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Case studies > Microfinance report back

Microfinance report back

Converted from MS PowerPoint presentation Despite seeing many important advances in our understanding of the basic science, the epidemiology of infection, and novel approaches for the care and treatment of people living with AIDS, there has been a relentless progression of the disease in country after country (Parker, 2000) Coutinho (1996): Despite broad recognition of the structural factors underlying the HIV epidemic, there is a notable lack of experience with interventions which aim to address them. Instead, emphasis on: Health promotion efforts which assume that providing information alone is sufficient to motivate behaviour change .(eg) “Abstain, Be faithful, Condomise” Technical, health sector interventions. (eg) treatment of STDs, VCT

Structural factors influencing the HIV epidemic: (Parker, 2000)

Complex Problem: Complex Interventions? Coutinho (1996): Despite broad recognition of the structural factors underlying the HIV epidemic, there is a notable lack of experience with interventions which aim to address them. Instead, emphasis on: Health promotion efforts which assume that providing information alone is sufficient to motivate behaviour change.(eg) “Abstain, Be faithful, Condomise” Technical, health sector interventions. (eg) treatment of STDs, VCT

Challenges to structural interventions… (AIDS 14, 2000) Causal links may be unclear/indirect May be seen as coercive Don’t easily conform to experimental design and evaluation frameworks Difficult to standardize; contextual Diffuse benefits; take time to accrue Require expertise outside health sector Hard to change structural conditions!

Intervention with Microfinance for AIDS and Gender Equity The IMAGE study, South Africa
Image = Microfinance + Health promotion
Microfinance: Poverty alleviation strategy Group based access to credit and saving services - creating social networks Proven impact on poverty and gender inequalities: Economic well-being Autonomy and self esteem, status in the HH, decision making (Sebstad, 1996) Health impacts – childhood nutrition, contraception (Mustapha, 1995; Schuler, 1994) Diffusion effect – benefits to non-participants living in the same village

Evaluation Prospective, randomized, community-matched design Participatory Wealth Ranking qualitative & quantitative social, behavioural, biological outcomes assess impact at multiple levels: individual, HH, community 3 years

HIV/AIDS and Microfinance: General Principles

Frustration is the mother of creativity

Structural interventions need to be workable, not just idealistic

Poverty causes disease	< - - - >	Unworkably complex models that span the life course of individuals and populations
Strike the right balance Need for clarity: Level of intervention Conceptual framework Outcomes being measured

Don’t go it alone Create effective partnerships Mutually beneficial Synergy Development is not sector specific, inter-dependency ‘tie-ins’

Be HIV-centric without being HIV specific

Programme Evaluation Best practice Linking research to the policy process

Communities at the centre Consultation and involvement in programme planning and delivery Community advisory boards Natural leaders, champions from within Feedback and dissemination of results

Good mitigation is good prevention - building resilient communities

Finding facilitators…

Scaling up…?

Microfinance is not a panacea ‘process not things’ Integrating HIV into development policies and programmes Need to generate a multi-level response that engages structural issues Agriculture policy, macroeconomic development, trade relations, migrant living hostels, tax incentives, legal interventions Shift from ‘public health policy’ to ‘healthy public policy’

Main organisers:
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