the importance of running health programs in conjunction with more traditional microfinance programs to help people lift themselves out of poverty.
Poonam is a Community Health Leader who wanted to learn about health issues and use that knowledge to help her village. Here, she is surrounded by the women of her village following a talk she gave on women’s health. Photo: Matthew Smeal
Q: Opportunity is known primarily as a microfinance organisation. Why health?
A: Opportunity’s history is in the area of microfinance, and that’s because we’re interested in tools that can help people work their way out of poverty. So health is just a natural expansion of that vision – with the tools of basic health knowledge and services, people can move from surviving to thriving, which is essential if we want to break the poverty cycle. We started working in this area because, in many conversations with microfinance clients and partner organisations, we learned that health was a primary barrier continuing to keep people in poverty. On top of that, health and microfinance combined are a really powerful solution.
Q: As Opportunity’s Asia Health Program Director, why are you based in India?
A: India is where Opportunity commenced its work in the area of health, and it makes up the greatest outreach of the Health Program. That’s partly because, of all the countries we work in globally, this is where we have the most outreach in general. It’s also because there is such a great need for improved health solutions in India, especially in the rural areas. And on top of that, India is such a hub for innovation. It’s a place where almost anything can happen and there’s always something interesting and seemingly impossible going on.
Q: What are the specific health needs that you’re seeing in India?
A: The program is built around three key obstacles affecting the health of people living in poverty. These are awareness, access and affordability. Firstly, basic health information – such as basic nutrition or the importance of hand washing – may not be readily available to people who are in poor and rural areas. Also, public and private health services may exist but people do not know or do not feel entitled to access these. Finally, health services or products that are available may not be affordable to someone living in poverty. So the health needs that we’re tackling are around these three areas.
The program has grown to reach nearly six million people over a six-year period…but in the context of Asia, that’s not enough.
Q: Why is Opportunity's approach so focused on the village/community level?
A: There is a big difference between knowing something and doing something. For example, you and I might know that going to the gym is good for us, but we may only visit every now and then. In the same way, a lot of the health knowledge shared through this program is only valuable if it leads to behaviour change. Since the behaviour change is led by local women who live in the community and are learning at the same time, community members are more likely to adopt new health-seeking behaviours such as using and building a household toilet. The Asia Health Program is a locally led program that leverages the expertise of a number of community organisations. Our technical health partner is Healing Fields Foundation, and we work with microfinance partners, such as Cashpor in India and KOMIDA in Indonesia. We also work with technology provider UkkoTeknik and have other relationships with academic and research institutions. All of these organisations feed into the local women who are microfinance clients and also agents for change within their own community.
Q: What does the day-to-day work of a health leader look like?
A: Health leaders provide community health education. They focus on different health topics each month and deliver lessons through microfinance groups and in general community settings. They also earn some extra income by selling health-related products such as sanitary napkins and some women have upskilled to become emergency responders that we call Basic Care Providers.
…we learned that health was a primary barrier continuing to keep people in poverty.
Neelum is a Community Health Leader who teaches women in her village in Uttar Pradesh the importance of clean water, sanitation and hygiene. Neelum makes a small income selling items such as soap, sanitary napkins and mosquito coils. Since she started, Neelum has seen the incidence of diarrhoea in her village drop dramatically. Photo: Matthew Smeal
Q: What impact are the initiatives having?
A: The program is having an impact in three areas – health, income and women’s empowerment. Firstly, the program improves health outcomes for the health leader, her family and in the community. This could look like improved cooking practices, more frequent hand washing or being more likely to give birth in a hospital. Then, for the health leaders, some women are able to earn up to $60 a month selling health-related products. Also, for those women, they are viewed with increased respect by the community and are more likely to be a decision maker within their household.
Q: This program sounds like an integration of traditional microfinance and health services; why are they so connected?
A: It’s not really an either/or, it’s more of a both/and. Delivering health services won’t solve the problem if people don’t know to access those services. The program leverages the relationships and reach of the microfinance platform – for Opportunity in Asia that’s about 30 million people including microfinance clients and family members – and then brings health knowledge to communities so that they can practice preventative behaviours and know how and when to access integrated health services.
India’s health care system is poorly funded and struggles to reach people in rural and remote areas.
Q: Is it something you believe should be scaled up and rolled out across Opportunity’s other programs?
A: The program has grown to reach nearly six million people over a six-year period, so we have already achieved some scale but in the context of Asia, that’s not enough. We are working with other program partners to scale and adapt the program to other contexts and countries.
Q: What are the challenges working in the health space in India?
A: India’s health care system is poorly funded and struggles to reach people in rural and remote areas. Government expenditure on health represents slightly more than 1% of the country’s GDP1. So a key issue is ensuring that we are building relationships with the private and public sectors so that they are reaching the people we serve.
India is such a hub for innovation. It’s a place where almost anything can happen…
Q: If you had limitless funding, what would you do?
A: Our vision is to keep training more women as health leaders, and we’d love to reach 20 million people in the next three years. On top of that, we want to make the solution sustainable, so that’s about strengthening the ways that the women can earn an income and sustain their role in the community. We want to keep learning and building new relationships so that we can create a truly system-changing solution to the health challenges facing rural communities living in poverty.
Community Health Leader Sumanthi Devi explains the food pyramid to women in Bihar and what local produce—which is accessible and affordable—can be used. Photo: Matthew Smeal