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The past decade has witnessed the emergence of many micro finance institutions (MFIs), most notably, a nationwide attempt, pioneered by nongovernmental organisations, and supported by the state, to create links between commercial banks, NGOs, and informal local groups -“self-help groups”. As MFIs both deepen and expand their reach, there is an increasing interest in developing lateral linkages to address a range of their clients’ needs, of which health-related care and expenditure is an important emerging concern. Today there are approximately 1.5 million SHGs across India. It has been estimated that the SHG-Bank Linkage programme reaches some 12 million women and their households. Programme evidence also indicates that interventions with women's groups can positively influence nutrition and health status of women and children. A combination of variables including maternal knowledge and access to information, participatory action planning, and improvements in womens status and decision-making have been associated with improved outcomes. Therefore, the existing and expanding network of these groups offer a strong incentivised channel for strategic interventions in poverty alleviation, capacity building, self employment, enlisting women’s participation in the development process, as well as for strategic intermediations in basic developmental areas like health.
 The past decade has witnessed the emergence of many micro finance institutions (MFIs), most notably, a nationwide attempt, pioneered by nongovernmental organisations, and supported by the state, to create links between commercial banks, NGOs, and informal local groups -“self-help groups”. As MFIs both deepen and expand their reach, there is an increasing interest in developing lateral linkages to address a range of their clients’ needs, of which health-related care and expenditure is an important emerging concern. Today there are approximately 1.5 million SHGs across India. It has been estimated that the SHG-Bank Linkage programme reaches some 12 million women and their households. Programme evidence also indicates that interventions with women's groups can positively influence nutrition and health status of women and children. A combination of variables including maternal knowledge and access to information, participatory action planning, and improvements in womens status and decision-making have been associated with improved outcomes. Therefore, the existing and expanding network of these groups offer a strong incentivised channel for strategic interventions in poverty alleviation, capacity building, self employment, enlisting women’s participation in the development process, as well as for strategic intermediations in basic developmental areas like health.
Based on these opportunities presented by women's self help groups of MFIs, and the positive evidences of working with women's groups for health and nutrition, this action-research project is centred around federated women’s micro credit self help groups as sites for community intervention in health and nutrition, with a particular focus on concerns of young girls, pregnant women and children. Located in the rural and tribal contexts of Tamil Nadu and Andhra Pradesh, across 6 districts - Madurai, Ramanathapuram, Dindigul, Theni, Thanjavur, and Adilabad, the project covers ten federations (approximately 200,000 population). Established in 2004, the initiative is structured around the concept of self-health governance which integrates micro-finance and health care by promoting health intermediation with the Self Help Group Federations promoted by the Kalanjiam Foundation, a subsidiary of DHAN Foundation which is a development institution with its base in Madurai, Tamil Nadu. Kalanjiam Foundation coordinates the Kalanjiam Community Banking Programme, providing technical and managerial support to the development of institutions that are owned and managed by the poor. Unlike most MFIs, that function as financial aggregators, the Kalanjiam Foundation has a human development orientation, with emphasis on social aggregation at the community level to undertake programmes in health, education, and other community issues, promoting and managing structures of self health and education which are linked with locally functioning mainstream institutions.
Integrating a strong operations research component into its design, the project seeks to study health intermediation and the potential of community participation in health through people’s institutions such as Self Help Groups; and the integration of micro finance and health in ensuring better health outcomes and demonstrating the sustainability of a community-based health care system owned and managed by the poor. The Foundation for Research in Health Systems (FRHS) has been the collaborating partner for formative research in the project.
To take forward the above-mentioned objectives, the key intervention strategies of the project include the following:
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Behaviour Change
Communication: Innovative Behaviour Change Communication
as key approach in negotiating changes in Knowledge, Attitudes
and Practices at the individual, household and community levels.
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Case Management:
This involves supporting women (both individually and
in groups), through stages of their pregnancies, delivery and
postnatal care, as well as during the first few years of child-care.
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Linkage Building
with Mainstream Service Delivery: Improving quality,
access and responsiveness of available resources to vulnerable
communities, through creating forums and avenues for interaction
between the Kalanjiam Federations and core health and nutrition
systemic structures at various levels. The constitution of a
steering committee and representative District and Block level
forums are some approaches designed to institutionalise such
relationships.
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Access to Diagnostic
and Referral Services: Diagnosis of common morbidities
and suitable referral become important in early identification
of illness, which is turn, will reduce unnecessary expenditure
due to late identification and inappropriate treatment. This
involves arrangement of block level diagnostic and referral
camps that address major contextual illnesses.
Interventions are translated through a cluster-level worker selected from one of the Kalanjiams called the Kalanjiam Health Guide (KHG), whose primary responsibilities are to work with the Village Health Nurse and the Anganwadi Worker on community based behaviour change communication and case management. Village health forums (VHFs) comprising of representatives from Kalanjiams in the village supports the activities of the KHG. Within the federation structure, Health Associates (HA) (two in each federation), and a Health Coordinator (HC) (one per federation) are responsible for guiding and supporting field efforts. The Health Associates are women with experience in the micro-finance activities of the federation and hence is familiar with contextual issues. They are the prime persons responsible for building linkages with mainstream health and nutrition systems and structures of delivery. The Health Coordinator is a technically qualified person whose responsibilities are to integrate all health activities in the federation. Sub-studies on anemia, child nutrition and health expenditure have also been planned and initiated.
Over a period of time, this project will also provide insights into the viability of the financing of health activities through the federations’ funds, help distill learnings in integrating health and nutrition interventions through such groups in different contexts, as well as in developing a ‘model’ whose components can be scaled and mainstreamed through appropriate systems and processes.
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