I have been thinking about informal and formal financial structures in developing countries recently and their impacts on health. This topic is on my mind because of a situation I find myself in. A cash transfer to a host’s account from a prior trip to Peru had somehow been blocked and now I find myself in a prolonged Whatsapp correspondence with one of the bank’s small town employees to try to encourage him to resolve the issue. (Unfortunately, it seems I have been ghosted.) In this region of Peru, having a bank account to transfer money into is an anomaly. As of 2014, only about 20% of Peruvians had bank accounts. Even with a bank account in hand, the modes of interfacing with financial institutions remain informal. This presents a fun/interesting challenge to an outsider like myself but would have more deleterious effects for local people who rely on the savings in their bank accounts day to day. The system on the ground does not always deliver streamlined, efficient service to troubleshoot issues.
When I was in Chiapas on the Global Health Track trip in July, the people I met did not have bank accounts. Most banks there charge a fee to maintain an account and there are no banks or ATMs within several hours drive. So, in most cases, the costs of opening a bank account outweigh the benefits. Difficulty in accessing financial structures due to distance may have important consequences for health, especially in terms of the modes of access to tertiary care institutions.
An interesting conversation about bank accounts arose one day over a breakfast of beans and eggs hosted by a gentleman who received care from the local health care system. He explained to the pasante (the rotating primary care physician) and me that he received support from Companeros En Salud to travel 14 hours by bus to Mexico City for specialized ophthalmology appointments due to a condition that would have otherwise left him blind. In Mexico City, he encountered exorbitant taxi fares, as the taxistas quickly determined he was from out of town. The pasante, a young female physician from a large city in northern Mexico, suggested he use Uber Pool, which offered far cheaper fares in the city. A bank account was a prerequisite, however, and while he had a smartphone, this gentleman did not have a bank account. The pasante knew of one bank operating in Mexico that did not require a minimum balance or charge a monthly maintenance fee. Our breakfast host made a plan to open such an account and start using Uber Pool.
Transportation is just one component of reaching health care that is affected by one’s access to a bank account. Traditional banking services offer access to many things, such as a safe location for savings and access to resources that prohibit cash pay. At least in this region of Chiapas, efforts from financial institutions to reach out to poor, rural areas remained quite limited. Access to banking is important to consider in examining global health and healthcare, especially among populations that are geographically or financially isolated from formal banking institutions.