Microfinance Institutions Are Found Effective in Delivering Essential Health Products to Underserved Communities on a National Scale While Reducing Costs
Microfinance institutions are popularly known for providing small loans to low-income entrepreneurs lacking access to traditional banking services. However, new research from The Arnhold Institute for Global Health at the Icahn School of Medicine at Mount Sinai, published today in the November issue of Health Affairs, suggests that the capabilities of microfinance networks expand well beyond banking, and that tapping into these networks can bring measurable health improvements to rural and underserved communities on a national scale with reduced cost.
Arnhold Institute researchers partnered with Fonkoze (the largest microfinance organization in Haiti) and tested whether training microfinance center chiefs to deliver micronutrient supplements during credit center meetings could improve the health of children under five. At the meetings, center chiefs distributed the nutritional supplements to Fonkoze borrowers (mothers who had children at home under the age of five), while also showing them how to mix and administer the supplements. The research team compared changes in blood test results and rates of anemia among 250 children who lived in villages where the intervention was delivered over three months, to a control group of 250 children in other villages who did not receive the supplements. The control children were, however, given the micronutrient powders after the three-month study period. The team found that the microfinance institution delivery worked, and that its health impact on the children was equal to a prior trial in Haiti where the same intervention was delivered through a non-profit health and nutrition program. The microfinance-health initiative is now being scaled nationally in Haiti through a social business model.
“Given the strength of informal institutions and markets in low-income countries like Haiti, we wanted to see if leveraging them could be effective in distributing essential health products,” said Aaron Baum, PhD, Lead Economist at The Arnhold Institute for Global Health and lead author of the study. “This is the first randomized trial that provides evidence of the beneficial health impacts from integrating microfinance and health care services. If we can increase coverage of existing health interventions such as vaccines, micronutrient supplements, and water purification tablets, two-thirds of child deaths could be prevented. We believe that MFI-based delivery of health services offers a promising approach to reach scale.”
Using MFI distribution networks as a part of scaling essential health interventions also has important policy implications. Globally, microfinance institutions reach 200 million households, with the number rising by about 20 million per year. Having MFI deliver basic health products may be a promising way to reach poor rural communities on a national scale. Moreover, using already-existing supply chains could reduce the total cost of mass delivery of micronutrient powders in low-income countries by 25 percent.
“We know there is a reciprocal relationship between poor health and poverty – that illness increases the likelihood of business failure and poverty, and poverty increases the risk of illness,” said Carine Roenen, MD, MPH, Executive Director, Fonkoze. “Careful integration of health services into anti-poverty initiatives in a sustainable manner provides real health benefits and improves the bottom line.”
“The findings indicate that networks organized by microfinance institutions offer an accessible bridge between health systems and the communities they serve,” said Prabhjot Singh, MD, PhD, Director, The Arnhold Institute for Global Health, and Chair, Department of Health System Design and Global Health, Icahn School of Medicine at Mount Sinai. “As a result, we recommend that policy makers looking to rapidly scale up community health programs consider incorporating microfinance institutions into their deployment strategy.”
Additional study collaborators include Wesly Elize, MD, MPA, and Florence Jean-Louis, MD, MPH. The research was supported by Vitamin Angels, a non-profit, non-governmental organization focused on combating childhood malnutrition around the world through vitamin supplementation.
About The Arnhold Institute for Global Health
The Arnhold Institute for Global Health at the Icahn School of Medicine, Mount Sinai Health System, seeks to improve the health of people and the communities they live in, both in the U.S. and abroad. The Arnhold Institute serves as a global arm of the Mount Sinai Health System, leading research on the design of more equitable and effective care models that are disseminated through digital products, training systems and input on policy design.
About the Icahn School of Medicine
The Icahn School of Medicine at Mount Sinai is an international leader in medical and scientific training, biomedical research, and patient care. It is the medical school for the Mount Sinai Health System, an integrated health care system which includes seven hospitals and an expanding ambulatory network serving approximately 4 million patients per year.
The School has more than 1,800 students in MD, PhD, and Master’s programs and post-doctoral fellowships; more than 5,600 faculty members; over 2,000 residents and fellows; and 23 clinical and research institutes and 34 academic departments. It is ranked among the highest in the nation in National Institutes of Health funding per principal investigator. The School was the first medical school in the country to create a progressive admissions approach for students who seek early assurance of admission through the FlexMed program.
The Graduate School of Biomedical Science trains PhD and MD/PhD students, and offers master’s-level programs in areas such as genetic counseling, clinical research, biomedical sciences, and public health, and an online master’s degree in health care delivery leadership. The seamless connections between our medical school, graduate school, and hospital campuses provide an extraordinary environment for translating scientific discoveries into clinical treatments.
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About the Mount Sinai Health System
The Mount Sinai Health System is New York City's largest integrated delivery system, encompassing eight hospitals, a leading medical school, and a vast network of ambulatory practices throughout the greater New York region. Mount Sinai's vision is to produce the safest care, the highest quality, the highest satisfaction, the best access and the best value of any health system in the nation. The Health System includes approximately 7,480 primary and specialty care physicians; 11 joint-venture ambulatory surgery centers; more than 410 ambulatory practices throughout the five boroughs of New York City, Westchester, Long Island, and Florida; and 31 affiliated community health centers. The Icahn School of Medicine is one of three medical schools that have earned distinction by multiple indicators: ranked in the top 20 by U.S. News & World Report's "Best Medical Schools", aligned with a U.S. News & World Report's "Honor Roll" Hospital, No. 12 in the nation for National Institutes of Health funding, and among the top 10 most innovative research institutions as ranked by the journal Nature in its Nature Innovation Index. This reflects a special level of excellence in education, clinical practice, and research. The Mount Sinai Hospital is ranked No. 18 on U.S. News & World Report's "Honor Roll" of top U.S. hospitals; it is one of the nation's top 20 hospitals in Cardiology/Heart Surgery, Gastroenterology/GI Surgery, Geriatrics, Nephrology, and Neurology/Neurosurgery, and in the top 50 in six other specialties in the 2018-2019 "Best Hospitals" issue. Mount Sinai's Kravis Children's Hospital also is ranked nationally in five out of ten pediatric specialties by U.S. News & World Report. The New York Eye and Ear Infirmary of Mount Sinai is ranked 11th nationally for Ophthalmology and 44th for Ear, Nose, and Throat. Mount Sinai Beth Israel, Mount Sinai St. Luke's, Mount Sinai West, and South Nassau Communities Hospital are ranked regionally.