Grameen Dialogue -- a regular publication from Grameen Trust

Poverty remains a serious concern in Pakistan. With a per capita gross national income (GNI) of $420, poverty rates had fallen substantially in the 1980s and early 1990s but started to rise again towards the end of the decade. According to the latest figures, as measured by Pakistan's poverty line, 33 percent of the population is poor.

There are also significant gender gaps in both literacy and health status in Pakistan. Gender disparities in education remain significant. While the male population completes an average of five years of schooling, the female population in Pakistan completes only two and a half years. Maternal mortality remains high at 200 per 100,000 live births. Gender disparities in Pakistan are severe and pervasive. Deep rooted cultural and institutional constraints prevent Pakistani women from fully participating in the development of their society. Their presence in the public sphere is condemned under the guise of cultural and religious values, thus, making their contribution outside the home difficult, if not impossible. Institutionalized violence against women in Pakistan allows crimes of 'passion' and 'honor' to go unpunished and has become, in the past two decades, one of the biggest constraints to widening their role in the public domain.

Microcredit programs in Pakistan are playing a major role in the fight for poverty alleviation as well as making significant progress in reducing gender inequality. They are bringing about myriad social changes as they target mostly women. At the forefront of the MFIs in Pakistan, is Kashf Foundation, a non-government Grameen Trust partner organization that is not only working for women in order to achieve economic sustainability, but is actually run by women themselves, a rare occurrence in a country dominated by religious beliefs that foster patriarchy. But this did not deter Kashf from being amongst the top 10% of MFIs across the world in 2003, with an outreach of over 45,000 clients and a phenomenal growth of 189% from the previous year, while achieving full financial self-sufficiency.

Emergency Loan To Cope With Crisis
Kashf’s products and services are completely geared to serve the rural poor women and apart from the General Loans, the Emergency Loan is fast gaining popularity, due to the relentless marketing done by the staff to introduce this product to their clients. Kashf’s General Loan clients are eligible to apply for the Emergency Loan, which acts as a security blanket and can be used during times of financial crisis to pay for medicines, utility bills, school books etc. The Emergency Loan, based on the idea of a credit card, allows Kashf clients to draw small amounts of cash of up to Rs. 4,000. In 2003 alone, Kashf disbursed 26,925 Emergency Loans worth Rs.52.7 million while the cumulative disbursement reached Rs.65.1 million. In terms of its General Loans, in 2003, the organization recorded a growth of 286% as they disbursed 45,763 new loans worth Rs.331.8 million while their total loans outstanding remained at Rs.447.8 million.

Shamim, living in one of the poorest urban slums of Lahore, praises the Emergency Loan, which she used to buy medicines for her 12-year-old son. “The Emergency Loan has put me at ease as I know that in case of emergencies, I don’t have to worry and can use this product to meet the unforeseen needs of my household”.

Accidental Insurance –
New Entrant in the Products and Services Portfolio
The accidental insurance is a new financial product added to Kashf’s portfolio. The product has been devised on a partner-agent model where Kashf will work with an insurance company in giving insurance coverage to all its clients. The insurance, in case of accidental death, offers coverage to the client by paying the outstanding loan amount and also paying Rs. 7,500 to the deceased family for bearing burial and other such expenses at the time of death. The insurance ‘premium’ consists of a one-off payment of Rs. 100 by the client at the time the client is insured. The product has been highly appreciated by the Kashf client and has been introduced to mitigate the risk in the lives of Kashf clients.

Accidental and the previously existing life insurance are provided as one package to the clients and all of the active clients are insured. Till date, the cumulative number of insurance claims paid out is 471 and amounting to Rs. 7.3 million.

According to a recent Impact Assessment Study conducted by DFID (UK), 32% of Kashf’s client households are able to move out of poverty within a year, while 60% of them belong to those earning less than a dollar a day. This automatically brought about a marked increase in household expenditures for better nutrition, healthcare and other basic necessities.

Promoting Women’s Healthcare
Reproductive healthcare is an extremely neglected area in rural Pakistan, where Maternal Mortality Rate is as high as 350 per 100,000 births and Infant Mortality Rate is a staggering 85 per 1,000 births. This is partly due to the purdah, or veiling, practiced by a large number of Muslim women, as well as widespread illiteracy and ignorance triggered by prevalent poverty, that prevents the women from seeking medical help beyond their homes. To tackle this growing problem, Community Support Concern (CSC), a not-for-profit, NGO and partner organization of Grameen Trust, launched an innovative program called Integrated Rural Reproductive Health Project in October 2001, to provide healthcare services to poverty-stricken rural and urban areas around Lahore. The project is funded by DFID (UK) with technical assistance provided by Population Concern (UK). CSC’s project involves the implementation of Community Clinics, which would provide its destitute clients with primary healthcare.The Clinics offers Health Insurance Schemes under which a family can have all their primary health concerns attended to by paying Rs.50 per family per month. Non-insured people can also avail the services of the clinics by paying on a per service basis.

The clinics are run by Lady Health Visitors and female visitors, so that women are more comfortable visiting them. The clinics are also regularly visited by a mobile team, consisting of a female and a male doctor, who provide back-up support and ultrasound facilities for the patients. The Community Clinics as part of the reproductive health services, also counsels its clients on pre-natal/ post-natal care, family planning, infertility, pediatric care, early detection of cervical and breast cancer etc. Confidentiality is highly regarded and strongly enforced in the counseling sessions.

To reduce maternal and infant mortality rates, CSC, under IRRHP offers training courses for Traditional Birth Attendants (TBA), who are usually the ones most likely to perform deliveries in the villages even though they lack proper training and expertise. The training is focused on conduction of safe deliveries, prevention of unsafe abortions, adoption of aseptic measures, identification of high risk pregnancies and timely referral and transfer of complicated cases to appropriate and nearby hospitals.

Apart from the Community Clinics, CSC also disseminates information about AIDS and the practice of safe sex, a taboo topic in the altogether conservative Pakistani society. Their target groups are factory workers, male and female college students, commercial sex workers and beggars among others.

As of the end of 2003, CSC has provided much needed healthcare services to more than 100,000 poor people from Pakistan’s rural and urban communities and despite the social hurdles they face in tackling sensitive issues like birth-control and AIDS prevention, the staff still remain undeterred to carry on their tasks.

Report prepared by Zain Bari

References: The World Bank Report on Pakistan (www.worldbank.org), Community Support Concern Annual Report 2002, Kashf Foundation Annual Report 2003 and Kashf Foundation Quarterly Report for the period January-April 2004.