New database tool can help you define and refine client outcomes

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Global Health Indicators Project
The Microcredit Summit Campaign has long been committed to promoting the uptake of measurement tools in the microfinance sector, especially the poverty measurement tools. Such tools provide MFIs the means to know for sure if they really are reaching the poorest. More recently, we have encouraged MFIs to implement these tools to track the movement of clients (hopefully) out of poverty. At the 18th Microcredit Summit next month, we have several sessions that will show participants the benefits and challenges of such tools, including the Client Outcome Performance (COPE) Indicators Database, which you’ll read about here.


>> Authored by Bobbi Gray, Freedom from Hunger

When I joined Freedom from Hunger several years back, I had the responsibility to carry on a decades-long commitment to research and evaluation. My predecessor, Barbara MkNelly, as well as my then-supervisor and president of Freedom from Hunger, Christopher Dunford, were already known for their contributions to the research efforts of the growing microfinance sector and the original set of SEEP/AIMS client assessment tools. Freedom from Hunger’s commitment to promoting easy-to-use and cost-effective tools also led to years of developing monitoring and evaluation systems for microfinance organizations that were coined as “Progress Tracking.” Fast-forward several years, and this is much better known as Social Performance Management.

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Mental health matters for microfinance

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>>Authored by Bobbi Gray, Research Director, Freedom from Hunger

First of all, a disclaimer. I am by no means a mental health expert. Like many, I’ve had my own experiences which have led to interests into the causes and impacts of mental health issues as well as the coping mechanisms we might use when we or someone we know suffers from a mental illness.

It’s Mental Illness Awareness Week, as you might know, and it has reminded me of a conversation that Josh Goldstein, vice president of economic citizenship and disability inclusion at the Center for Financial Inclusion at Accion, and I started a while back. A conversation that also led to an exchange of ideas on his blog post “4 interventions to help victims of trauma find hope and dignity” in which he summarized his remarks at the 8th Annual PCAF Pan-African Psychotrauma Conference held in Nairobi, Kenya. (Josh’s full conference remarks can be found here.) During this conference, Josh tried to answer the question of whether microfinance institutions (MFIs) can help victims of trauma who suffer from mental health disorders, such as post-traumatic stress disorder (PTSD), to find hope and dignity through self-employment.

In his post, Josh suggests steps to be taken by our sector to be inclusive of those suffering from mental health disorders. In this post, I’ll address two of those steps:

  1. More linkages between mental health providers and MFIs can take place such that people have access to financial services and business and financial training.
  2. Create a set of global standards and indicators for MFIs and other financial service providers to follow that will establish the importance of and offer guidance on serving PTSD survivors and other persons with psycho-social disabilities.

While Freedom from Hunger works actively with our partners to link their clients to health service providers through our integrated approach, I can’t speak yet to having a lot of success on Josh’s first step above — i.e. the specific linkage to mental health service providers. Though this doesn’t mean there aren’t already bright spots. This (really interesting) Freakonomics podcast discusses how cognitive behavioral therapy (CBT) and cash transfers are being combined for child soldiers in Liberia. Spoiler alert, CBT plus cash transfers leads to men staying out of trouble, compared to getting only CBT or only a cash transfer.

On Josh’s second point, regarding the need to start by understanding and measuring the extent of psycho-social disabilities, we’re just dipping our toes in the water.

In the paper we produced called “Healthy, Wealthy, and Wise: How Microfinance Can Track the Health of Clients,” in which we share experiences in selecting and pilot-testing our Health Outcome Performance Indicators (HOPI) among MFIs, some of our initial testing around mental health indicators was limited and was initially driven by the acknowledgement that consequences of domestic violence should be better understood and tracked.

Since the publication of that paper, we’ve conducted research in Burkina Faso with 46 women that we followed over a 7-month period to better understand resilience. We tried to look at resilience holistically and included “attitude” questions in all 10 surveys we conducted. One survey focused entirely on attitudes and perceptions of one’s life. We pulled heavily from research conducted by Johannes Haushofer, who is a professor and researcher of psychology and public affairs at Princeton. He took variables from a World Values Survey and compared them to poverty status.

In the research in Burkina Faso, we compared self-perceived resilience status (i.e., “Based on what you consider to be a resilient household, do you believe your household is resilient?”) to a series of indicators, approximately 14 of which were attitude/perception indicators. We found that those who considered themselves resilient were also likely to report feeling supported, hopeful, capable of meeting one’s financial obligations, trustful of others, and not living one’s life “day to day.” They reported that they would try anything to improve their life. (This research will be available by the end of October through CGAP).

These indicators are just one slice of mental health — but it is a starting point. We have Haushofer’s research as well as our simple forays into developing the HOPI, which we think MFIs can use to measure and monitor client status. Given this headway, I think we all can have a greater appreciation of the power that positive or negative mental health can have on a person’s productivity and their likelihood of success with the types of financial tools we can provide.

For microfinance and beyond, I think we have the research we need to argue that mental health matters. (See this recently published paper in the Lancet regarding mental health research in Europe.) The direct costs (i.e., healthcare costs and productivity losses) and the indirect costs (i.e., wage and productivity losses of caregivers and family members) can be significant.

And mental health matters even if we’re not distinguishing between people with diagnosed mental health impairments versus the mental health challenges poverty often creates. In fact, in the book Scarcity by Sendhil Mullainathan and Eldar Shafir, we are challenged to recognize this. They explain how “scarcity captures the mind. The mind orients automatically, powerfully, toward unfulfilled needs. Scarcity…changes the way we think. It imposes itself on our mind. The consequence of having less than we want is simple: we are unhappy.”

I think we’ve all had periods of our life in which we can relate to what mental distress feels like. Your mental bandwidth is limited, and its hard to feel hopeful when you’re going through a trial. I wonder if we should assume that the starting point is that all clients we serve could benefit from mental health support given what we know about the psychology of poverty. Everyone deserves a financial product or process that helps them through life’s short and long-term crises — whether it’s a purely economic crisis, a visible health crisis like dealing with cancer, or a mental health crisis that has no obvious cause.

Obviously, this is easier said than done. But, over time, I’ve come to really value and appreciate what the mental health and psychosocial indicators can tell me about a person’s life. Even if a person’s poverty status hasn’t changed but their belief that their life is better and more manageable, I can see where that can be considered success.

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The importance of measuring client outcomes

Outcomes process

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The World Bank is hosting a day-long event today (as I write this, actually) presenting lessons and implications of the latest research on microcredit. Based on the swiftness of my Twitter feed, the event, “Financial Services for the Poor: Lessons and Implications of the Latest Research on Credit,” is very popular and timely. (You can follow it using the hashtags #WBlive and #Microcredit2015.) Much of the evidence shared this morning (when they had a live video feed of the event), confirmed our understanding that microcredit alone is not enough.[1]

Indeed, the speakers in the 10 AM session (agenda), in response to an audience question, “If you had $1 million, how much of it would you put toward microfinance?”, recommended that we should invest our money in human capitol, namely early childhood education and conditional cash transfers (CCTs).

We would add health-related products and services: from health education for positive behavior change to healthcare delivery, and everything in between. We also believe that it is essential to measure and track the client outcomes of our interventions over time — be they microcredit, savings, insurance, or non-financial products and services.

On February 4th, the Social Performance Task Force (SPTF) Outcomes Working Group hosted a virtual meeting on the “Selection of Outcomes Indicators.” The purpose of this working group is to develop practical guidelines for credible measurement of and reporting on outcomes, drawing on experience with different approaches and tools.

Frances Sinha of EDA Rural Systems introduced the session and explain how theory of change connects to indicators. Bobbi Gray of Freedom from Hunger explained the criteria applied to developing outcomes indicators — including a new set of Health Outcome Performance Indicators (HOPI) in partnership with the Microcredit Summit Campaign — and lessons learned. Anne Hastings of the Microfinance CEO Working Group discussed their plans for laying the groundwork for a common measurement and monitoring system.

Feb 5th meeting resources

If you would like to learn more about the pros and cons of the Health Outcomes Performance Indicators, join us on March 4th with the SEEP Network’s HAMED Working Group for the webinar, “Healthy, Wealthy, and Wise: How MFIs Can Track the Health of Clients.”


SPTF’s Outcomes Working Group will host a repeat of their December 14th virtual meeting on Tuesday, March 3rd at 4 AM (EST) // 9 AM (GMT) // 12 PM (East Africa) // 2:30 PM (India). Panelists will discuss the Theory of Change and how it helps us think about what to measure and when.

Recordings and materials from the original meeting (December 14th) are available online.

Speakers:

  • Frances Sinha, EDA Rural Systems
  • Anton Simanowitz, Independent consultant

The idea of a Theory of Change is now increasingly applied to strategic planning. It is beginning to be applied to measurement of change. This webinar will review the framework of a Theory of Change and to discuss how it can help an institution think through the ways in which it aims to achieve change, what inputs lead to what outcomes, and the time frame for expected change to take place. These are questions that are fundamental to appropriate research design and help in identifying relevant outcome indicators (short-term and long-term) and in analyzing the data to reflect a relevant sequence of inputs, outputs and outcomes.

About the Outcomes Working Group

  • Facilitator: Frances Sinha, director of EDA Rural Systems (India) and SPTF Board member.
  • Purpose: Develop practical guidelines for credible measurement of and reporting on outcomes, drawing on experience with different approaches and tools.
  • Introductory presentation

[1] Social Performance Task Force (SPTF) “Repeat session of the Outcomes Work Group: Theory of Change” WebEx meeting.

Tuesday, March 3, 2015 at 4:00 am | Eastern Standard Time (New York, GMT-05:00)

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Domestic Violence and Microfinance: What Is Our Role as Financial Service Providers?

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Originally posted on Center for Financial Inclusion Blog:
> Posted by Bobbi Gray, Research and Evaluation Specialist, Freedom from Hunger Embed from Getty Images The day after the closing of the Microcredit Summit in Merida, Mexico, conference participants were also invited…