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BMJ Open Is Committed to Open Peer Review. As Part of This Commitment We Make the Peer Review History of Every Article We Publish Publicly Available BMJ Open: first published as 10.1136/bmjopen-2020-043544 on 5 January 2021. Downloaded from BMJ Open is committed to open peer review. As part of this commitment we make the peer review history of every article we publish publicly available. When an article is published we post the peer reviewers’ comments and the authors’ responses online. We also post the versions of the paper that were used during peer review. These are the versions that the peer review comments apply to. The versions of the paper that follow are the versions that were submitted during the peer review process. They are not the versions of record or the final published versions. They should not be cited or distributed as the published version of this manuscript. BMJ Open is an open access journal and the full, final, typeset and author-corrected version of record of the manuscript is available on our site with no access controls, subscription charges or pay-per-view fees (http://bmjopen.bmj.com). If you have any questions on BMJ Open’s open peer review process please email [email protected] http://bmjopen.bmj.com/ on September 30, 2021 by guest. Protected copyright. BMJ Open BMJ Open: first published as 10.1136/bmjopen-2020-043544 on 5 January 2021. Downloaded from Health-related outcomes among female informal workers in debt: Retrospective quasi-experimental study on the impact of microfinance health interventions in Pakistan ForJournal: peerBMJ Open review only Manuscript ID bmjopen-2020-043544 Article Type: Original research Date Submitted by the 09-Aug-2020 Author: Complete List of Authors: Jafree, Sara; Forman Christian College Zakar, Rubeena; The University of Lahore Ahsan, Humna; Forman Christian College Mustafa, Mudasir; Utah State University Fischer, Florian; Charité Universitätsmedizin Berlin, Institute of Public Health; University of Applied Sciences Ravensburg-Weingarten, Doggenriedstraße Health policy < HEALTH SERVICES ADMINISTRATION & MANAGEMENT, Keywords: PUBLIC HEALTH, EPIDEMIOLOGY http://bmjopen.bmj.com/ on September 30, 2021 by guest. Protected copyright. 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Where the Submitting Author wishes to make the Work available on an Open Access basis (and 21 intends to pay the relevant APC), the terms of reuse of such Open Access shall be governed by a Creative 22 Commons licence – details of these licences and which Creative Commons licence will apply to this Work are set 23 out in our licence referred to above. 24 25 Other than as permitted in any relevant BMJ Author’s Self Archiving Policies, I confirm this Work has not been 26 accepted for publication elsewhere, is not being considered for publication elsewhere and does not duplicate 27 material already published. I confirm all authors consent to publication of this Work and authorise the granting 28 of this licence. 29 30 31 32 33 34 35 36 37 http://bmjopen.bmj.com/ 38 39 40 41 42 43 44 45 on September 30, 2021 by guest. Protected copyright. 46 47 48 49 50 51 52 53 54 55 56 57 58 59 60 For peer review only - http://bmjopen.bmj.com/site/about/guidelines.xhtml BMJ Open Page 2 of 41 BMJ Open: first published as 10.1136/bmjopen-2020-043544 on 5 January 2021. Downloaded from 1 2 3 Health-related outcomes among female informal workers in debt: 4 5 6 Retrospective quasi-experimental study on the impact of microfinance health 7 8 interventions in Pakistan 9 10 11 Sara Rizvi Jafree, Rubeena Zakar, Humna Ahsan, Mudasir Mustafa, Florian Fischer 12 13 14 15 Dr. Sara Rizvi Jafree 16 Department of Sociology,For Forman peer Christian review College University, only Lahore, Pakistan; 17 18 [email protected] 19 20 Prof. Dr. Rubeena Zakar 21 22 Institute of Social and Cultural Studies, University of the Punjab, Lahore, Pakistan; 23 [email protected] 24 25 26 Dr. Humna Ahsan 27 Department of Economics, Forman Christian College University, Lahore, Pakistan; 28 [email protected] 29 30 31 Mudasir Mustafa 32 Department of Sociology, Social Work, and Anthropology, Utah State University, Logan, United http://bmjopen.bmj.com/ 33 34 States of America; [email protected] 35 36 Dr. Florian Fischer 37 38 1) Institute of Public Health, Charité – Universitätsmedizin Berlin, Germany; 39 [email protected] 40 2) Institute of Gerontological Health Services and Nursing Research, Ravensburg-Weingarten on September 30, 2021 by guest. Protected copyright. 41 42 University of Applied Sciences, Germany; [email protected] 43 44 Corresponding author: 45 Dr. Florian Fischer 46 47 Charité – Universitätsmedizin Berlin 48 Institute of Public Health 49 Charitéplatz 1 50 51 10117 Berlin 52 E-Mail: [email protected] 53 54 55 Word count: 4,259 56 57 58 - 1 - 59 60 For peer review only - http://bmjopen.bmj.com/site/about/guidelines.xhtml Page 3 of 41 BMJ Open BMJ Open: first published as 10.1136/bmjopen-2020-043544 on 5 January 2021. Downloaded from 1 2 3 1 Abstract 4 5 6 2 In countries where dependable public health service structure and universal financial protection 7 8 3 for health coverage is missing, particularly impoverished families are at risk. In the past years, 9 10 4 different kinds of microfinance health interventions were established to promote health among 11 12 disadvantaged population groups. The purpose of this study is to assess the impact of microfinance 13 5 14 15 6 health interventions (health insurance and health awareness programs) on health-related outcomes 16 For peer review only 17 7 of female informal workers in Pakistan. We conducted a retrospective quasi-experimental study 18 19 8 among a total of 447 female borrowers from seven microfinance providers (MFPs) in 2018. A 20 21 22 9 standardized tool was used for data collection. Probit regression has been used to identify the 23 24 10 probability of female borrowers gaining improvement in health outcomes based on their socio- 25 26 11 demographic characteristics. Propensity score matching (PSM) has been used to assess the overall 27 28 29 12 impact of health interventions. Results show that women receiving health insurance and health 30 31 13 awareness programs had greater probability of better health outcomes when they were from 32 http://bmjopen.bmj.com/ 33 14 Punjab, borrow in groups, and attend monthly meetings at MFPs. The results of the PSM show 34 35 significant improvements in overall perceived health status when women received health insurance 36 15 37 38 16 and improvement in the purchase of prescribed medicine when women received a health awareness 39 40 17 program. Health and social policies are vital to secure health and wellbeing of poor women 41 on September 30, 2021 by guest. Protected copyright. 42 18 working in the informal sector of the economy. Targeting improved equity across female 43 44 45 19 population groups for health intervention will in the long run improve women’s health, capacity 46 47 20 expansion and income-earning abilities. 48 49 21 50 51 52 22 Keywords: borrow, informal sector, health insurance, health awareness, microfinance 53 54 23 55 56 57 58 - 2 - 59 60 For peer review only - http://bmjopen.bmj.com/site/about/guidelines.xhtml BMJ Open Page 4 of 41 BMJ Open: first published as 10.1136/bmjopen-2020-043544 on 5 January 2021. Downloaded from 1 2 3 24 Strengths and limitations of the study 4 5 6 25 This study is part of a larger mixed-methods study on the well-being of female 7 8 26 microfinance borrowers. 9 10 27 Potentially the first study which focuses on female microfinance borrowers in Pakistan to 11 12 13 28 assess the impact of health interventions on health-related outcomes of poor women. 14 15 29 Although a quasi-experimental analysis framework has been used, the two-group cross- 16 For peer review only 17 30 sectional designs suffers from the limitations related to a single measurement for all 18 19 20 31 subjects. 21 22 32 Future studies need to consider additional burdens of loan repayment and small business 23 24 33 investment. 25 26 27 34 28 29 30 31 32 33 http://bmjopen.bmj.com/ 34 35 36 37 38 39 40 41 on September 30, 2021 by guest.
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