Should Financial Institutions Offer Healthcare Services?

Upon starting my fellowship at ProMujer Bolivia in La Paz, I became quickly aware of the fact that this microfinance institution (MFI) offers its customers one thing that the other MFI’s I’ve worked with and observed don’t, namely healthcare services.  In a country where national health data show high infant and maternal mortality, and the lowest life expectancy in Latin America*, the value of these services offered by ProMujer is obvious. However, a part of me questions the notion that a person’s access to healthcare and health services should be so intricately linked to his or her business loan.

In order to address my own doubts (and to attempt to write a well-informed blog post), I started to do some research on the topic. The arguments in favor of MFIs offering health services are the following*:

  1. MFI’s are able to reach a broad segment of the population, specifically people living in poverty;
  2. There is a need for improved accesss to healthcare services amongst microfinance clients, so MFI’s are responding to a need they see in the communities they work;
  3. MFIs are able to add healthcare to the other services they already provide at a relatively low cost.

In addition to the social motivation to offer healthcare, there is also a business case for MFIs to make such services available to their clients. Providing additional services for clients gives the MFI a competitive advantage and, moreover, clients in good health are more likely to pay back loans.

There are a variety of ways through which MFIs can extend healthcare services to their clients: health education, health micro-insurance, linkages to health providers, health product distribution, etc. Pro Mujer in Bolivia manages professionally staffed health clinics on-site, offering medical services ranging from PAP smears to breast exams, STD screenings and pre- and post- natal care for pregnant women. The entire ProMujer network which spans five countries offers healthcare support to clients and their families for as little as $2 USD to $9 USD per year.

Health services are delivered by a team of doctors and nurses at Pro Mujer's neighborhood centers in El Alto. For a monthly fee of $0.50, clients are entitled to primary healthcare for themselves and their families.

My instincts tell me that people’s relationship to healthcare service providers should be long-term, while this may not necessarily be the case for their relationship to providers of micro-loans. Moreover, I am skeptical of the idea of access to healthcare being contingent on need for capital. What happens when a customer of ProMujer decides she no longer needs to borrow money? Is it feasible that she may continue borrowing and incurring unnecessary debt solely to access the healthcare services she’s grown accustomed to?

Too many people in Bolivia do not have access to proper healthcare and it can definitely be argued that healthcare connected to micro-loans is better than no healthcare at all. This is why I would now like to open this to a debate, to initiate a conversation on the topic and invite responses about the benefits and drawbacks of MFIs providing healthcare. To those of you out there who have worked with an MFI that offers such services, I would greatly appreciate your insight and observations. Additionally, any Kiva Fellows currently working at an MFI offering these services, I encourage you to write a post describing your organization’s healthcare services and your observations regarding the role MFIs should play in this area.

* Freedom from Hunger, 2008; 2010

Julie Shea is a Kiva Fellow currently working with three of Kiva’s Bolivian field partners: ProMujer BoliviaCIDRE, and Emprender.

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