REACH PROJECT

The effects of the Rojiroti UK microfinance programme in Bihar on the nutritional status and health of under-five children: a cluster randomised controlled trial.

Need for the research

Child malnutrition remains is a major health concern – underweight is an underlying cause in 45% of all child deaths.

The poorest regions in the Northern states of India, such as Bihar, have the highest level of child malnutrition.

There is a need for evaluating approaches to alleviate child malnutrition. Rojiroti UK microfinance increases the economic resilience of rural communities and may improve nutrition of their children. It may offer an alternative to traditional methods of improving child health and could be readily scaled up to cover the poorest communities over a large region.

Primary research question

• Does the Rojiroti UK microfinance programme, introduced through self help groups (SHGs) for very poor women, reduce the degree of acute malnutrition (measured by weight for height Z score) amongst children under 5 years?

Secondary research questions

• Does Rojiroti UK microfinance improve other anthropometric measures (mid upper arm circumference, height for age Z score, weight for age Z score)?
• Does Rojiroti UK microfinance lead to changes in under 5 mortality?
• Does Rojiroti UK microfinance affect indirect measures of children’s wellbeing, including immunisation rates and school attendance?
• What are the mechanisms through which Rojiroti microfinance affects children’s survival and nutritional status?

The intervention

Rojiroti UK is an innovative microfinance scheme, aimed at the very poor. Initially, CPSL staff introduce the idea of Self Help Groups (SHGs) to the women and support them in forming their own SHGs. The women are encouraged to contribute their own savings initially (Rs2.5 per week) and expected to attend at least 4 weekly meetings before their savings entitle them to a loan. External funding for loans is administered by CPSL and the group is entitled to receive external loans after 3-6 months. The group members apply to the SHG for loan and if all members agree, the individual can borrow the required amount either from within the groups savings or from CPSL. These loans are usually small (Rs50 for general purpose loans and larger sums for emergency loans). The groups manage their own savings and loan can be requested for any purpose. The participant taking the loan specifies the loan tenure and institutional loans have an interest rate of 18% APR.

CPSL has been highly successful in running Rojiroti UK microfinance schemes amongst the very poor in Northern India since 2001. By 2011, there were around 50,000 Rojiroti UK members (almost all women) in 4,100 SHGs. In the past CPSL have recovered 80-90% of the loans within the time specified by the members.

Research method

The REACH project is designed as a cluster randomised trial.

Participating tolas will be randomised to early or delayed Rojiroti UK microfinance. Tolas will be grouped in pairs so that each tola in a pair is from a similar agro-economic zone and of similar population size and where the tolas are at least 15km apart (to avoid “viral” spread of SHGs).

Informed consent will be taken from the women in the villages by video recording, as trialled in the Pilot Project.

The nutritional outcomes will be measured in all children who are under five years of age at the start of the study and those who are born during the study period. The anthropometric assessments will be performed at the start of the study, at 9 months, at 18months (when the SHGs will be introduced in the control tolas), at 27 months and finally at 36 months.

Economic, social and qualitative measures

Two qualitative researchers (an anthropologist and an economist) will explore the following mechanisms through which Rojiroti UK microfinance might affect children’s survival and nutritional status.

They will compare the early and late intervention tolas using a number of social and economic parameters such as,

• Demographics
• Nutrition (exclusive breastfeeding, complementary feeding, food availability)
• Health (immunisation, care-seeking for childhood illnesses, prevention)
• Household income
• Women’s empowerment using the women’s empowerment in agriculture index, a questionnaire, piloted by CPSL in Bihar which collects data on the following:
  • demographics (including caste)
  • knowledge of household finances
  • children’s ages and school attendance
  • land ownership and share cropping
  • house ownership and condition
  • ownership of livestock, domestic appliances, vehicles and agricultural equipment
  • use of the Indira Awas (housing) or Janani Surksha (maternity) schemes
  • use of local money lender and current debts
  • experience of domestic violence
  • recent emergency asset sales

Potential impact

There is evidence that conventional nutritional intervention programmes do not favor the marginalized and most poor. Rojiroti UK targets women in this group – 62% are from scheduled castes and 80% are below the poverty line. If the approach is shown to improve nutrition in children , then it may be scaled up further and used alongside nutritional interventional programmes to improve the health and nutrition of the poorest children.

Lessons learned in India may be directly relevant to other low and middle-income countries.