Delivering Sustainable Health Services through Microfinance
by Agnes Cho, program associate, Global Partnerships
With the support of the Inter-American Development Bank (IDB), Linked Foundation, FMO (the Dutch development bank) and other generous funders, Global Partnerships has worked with five of our partners in five countries since 2011 to design, implement and scale sustainable business models. In August, GP traveled with three of our health partners to La Paz, Bolivia to present these learnings at the 7th Annual Latin American Village Bank Forum. The presentation represented more than three years of learnings from piloting and scaling these programs, including case studies on four separate business models.
Latin American microfinance has its roots in the high-impact village bank methodology, which was developed to extend financial inclusion and complementary products and services to the world’s poorest people. Since the origin of village banking, this methodology has been used to deliver microloans, savings and business education to improve the lives of people, mostly women, living in poverty and build up their economic resilience.
At the heart of village banking is the recognition by mission-driven MFIs that credit is just one of many tools to help people living in poverty. As part of GP’s Health Services initiative, we work with partners confronting the constant challenges of poor health and limited access to quality health services that their clients face. These challenges are often significant contributing factors to persistent poverty, and the group lending platform provides our partners with a touch point through which they can efficiently and effectively respond to the health needs of their clients.
There are numerous ways in which MFIs can deliver a health program shaped by client need, market demand and regulatory context. The Global Partnerships moderated panel at this year’s Forum featured the business models used to provide health services to clients by three of our MFI partners: Friendship Bridge in Guatemala, Fundación ESPOIR in Ecuador and Pro Mujer in Nicaragua.
All three organizations leverage their clients’ monthly repayment meetings to provide tailored education sessions about common health needs. Pro Mujer and Fundación ESPOIR* also run their own health clinics, where they provide basic preventive screenings and primary care consults. Pro Mujer markets an optional package with coupons that can be redeemed for specialized medical attention and Fundación ESPOIR offers clients access to a national network of dentists, clinics and pharmacies through a micro-insurance package. Friendship Bridge has created a strategic alliance with a third-party health provider for consults focused on women’s health via mobile clinics that travel to client communities.
As MFIs and other social enterprises redouble their commitment to addressing clients’ holistic development needs beyond access to credit, knowledge sharing is critical. With this in mind, as well as the goal of helping organizations throughout the global development sector further develop, refine and scale sustainable business models that provide high-impact, non-financial services, Global Partnerships is working to disseminate the lessons we and our partners have learned. The panel at this year’s Latin American Village Bank Forum was an ideal setting in which to present these key learnings. GP will continue to share and discuss these learnings at other industry events, including the ANDE (Aspen Network of Development Entrepreneurs) Annual Conference the week of Oct 1, 2015. These discussions focus on some of the key questions raised by GP’s work with our health services partners:
- Should MFIs build their own clinic infrastructure or create alliances with third-party providers?
- Should MFIs opt for a prepaid or insurance model? A voluntary or mandatory health package?
- How can critical health services be delivered sustainably by MFIs and other organizations working in global development?
We delve into these questions in greater detail and present the full scope of Global Partnerships’ Health Services Initiative to date in our recently published case study, Sustainable Health Solutions for People Living in Poverty in Latin America.
Blog Tags: Ecuador Espoir Friendship Bridge Guatemala health health services Health Services Fund Latin America microfinance Nicaragua Pro Mujer in Nicaragua sustainable health village bank women's health
Reflections on Impact Evaluation
by KJ Zunigha, impact evaluation officer, Global Partnerships
Last month, I joined nearly 100 of my monitoring and evaluation peers in Washington, DC to talk impact, measurement and data at the 2015 Metrics Conference hosted by the Aspen Network of Development Entrepreneurs (ANDE). Held annually since 2010, the conference provides people working in the impact evaluation space the opportunity to dig deep into the exciting, challenging and often nebulous nature of measuring how much and what kind of impact the social enterprises in which we invest are having on the lives of the people they serve.
Three of the top themes that emerged from the conference were:
1. Right-sizing evaluations
Although randomized controlled trials (time- and resource-intensive studies) are considered the gold standard in evaluation, they are not always the right type of evaluation to conduct. As an impact investor working to categorize and evaluate the impact we and our partners have at the household level, Global Partnerships (GP) needs to look at the size of the project, the question(s) we want answered, and the resources we and our partners have available to help guide evaluation design. We must always keep our partners and their clients at the forefront of this process so that any evaluation activities we undertake do not overly burden or interrupt the work of the people we are ultimately working to serve. The right evaluation must be as rigorous as possible within the bounds of the environment in which we and our partners operate.
2. Understanding different audiences and communicating effectively
Impact evaluators collect, analyze, synthesize and report impact data for a wide variety of audiences, each of which has different needs. Some may need only an "elevator pitch" or talking points, some want to dive deep into the details, while others are looking for a specific kind of finished product—a case study, a story, a trend report or projection. There are countless ways we can measure, discuss and share data, so as evaluators it is critical for us to understand the needs of our various audiences so that we are able to communicate our work effectively.
3. Maintaining continuity with investors at all stages
GP provides debt financing to social enterprises that are looking to grow and scale their organizations, and may be one of a number of investors and supporters. Too often in this sector, investors at various stages in a social enterprise's development don't communicate their measurement approaches. This creates the likelihood of a dramatic shift in measurement activities and data requirements—and a potentially significant burden for the social enterprise—as it grows and seeks new types of capital.
While measurement approaches and indicators may change as a social enterprise grows and matures, it is important that all investors at every stage of a social enterprise's development have visibility into each other's measurement activities to create a more streamlined approach and a sense of continuity.
Tara Murphy Forde, GP's Director of Impact & Strategic Initiatives, led a conference session on this topic with Vox Capital's Rebecca Obara, looking at the impact frameworks of their respective organizations. The session focused on Vox's custom, hands-on approach to working with its investees as an early-stage investor, and GP's approach that focuses on impact at the household level across our portfolio and multiple initiatives. One way GP supports visibility into our impact framework is by feeding our data into IRIS (Impact Reporting and Investment Standards), a database of social impact metrics intended to help create a common framework for impact measurement.
Perhaps the greatest overall takeaway from this year's ANDE metrics conference is that, with our broad portfolio of initiatives, Global Partnerships' best opportunity to gain meaningful data and insight is to approach impact measurement with flexibility. With an eye on the big picture, the data we collect from each of our partners can tell us about what their work really means for the people they serve.
If you enjoyed this post, you might also like:
- Meet KJ, GP's new impact evaluation officer
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4 things learned at Mission Investors Exchange
by Jason Henning, VP, Investor & Donor Relations, Global Partnerships
I recently attended the Mission Investors Exchange 2014 National Conference, a gathering of foundations and others in the philanthropic community focused on sharing insights and experiences around investing for social impact.
This is the third MIE I’ve attended, and one particularly encouraging trend I’ve observed is this: foundations are moving off the sidelines. They are going beyond educating themselves on program and mission-related investments, to exploring opportunities that can enable them to acquire firsthand experience. Over three days of smart, substantive conversations, here are four of the most compelling insights I heard:
1. “The capital markets are great at scaling things, but not at pioneering.”
- Kat Taylor, CEO, One PacificCoast Bank
While microfinance has been heralded around the world as a successful example of a market-sustained approach to alleviating poverty, most people forget the sector was originally nurtured with billions in philanthropic support. Foundations, with a range of capital at their disposal, can play a vital role in testing and proving early stage opportunities that have enormous potential.
Similar to point #1, most of the capital stacking up in the impact investing sector is seeking risk-adjusted market rate returns. The problem is there aren’t enough impact-generating opportunities to match this type of capital. What’s truly needed in the field are investors willing to take bets on emerging, disruptive business models that have the potential to scale and reach millions of people living in poverty. Or more appetite for opportunities that focus on underserved, last-mile communities, understanding that the economics of serving these communities don’t lend themselves to high financial returns.
The inference here is that “intermediaries” does not fully describe the value these actors bring to the impact investing space. Fund managers and other intermediaries provide sector expertise, lower risk for investors, manage strong networks along specific value chains, hold the capacity for impact measurement, and provide investors broad exposure to market innovation. A recent Alliance magazine article reinforces this concept, pointing out the need for intermediaries (e.g. nonprofit impact investors like GP) because of the added value they offer by way of “human capital” (e.g. staff time/expertise to provide social organizations with technical assistance in addition to financial capital).
4. “Foundations can provide much more than an investment.”
Foundations can deliver much more beyond investment capital. Foundations provide accountability to their investees, can serve as partners in the development of social metrics, offer legitimacy for new intermediaries, provide trust-based introductions to other investors, and can collaborate in fund structure development.
Foundations are playing an instrumental role in growing the impact investment sector, from capacity-building grants to deploying a broad range of capital directly, and through funds. And the Mission Investor Exchange is at the forefront of helping those foundations develop the financial and educational tools they need to align more capital with mission.
Why does this matter?
Foundations, investors and intermediaries each have unique opportunities to help grow the impact investing sector and generate more social impact.
Foundations can fund risky early-stage opportunities as well as grow the networks and institutions needed to advance the sector. Investors can seek opportunities that prioritize impact over returns. Intermediaries can continue proving that they can provide value beyond financial capital.
Each opportunity and each actor’s potential to meet the need complements one another; through continued collaboration, we have a tremendous opportunity to achieve collective impact.
GIIN Investor Forum: Common Themes Emerge from Inaugural Meeting
by Jason Henning, director of investor relations, Global Partnerships
Blended capital. Bottom of the pyramid. Pay for success contracts. MFIs, CDFIs, IRIS and SMEs. Dive headfirst into a conversation on impact investing and it’s likely you’ll need a glossary of terms within reach.
Fortunately, the Global Impact Investing Network (GIIN) was established not only to help industry participants navigate the field, but also to build the field itself. The GIIN is aimed at increasing the scale and effectiveness of the impact investment industry by creating infrastructure and developing education and research. I recently had the pleasure of participating in the inaugural GIIN Investor Forum, an event designed to address common themes and best practices from the industry.
Topics covered a range of salient issues facing the sector, including a focus on specific impact areas (viable food systems, financial services for the poor) and discussions on the legal, operational and political aspects of investing. But two themes were given consistent voice throughout the two-day conference:
1. market-rate solutions in impact investing; and
2. the need for catalytic first-loss capital in getting more money flowing to viable programs.
As more institutional investors with financial obligations look to link their investments with social impact, capital that seeks market-rate returns is stacking up. Fund managers can often be caught in the middle, as some investors look to maximize profit while others are seeking high social performance within the same fund.
Speakers at the forum, however, mostly issued words of caution. Matt Christensen, Global Head of Responsible Investment at AXA Investment Managers, warned that if investors don’t adjust return expectations to risk, an impact investing bubble is on the horizon, much like the shock Andhra Pradesh sent through the microfinance sector. Investors were urged to tie pricing and time horizon directly to the impact they’re seeking; in rural settings, for example, where there are fewer economies of scale, investors must be more patient and be realistic on rate.
The value of risk capital also permeated the conference. With the GIIN’s most recent issue brief as a backdrop, many presenters spoke to the importance of catalytic first-loss capital in generating the flow of more traditional capital into the impact investing space. Most capital within the industry is sitting on the low-risk end of the spectrum, while most impact investment deals are higher risk. A range of credit enhancement products aimed at unlocking private capital was explored—including grants, subordinated debt and guarantees—all designed to peel back the first layer of risk.
Topics discussed at the GIIN Investor Forum parallel much of what we’re trying to accomplish here at Global Partnerships. Our goal is for 100 percent of our capital to be catalytic and aimed towards impact. We see the importance of philanthropy within impact investing to seed early-stage opportunities and later attract private investors. And we work closely with our investors on establishing rate expectations to align with the specific impact we’re seeking. We look forward to continuing to add our voice to the conversation and help build the industry.
Could Social Impact Bonds Be Used to Capitalize Preventive Health Care Solutions in Latin America?
by Lara Diaconu, vice president, Health Services Fund, Global Partnerships
Social impact bonds (SIBs) are an emerging impact investment vehicle that enables governments to innovate in the prevention of costly social ills. The way it works is that impact investors (i.e. foundations and high net worth individuals) receive a return linked to clearly defined program results. Social impact bonds have to date been devised to finance interventions that reduce recidivism rates, teenage pregnancy rates, juvenile delinquency, and to increase employability of students.
In early October, the US Department of Labor announced $24 million in grant awards to pilot SIBs to increase employment and reduce recidivism among formerly incarcerated individuals in Massachusetts and New York. And at the IDB’s annual FOROMIC conference last week in Guadalajara, Mexico, experiences were shared from the UK and Colombia. Despite relatively recent reports that remain skeptical about their efficacy noting that it’s too early to see results, SIBs seem to be gradually gaining in popularity as a means for the public sector to encourage funding innovation for social impact – using more risk-tolerant sources of capital.
On the surface, it would seem that there could be lot of potential for SIBs to work in the health sector as well. We know that investing in prevention (like PAP exams to detect cervical cancer) and behavior change (replacing sugary drinks with water, eating healthier, getting more exercise) can reduce the incidence of cancer and diabetes. We know that the overall costs of care decreases, and quality of life increases, when those living with chronic conditions receive maintenance care from a primary level health care provider instead of waiting until their condition deteriorates so much that they require hospitalization.
Could SIBs be used to capitalize preventive health care solutions in Latin America?
A couple of initial thoughts:
- In many countries, the public sector does not currently absorb the long term cost of health care, so the economic incentive to invest in prevention might not yet be clear. Across Latin America governments are struggling to finance the most basic health infrastructure, and budgets may not be bearing the burden of preventable conditions such as cervical cancer or diabetes. The costs of not getting an annual PAP exam, or of consuming foods high in fat and sugar, is currently being borne directly by individuals, who incur exorbitant costs treating chronic conditions diagnosed in a later stage. At least this is the case for the large majority of people working in the informal sector with no insurance coverage.
- Many health prevention interventions are largely proven, but lack the resources and distribution channel to reach the last mile. SIBs might be an option if the public sector in fact has the mandate and resources allocated to address a given preventable condition (for example cervical cancer), but decide to take a risk on a lower cost distribution channel (like a microfinance institution, or a non-profit organization).
In reflecting on my time at the FOROMIC conference, I see many possibilities and I look forward to learning more as the sector grows. Social impact bonds appear to have some supporters, but the jury is still out on whether or not they’ll have an impact.
3 Things Learned at SOCAP13
by Jason Henning, director of investor relations, Global Partnerships
Last week I had the good fortune to attend SOCAP13, an event touted as the “intersection of money and meaning.” Over 1,800 people attended countless plenary sessions, panels, meetings, and receptions that facilitated idea exchanges on impact investing and social enterprise. Below are three of the major themes I took away from this year’s conference:
1. “This is not a sector, it’s a point of view.” – Tim Freundlich, President of ImpactAssets
As impact investing moves mainstream, most within the industry don’t see the approach as an asset class, but rather, a lens through which one views all asset allocation. There are a growing number of individuals, foundations and family offices that are all aligning 100% of their balance sheets on mission, and they were well represented at this year’s event.
2. Impact investing 2.0
Jed Emerson, Cathy Clark and Ben Thornley previewed their upcoming case studies focused on 13 high-performing investors. In what they coin “Impact Investing 2.0,” they see a maturing landscape of different stripes of capital with various motivations being managed by dynamic, cross-disciplinary fund managers. The trio also put a rest to the “impact first vs. finance first” debate by declaring “It’s mission first. And last.”
3. Deals are getting done
In a recent JP Morgan/GIIN impact investor survey, a “shortage of high quality investment opportunities” was cited as the second largest barrier to growth within the impact investment industry. But at SOCAP, there was no shortage of strong teams representing high-impact funds meeting difficult social challenges, from fresh food finance to aquaculture to investing in women. And the investors – from individuals to foundations to development banks – were in attendance and listening.
GP was represented among the conference's panelists by my colleague Lara Diaconu, vice president, Health Services Fund. She participated on a panel entitled, “Doing Well by Doing Good.” Lara spoke about how different types of capital (such as knowledge, philanthropic and debt capital) are required to meet different health challenges. Please feel free to watch the video recording of the panel.
Lastly, SOCAP has historically served as a welcoming venue to make new announcements. Continuing this tradition, B Lab announced its launch of B Analytics, a platform for measuring, benchmarking and reporting on impact. ImpactAssets followed by trumpeting the creation of Seed Ventures Platform, an online community that seeks to address the market gap in seed stage risk capital by connecting investors with impact entrepreneurs.
Interested in some of the top sessions from SOCAP13? Many of them were recorded and are available here.
GP Presents at SOCAP13 — Annual Conference that “Grows Social Good Economy” via Impact Investing & Social Enterprise
by Jason Henning, director of investor relations, Global Partnerships (GP)
UPDATE: Read our blog post on "3 Things Learned at SOCAP13" here.
As a fund development professional, my weeks are often filled with insular activities that lead to a rather intimate relationship with my keyboard and telephone. My day to day includes reviewing prospect lists, drafting investor reports, and setting up meetings with funders. Please don’t misunderstand me; these are all important aspects of my role at GP, but they often leave me wanting for face to face dialogue and discussion.
That’s why I look forward to real-world meetings and substantive impact investing events. Fortunately for those of us in this sector, the good folks at Social Capital Markets have been hosting the SOCAP conference series since 2008. SOCAP is a gathering of investors, foundations, institutions, and social entrepreneurs “dedicated to increasing the flow of capital toward social good.” Last year was my first time attending SOCAP, and I can honestly say that the quality of the conference content is equal to the ease with which you can make personal connections. Nearly 2,000 attendees are expected at this year’s event, dedicated to “Accelerating the Good Economy.” Among the attendees is my colleague, Lara Diaconu, vice president, Health Services Fund, who will participate on a panel on how different kinds of public and private sector investments can be used to create positive impact in global health.
The themes for next week’s conference include:
- Health: investing in health and well-being
- Oceans: investing in the link between people and planet
- Communities: place-based innovation and development
- Meaning: the connection between mission and me
- Investing: impact investing and philanthropy
From my experience it’s rare for a conference to provide both a platform for rich, meaningful dialogue on topical issues and the opportunity to engage with fellow attendees and practitioners. SOCAP gets this right.
I look forward to sharing anecdotes and insights from SOCAP13 real-time via the GP Twitter account (@GPSocialImpact). I’ll also provide a summary of the event after its conclusion, so please subscribe to our blog if you haven’t already—you won’t want to miss out.
You can attend SOCAP13 virtually by:
- Getting live tweets from SOCAP13 via our Twitter page @GPSocialImpact
- Following the conversation on Twitter with #SOCAP13
An Inside Look at the 6th Latin American Forum on Village Banks
Our team returned earlier this month from the 6th Latin American Village Banking Forum held this year in Guayaquil, Ecuador. Wonder what happened? Here’s a photo recap.
Who attended the conference?
- Mark Coffey, chief investment and operations officer
- Lara Diaconu, vice president of GP’s Health Services Fund
- Ricardo Visbal, vice president of portfolio management
You can learn more about our team here.
Here's what our team did:
1. Met with current partners that also attended the conference and got updates from them
2. Conducted field visits with partners to see their impact in action
3. Met new potential partners
4. Moderated a panel called “Sustainable Models of Village Bank and Health Services”
5. Celebrated Latin American culture
All photos © Global Partnerships 2013