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).

Related reading

The Campaign in 2014: Making Progress Toward Ending Extreme Poverty

Expokonool vendors being recognized in the closing ceremony for their hard work

At the 17th Microcredit Summit, Expokonool vendors were recognized in the closing ceremony for their hard work

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As we come to the end of the year, we reflect on 2014.

In 2014, we more than DOUBLED the number of Campaign Commitments, and in the past two years, 54 Commitments have been announced by 48 organizations, including AGFUND, the Food and Agriculture Organization (FAO) of the United Nations, the International Labour Organisation (ILO), BRAC, Grassroots Capital Management, Red Financiera Rural, Oikocredit, and Grameen Foundation. These organizations join a coalition to advance the industry toward helping 100 million families lift themselves out of extreme poverty.

With the first 5 installments of the Campaign’s new E-Workshop Series featuring Commitment-making organizations, more than 400 participants learned important practical lessons on innovations and tools that work to support those making the journey out of extreme poverty.

Organizations that made a Campaign Commitment are recognized on stage at the 17th Microcredit Summit in Mexico.

Organizations that made a Campaign Commitment were recognized on stage at the 17th Microcredit Summit in Mexico.

17th Microcredit Summit #17MCSummitIn September, 875 people from 60 countries joined us at the 17th Microcredit Summit in Mexico, including high-level dignitaries like Secretary of Economy Ildefonso Guajardo Villarreal, Yucatán Governor Rolando Zapata Bello, and Nobel laureate Muhammad Yunus. The agenda focused on the theme “Generation Next: Innovations in Microfinance.”

“The participation of global leaders in combating poverty. The cases that inspired partnership work in a joint effort to build a better future for generations.”
— a participant on what was best about the Summit

In the lead up to the Summit, the Campaign led 6 policy makers from Ghana, Mozambique, and Malawi on a 12 day intensive field visit to sites in Ethiopia and Mexico for a deep dive into successful strategies for implementing social protection and livelihood development programs. The policy makers developed innovation plans for implementing throughout 2015 the lessons learned from their trip on returning home.

Throughout the Summit, more than 160 presenters participated in 7 plenaries, 35 workshops, and 6 full-day trainings; the materials, including videos and presentations, can be viewed online. Together, we built a vision for the next generation of financial services that reach everyone and that provide even the poorest and most remote with the tools and resources they need to complete the journey to sustainable livelihoods.

To get an overview of the 17th Microcredit Summit and key topic areas discussed, you can read our article in the forthcoming winter edition of the Journal for Social Business to learn more about the financial and social services that are building pathways out of poverty.


In June, we launched Resilience: State of the Microcredit Summit Campaign Report, 2014. The report emphasizes the key role that actors in the financial ecosystem can play in helping end extreme poverty by promoting the frameworks, systems, partnerships and strategies that deliver the types of products and services that help build resilience.

In July, we published Integrated Health and Microfinance in India, Volume II with Freedom from Hunger and the Indian Institute of Public Health-Gandhinagar. It highlights the policy measures in the Indian microfinance sector since 2011, documents best practices towards integrating health and microfinance, and proposes an agenda for moving forward to expand access to healthcare.

We also launched a joint project in July called “Healthy Mothers, Healthy Babies: Partnering to improve maternal health in the Philippines” with Freedom from Hunger and CARD, the largest MFI in the Philippines. Together, we aim to improve health knowledge and promote behavior change for more than 600,000 women by December 2015 and strengthen “MFIs for Health,” a collaboration of health and microfinance practitioners in the Philippines.

Pregnant woman attending the first community health fair of “Healthy Mothers, Healthy Babies” program in the Philippines

Join us for a fantastic 2015!

The 100 Million Project: Commitment to Action at the Summit

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Participant writing on the Wall

A  Summit participant writes on the Commitments Wall

Where to find Commitments at the Summit?

The 17th Microcredit Summit in Mérida was a huge success, bringing together some 1000 people from 75 countries and featuring 162 speakers and presenters in 7 plenary sessions and 35 workshops. Throughout sessions delegates had the opportunity to hear about the Campaign Commitments their colleagues from other organizations weremaking ahead of the Summit. Launched in 2013 with 18 original Commitments, we celebrated together the 36 new organizations joining them now 2014. Many present were inspired to become leaders in the movement as well and joined (or reaffirmed their role in the Campaign) by stating their own at the Commitment Café. Join them by making your own Campaign Commitment to action! Write to mycommitment@microcreditsummit.org or visit our Online Commitment Form.

Full Commitment wall

51 organizations, including Plan International, the Rotary and the Ministry of Gender, Children and Social Protection from Ghana, wrote on the Commitment Wall.

Throughout the Summit, around 200 attendees visited the Commitment Café every day and 51 new Commitments were written on the Commitment Wall. The Café and the Wall were the gathering area for Summit delegates to join the Campaign, by stating their Commitment to actions that contribute to the global movement to end extreme poverty. There, they had the opportunity to meet with Commitment coaches who helped them form their Commitments. Commitment Makers then posted their actions on the Commitment Wall – creating a dramatic and inspiring range of actors and actions that will help move the industry toward ending extreme poverty.

Commitment Coach

A Commitment Coach is helping a Summit Participant to state her Commitment at the Cafe.

At the Closing Plenary, Summit delegates together with Mohammad Yunus, Larry Reed, John Hatch and Carmen Velasco celebrated the efforts of all Committed Organizations. We particularly acknowledged the 12 organizations who met their 2013 Commitment. The 36 Commitments announced in 2014 were also applauded and represent a great step towards galvanizing the movement to help 100 million families lift themselves out of poverty.

What Commitment Makers say about Campaign Commitments

During the Summit, we conducted interviews with representatives from Commitment Makers to learn more about their Commitment. They shared with us their own Commitments, their current progress on those actions and also told us why it is important for their organization to join the movement to end extreme poverty.

Yves Moury,  Founder and CEO, Fundación Capital (see his short Interview at the Video Corner here)

“We need massive alliances among all sectors of civil society. We invite governments, banks, private companies, civil society institutions to join us for the magnificent objective of ending extreme poverty by 2030.”

Anne Hastings, Microfinance CEO Working Group (see her short interview at the Video Corner here)

“I am here at the Summit because the 8 CEOs I represent have made Commitments. We are here to learn what we can about partnerships that we need to be building and how to collaborate better with the rest of the sector. The challenge for the microfinance sector today is to demonstrate results and especially results in reaching and assisting the extremely poor to get out of poverty.”

William Maddocks,  Program Director, Sustainable Microenterprise and Development , Carsey School of Public Policy

“We want to be part of this Campaign. Making this commitment is an opportunity for us to tell more people about what we do and to support the work of the Campaign. We want our voice to be a part of this Campaign.”

Closing Ceremony: we celebrated 2013 and 2014 Commitments.

Closing Ceremony: we celebrated 2013 and 2014 Commitments. Click here to see all Committed organizations.

Jared Penner,  Head of the Education Division Child and Youth Finance International: “Commitments are made within a community of believers that think this is something incredibly important to advance the industry and these targets give us something to really aspire towards. They are not legally-binding commitments, but there is something that allows us to keep each other accountable and see how things are advancing within our own operations.”


What you can do today

Op-ed Published on Devex: Microfinance is the key for the Philippines to meet MDG 5

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An op-ed by the heads of Freedom from Hunger, the Microcredit Summit Campaign, and CARD MRI. Continue reading

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…

Microfinance communities working together to improve maternal health

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1700+ women attended a two-day community health fair in the Philippines got a checkup, learned about pre- and post-natal care, and more! EspañolFrançais Continue reading

Improving Maternal Health in the Philippines Through Microfinance

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Collaborating on a cross-sectoral program to help achieve MDG 5 in the Philippines EspañolFrançais Continue reading

New Report on Integrated Health and Microfinance in India Shows the Way Forward

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Read it today! EspañolFrançais Continue reading

A Comprehensive Approach to Helping the Poor Lift Themselves out of Poverty

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Partnerships against Poverty Summit Banner with logos

Going the Extra Mile: From Safety Nets to Pathways out of Poverty
Track: Partnerships Targeting the Vulnerable
Date: Thursday, October 10th
Time: 9:00 – 10:30 AM

Going the Extra Mile_Picture _Roshaneh Zafar_288x360

Roshaneh Zafar, Managing Director, Kashf Foundation

Partnerships between financial institutions, governments, and social welfare programs are essential for empowering the extreme poor reduce vulnerability and gain self-sufficiency. Moderating the 2013 Partnerships against Poverty Summit plenary session “Going the Extra Mile: From Safety Nets to Pathways out of Poverty,” Roshaneh Zafar of the Kashf Foundation (Pakistan) noted that “poverty is a complex matter. We need multiple solutions, we need synergy, we need leverageability, we need scalability; and we all need to work together and do much more.”

The discussion opened with Department of Social Welfare and Development (DSWD) of the Philippines Secretary Corazon “Dinky” Juliano-Soliman, who told of their “convergence strategy,” a means to help beneficiaries graduate and stay out poverty through conditional cash transfer (CCT) community-driven development and sustainable livelihoods converging. Through this program, they also partner with microfinance institutions to provide credit to clients that need larger loans than DSWD provides (10,000 pesos, or approximately $230).

Juan Borga (Inter-American Development Bank) and Secretary Soliman

Juan Borga (Inter-American Development Bank) and Secretary Soliman

Juan Borga of the Inter-American Development Bank shared their efforts toward poverty reduction. Working mostly with conditional cash transfer (CCT) programs, they are trying to create a system that creates a relationship between the recipients of the CCTs to the financial institutions so that they will have “the right instruments [to save] and the right incentives to do it.” Commonly, “the financial institutions are not really providing them with the right products they’d like to have.”

Nelly Otieno of CARE International in Kenya and Yves Moury of Fundación Capital (Colombia) highlighted the necessity of building assets through methods such as savings groups and CCTs in order to create pathways out of poverty and to prevent long term dependence on financial programs.

Moury, in particular, stressed the importance of asset building and capacity building as a catalyst to spur sustainability and self-sufficiency–and thus an exit strategy for the implementers. According to Moury, “Linking savings and CCTs has been just like putting wheels on suitcases—a powerful combination.”

The speakers agreed that health insurance, mobile phones, identification cards, social protection, and bank accounts, working in tandem, greatly help to supplement financial inclusion initiatives and create pathways out of poverty.

Syed Hashemi,  CS Ghosh, and Nelly Otieno

Syed Hashemi, CS Ghosh, and Nelly Otieno

Syed Hashemi of BRAC Development Institute (Bangladesh) spoke about incorporating governments into exit strategies that allow clients to protect their assets and take advantage of new opportunities. He emphasized that, “through national governments, we can come up with an integrated, holistic, national social protection system that combines CCTs with graduation programs so we can collectively achieve this commitment of eradicating extreme poverty by 2030.”

Hashemi also touched on the cost-effectiveness of social protection policies that include safety nets and offer self-employment because, although graduation programs that include extremely intense monitoring and coaching have been seen to have an initially higher cost, they require a shorter timeline.

Innovative methods of providing health services to the poor are equally crucial to comprehensively reducing the amount of individuals living in extreme poverty. Chandra Shekhar Ghosh of Bandhan (India) stated, “Poverty is a complex syndrome. It is not only possible to eliminate poverty through credit support to the poor.”

23_plenary_audience(4)_MarciaMetcalfe+CarmenVelasco+JohnHatch_400x300_photo credit - Vikash Kumar

(Photo credit: Vikash Kumar Photography)

Organizations and government institutions working toward eliminating poverty must implement additional services beyond credit, including social, health, and educational programs that target the underlying causes of poverty beyond financial inclusion.

Overall, the plenary constructively critiqued the current successes, challenges, and future opportunities in the effort to create the pathways the extreme poor can take advantage of to lift themselves out of poverty.

However, the speakers recognized that the road ahead is difficult. As Secretary Soliman stated, “We hesitate to say graduation or exit because poverty is very complex. The notion of graduation gives the impression that we are done. But with poverty you can never be done, and that’s why we call it transition.

Watch the full video of this plenary

News Round-up for Friday, July 26

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Free solar panels for 2 m of the poorest families in Peru & our report on integrated health and microfinance in the Andes tops the charts Español Français Continue reading

Problems with scaling technological innovations

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With water filtration systems, filters have to be regularly replaced. Because filters are often expensive or difficult to find since they are model-specific, donated home filtration systems go to waste. Continue reading

What about Non-Financial Services? (reblogged from Truelift)

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Clearly, the Microcredit Summit Campaign advocates for providing non-financial services such as health education and such along side credit, savings, and insurance. We think it is a key ingredient in meeting the needs and preference of clients. With our Financing Healthier Lives project, our partner MFIs are providing those very educational interventions that help women change behaviors at home, thus eliminating diarrhea and improving the health of their family.

You can read about our work here:  

Truelift

Lively discussion
During the Technical Committee (TC) meetings leading up to the final methodology for Truelift Assessment and the Pro-Poor Principles, there was a great deal of discussion about non-financial services and whether or not they are essential to pro-poor microfinance. Initially, the TC explored a full dimension of the methodology dedicated to assessing non-financial services when undergoing Truelift Assessment. As these discussions evolved, some broader questions rose to the fore, including the pro-poor intent and strategy behind services provided, and the degree of commitment to pro-poor services in terms of quality, coverage, and duration.

Appropriate non-financial services
The result of the Technical Committee (TC) deliberations ultimately yielded Pro-Poor Principle #2: Services that Meet the Needs of People Living in Poverty. “Services” is perhaps an oversimplification as we include here products, delivery channels, and any other modifications that an MFI has implemented in favor of its poor clients. The indicators in…

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Invitación al Evento Microfinanzas y Salud – 30 de Mayo – Lima, Perú

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Tenemos el agrado de invitarles a participar en el lanzamiento del informe “Estado de la Práctica de la Integración de Salud en los Servicios de Microfinanzas en Bolivia, Ecuador y Perú”. El evento se llevará a cabo este 30 de mayo de 5pm a 7pm, en el Hotel Meliá en Lima. Continue reading

Financial Inclusion is a Start; How about Health Inclusion?

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In much of the developing world, where people are one illness away from losing everything, better provision of sanitation, clean water, other basic health services and health education would make the greatest difference to health outcomes. In the absence of … Continue reading

Seeing is Believing, Part 2: Potential for Integrated Health & Microfinance

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Marcia Metcalf from Freedom from Hunger and the Health and Microfinance Alliance, co-author of the recently released report titled Integrated Health and Microfinance in India: Harnessing the Strengths of Two Sectors to Improve Health and Alleviate Poverty—State of the Field of … Continue reading