Microeconomic loans and health education to families in impoverished communities: implications for the HIV pandemic.

Poverty is among the root causes of death and poor health worldwide. Project HOPE's Village Health Bank (VHB) program is a public health intervention that combines integrated microcredit lending and health education. Groups of 18 to 25 women receive small loans, and biweekly, one-hour health education sessions. Since 1993, about 50,000 women in 949 VHBs have participated in seven countries in the Americas, Africa, and Southeast Asia, receiving more than US$25 million in loans and 8,445 hours of health education. Members of VHBs are charged modest interest rates that enable them to become self-sufficient (eg, able to cover all operating charges, including the costs of the health education staff, and the necessary loan capital to continue without infusion of outside resources). The VHB program produces substantial economic improvements for individuals and groups, and benefits in health knowledge and behaviors, including increased utilization of healthcare services. Data from Guatemala, Malawi, and Thailand demonstrate that VHBs in countries with high HIV prevalence have been comparably successful in spite of the enormous added burdens of chronic illness, deaths, and orphans in need of support. For example, in 2004, 48 percent of 266 VHB members in Malawi experienced at least one death in their household in the preceding year, and 67 percent housed one or more orphans with an average of two orphans per household. Because of the unique combination of increased household economic stability and improved health knowledge, the VHB program is now being adapted to families of people affected by HIV/AIDS, including orphans.