Appraising the Poverty Outreach of Microfinance: A Review of the CGAP Poverty Assessment Tool (PAT)

Assessment of the poverty level of microfinance clients is important for both practitioners and donors. For practitioners, increased understanding of the target market and whether it is being reached can help in the design of financial services better suited to the needs of different groups of clients. For donors seeking to ensure the most effective use of their scarce resources for combating poverty, poverty assessment is used to assist in making decisions on resource allocation. While there is much evidence that microfinance can be a critical input towards the achievement of the Millennium Development Goals and the reduction of poverty (Littlefield et al. 2003), the impacts of microfinance are not automatic. To achieve significant directs impacts on poverty it is essential that Microfinance Organisations (MFOs) reach poor and very poor clients, and therefore measurement of poverty outreach becomes an important proxy indicator for the success of microfinance in achieving impacts on poverty. This paper is aimed at donors, policymakers and practitioners interested in the mechanisms by which the poverty level of microfinance clients can be assessed. It is primarily a review of the CGAP Poverty Assessment Tool (PAT), and highlights the potential applications for the tool, issues to consider in its use, and possible further steps in the development of the tool. It goes on to consider the broader issue of poverty assessment in microfinance, and proposes an important additional use for the PAT in validating and improving the credibility of low-cost practitioner assessment and monitoring tools.Financial Economics, Food Security and Poverty,

Identification of poor households for premium exemptions in Ghana’s National Health Insurance Scheme: empirical analysis of three strategies

OBJECTIVES: To evaluate the effectiveness of three alternative strategies to identify poor households: means testing (MT), proxy means testing (PMT) and participatory wealth ranking (PWR) in urban, rural and semi-urban settings in Ghana. The primary motivation was to inform implementation of the National Health Insurance policy of premium exemptions for the poorest households. METHODS: Survey of 145-147 households per setting to collect data on consumption expenditure to estimate MT measures and of household assets to estimate PMT measures. We organized focus group discussions to derive PWR measures. We compared errors of inclusion and exclusion of PMT and PWR relative to MT, the latter being considered the gold standard measure to identify poor households. RESULTS: Compared to MT, the errors of exclusion and inclusion of PMT ranged between 0.46-0.63 and 0.21-0.36, respectively, and of PWR between 0.03-0.73 and 0.17-0.60, respectively, depending on the setting. CONCLUSION: Proxy means testing and PWR have considerable errors of exclusion and inclusion in comparison with MT. PWR is a subjective measure of poverty and has appeal because it reflects community's perceptions on poverty. However, as its definition of the poor varies across settings, its acceptability as a uniform strategy to identify the poor in Ghana may be questionable. PMT and MT are potential strategies to identify the poor, and their relative societal attractiveness should be judged in a broader economic analysis. This study also holds relevance to other programmes that require identification of the poor in low-income countries

Protein clearances and renal protein selectivity in the proteinurias of pregnancy

Ever since the association between altJ.Jminuria and eclampsia was noted by Lever in 1843, the kidney has figured in the forefront in the search for aetiological factors. Lever, who was a contemporary of Bright at Guy's Hospital, observed the close similarity in appearance between many of his eclamptic patients and patients with Bright's disease. Examination of the urine was the logical next step. Having fould albumin in nine out of ten eclamptic patients in whom the urine had been examined, he went on to exanine the urine of fifty "normal 11 controls, and (rather surprisingly, since one would have anticipated a proportion of unrecognised preeclamptic patients amongst these) found albumin to be absent in every case. Lever recognised the "transitory nature 11 of pregnancy proteinuria and concluded that the condition differed from the permanent proteinuria of Bright's disease.In the same month of the same year (1843), Simpson made a similar observation in Edinburgh regarding proteinuria and eclampsia. Whilst also recognising that albuminuria disappeared in those patients who survived, he never theless attributed the syndrome of albuminuria and convulsions to underlying Bright's disease. This was a view that persisted for some time despite its obvious inconsistencies. Carl Braun of Vienna endorsed this concept and the chapter dealing with albuminuria and eclampsia in his "Lerbuch" was translated and run as a series of articles in the Edinburgh Medical Journal (1856 57). In this work, Braun states firmly that eclampsia is a direct result of the uraemia resulting from poorly functioning kidneys. The kidney featured prominently in many subsequent theories on aetiology but the idea of primary renal disease being the origin of the process leading to eclampsia was shortlived

Poverty, voice and advocacy: a Haitian study

Over the past ten years, Fonkoze (a non-profit organisation in Haiti) has adapted the 'graduation' model of lifting families out of extreme poverty through its Chemen Lavi Miyò (CLM) or 'pathway to a better life' programme. Yet despite international recognition for this approach, Fonkoze’s work is little known within Haitian policy circles on social protection and poverty. This paper is the product of a 12-month action research project by Fonkoze with support from the Institute of Development Studies (IDS). It used a rapid outcome mapping approach (ROMA) as a framework for creating an advocacy strategy through which Fonkoze could influence the development of Haiti’s social protection policy. It also aimed to give voice and promote downwards accountability to people who have lived experience of ultra-poverty by enabling them to articulate their views within the policy process. he report concludes by highlighting the problem that donors tend to channel their resources through separate government ministries or departments, which though inevitable (to some extent) given the context, is also unhelpful in promoting a coordinated social protection policy.DFIDUSAIDSidaOmidyar Networ

Environmental flow requirements: A social dimension

Environmental flow requirements: A social dimensio

Assessing household wealth in health studies in developing countries: a comparison of participatory wealth ranking and survey techniques from rural South Africa

BACKGROUND: Accurate tools for assessing household wealth are essential for many health studies in developing countries. Household survey and participatory wealth ranking (PWR) are two approaches to generate data for this purpose. METHODS: A household survey and PWR were conducted among eight villages in rural South Africa. We developed three indicators of household wealth using the data. One indicator used PWR data only, one used principal components analysis to combine data from the survey, while the final indicator used survey data combined in a manner informed by the PWR. We assessed internal consistency of the indices and assessed their level of agreement in ranking household wealth. RESULTS: Food security, asset ownership, housing quality and employment were important indicators of household wealth. PWR, consisting of three independent rankings of 9671 households, showed a high level of internal consistency (intraclass correlation coefficient 0.81, 95% CI 0.79-0.82). Data on 1429 households were available from all three techniques. There was moderate agreement in ranking households into wealth tertiles between the two indicators based on survey data (spearman rho = 0.69, kappa = 0.43), but only limited agreement between these techniques and the PWR data (spearman rho = 0.38 and 0.31, kappa = 0.20 and 0.17). CONCLUSION: Both PWR and household survey can provide a rapid assessment of household wealth. Each technique had strengths and weaknesses. Reasons for differences might include data inaccuracies or limitations in the methods by which information was weighted. Alternatively, the techniques may measure different things. More research is needed to increase the validity of measures of socioeconomic position used in health studies in developing countries

Small individual loans and mental health: a randomized controlled trial among South African adults

<p>Abstract</p> <p>Background</p> <p>In the developing world, access to small, individual loans has been variously hailed as a poverty-alleviation tool – in the context of "microcredit" – but has also been criticized as "usury" and harmful to vulnerable borrowers. Prior studies have assessed effects of access to credit on traditional economic outcomes for poor borrowers, but effects on mental health have been largely ignored.</p> <p>Methods</p> <p>Applicants who had previously been rejected (n = 257) for a loan (200% annual percentage rate – APR) from a lender in South Africa were randomly assigned to a "second-look" that encouraged loan officers to approve their applications. This randomized encouragement resulted in 53% of applicants receiving a loan they otherwise would not have received. All subjects were assessed 6–12 months later with questions about demographics, socio-economic status, and two indicators of mental health: the Center for Epidemiologic Studies – Depression Scale (CES-D) and Cohen's Perceived Stress scale. Intent-to-treat analyses were calculated using multinomial probit regressions.</p> <p>Results</p> <p>Randomization into receiving a "second look" for access to credit increased perceived stress in the combined sample of women and men; the findings were stronger among men. Credit access was associated with reduced depressive symptoms in men, but not women.</p> <p>Conclusion</p> <p>Our findings suggest that a mechanism used to reduce the economic stress of extremely poor individuals can have mixed effects on their experiences of psychological stress and depressive symptomatology. Our data support the notion that mental health should be included as a measure of success (or failure) when examining potential tools for poverty alleviation. Further longitudinal research is needed in South Africa and other settings to understand how borrowing at high interest rates affects gender roles and daily life activities. CCT: ISRCTN 10734925</p