Chronic hunger is an indicator of extreme poverty, and poverty and ill health are closely linked. Imagine having to make a choice between feeding your family today, or buying medicine to cure your child who is feverish with malaria! When a chronically hungry mother is taking meaningful steps (like running a tiny but successful business) toward pulling her family out of poverty and providing adequate food for the household, a single illness can wipe out months or even years of progress – sending the family back to where they began.

The vast majority of health problems that chronically hungry people face are 100% avoidable. But many people lack basic knowledge about preventive practices, or the cash in hand necessary to see a doctor or purchase medicine before a simple illness turns into a grave emergency, or access to affordable and high-quality medical care and health products in their isolated communities.

Freedom from Hunger’s microfinance partners have relationships with thousands of poor women in remote areas – relationships based on the trust that comes with regular meetings, loan repayments and savings deposits. We believe that by building on these relationships to bring critical health products and services to poor women and their families, Freedom from Hunger and our partners can have a much greater impact on people’s ability to end their own hunger for good.

Malnutrition is the most pressing health problem faced by the world’s poor, and no, it certainly does not get adequate attention. Malnutrition is a silent undercurrent in so many diseases of poverty. Under-nutrition predisposes children to killers like diarrhea and malaria, while over-consumption of the high-fat, high-sugar, nutrient-poor foods that are increasingly replacing traditional, more nutritious staples in poor communities, paves the way to chronic diseases like diabetes and cardiovascular disease.

Implementing more effective and sustainable solutions to addressing malnutrition on a massive scale would have a dramatic impact on the health of the world’s poor. And that is precisely what Freedom from Hunger is working to achieve.

Credit with Education is an approach that Freedom from Hunger pioneered almost 20 years ago, combining group-based microfinance services with interactive education on health and business topics. Freedom from Hunger has conducted rigorous evaluations to establish the impact of Credit with Education.

These evaluations have shown that:
- Credit with Education improves Women’s Empowerment (in terms of civic involvement, strength of social networks, confidence)
- Women have greater income, savings, and assets which helps them cope with income shocks and reduces risk of hunger.
- Women who participate in education sessions are more likely to adopt better practices that lead to improved nutritional status of themselves and their children.

MAHP builds on our experience and learnings related to Credit with Education and seeks to go beyond the provision of health education to offer a variety of complementary health-related services.

The goal of the Microfinance and Health Protection initiative is to develop a set of tested approaches for microfinance institutions to effectively and sustainably address the most pressing health needs of their clients. Our partner microfinance institutions are experimenting with innovations like practical education on prevention and home-based treatment, dedicated health savings accounts, health loans for major medical expenses, health insurance mechanisms, linkages to doctors, and entrepreneurial approaches to getting life-saving, over-the-counter health products like anti-malarial bed nets and oral rehydration salts out to isolated communities who need them. (An example of the latter is microfinance clients selling health products door to door with training and mass sourcing provided by the microfinance institution.)

We are measuring results by looking at whether such products and services do in fact reduce the incidence of common health problems, whether participants experience fewer economic shocks and are able to better run and grow their businesses, repay loans and build savings, as a result of having access to health protection services. We are also examining the capacity of microfinance institutions to offer such services without negatively impacting their core business – in fact, our hypothesis is that the microfinance services they provide will be strengthened by health protection services, since clients will have better health for themselves and their families, and more productive time to focus on income generating and other activities.

You can help by becoming a virtual volunteer and spreading the word online. Send one of the e-cards that are available on our website, join our Facebook and MySpace groups, or mention Freedom from Hunger on your personal website.

If you are looking for a non-traditional way to help build awareness and support for Freedom from Hunger, we encourage you to try one or all of these activities: host a party, plan a car wash, start a Freedom from Hunger Chapter at your school or club, or organize a jog-a-thon or read-a-thon. For more information, Visit our website at http://www.freedomfromhunger.org/action/, or join our 4:00 pm chat with current intern Krystal Beckham and staff member Julie Helmus. They will be able to provide you with more ideas on how to get involved.

Freedom from Hunger focuses on innovation, and that is the hallmark of all our initiatives. As a result, while all of our work aims to achieve the same goal of ending hunger for good, each initiative is unique.

The Microfinance and Health Protection initiative is focused on breaking new ground in integrating microfinance with health-related products and services.

It builds on Credit with Education to help microfinance institutions add linkages to doctors, community-based microinsurance, health product distribution, and more.

It is distinct from our Reach initiative (which you may have learned about in Alay's chat today), which is focused on distributing innovative services at massive scale.

And it is different from Microbusiness for Health (which you may have heard about earlier in Danny's chat) and its franchise network of Health Keepers, in that MAHP involves microfinance institutions as the key actors and drivers in providing the products and services.

MAHP is a 4-year innovation period with a limited number of microfinance institutions. Our goal is to experiment with new services and approaches, distill lessons about how these can best be delivered in the future, and then -- at the end of the initiative -- share the learnings, models and management tools very broadly with microfinance institutions around the world.

For MAHP, we needed a small number of microfinance institutions that were committed to innovation and interested in health-related solutions for their clients. We looked to organizations with which we had worked before on Credit with Education, as well as organizations new to Credit with Education. We sought a diverse array of institutional sizes, structures and operating contexts, so that we could experiment with offering microfinance and health services in as many different environments as possible.

Microfinance institutions are reaching out to and successfully serving tens and hundreds of thousands of poor women each, and many of these are in hard-to-reach areas. Meanwhile a challenge of the health sector has been to reach people outside urban areas with health interventions at great scale and on a sustainable basis. Given the synergies between economic and health interventions, using microfinance as a "platform" to extend other needed services -- especially in health -- can be extremely powerful. And using the income-generating element of microcredit, along with the business savvy of microfinance managers can lead to public health services that essentially pay for themsleves.

Each context is different. In Africa, infectious diseases like malaria are much more common, while in India and the Philippines, and even Bolivia, chronic diseases like cardiovascular disease and diabetes are major issues.

The microfinance institutions participating in MAHP are each offering a unique “package” of health protection services, based on detailed market research in the field as well as secondary research on local health-related needs and gaps. Here are descriptions of these unique packages.

Bandhan is providing its clients in India with health education on prevention and treatment of common ailments such as diarrhea, gynecological problems and tuberculosis. This education is accompanied by access to affordable, high-quality health products such as oral rehydration salts, paracetamol and water disinfectant solutions. Both the education and health products are delivered by village health entrepreneurs selected and trained by Bandhan. Bandhan is also providing health micro loans to cover more serious health issues, such as those requiring hospital care.

CARD is pursuing the development of two health protection service packages in the Philippines. In an urban pilot area, CARD is offering its clients health loans to pay the premium for PhilHealth, a national health insurance program that provides hospital coverage to CARD clients through a partner-agent model. In a rural and semi-rural area, CARD is creating linkages with health care providers to increase affordable access to primary care and exploring a franchise network for distribution of affordable essential drugs. CARD is also extending health education on financial planning for better health, rational use of available health services, and on preventing and treating dengue fever.

CRECER is providing its clients in rural Bolivia with linkages to health care providers who regularly visit communities to conduct “health days” when primary care and basic diagnostic services are made available. Group health loans help clients pay for these community-based services. Individual health loans are also available to cover referrals for major health needs such as surgery. New health education sessions focus on prevention and treatment of common and chronic illnesses, effective health-seeking behavior and managing health-related financial risks.

PADME is instituting Credit with Education with a particular focus on health in rural Benin. Behavior-change education will be delivered on malaria (a high economic burden in the area), common but deadly childhood illnesses and HIV/AIDS. To complement the health education, PADME is providing access to health products, such as insecticide-treated bednets, oral rehydration salts and condoms. PADME will also conduct a feasibility study on establishing a prepaid health plan whereby health care services would be provided to enrolled clients for a flat annual fee.

RCPB’s innovation package in Burkina Faso includes three complementary financial products: health savings to cover primary care and medicine for common illnesses; health loans to cover treatment that exceeds clients’ health savings; and a health solidarity fund for communities to invest as they wish toward the improvement of local health services and issues. RCPB is also offering health education on planning ahead to pay for health expenses and advocating for better health services. RCPB is promoting quality care for its clients by forming alliances with rural health centers.

Most of our microfinance institution partners are able to cover all of their operating expenses with revenues from their loans. Some do continue to receive subsidies.

In terms of Credit with Education, our partners typically find it possible to break even and offer the service sustainably within two to three years of beginning the service. In some cases, the institutions continue to offer Credit with Education with corss-subsidies from their other products, because Credit with Education serves their social mission and helps them broaden their services to new markets.

Freedom from Hunger intends to reach three million very poor women and their families by the end of year 2010.

To achieve this, we are working on the one hand to develop innovative products and services that truly meet the needs of chronically hungry people, and on the other hand to establish distribution mechanisms that will enable our innovations to be extended on a massive scale.

We know this is possible, and with the support of our partners, staff and people like you around the globe all committed to ending hunger -- we know we will achieve it.

Freedom from Hunger brings technical expertise to organizations based in developing countries, to assist them in designing, testing and evaluating innovative products and services.

Our staff and resource people travel to and communicate with local organizations on a regular basis. This "technical assistance" helps local organizations to: carry out market research; design products that can be offered at scale and on a sustainable basis; develop and implement management tools that ensure sound supervision, good internal controls, and quality of care; evaluate the impact of the new services on both clients and the institution itself; and fulfill their social missions to improve the lives of the very poor.