Evaluating health outcomes for microcredit clients

BACKGROUND: An increasingly popular scheme for poverty alleviation is microcredit, the awarding of small loans to individuals who are too poor to access traditional banking services. Several studies have questioned the ability of microcredit programs to positively impact the financial standing of borrowers, and only a handful have examined whether the added income improves health outcomes. METHODS: This study is a cross-sectional analysis of baseline data from an ongoing randomized controlled study that seeks to evaluate the potentially synergistic impacts between microcredit services and health education. Data were collected in February 2007 from 1,593 female microcredit clients of a microcredit organization in Peru. This included information on demographics, socioeconomic status, and various health indicators, including general health, nutrition, and mental health. The main predictor variable was length of participation as a microcredit client. RESULTS: Women reported 2.4 ± 6.1 sick days in the last month, and 35.8% reported receiving a cancer screening in the last year. Mean body mass index (BMI) was 28.0 ± 4.77. Mean hemoglobin was 12.4 ± 1.3 g/dL. Women reported 18.3 ± 8.6 depressive symptoms on the Center for Epidemiological Studies Depression scale, with 52.2% exceeding the cut-off at which professional care is recommended. In unadjusted analyses, longer participation was significantly associated with more sick days in the last month (p=0.09), higher BMI (p=0.06), higher hemoglobin (p<0.01), and fewer depressive symptoms (p=0.01). After controlling for age, marital status, education, and poverty level, longer participation only remained significantly associated with higher hemoglobin (p=0.04). The significance and magnitude of other associations was reduced, suggesting these relationships were confounded by demographic and socioeconomic factors. Moreover, a decrease in the number of participants who had remained clients for more than two years suggests the possibility of significant drop-out rates and survivorship bias, such that unadjusted analyses may further overestimate positive impacts. CONCLUSIONS: These findings question the impact of microcredit on health outcomes and highlight the need for further investigations. This information will be crucial in deciding how to proceed with the funding and planning of microcredit programs, which have been proposed as an important mechanism for economic and social development in the developing world.