1

Health and Poverty

Mayeesha YH TsengPh.D Candidate

Institute of Health Policy and ManagementNational Taiwan University

2

1.Agree2.Disagree

1. People in a poor country suffer from ill-health

3

Growth of life expectancy by increase of GDP/capita in Bangladesh, Japan and USA, 1960-2008

4

1. Can’t do or demand anything.2. Government should ensure universal health

care, despite the ability to pay.3. Charity organizations should offer help.4. Sell all properties to buy back health.5. Borrow money from friends or bank for

treatment.

2. When a poor person gets sick,…

5

1. Government service is trustworthy.2. It is cheap.3. It offers quality care.4. It is close to where you live or work.5. It ensures privacy.

3. When you are sick, you choose to go to public health facilities because…

6

1. Private service is trustworthy.2. It offers quality care.3. It is cheap.4. It is close to where you live or work.5. It ensures privacy.6. Doctors give you more time.

4. When you are sick, you choose to go to private health facilities because…

7

1. Healthy people contribute to economic growth and productivity.

2. Health itself is important. (health as an end)

3. Health is a tool that enables us to live a life we value. (health as a means)

5. Population health is important for a society because…

8

Determinants of Health

9

Poverty & Health

MICROCREDIT A global movement

10

Microcredit: specially designed collateral free, small loans for the poor who have no access to loan. Also referred to as Microfinance.

Microcredit: from 1976 to 2012

11

Region Total clients Poorest women clients

Asia & the Pacific 169,125,878 104,752,430

Latin America & the Caribbean 13,847,987 2,363,100

Sub-Saharan Africa 12,692,579 4,783,256

Middle East & North Africa 4,290,735 1,165,358

Developing World Totals 199,975,179 113,064,144

(Microcredit Summit Report 2012)

12

Banks do not have microcredit programs. Conventional banks don’t offer microloans.

Micro Finance Institutions (MFI) : An NGO (Non-governmental organizations ) that runs Microcredit program

3,589 microfinance institutions (MFIs) in 145 countries

Who operates Microcredit program?

13

Characteristics of Microfinance Institutions (MFIs)

1. Rural based 2. Integrated network with grassroots

communities 3. Motivate poor women 4. Skill in group formation5. Conflict resolution capacity6. Comprehensive monitoring system

14

Microcredit in Bangladesh

15

Credit Where Credit’s Due

A documentary (23 min)

16

Who receives Microloans?98% of microcredit borrowers are poor village women

17

Income Generating Activities

Homestead

Technology

19

GraduationFrom Home to Factory - Business Center

20

Why Women?

21

Group Exercise (10 min break + 30 min discussion)

1. Every subgroup is a solidarity group in a rural setting

2. Within NT$5,000, everyone will propose an income generating plan

3. Pay back NT$5,750 in 51 weekly installments4. Smooth repayment ensures disbursement for

the next group member5. Group leader is the last to borrow6. MFIs give no suggestion about your

investment7. At the end of discussion, group leaders report

business profiles of your group to TAs

22

Business Profiles of NTU Village1A 1B 2A 2B 3A 3B 4A 4B 5A 5B

Raise cow

Grocery

23

8. Impact of Microcredit

On women? On children? On family? On health? On economy? On society? On others?

Identify at least 2 aspects

24

Study Design

Impact on poverty alleviation

Impact on women’s

empowerment

Impact on health

Impact on other outcomes

Review Steward (2010) ±Hermes (2011) ±

Steward (2010)＋Hermes (2011) ＋

Leatherman(2011)＋Steward (2010) ＋Schurmann (2009)＋

Lund (2011) －

Cross-sectionalSurvey

Nawaz (2010) ＋Panda (2009) ＋Kotir (2009) －

Mahmud (2003) ＋

Nawaz (2010) ＋Pitt (2003) ＋

Ahmed (2002) ＋De Silva (2007) －

Ahmed (2001)** n/e

Panel Karlan (2011) －Khandker (2005) ＋Amin (2003) －

Karlan (2011) － Karlan (2011) － Berhane (2011)＋[housing]

critique,

commentary,

anthropology,

Policy analysis

Lashley (2008) ＋Bond (2007) －

Mohindra (2005)＋Bond (2007) －

Rahman (1999) －Goetz (1996) －

Pronyk (2007)＋Mohindra (2008)＋Mohindra (2005)＋

Bond (2007) －

Dowla (2006)－[social capital]

25

A magic bullet to alleviate poverty?

Microcredit and Health Provision

1. MFIs run private clinics/hospitals for its clients

WHY? GOOD OR BAD?

2. Microcredit borrowers run pharmacies and clinics.

GOOD OR BAD?

26