A review of organizational arrangements in microfinance and health programs.

BACKGROUND:Combining health programs with microfinance is gaining more recognition as a pathway for improving health and increasing access to health services among the poor, especially women living in low-income countries. Recently published reviews have summarized the changes in health behaviors and health outcomes due to the effective layering of health interventions with microfinance initiatives. However, a large gap remains in defining and understanding the organizational strategies for implementing effective health programs and services that improve the health and social well-being of women and their families. METHOD:As microfinance organizations and the global health community recognize the largely untapped potential of developing effective multidimensional channels of providing access to a variety of health interventions through a microfinance platform, there is a need for more evidence to guide organizational strategies that are feasible, sustainable and produce results. We developed a framework and classification scheme for identifying organizational arrangements between microfinance and health, outlined the criteria for article identification and selection, and reviewed original articles that included a discussion on organizational strategies published in peer-reviewed journals to better inform future research and effective program development. RESULTS:Our review found that most MFIs operate in cooperative and collaborative partnerships for expanding health and social services with health education as the leading intervention. The extreme ends of the integration-partnership continuum, ie, no partnership on one end and complete merger on the other, are rare if they exist. CONCLUSIONS:The drivers of organizational strategy are related to the context, health needs of the clients, and individual capacities of MFIs to develop effective services. However, approaches to establishing these processes and decision-making for effectively structuring and delivering health and microfinance services is an inadequately explored area. Future progress depends on bridging public health, microfinance, and organizational research silos to study how different organizational arrangements affect implementation and outcomes.