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Community Development Journal Advance Access published online on August 21, 2008
Community Development Journal, doi:10.1093/cdj/bsn029
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© Oxford University Press and Community Development Journal. 2008 All rights reserved. For permissions, please email: journals.permissions@oxfordjournals.org

Utilization and management of maternal and child health funds in rural Nepal

Joanna Morrison, David Osrin and Anthony Costello

Rita Thapa, Aman Sen, Rishi Neupane, Kirti Man Tumbahangphe and Dharma Manandhar

Jo Borghi

Address for correspondence: Joanna Morrison, Tel: +44 207 905 2000; Fax: +44 207 404 2062; Email: j.morrison{at}ich.ucl.ac.uk

Maternal and neonatal mortality rates are highest in the poorest countries, and financial barriers impede access to health care. Community loan funds can increase access to cash in rural areas, thereby reducing delays in care seeking. As part of a participatory intervention in rural Nepal, community women's groups initiated and managed local funds. We explore the factors affecting utilization and management of these funds and the role of the funds in the success of the women's group intervention. We conducted a qualitative study using focus group discussions, group interviews and unstructured observations. Funds may increase access to care for members of trusted ‘insider’ families adjudged as able to repay loans. Sustainability and sufficiency of funds was a concern but funds increased women's independence and enabled timely care seeking. Conversely, the perceived necessity to contribute may have deterred poorer women. While funds were integral to group success and increased women's autonomy, they may not be the most effective way of supporting the poorest, as the risk pool is too small to allow for repayment default.


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