Your impact
through health

Health Report – October 2019 (data to June 2019)

Thanks to your support, Opportunity's program partners in Asia are empowering 4,475 women as health leaders. These women, having begun their journey as small loan recipients, elect to participate in basic health, hygiene and nutrition education which they share with community members.

The health leader solution helps families on their journey out of poverty with improved health education and access to better quality healthcare. Health leaders are currently reaching 5,593,750 community members with essential health and sanitation knowledge.

INDIA

HIGHLIGHTS

The awareness programs and training provided by the Community Health Leaders have been well-received, resulting in improved health and cleaner neighbourhoods. This is helping prevent health emergencies and reducing the expenses on healthcare, which can otherwise be a major financial shock for households in poverty.

Many participants have started earning their own income through the health entrepreneur program – 215 health leaders are currently participating in the pilot program, selling vital sanitation products to those in their communities. Selling these products adds to the overall household income and increases the freedom and respect for the entrepreneurs within their household and community.

Health leaders continue to expand on their knowledge by progressing through first-responder training. 106 health leaders have been trained as Basic Care Providers, equipping them to provide basic emergency assistance in their communities.

LESSONS

The 215 health leaders who have undertaken health entrepreneurship training are participating in a unique and challenging pilot that is attempting to reshape local markets and reach the last mile. This means that finding suppliers willing to sell products in remote areas has presented a challenge. Many of the suppliers see “last mile” communities as a financial risk rather than a market opportunity and that has meant they typically require their products to be purchased upfront. But the limited financial capacity of the health entrepreneurs means that they can only buy small amounts of stock to trade, which affects their income potential. We are focusing on working with suppliers as well as managing distribution dynamics carefully to help increase the profit for health entrepreneurs and support them to provide greater value to the communities in which they live.

INDONESIA

HIGHLIGHTS

Opportunity’s first cohort of health leaders in Indonesia has completed their initial training and are wrapping up their six-month internships. Throughout their internships these health leaders participated in refresher training on crucial topics such as handwashing, nutrition, and air and water borne diseases. So far these health leaders have reached 162,449 community members with health and sanitation education.

As anticipated, this pilot program has delivered key lessons in adapting the health leader model to best reach families in Indonesia. Following the completion of the health leader pilot program, new community health leaders are now being recruited to start the next round of health leader training.

LESSONS

Unlike in India, where there are many cohorts of health leaders and the program has a strong and positive reputation, the health leaders in Indonesia are trailblazers with no peers to look to and learn from. As to be expected at this early stage of the pilot, a number of women have struggled with motivation and finding ways to keep their communities engaged. We are focused on supporting these women as they continue delivering basic health education in their villages, while also exploring other ways for them to keep providing valuable knowledge and services. 

Health Report – March 2019 (data to December 2018)

To December 2018, 4,339 women have been trained as health leaders in Asia. These women are reaching families in their communities with simple but life-changing health, hygiene and nutrition information to build healthier communities.

INDIA: PAVING PATHWAYS TO HEALTH LIVELIHOODS

Our two livelihoods pilots – Basic Care Providers as first-responders, and Health Entrepreneurs to distribute vital health products – are continuing with ongoing refinement through lessons learnt. To December 2018, 215 health leaders are participating in the Health Entrepreneur pilot and 53 as Basic Care Providers.

INDONESIA: PUTTING KNOWLEDGE IN TO PRACTICE

Having completed their six-months training, our first cohort of health leaders in Indonesia have begun their six-month internships. So far they’ve reached 13,500 families with health knowledge and hygiene practices. As anticipated, the pilot has delivered key lessons in adapting the health leader model to best reach families in Indonesia.

Three months in to their internships, a common challenge so far is the lack of resources families have to implement what they’ve learnt. This challenge is shared with families in India – a key motivation for exploring our Health Entrepreneur pilot, to equip health leaders to be local distribution channels for essential products like sanitary napkins.

Meet Sumanthi

Sumanthi Devi teaches the importance of good nutrition to women in Bihar, India. Many people in the community have little knowledge about nutrition and its impact on health.

To teach better eating habits, Sumanthi explains the food pyramid, showing where local foods—which the villagers have easy and relatively cheap access to—fit. 

“It is important for the community to stay healthy to reduce medical issues,” she said. But there is an added bonus for this community health leader. 

“Teaching was my dream. Now I get to teach children as well as the wider community."

By building on the base of existing small loan clients, Opportunity's Health program focuses on training local women to become health leaders in their communities, allowing them to spread life-saving knowledge and care while earning an income to support their families.

To become health leaders, those interested and accepted into the program undertake six months of training in hygiene and sanitation, including community mapping which helps them more thoroughly understand their community's health needs. Within six months of graduating from the program, a health leader will be able to educate up to 200 households with basic health information, while selling products like soap and sanitary napkins.

Operational sustainability is the ability of an organisation to cover the costs of its lending program with the revenue earned from its lending program. 

Portfolio at risk is a stringent measure of a microfinance institution’s loan portfolio quality. The portfolio at risk calculates the total value of outstanding loan balances for loans, for every payment that is overdue by more than 30 days.

Meet Sunita

Sunita is from a small village in a rural area of Uttar Pradesh, India, where she lives with her husband of 18 years and their five children – as well as her brother-in-law, his wife and their three children. She earns an income through the family's buffalo and her small tailoring business, which she started several years ago with a loan from Opportunity's program partner Cashpor.

When Sunita heard about the health leader program she was eager to join. Attending classes meant battling her husband’s disapproval –until her new knowledge saved his life.

A seasonal labourer, Sunita’s husband Subash often works away for months at a time.

Luckily for Subash, Sunita had been attending classes under the guise of visiting friends.

When he returned from working away with a badly infected ulcer on his leg she knew he needed to get to a hospital immediately. After seven days in hospital, Sunita knew how to dress his wound and took care of Subash for the next three months. Without her training the family don’t know how they would have covered the cost of his care.

Now, Subash is Sunita's biggest supporter. He is proud of her role in their community

Sunita is grateful to have had the chance to learn about basic health, hygiene and nutrition, and to share this with her family and community. Without these skills, her husband might not be around today.

Meet Sashikala

Sashikala is a health leader and mother to three daughters. The family has a small farm, that they've grown over the years with small loans to invest in buffalo and seeds for vegetables. Most of their food comes from the farm, and they sell what remains at the markets, and live off the small income.

She's seen many children die from preventable illnesses including diarrhoea. She's also seen a number of adults in the village suffer from tuberculosis.

Sashikala's family is one of just five households with a toilet, in a community of around 2,500 people. She and her husband built it because they worried about their daughters going outside at night, and were also concerned about their young children being bitten by a snake during the rainy season.

When Sashikala heard about the training being offered through Opportunity's program partner Healing Fields Foundation, she put up her hand immediately to become a health leader. She has focused on encouraging families to build toilets and sells sanitary napkins to the community.

When Sashikala completed school, she wanted to become a nurse, but was unable to get the further education needed to qualify. Now, as a health leader, she is proud to help others improve their wellbeing. Her eldest daughter Schweta wants to be a midwife, inspired by her mum.

Health Report – March 2020 (data to December 2019)

India

HIGHLIGHTS

Education on health, hygiene and nutrition provided by the Community Health Leaders has been well-received, and community members have changed their behaviour, resulting in improved health and cleaner neighbourhoods. The digital literacy of the Health Leaders is improving through the program and some are now using the messaging application WhatsApp to receive health messages that are informed by Opportunity’s program partners.

The Health Leader training slowed slightly over the past six-months as more focus was placed on strengthening the Health Entrepreneur and Basic Care Provider pilots. 215 Health Leaders continue to earn income through the Health Entrepreneur pilot program, selling basic sanitation products such as soap, which support change in behaviour like handwashing that is needed to prevent illness in communities.

106 Health Leaders have been trained as Basic Care Providers, equipping them to provide basic emergency assistance.

LESSONS

The key to sustained income generation through selling health-related products depends heavily on securing reliable supplies of those products that also need to be accessible and affordable for the health entrepreneurs. Buying stock up-front presents a big risk and barrier for the health entrepreneurs given their low savings and the delayed return on their investment. The pilot is continuing to explore product suppliers and community demand to develop a scaled and sustainable supply chain that helps these women earn health-related incomes.

Indonesia

HIGHLIGHTS

The program has expanded with 30 new Health Leaders in Indonesia beginning an initial six-month training program to equip them to deliver health education in local villages. This second cohort of Health Leaders will begin reaching additional community members in 2020. So far, the first cohort of Health Leaders in Indonesia has reached 162,479 community members with health and sanitation education.

Work has begun on digital data collection tools using tablets or phones to gather information on the people benefitting from the health program.

LESSONS

Expansion of the program depends on the successful recruitment of staff to train the health leaders, drive scale, manage the program, build links with government bodies, and explore other partnerships, for example with health insurance and telehealth providers. 

Bangladesh

HIGHLIGHTS

On the back of the success of the health program in India and Indonesia, Opportunity began a new partnership with a large microfinance institution (BURO) in Bangladesh to provide primary health care to women living in poverty. Offering financial services to more than 1.75 million women living in poverty in every district across Bangladesh, BURO is well placed to expand their offering with the addition of health education to improve the health and wellbeing of millions of families. 

The program was designed by BURO with health curriculum developed for the Bangladeshi context with the support of an expert with previous experience developing community health programs for the World Health Organization and UNICEF.

Using a train-the-trainer model, 180 staff at BURO were trained as Health Educators to, in turn, equip selected microfinance recipients to become Health Leaders. Health Leaders complete ongoing training with support and mentorship from the BURO Health Educators. In 2020, the women will begin providing health education to an average of 200 households each in their local communities.

LESSONS

BURO has a long history of providing multi-layered solutions to the families it serves, through microfinance, health, education and other initiatives. The new health partnership will enable BURO to leverage some of its existing health initiatives—which include a hospital and telemedicine pilot—to provide more integrated health services to more clients. With the Health Leaders providing health, they can also build community support to use other health initiatives, such as diagnostic and referral services, and low-cost access to doctors. 

Health Report – October 2020 (data to June 2020)

Opportunity’s Health program addresses limited knowledge as the primary obstacle to accessing health care for communities living in poverty. Increasing that knowledge means women and their family members can thrive and pursue meaningful economic and social opportunities that enable them to reach their full potential. Women are empowered as health leaders in their communities to improve awareness of how to prevent common illnesses. Thanks to your support, the health leader solution is helping families avoid illness, including COVID-19. During the pandemic, community health education that focusses on how to look after your family’s health is more important than ever.

This project is supported by the Australian Government through the Australian NGO Cooperation Program (ANCP).

STRATEGIC DIRECTION

COVID-19 has had a significant impact on the Health Program due to lockdown and other restrictions implemented to contain the spread of the virus. India enforced a lockdown from March through to June. In Indonesia a partial lockdown was in place from April to May, with many local communities imposing their own restrictions to protect the local populations. In Bangladesh, the Government mandated a ‘holiday’ from April to June. All of these restrictions meant that the health program activities were slowed or paused during that period. 

Opportunity’s program partners adapted quickly to the restrictions, using digital channels like WhatsApp to share key messages to help slow the spread of COVID-19 and to keep in touch with community members when physical visits were not possible.

In India, a pilot program has begun to establish e-clinics in Opportunity’s program partner’s branch offices. These will increase access to health solutions and affordable health care by providing community members with access to general and specialist health advice through telemedicine. Health leaders will also be employed to facilitate digital access to the doctors, earning an income from this activity which will enhance their economic empowerment.

STRATEGIC DEVELOPMENT GOALS, SPM, PPR

In India, an additional 296 women have been trained as health leaders in their community. This exceeds the initial target to train a total of 4,700 women as health leaders in India to provide health education to local communities to improve awareness of preventable health issues, including COVID-19.

In Indonesia, health leaders made a video demonstrating how to use a face masks as part of the #AyoPakaiMasker (let's use the face mask) campaign.The video was distributed by health leaders to community members through WhatsApp. The video was shared with all of Opportunity’s program partners in Indonesia to share with both staff and community members.  

In addition to expanding the health leader program in Bangladesh, Opportunity’s Health Program partner created a mass-media awareness campaign using billboards, posters and pamphlets to reach 2.2 million people with vital COVID-19 prevention information.

URMILA'S STORY

HEALTH LEADER AND ADVOCATE FOR HER COMMUNITY

Urmila is a health leader rooted in the community she serves in Hamirpur, Uttar Pradesh in India. Urmila became a health leader to help people in her community become more resilient to preventable diseases, understanding the link between poverty and poor health. She was trained to understand that good nutrition builds immunity to fight disease and she was able to work with 110 families to develop kitchen gardens to supplement their diet with fresh herbs and vegetables.

When COVID-19 pandemic made its way to India, Urmila’s lessons about the importance of good hygiene became even morecritical. Urmila continued to spread awareness of hand washing and sanitation to prevent the spread of infection diseases like COVID-19. She encourages villagers to wear masks but was all too aware that for some people living in poverty the cost of buying masks was prohibitive, so she came up with a solution. She stitched and distributed 200 masks to the poorest families in her village. 

As the economic fallout due to the COVID-19 lockdown became apparent, Urmila lobbied the local government village council (Panchayat) on behalf of 250 villagers for their inclusion in the MNREGA (Mahatma Gandhi Rural Employment Guarantee Act) scheme which ensures unskilled manual work as a welfare measure. Urmila’s advocacy on behalf of her community shows how confident she has become at her own abilities to use her influence to make a positive difference. 

MOBILISING HEALTH LEADERS TO RESPOND TO COVID-19

In India, COVID-19 poses multiple hardships to millions of workers who had migrated from their home villages to urban centres for work. With factories and workplaces shut down with just four hours’ notice due to the nationwide lockdown imposed to restrict the spread of COVID-19, these workers had to deal with loss of income, food shortages and uncertainty about their future. With no means of transportation due to the lockdown, hundreds of thousands of workers risked their lives by walking hundreds of kilometres to return to their hometowns and villages in the biggest internal migration since independence. Many migrant workers were branded as carriers of COVID-19 as they made their long journey home. State governments set up thousands of camps to house migrant workers to stop the exodus. Sadly, there were reports of truck drivers taking advantage of desperate travellersby charging exorbitant rates to transport them in unsafe and unhealthy conditions. 

Opportunity’s health program partner in India responded to the crisis by mobilising 1200 health leaders across 31 districts in six states to take a multi-pronged approach to relief operations. Transport was provided to 2,000 migrant labourers in 36 buses to return them home safely. At the destination districts, health leaders provided medical check-ups for the returnees.

For the migrant workers who made it home, many were barred from entry due to fears that they might bring the virus to their village. Health leaders facilitated the establishment of 103 safe and hygienic quarantine centres in villages’ school buildings for 4078 returned migrant labourers. Returnee migrants were provided with clean bedding, dry rations and meals, and medical checks while they completed a 14-day quarantine period.

Health leaders disseminated accurate COVID-19-related information, including hand washing and social distancing protocols, using voice-based communication platforms that enable voice messages to be accessed by community members using a toll-free number. Callers can also leave questions that can be answered by health leaders. The voice applications are simple to use and accessible to poorly literate or illiterate users. Health leaders received 20,570 calls and 600 high risk cases were identified and referred to formal healthcare.

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This project is supported by the Australian Government through the Australian NGO Cooperation Program (ANCP).

Health Report – March 2021 (data to December 2020)

There are many obstacles to good health for communities living in poverty, but some of the most significant include limited access to health services and lack of knowledge. Without these, it is difficult for women and their family members to thrive, as they often aren’t able to pursue meaningful economic and social opportunities that enable them to reach their full potential.

The women who are empowered as Health Leaders by Opportunity’s programs pivoted during 2020 to bring COVID-19-awareness activities and supplies to their communities, in addition to their existing responsibilities. Without them, there is no doubt that many more people would have fallen victim to COVID-19.

Thanks to your support, these Health Leaders are not just bridging the gap between communities and health services, but actively saving lives, helping families avoid preventable illness and accessing treatment when they need it.

DELIVERING HEALTHY MATERNITY CARE

Bangladesh is a risky place to give birth. Health Educator Rozina joined the Health Education Program in Bangladesh because she wanted to make a positive, tangible difference to the lives of the women living in her remote rural village, many of whom had never received any formal education.

During 2020, Rozina received training that enabled her to provide 25 sessions of basic health education to the women in her community, including sessions on the importance of getting health check-ups during pregnancy and maternal health. Rozina was delighted to see the women follow her advice and encourage other members of their families to do the same.

Sixty-two-year-old Momotaj attended Rozina’s weekly health education sessions. She learned the importance of attending at least four antenatal care sessions during pregnancy to reduce risks to mother and baby. Momotaj hadn’t received any antenatal care when was pregnant with her four boys – she wasn’t told anything about danger signs during pregnancy and she didn’t know about delivery plans. But after learning about their importance from Rozina, she was determined that her daughter-in-law would be well taken care of during her pregnancy. She encouraged her daughter-in-law to see a doctor for a check up; the doctor discovered that she was anaemic. Untreated anaemia in pregnancy increases the risks of premature birth, low birth weight and even death so Rozina’s work had immediate benefits for her community.

Once diagnosed, Momotaj’s daughter-in-law was put on an iron supplement and Momotaj made sure she had plenty of iron-rich foods. Momotaj and her daughter-in-law made a birth plan, identifying a health facility where she could receive assistance from a skilled birth attendant during delivery, and a plan for how they’d get there. They began saving so that they would have the funds to cover the delivery expenses.

Rozina’s advice and guidance gave Momotaj the knowledge she needed to give her grandchild the best possible start in life. For her part, Momotaj is grateful for the opportunity to learn and improve the health of her family and neighbours.

WORKING TOWARDS SDGS

The third sustainable development goal (SDG) – Ensure healthy lives and promote well-being for all at all ages – includes target 3.8: Achieve universal health coverage, including financial risk protection, access to quality essential healthcare services and access to safe, effective, quality and affordable essential medicines and vaccines for all. While great strides have been made regarding this goal, access to a trained, competent healthcare workforce remains a challenge in many countries, particularly in rural settings.

In 2013 the World Health Organization stated that, ‘Recent global investments in fibre and wireless infrastructure, as well as innovations in e-learning, electronic health (eHealth) and mobile health (mHealth) and in the social media, can be leveraged to train, deploy, support and empower health workers'.³ The global pandemic in 2020 hastened the need to use digital technology to train health workers and provide access to trained health professionals in cost-effective ways, saving travel time and costs, including time away from income-generating activities.

Opportunity is working with partners in India, Indonesia and Bangladesh to train lay community members to be Health Leaders, providing basic health education and linking patients to existing health services, increasingly through digital technology. As an example, much of the vital messaging around limiting the spread of COVID-19 was distributed by our Health Leaders to their communities using WhatsApp.

STRATEGIC DIRECTION

The barriers for people living in poverty to accessing healthcare are exacerbated for those in remote rural locations. Availability of health services in remote locations is a problem, with patient:doctor ratios much higher than in urban centres. The cost of travel and health services fees are also prohibitive for families living in poverty. It’s a double-edged sword: time spent away from work while seeking medical treatment is potential income lost but so is the time that people spend unable to work due to illness.

COVID-19 restrictions interrupted 2020’s new Health Leader training program but gave the existing network of Health Leaders the opportunity to deliver vital information to communities, helping to protect them from the virus. The global pandemic also heightened the need for access to medical services remotely, with telemedicine coming to the fore.

Mobile healthcare (mHealth) — medicine and public health supported by mobile devices — extends health systems to the most remote and inaccessible parts of the developing world. It promises to address barriers to accessing healthcare, increasing ‘timely access to appropriate interventions including faster access and access to services that may not otherwise be available.

INDIA

COVID-19-related restrictions imposed to halt the spread of the virus and the high risk of contagion during the pandemic heightened the need for remote healthcare and contactless consultations that reduce unnecessary and avoidable transmission to health care workers and patients.

Right at the beginning of the pandemic, on 25 March 2020, the Medical Council of India released its telemedicine practice guidelines, enabling registered medical practitioners to provide healthcare remotely using digital platforms. India’s telecommunications infrastructure and widespread 4G network are now making telemedicine a reality. Competition among telecom players means that data is cheap in India and most people in urban areas have access to a mobile phone.

To improve access to health services for families living in remote rural India, Opportunity’s health partner there teamed up with a digital health services company providing a telemedicine platform so that our microfinance clients could access free medical consultations with doctors over the phone in their local language around the clock, every day of the year.

Telemedicine overcomes all of the usual barriers to accessing healthcare by offering health services directly to the household. Telehealth’s many advantages, especially during COVID-19 travel restrictions, have seen 47,700 people use the service since last October.

Opportunity’s health partner in India plans to establish 54 e-clinics to support the telemedicine program. Each e-clinic will be run by four female Health Leaders who will be trained to use basic medical equipment and perform check-ups and observations such as temperature, blood pressure, pulse and oxygen saturation. They will also have tablet devices to facilitate video consultations with doctors. So far, 855 microfinance clients have accessed health services through the e-clinics.

INDONESIA

In Indonesia, the Health Leader training timetable was delayed because of COVID-19-related restrictions on movement and gatherings, as well as the relocation of many Health Leader trainees back to their home towns when their regular opportunities to earn income dried up.

Where trainers were unable to travel to out-of-area locations to conduct face-to-face sessions with Health Leader recruits, sessions were replaced by video calls and Facebook was used as a platform to deliver basic health education. In future, Health Leader Trainers will be recruited from areas close to trainee Health Leaders to avoid delays caused by COVID-19 restrictions.

Once trained, Health Leaders provided basic health education to women in their local communities. In line with COVID-19 restrictions, the number attending each health education session was reduced and masks were worn. The Health Leaders are paid a small incentive (IDR20,000 = A$1.80) for each session they run to supplement their household income.

Opportunity’s health partner in Indonesia is preparing to expand the program this year, recruiting and training eight new staff members to support an expected increase of 275 Health Leaders in eight new locations in Java.

BANGLADESH

While Bangladesh has improved its health outcomes substantially over the past few decades from a very low base, some major challenges remain, including the ratio of maternal deaths to live births. Less than 40 per cent of Bangladeshi women receive the minimum recommended four antenatal care visits during their pregnancy. Consequently, many Bangladeshi women still give birth unattended and the maternal mortality rate in Bangladesh remains high: 173 deaths per 100,000 live births compared with five per 100,000 in Australia.

The health education provided through Opportunity’s health program covers maternal and neonatal health care, encouraging pregnant women to visit a qualified health professional during their pregnancy and to plan to have a qualified attendant at the birth.

200 women completed their Health Leader training in November and December 2020. Once training was complete, the Health Leaders began delivering basic health education sessions to 40,188 households in rural Tangail. The Health Leaders are paid a stipend to supplement to their household income. A total of 202,789 women living in poor communities have been reached with health education by trained Health Leaders since the program began in Bangladesh in 2019.

ELECTRONIC-BASED CURRICULUM BREAKING BARRIERS TO HEALTHCARE TRAINING IN INDIA

Opportunity’s health partner in India participated in a Stanford University study to test the feasibility of using an electronic-based curriculum to train local women in resource-poor communities to be health care workers.

The pilot curriculum included 14 modules based on common illnesses reported in the villages and was delivered to 55 Health Leaders in Uttar Pradesh and Bihar. The course was facilitated by four tertiary-educated technology-literate local trainers, important for women trainees whose lack of familiarity with technology would have made it challenging for them to navigate a self-study course. Course content was preloaded onto tablet devices to avoid any issues related to poor connectivity and the modules were viewed by the group.

The results demonstrated the feasibility of electronic-based training to equip lay women to provide basic health care with minimal involvement by formally-trained health professionals. Findings showed that three challenges were addressed; providing training to women with little formal education and poor literacy; using technology as a platform for learning; and making the curriculum applicable to the specific cultural and geographic settings.