Economic empowerment programs in Kenya

Arriving late to a GISE (Group Integrated Savings for Empowerment) meeting warrants a ten-Kenyan shilling fee per person. The Sinoko GISE assembly was pleased when a group of five AMPATH health care workers walked in ten minutes late. The GISE group leader smiled and said that they welcome late visitors anytime as each visitor dropped their shillings into the pot.

The Sinoko GISE group meets every two weeks in a tin-roof church rustically furnished inside with wooden benches. The committee collects weekly contributions from each of the 25 members and tallies the total permissible to allocate for loans requested by the members. Currently there are over 400 self-managed GISE groups in the AMPATH catchment area. In several areas, including Sinoko, AMPATH has also begun a pilot project called BIGPIC (Bridging Income Generation through Provision of Incentives for Care) to bundle diabetes and hypertension screening and monitoring with the bi-weekly GISE meetings.

Once a month, health care workers travel to the pilot GISE sites to monitor those enrolled in the BIGPIC program. This unique pilot starts by holding a community based screening for hypertension and diabetes amongst specific villages. Instead of linking patients to traditional facilities, AMPATH’s Family Preservation Initiative helps positive patients form microfinance groups of 20-30. Patients enrolled are given a health and wellness target goal with incentives for the GISE group that completes the highest percentage of recommended healthcare services. The aim behind BIGPIC is to provide infrastructure for income generating opportunities while simultaneously providing high quality, portable, subsidized care that they can now comfortably afford. The hope is to improve patient’s health by keeping him or her motivated to stay on the appropriate treatment plan through peer motivation, encouragement, and group incentives.

A six month review of BIGPIC shows the program to be working with patients demonstrating a statistically significant 13 mmHg drop in systolic blood pressure and collecting 30% interest on the savings they deposit with the group. Moving forward AMPATH would like to roll out the BIGPIC project in other sites throughout the catchment area and increase the types of conditions treated through this group based model.