Global Public Health through an Economics Lens

Economic Analysis of Domestic Violence

Most economists, when studying the economics of a family unit, study cooperative families. An example of a non-cooperative unit is a family with domestic violence, one of the most widespread crimes against women. In a paper titled, “An Economic Analysis of Domestic Violence”, Amy Farmer argues that level of violence in a family decreases when the women receives greater income and support from outside the marriage. This seems to support the hypothesis that increased financial empowerment of women will lead to decreased levels of violence in abusive relationships.

The paper elaborates with economic analysis on the how women’s income contributes to this decrease. The rationale provided is that when a woman’s income increases, so does her consumption. This makes the significance of each purchase less, and because each purchase is less meaningful to the woman, the husband is less able to inflict violence on her for a given transfer. They are still unsure as to whether the husband’s income factors into this model. They also say that as women’s alternatives to violent marriage improve, so does the violence they face.

According to the paper: “Men are assumed to indirectly receive positive utility from inflicting violence while women get negative utility from having violence inflicted upon them. A woman stays in the relationship as long as her relationship utility exceeds that of her utility outside the relationship, her threat point. A man may choose to make transfers to the woman to increase her marital utility and, therefore, keep her in the violent relationship. The comparative statics derived from the noncooperative model provide some clear predictions on the determinants of violence in an abusive relationship. An increase in the woman’s income is predicted to decrease the amount of violence.”

Although this is a lot of economic jargon, it is interesting to note the economics behind the concepts that we discuss in domestic violence. The woman stays often because staying provides some better options than leaving. Oftentimes, these benefits are monetary, and that’s where the economics come in. This idea that the abuser keeps the victim in the violent relationship by “making transfers…to increase her martial utility” is also very interesting. It seems to highlight the control aspect of an abusive relationship and the extent to which the perpetrator will go to keep the victim in a place of subservience.

According to the study, women who have better economic opportunities outside the household tend to be more likely to leave violent situations. Additionally, a study by Tauchen showed that among women who choose to stay, those with higher incomes will experience less violence. This seems to support the sociological model of domestic violence which sees domestic violence as a result of the inequality of women. They argue that “Wife abuse happens because it can happen. If women have more alternatives then it can no longer happen.”

Using this economic analysis, the paper argues that “The model…assumes that services affect the level of violence only as an exogenous variable which increases a woman’s threat point. However, if the threat point of the woman is unknown to the man, she may use services to signal to him that the violence must decrease or she will leave the relationship. Use of services such as shelters, help-lines, police intervention or the court system may be a way for women to send the appropriate signal. This analysis could explain why so many women use services only to return home or drop charges in a few days.”

I had never thought about reasons for women leaving or staying in a domestic violence situation on the basis of economics. It would be interesting to see how well this theory applies to correlations of the wealth of a country and rates of domestic violence. I would also like to see if other forms of leverage that women may have, besides monetary leverage, could also contribute to this negative correlation with domestic violence.

Farmer, Amy, and Jill Tiefenthaler. 1997. An economic analysis of domestic violence. Review of Social Economy 55: 337-58.

“The difference between what we do and what we are capable of doing would suffice to solve most of the world’s problems.” – Mohandas Gandhi

This week I intend to evaluate the role of the media in the attainment of Millennium Development Goals. I hope to establish that the media can serve as a crucial instrument to inspire change in any given society. It is quite obvious that the media is a significant force in modern society. The role of the media in the formation of public opinion is described in the agenda-setting theory. The agenda-setting theory asserts that the media impacts the saliency of issues in terms of public opinion in what it decides to cover, the importance and urgency it assigns various issues, dictating what the public should deem urgent and what can be ignored. Studies show that the agenda-setting theory certainly does manifest itself in some cases, namely during political campaigns and elections. For example, in the 1968 United States presidential election, a survey asked 100 people what they believed were the key issues of the election. Their responses were almost identical – in selection and in ranking – as the ones asserted by national media sources at the time (4).

This agenda-setting theory has important implications for affecting change in terms of attainment of the MDG goals. Essentially, the process works as follows. The media equips citizens with crucial information of which they would otherwise be unaware. Armed with this information, the citizens would ideally pressure their governments to bring about change. The governments would need to respond to such demands to increase their chances of reelection. Thus, the media informs citizens of the shortcomings and inaction of their governments and makes these governments accountable and more likely to make changes.

This can directly apply to the Millennium Development Goals. UN Secretaries General stated that the “lacking ingredient in achieving the MDGs is political will…the MDGs are not achieved at the United Nations…only citizens and parliaments can hold governments [accountable]” (1). Citizens cannot hold their governments accountable if they are unaware of the goals set out to be achieved by 2015 and if they are unaware of the lack of progress or effort made on the part of their government.

Many believe that the lack of progress made on MDGs are more an issue of apathy as opposed to ignorance. It’s not that people don’t know about the MDGs and the need to improve efforts; it’s that they don’t care. However, polls demonstrate that this is clearly not the case. In fact, most citizens in rich countries demonstrate a moral imperative to a certain extent. For example, in the aftermath of the devastating tsunami, the media played an instrumental role in raising awareness, which led to 600 million euros being raised from private donors (1). While apathy remains an issue in mobilizing the necessary agents of change, it is public unawareness that is severely hindering the ability for countries to move closer to the attainment of MDGs. Looking at this from a regional perspective, the role of the media in the south is extremely important because the progress of developing countries are the most critical in achievement of goals.

So, what should be done so that the media can catalyze progress towards MDG attainment? First, the media should discuss MDGs in a general sense so that the public is aware of what they are in the first place. Moreover, there should be reporting on MDGs progress in the context of a given country (and the reporting should take place within that country). This measure would increase accountability and frame progress in a sense that is both measurable and able to be monitored (1). When people are made aware of where their government is coming up short, they will be more able to put pressure on their government. Lastly – on a more national level – various nations should follow the example of the Ghanaian state. In a media dialogue conference that discussed a collaboration between the media and the state, there was a call to develop an official national agenda that recognized the attainment of MDGs as binding. This agreement declared that this commitment would be maintained regardless of the government in power at any given time (2). By implementing the above measures, the world can be one step closer to achieving the goals that would benefit the lives of millions upon millions of people. As such, the media proves a useful tool in making this change happen and should not be overlooked.

Sources:
(1) http://www.endpoverty2015.org/node/111
(2) http://news.myjoyonline.com/news/200905/30229.asp
(3) http://www.palgrave-journals.com/development/journal/v48/n1/pdf/1100103a.pdf
(4) McCombs, M.E., and D.L. Shaw. (1972) The Agenda-Setting Function of Mass Media. Public Opinion Quarterly, Vol. 36 p.176-187

I have written over the past few weeks about some of the benefits and models of coordinated microfinance and health services. With this post, I thought it would be helpful to think about some of the potential challenges or problems raised by the direct comibination of microfinance and health promotion efforts. I’ll be using the specific example of the incorporation of HIV/AIDS education into microfinance institutions (MFIs), an idea that has been referenced in previous posts as an example of useful collaboration between the realms of poverty reduction and health.

One initiative that has looked into both the pros and cons of integrated HIV and microfinance efforts is called Intervention with Microfinance for AIDS and Gender Equality (IMAGE), an effort in South Africa to partner MFIs with HIV/AIDS organizations to “explore the interaction between microfinance, gender inequalities, and HIV prevcntion.” Staff from the HIV/AIDS organization participate in the regularly set meetings of client groups of the MFI, bringing an educational and training component into the existing credit and loan services. Research into the effectiveness of these efforts found large levels of success, both on the end of HIV and health — many clients used the skills and leadership training they gained to engage in social mobilization efforts with positive community health impact — and on the end of financial sustainability — clients participating in the integrated services showed had lower drop-out rates, and in the long-term improved health should contribute to further success and enabled participation in the loan programs. However, the following challenges were also acknowledged:

• Barriers may exist to successful long-term partnerships between HIV and microfinance institutions, including the need for extensive training for the staff of one to fully understand or be able to implement the services of the other; differences in scale or resources betweent he organizations might inhibit match-ups in scale of the integration; target clientelle might vary; long-term logistics of coordinating the partnership may be complicated or require extensive resources.
• On an epidemiological level, those most vulnerable to HIV are a younger segment of the population than the usual recipients of microfinance loans. For women, HIV most heavily hits those between the ages of 15 and 25, while MFIs consider young people in this range as credit risks (less likely to successfully complete a loan cycle with the MFI). For this reason, about two thirds of MFI clients are at least 35 years old. This difference means that any HIV services provided through the MFI will need to take into account the population being served, and consider other approaches to community health impact (IMAGE does this by taking advantage of the importance of older women in enacting community change, and training the older women who participate in the coordinated MFI services to be social action leaders to impact the rest of their communities with their improved HIV knowledge)
• Donors place great pressure on MFIs to be financially sustainable, and to focus their efforts in order to do so. There is concern that if MFIs try to incorporate more services beyond their area of expertise, integrating health efforts in addition to their core financial services, they will do less well in their area of focus. Donors worry that the divided focus, as well as the significant additional resources, training, and staff that are required to successfully bring health promotion into the scope of the MFI’s work, will harm financial sustainability. IMAGE argues that the long-term savings and success that HIV and health services  may bring to MFIs justifies the investments.

These are just a few concerns raised by critics of integrated HIV and microfinance programs; it’ll be interesting to think about the variety of issues raised by different types of MFI partnerships beyond HIV/AIDS organizations, and how different organizational structures may alleviate or add to such concerns.

Cited:
http://66.102.1.104/scholar?hl=en&lr=&client=firefox-a&q=cache:Wd6IDaVA06IJ:web.wits.ac.za/NR/rdonlyres/56408C66-1FC2-444B-BCA1-E39F3DC3A0C/0/Pronyk_MF_and_HIV_Small_Enterprise_Development.pdf+Using+microfinance+to+improve+the+quality+of+reproductive+health+services

Building off my post on human trafficking last week, I thought it would be interesting to explore the economics behind prostitution and how that creates the market for and the continuation of prostitution. Prostitution provides an interesting issue in global public health because a) it is present universally throughout the world, b) it is often associated with violence against women, and c) it provides interesting dilemmas in the spread and treatment of venereal disease and STIs.

According to a study cited in an article in January of 2008 in the Economist, it was found that prices in prostitution vary as in any other business: they depend on service requested and risk involved in providing that service. It was also found that while pimps work less, they get paid more than prostitutes. In order to get the most desirable workers, pimps pay what the study calls “efficiency wages”, which are above the going rate of the prostitute. Because of this many sex workers request to be introduced to pimps—an article in salon.com refers to this the equivalent of networking in the legal business world.

According to the same study, prostitutes make (on average) $25-30 per hour, which is apparently four times what they would make outside the sex industry. This does not take into account the risks of the jobs including transmission of STIs, the threat of being arrested, and sexual assault. Some estimate that prostitutes and sex workers are assaulted on average once a month. According to the article in the Economist (in what may sound like a snide remark): “Prostitutes are more likely to have sex with a police officer than to be arrested by one.”

Forbes magazine takes another interesting spin on the economics of prostitution. In an article, they cite a study done by Lena Edlund and Evelyn Korn in the Journal of Political Economy where both wives and what they termed as “whores” are viewed globally as economic good where men buy and women sell. The authors admit that wive and sex workers are not the same, namely in the fact that wives can offer reproductive sex but prostitutes cannot. Of course, their view is oversimplified, but they present it in order to answer the question of why prostitutes make as much money as they do, considering the skill set and material cost required.

The articles in Forbes says “according to data assembled from a wide variety of times and places, ranging from mid-15th-century France to Malaysia of the late 1990s, prostitutes make more money–in some cases, a lot more money–than do working girls who, well, work for a living.” This is apprarently also true in places with legalized and safe (relatively) prostitution. So, that means that the high pay is not simply compensating for the high risk involved.

This also begs the questions of why married men don’t simply go to their wives for sex (as awful as that sounds, but remember I’m going through this with an economics lens), instead of buying sex from prostitutes. I still have not found the answer to this.

http://www.forbes.com/2006/02/11/economics-prostitution-marriage_cx_mn_money06_0214prostitution.html

http://www.salon.com/mwt/broadsheet/2008/01/18/prostitution/

The Millennium Development Goals (MDGs) address the world’s main development issues, by recognizing the interdependence between poverty reduction, growth and sustainable development. The eight goals are the following:

1. Eradicate extreme poverty and hunger
2. Achieve universal primary education
3. Promote gender equality and empower women
4. Reduce child mortality
5. Improve maternal health
6. Combat HIV/AIDS, malaria and other diseases
7. Ensure environmental sustainability
8. Develop a Global Partnership for Development

The MDGs synthesize into one plan some of the most important commitments made towards global development thus far. The goals are based on time-sensitive and measurable targets along with indicators that allow for monitoring progress. When doing an economic assessment of the MDGs, it is important to outline how much it will cost to achieve the goals and how much each country and the population at large will benefit.

Where is the money coming from?

First, there will need to be a major increase in domestic resource mobilization to cover increased expenditures on the MDGs. These resources will likely come from a broad-based revenue source such as a value-added tax. Additionally, national governments will need to reevaluate their budget allocation and prioritize more highly the MDGs investments. In addition to this increase in domestic resource mobilization, external financing will be necessary for many low-income countries to achieve the MDGs. Most low-income countries will cover the cost of achieving the MDGs by splitting equally between domestic finance and official development aid (ODA). Middle-income countries should be able to cover MDG investments solely from domestic finance. External financing may assist middle-income countries in addressing significantly impoverished subpopulations. According to current estimates, the total cost of addressing the MDG financing gap for a low-income country is about $73 billion in 2006, and $135 billion in 2015. Middle-income countries would require $10 billion in direct monetary support for MDG. Furthermore, the total cost of meeting the MDGs in all countries is estimated to be $121 billion in 2006 and $189 billion in 2015. The table below illustrates these figures.

To successfully meet the MDGs, developing countries need to follow through on their commitments to improved governance and rich countries need to honor their commitment to meet the target of 0.7% of GNP as ODA to developing countries.

How do individual countries and the world benefit?

If the MDGs are met, more than 500 million people would be lifted out of poverty. Additionally, millions of children would be granted the opportunity to attend primary school, tremendous environmental degradation would be reversed, and millions of women and children will be given freedoms previously deprived of them. Further benefits can be considered when looking at the costs of inaction (lives and opportunities lost).

In assessing the costs and benefits associated with achieving the MDGs, the costs are affordable and outweighed by the benefits accrued. The doubling of annual ODA to $135 billion in 2006 is highly affordable when compared to the world’s $900 billion annual military budget. International leadership and responsibility in administering joint action on structural and institutional reform justifies the risks and benefits that are shared globally and also ensures sustainable development.

Source:

2006 Millennium Project

http://www.unmillenniumproject.org/reports/index_overview.htm

In the research I have done over the course of crafting this blog, I have seen a repeated link between science and technology (S&T, for the sake of this post) and achievement of the MDGs. The link was too significant to ignore, and I will thus turn my attention to the importance of S&T in pursuit of these MDGs we have been looking at. History tells us that S&T has been extremely successful in solving global health issues in the past, and an article found in an Indonesia newspaper provides two excellent examples. First, the invention of antibiotics has prevented many deaths; without them, people would be dying from simple everyday infections. Moreover, a study estimates that without the invention of chemical fertilizer and crop improvement, the last 2.7 billion people would not have been born because traditional farming systems would be able to sustain a maximum population of 4 billion people (1). As we can see, S&T has had a tremendous impact on solving past problems, and it should not be overlooked as a route to achieve MDGs for the future.

In what ways could S&T provide for a better future and help attain MDGs? To start, 75% of the world’s poor live in societies reliant on rural agrarian economies. Technologies such as farm mechanization and enhanced crop seeding (for instance) can greatly improve the agricultural efficiency and in turn feed more people (2). Also, S&T can promote basic health care by applying knowledge to drinking water systems in poor areas. These are a few examples of how S&T is crucial in achieving MDGs and improving the lives of others. As such, it is essential to promote it.

To promote S&T, it is important to give it more of a priority both when creating developmental policy in developing countries, but also be supported by the government as well as other institutions, such as universities, NGOs, and international agencies. The focus should be on creativity and innovation within the disciplines of science and technology. This need is particularly urgent in Asia and the Pacific region, which contains over 50% of the world population and has high population densities, as well as high biodiversity and a supply of natural resources (1). S&T is crucial in that area to allow societies to manage resources and behaviors in a sustainable way. Asia, however, seems to be having difficulty in promoting S&T. We can see this from the allocation of national budget to R&D. OECD countries recommend that 3% of a country’s GDP should be spent on R&D. Regrettably, countries in the Association of Southeast Nations (ASEAN) are spending less than 0.5% on R&D.

Moreover, S&T cannot simply be a government initiative. Central to effective and beneficial S&T is the buildup of human capital, which is most directly seen in schools. Students should be encouraged to study in subjects relevant to S&T. Moreover, subjects should be taught from a scientific perspective one to foster this interest in S&T early on, but also to promote good health and hygiene among students. Moreover, a United Nations Global Roundtable Forum on Innovation and Investment recommends that each country should establish at least one research university, which would have a tremendous impact in scaling up S&T (3). This S&T promotion is also dependent upon partnerships between different levels of institutional governance to ensure that this promotion is reflected in national policy as well as supported at the local level.

As such, MDGs are achievable, but only with the proper ingredients. While much of this achievement relies on international cooperation, national implementation, and adoption of healthier and more sustainable practices, creativity and innovation will also be a major catalyst for progress. Because of this, S&T should be promoted in every respect possible, to improve the lives of millions.

Sources:
(1) http://www.antara.co.id/en/arc/2009/5/14/science-and-technology-key-for-mdg-achievement/
(2) http://www.unctad.org/templates/Page.asp?intItemID=3795&lang=1
(3) http://www.icsu.org/Gestion/img/ICSU_DOC_DOWNLOAD/836_DD_FILE_ICSU_input.pdf

This week Jeff Conant came in to speak about A Community Guide to Environmental Health, a book that provides education for poor communities with little or no access to resources or care. The book’s goal is to teach community members how to address issues by changing their underlying causes, while providing life-saving skills and problem-solving techniques. As a result of its community-based focus, this book provides an interesting and unique perspective on food and the food market.

In addition to hunger, one of the greatest problems for a community can be food dependence, a situation that can develop in a few different ways. Corporate control is one of the main threats to food security, and oftentimes increases hunger more than anything else. Corporate control of food, rather than local sustainable businesses, makes communities dependent on the global market for food rather than on themselves and their neighbors. If or when the market fails, people go hungry and corporations can profit even more by selling food to the government as food aid.

Genetically engineered crops even further reduce food security. To begin, GE crops are costly. Farmers rely on purchasing seeds, pesticides, and fertilizers each season. Usually, the company that sells the seeds owns the right to the genes, so a farmer cannot save seeds from the year before and plant those. Each season he or she must make an investment to buy the seeds anew when they are naturally free. These economic costs lead to reduced food security and sovereignty. However, these costs do not even cover all of the externalities that communities face as a result of using GE crops. Health costs can include reduced nutrition and pesticide poisoning. Environmental costs include biodiversity loss, loss of natural pest controls, and harm to other wildlife/soil.  Each of these consequences can be destabilizing to a community.

Foreign aid, while well-intentioned, is yet another factor that can lead to dependence. It is a short-term solution that fights hunger, but does not attack its underlying cause, which is the ultimate goal in the community guidebook. Accepting foreign aid is like putting on a band-aid, rather than creating a situation of food sovereignty. Even further, genetically engineered crops are often the ones “dumped” as food aid. Rather than just giving a hungry community food, the guidebook advocates ways to attack hunger at the root, to promote sustainable farming and infrastructure for a local marketplace.

Good nutrition is also linked to food security. Both undernutrition and malnutrition are incredibly destabilizing to communities. Food security is directly related to good health, a state of being necessary in order to work, to learn, to fight disease.

The ultimate goal provided by A Community Guide to Environmental Health is self-reliance, or food sovereignty. Unlike farming during the Green Revolution, practices need to be sustainable. Food sovereignty is dependent on how communities grow crops (use of natural fertilizers/pest control, native biodiverse crops, community farmers), how communities trade (at fair prices, local coops, safe storage in food banks, food projects with other nearby communities), and what communities eat (a wide range of nutrition).

A few weeks ago, we discussed the criticisms surrounding the Washington Consensus (and its core theory of neoliberalism), focusing specifically on the negative aspects of fiscal conservatism, trade liberalization, and rapid privatization in relation to development economics. As part of the backlash, new economic theories came to the fore – welfare economics and human development theory – which we will discuss in this week’s post.

Welfare economics “attempts to maximize the level of social welfare by examining the economic activities of the individuals that comprise society” (1). Essentially, the theory boils down to a focus on the individual benefits from economic progress rather than those for the country as a whole – the individual, rather than groups or communities, is the basic unit of an economy, and progress should thus be measured on this micro level. Welfare economics differs from neoliberalism because neoliberalism focuses on the macro level (the shift of an overall economy from centralized to decentralized, for example), whereas welfare economics measures progress based on the overall state of society on an individual level.

Human development theory covers a wider set of principles, as it merges welfare economics with ecological economics, sustainable development, and feminist economics. Specifically, human development theory “focuses on measuring well-being and detecting uneconomic growth that comes at the expense of human health. However, it goes further in seeking not only to measure but to optimize well-being by some explicit modeling of how social capital and instructional capital can be deployed to optimize the overall value of human capital in an economy” (2). This essentially means that economic development can be looked at in terms of the progress made by the individuals contributing to it, but instead of looking just at financial improvements, it also takes social indicators into account. The main method of measurement within human development theory is the Human Development Index, which synthesizes life expectancy, literacy, educational attainment, and GDP per capita into global rankings (3).

As the two aforementioned theoretical principles gained support in the academic world, policy-makers began looking for new ways to focus development around progress on the individual rather than societal scale – a process which eventually manifested itself in the 2004 Copenhagen Consensus, which we will discuss next week.

(1) http://www.economicexpert.com/a/Welfare:economics.html

(2) http://www.economicexpert.com/a/Human:development:theory.html

(3) http://en.wikipedia.org/wiki/Human_Development_Index

For this week’s blog post, I’d like to look into the economic drivers behind global human trafficking. According to a paper published in February of this year, “migration pressure combined with informal migration patterns and incomplete information are the key determinants of human trafficking.”

It is estimated that at least 12 million people are currently trapped in positions of forced labor, and about a fifth of these people are in that condition because of human trafficking. Human trafficking has proved to be one of the most profitable businesses in the world—a fact that is truly terrifying. It is the fastest growing source of income for crime, and is the third most prevalent (below drugs and arms trade). Considering all this, the need to address the economic drivers of this act becomes increasingly important.

However, academic research on this field is lacking. Most research on crime has ignored the issue of human trafficking altogether. Most of this is likely due to the difficulty of gathering reliable data that represents the true parameters of the problem.

According to the paper, human trafficking is the unfortunate byproduct of a world with closed borders in which there is pressure to migrate. Because of a lack of legal means to migrate has led to the formation of such networks for smuggling. These criminal organizations have found a way to make profit from people’s desires to work abroad—in fact, it has become a multi-million dollar industry. The paper also predicts that rates of human trafficking will be highest in areas with high rates of out-migration. Also, people in high-migration areas are expected to take more risks when leaving.

In these ways, we see the way in which the informal sector leads and migration leads to increased rates of human trafficking. For example, an article in the Washington post predicted an increase in prostitution and trafficking in Cambodia as the unemployment rates increased and the economic downturn progressed. In a time of economic changes, it becomes more and more important to look at the effect this will have on health and women’s rights. We need to start devising plans to address such issues before they rise to an unmanageable level.

http://www.washingtonpost.com/wp-dyn/content/article/2009/05/06/AR2009050601222.html

http://www.ifw-members.ifw-kiel.de/publications/the-economic-drivers-of-human-trafficking-micro-evidence-from-five-eastern-european-countries/kap1480.pdf

After discussing some of the general benefits of linking microfinance with health initiatives, and emphasizing a few ways in which microfinance institutions  (MFIs) can incorporate health into the services they provide, I wanted to provide a brief case study on how the partnership can work from the other angle: a health care organization bringing microfinance into its own work. While it was difficult for me to find much clear cut research on health service providers bringing microfinance into the scope of their foci, I was able to learn a bit about this type of partnership through descriptions of some of the work of Partners in Health. PIH began as a simple provider of free, high-quality health care to the poor, but has incorporated more and more socioeconomic-related services into its work. I describe a bit of their microfinance-specific partnerships below.

In describing the model of its work, PIH constantly refers to the need to treat patients with a holistic outlook on well-being, with careful attention to the economic factors that cause or aggravate poor health. They attempt what they call a “comprehensive socioeconomic approach to HIV/AIDS,” for example, pointing out that socioeconomic factors often act as major risk factors for opportunistic infections that prove fatal for AIDS patients. For instance, inadequate housing acts as a strong risk factor for respiratory infections such as TB, lack of screens / mosquito nets is a risk factor for malaria, unpaved floors / lack of shoes can lead to helminthic infections, etc. For these reasons and many others, PIH considers  “the provision of socioeconomic support to impoverished patients and their families… an integral part of any HIV prevention and care package.” The list among the socioeconomic interventions they consider relevant to their HIV work nutritional supplementation, home building projects, and enrollment in microfinance programs. They use established patient assessment metrics to determine which patients they should connect with such economic services, including analysis of “overall economic situation: occupation, educational attainment, history of domestic servitude, history of migration for work, history of displacement, history of detention or imprisonment, land ownership, radio ownership.” To me, it seems like another level of doctor diagnostic work.

One example of PIH’s utilization of microfinance is their partnership in their Haiti site with the Fonkoze Foundation - Haiti’s Alternative Bank for the Organized Poor - the largest MFI in Haiti. The worked with Fondoze to establish branches of the MFI in each of PIH’s clinic locations. PIH provides operational support to facilitate the connection of its patients with Fonkoze’s many services, including microcredit, money transfers, business development, and savings. PIH also chose to work closely with Fonkoze because if the foundation’s emphasis on education, through the literacy training it provides to clients who cannot read or write.  This educational component has direct positive effects both on the client’s economic status, and their potential health, as discussed in our readings and lectures on the connection between health and education. Furthermore, the literacy classes are taught by already literate clients of Fondoze - connecting well with PIH’s model of providing employment options to the people they serve whenever possible through positions such as the community health worker - and focuses on business skills and reproductive health knowledge. PIH stated when it established the partnership in 2003, “Our partnership with Fonkoze will advance our joint commitment to health, education, and economic sufficiency for all.” Six years later, it is still hard to see what long-term outcomes will be, but the partnership seems to be progressing positively.

PIH’s Peru branch, Socios en Salud (SES), offers another example of how the organization has brought microfinance into its work. In 2007, SES decided to adapt its TB model for people living with HIV/AIDS, many of whom were enrolled in a program called Community-based Accompaniment with Supervised Antiretrovirals (CASA), to include microfinance. For several years SES had attempted to facilitate the reentrance into the workforce of HIV patients, and to to help them connect with MFIs. In 2007 they took this a step further, instituting a no-interest microloan program for participants in the CASA program. (My sense is that microfinance is particularly helpful to HIV patients, who face increased difficulty finding or maintaining employment due to the stigma of HIV. But that’s an aside… maybe an interesting topic for another post?)  SES connected the training and services of the microfinance component of their model directly to the rest of the services the patients received through community health care workers. The first group of patients received loans and training to start or grow small businesses. The plan is for the repayment of the loans to be used to fund a new group of patient borrowers. The program is still in its pilot stage, so full efficacy and overall results remain to be seen. It will be interesting to see how this very direct combination of patient services turns out.

I would still love to learn more about the operational end of coordinate microfinance and health services, but this glimpse into some of the efforts PIH has made to merge the two important realms indicates the vast potential for not only incorporation of health information and services into MFIs, as discussed in past weeks, but also the direct possibility of health care providersbeing the ones to bring microfinance into their field of work.

Cited:

“Keeping HIV Patients Health: A Comprehensive Socioeconomic Approach.” http://model.pih.org/HIVmanual/chapter3/section11

“Microfinance Among Peruvians living with HIV/AIDS and extreme poverty.” http://www.pih.org/inforesources/IAS_2008_Mexico_City/Posters/Microfinance_Peru.pdf

“PIH/ZL and Fonkoze: A New Partnership in Haiti,” PIH Winter 2004 Newsletter. http://pih.org/inforesources/newsletters/PIH-Newsletter-2004Winter.pdf