Measuring client health outcomes using simple indicators

A local community health volunteer trained and supervised by Bandhan, an Indian MFI, meets with members of a local self-help group and their families. (Photo courtesy of Johnson & Johnson)

A local community health volunteer trained and supervised by Bandhan, an Indian MFI, meets with members of a local self-help group and their families. (Photo courtesy of Johnson & Johnson)

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>>Authored by Sabina Rogers, Communications and Relationships Manager

More than two years ago, we set out with Freedom from Hunger to develop and test a standardized set of health indicators as part of a Campaign Commitment we co-launched in 2013. This has culminated with the release of Healthy, Wealthy and Wise: How Microfinance Institutions Can Track the Health of Clients. The report describes our experience in selecting and pilot-testing a set of indicators. It will help you choose the right indicators for monitoring client health outcomes over time. And finally, the report summarizes key recommendations for developing “standardized” client outcome monitoring indicators.

We hope financial services providers and others will use our “health outcome performance indicators” (HOPI) to assess the health and well-being of clients and their families. We believe that wide usage of the HOPI would create short- and long-term value for practitioners (both health and financial services), social investors and donors, raters, and other actors. “Health” is a basic need that crosses all borders and all demographics, making the HOPI compelling measures for understanding client outcomes for financial service providers.

Four MFIs pilot tested the HOPI in 2014 (see below), and we shared results from ESAF’s and Equitas’ experiences in India in a webinar in March.

Financial Service Provider Country No. of Clients being served by FSP No. of clients participating in health indicators survey
ESAF India 450,000 700
Equitas India 1,344,361 551*
CARD Philippines 1,828,052 472
ADRA Peru 17,039 95

*Equitas had completed 234 surveys by the time we began data analysis. Therefore, the HOPI report only covers analysis for the first 234 data points

The HOPI measure 6 dimensions: poverty, food security and nutrition, preventive health care, curative health care, water and sanitation, and attitudes. The results from these four MFIs highlighted the added value of health indicators when combined with poverty measurement in helping MFIs understand client well-being. For example, the food security measure was useful to detect vulnerability; while very few clients in Peru fell under any of the poverty lines, 40 percent of them scored as food insecure.

We also found that whether clients treat their water was most frequently associated with poverty levels. However, to correctly interpret this measure, this dimension should not be used without assessing household drinking-water sources as well.

The curative health care dimension results were particularly informative and the questions have broad applicability across contexts. Results from the four MFIs showed that up to 60 percent of clients didn’t seek treatment because of costs. In Peru and the Philippines, we also learned that clients were not very confident in their ability to cover future health costs or to receive adequate medical care.

Because it’s so context-specific, the preventive health care dimension is the most complicated, yet it is also very important to include because it could be predictive of future health outcomes. As we look at adapting to new countries, national health surveys will be the most useful source for indicators.

While collecting the data was fairly simple, the bigger test will come from an organization’s ability to analyze and interpret the data so that action can be taken. In the pilots, we provided technical support to the four MFIs to analyze the data, but that level of input is not likely to be sustainable. Therefore, we are now developing an easy-to-use, Excel-based data collection and analysis tool for distribution later this year. If you are curious, then, about the health outcome performance indicators, here is what you should know:

  • They are practical to measure and monitor client health over time (annually or as part of other monitoring tools such as the Progress out of Poverty Index®).
  • They can be reported by clients in a monitoring survey.
  • They can be benchmarked to other regional, national, and global health goals and data.
  • They are reliable and are subject to change over time.
  • They will be relevant and useful for FSPs to measure and improve measures of program impact on client health and well-being.
  • They will provide donors, investors, government, health actors, and others with important information to guide decisions about support and social investment.

If you would like to learn how you can adapt the HOPI to your institution’s needs, contact Bobbi Gray (email) or DSK Rao (email).

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