Saha S, Kermode M, Annear P L
Nossal Institute for Global Health, University of Melbourne, Australia; Indian Institute of Public Health Gandhinagar, Gujarat, India.
Nossal Institute for Global Health, University of Melbourne, Australia.
Public Health. 2015 Nov;129(11):1510-8. doi: 10.1016/j.puhe.2015.07.010. Epub 2015 Aug 21.
Women's participation in microfinance-based self-help groups (SHGs) and the resultant social capital may provide a basis to address the gap in health attainment for poor women and their children. We investigated the effect of combining a health program designed to improve health behaviours and outcomes with a microfinance-based SHG program.
A mixed method study was conducted among 34 villages selected from three blocks or district subdivisions of India; one in Gujarat, two in Karnataka.
A set of 17 villages representing new health program areas were pair-matched with 17 comparison villages. Two rounds of surveys were conducted with a total of 472 respondents, followed by 17 key informant interviews and 17 focus group discussions.
Compared to a matched comparison group, women in SHGs that received the health program had higher odds of delivering their babies in an institution (OR: 5.08, 95% CI 1.21-21.35), feeding colostrum to their newborn (OR: 2.83, 95% CI 1.02-5.57), and having a toilet at home (OR: 1.53, 95% CI 0.76-3.09). However, while the change was in the expected direction, there was no statistically significant reduction in diarrhoea among children in the intervention community (OR: 0.86, 95% CI 0.42-1.76), and the hypothesis that the health program would result in decreased out-pocket expenditures on treatment was not supported.
Our study found evidence that health programs implemented with microfinance-based SHGs is associated with improved health behaviours. With broad population coverage of SHGs and the social capital produced by their activities, microfinance-based SHGs may provide an avenue for addressing the health needs of poor women.
女性参与基于小额信贷的自助小组(SHGs)以及由此产生的社会资本,可能为解决贫困妇女及其子女在健康获取方面的差距提供基础。我们调查了将旨在改善健康行为和结果的健康项目与基于小额信贷的自助小组项目相结合的效果。
在从印度三个街区或地区分区挑选出的34个村庄中开展了一项混合方法研究;一个在古吉拉特邦,两个在卡纳塔克邦。
将代表新健康项目区域的17个村庄与17个对照村庄进行配对。对总共472名受访者进行了两轮调查,随后进行了17次关键信息人访谈和17次焦点小组讨论。
与配对对照组相比,接受健康项目的自助小组中的女性在医疗机构分娩(比值比:5.08,95%置信区间1.21 - 21.35)、给新生儿喂初乳(比值比:2.83,95%置信区间1.02 - 5.57)以及家中有厕所(比值比:1.53,95%置信区间0.76 - 3.09)的几率更高。然而,虽然变化方向符合预期,但干预社区儿童腹泻情况的减少在统计学上并不显著(比值比:0.86,95%置信区间0.42 - 1.76),并且健康项目会导致治疗自付费用减少这一假设未得到支持。
我们的研究发现有证据表明,与基于小额信贷的自助小组一起实施的健康项目与改善健康行为相关。鉴于自助小组广泛的人口覆盖范围及其活动所产生的社会资本,基于小额信贷的自助小组可能为满足贫困妇女的健康需求提供一条途径。