In Uttar Pradesh, health and welfare programs often operated in silos, which limited comprehensive service delivery to communities. The central government sponsors multiple schemes in health, nutrition, sanitation, education, and livelihoods. However, rural blocks, such as Sewapuri, faced fragmented implementation, low convergence among departments, and limited coordination among development agencies. These gaps resulted in inefficient resource use, poor awareness of entitlements, and missed opportunities to serve vulnerable populations effectively. 

The NITI Aayog, the Government of India’s think tank, identified the Sewapuri block in Uttar Pradesh to address these challenges. The organization sought to pilot a replicable administrative model at the local government level for the integrated delivery of health and welfare services. The initiative intended to show how coordinated governance and community-level convergence could sustainably improve outcomes and inform national scale-up. 

MSC helped the Varanasi district administration operationalize the Sewapuri Vikas Abhiyan (SeVA). Our team supported the district administration to: 

• Establish a full-time program support unit (PSU) to drive implementation and convergence; 

• Design strategic sectoral plans for health, nutrition, education, sanitation, and financial inclusion, supported by detailed action frameworks; 

• Facilitate convergence among development agencies operating in the block. These agencies include the Piramal Foundation, UNICEF, Jhpiego, IHAT, PCI, IDinsight, and WaterAid; 

• Develop field-level optimization solutions and a monitoring, evaluation, and learning framework to track progress across defined health and nutrition indicators, which include immunization, antenatal care, and nutrition services for children and pregnant women; 

• Provide advisory and coordination support aligned with the public healthcare delivery system. 

The integrated efforts led to: 

• Saturation of interventions across all 87 gram panchayats that reached more than 234,000 residents; 

• Strengthened service delivery across the primary healthcare spectrum, which includes communicable and noncommunicable diseases, reproductive, maternal, neonatal, and child health, and childhood and maternal anemia; 

• Screening of 95% of the eligible population aged 30 years and above for diabetes and hypertension through health and wellness centers, with referrals to public health centers in line with National Health Mission protocols; 

• Convergence across 13 central and state ministries, which delivered measurable improvements in health and nutrition outcomes without significant additional funding; 

• Development of a replicable convergence model that informed national scale-up through the Aspirational Blocks Programme across 500 blocks (district subdivisions) in India. 

The NITI Aayog and the Government of Uttar Pradesh commissioned this project with support from the Gates Foundation, Jhpiego, and WaterAid. MSC served as a technical and strategic partner to the Varanasi district administration. 

 

In Bihar, India’s third-most populous state, the public health system struggles with persistent gaps in infrastructure, workforce availability, and diagnostic capacity. Public health facilities operate below required standards due to chronic shortages of health workers, which constrain service delivery. Cancer care is particularly limited, with only eight comprehensive cancer centers for an estimated 109,000 new cases annually and screening rates below 1%. This restricts access to timely, high-quality care for rural and underserved populations. 

The Government of Bihar sought to accelerate progress toward critical health sector development goals across cancer care, medical education, and public procurement to address these challenges.  

MSC supported the Government of Bihar through the establishment of a multi-sector program management unit and the design of targeted interventions across three priority areas: Cancer care, medical education, and public procurement. 

For cancer care, MSC helped establish the Bihar Cancer Care and Research Society. We designed the institutional architecture, supported multi-departmental approvals, and enabled leadership recruitment. This laid the foundation for a state-wide, three-tier cancer care system that spans prevention, treatment, and rehabilitation. 

For medical education, we designed a context-specific public–private partnership (PPP) model for medical colleges to define bidding criteria and eligibility norms. We provided transaction advisory support for the establishment of medical college hospitals under the PPP mode through tailored models for greenfield and brownfield projects. 

For public procurement, we are supporting reforms to streamline procurement governance, enhance transparency, and institutionalize accountability across departments. 

The Bihar Cancer Care and Research Society is now operational, with leadership in place. The three-tier cancer care ecosystem is expected to benefit more than 140,000 new cancer cases diagnosed annually in Bihar and enable population-wide screening for the state’s 131 million residents. 

Medical college hospitals approved under the PPP mode will add nearly 2,300 Bachelor of Medicine, Bachelor of Surgery (MBBS) seats to the existing 1,645 seats in government medical colleges. The establishment of medical colleges and hospitals across greenfield and brownfield sites is expected to mobilize approximately USD 430 million in private investment and USD 95 million in government investment. 

The Gates Foundation commissioned the project. 

Around the world, women face interconnected challenges related to economic stability, access to healthcare, and nutrition. Development programs often address these needs in isolation, which limits their overall impact and sustainability. 

MSC (MicroSave Consulting) supported the Gates Foundations’ learning agenda on integration of health and nutrition within women’s economic empowerment (WEE) interventions. We built a strong evidence base and identified viable investment pathways for high-impact future programs. 

We mapped 48 interventions implemented by 27 organizations and microfinance institution (MFI) consortia across more than 30 countries to identify programs that integrate women’s economic empowerment with health and nutrition services. We applied filters aligned with the Gates Foundation’s health priorities to shortlist 10 organizations, and then conducted in-depth interviews with these organizations to assess implementation approaches, sustainability, and financing mechanisms. 

The analysis identified four effective models that integrate health and nutrition into WEE programs. Community health worker–led models deliver maternal, newborn, and child health services. These models showed an approximately 25% reduction in neonatal mortality and a 40% to 45% increase in care-seeking for maternal and newborn complications.  

The models that integrate health services within MFIs showed a threefold increase in uptake of preventive screenings and significant improvements in health knowledge. Health financing models delivered through MFIs, banks, and asset platforms increased overall healthcare utilization by 1.6 times and doubled facility-based deliveries. They also reduced catastrophic health expenditure by approximately 30%.  

Poverty graduation programs with integrated health support led to 5% to 8% higher household consumption, around 15% growth in productive assets, and improved household investment in health and nutrition. 

Digital solutions emerged as a cross-cutting enabler across all four models, which include teleconsultations, partnerships with digital health providers, and digital tools for community health workers. These solutions offer scalable pathways to expand integrated service delivery. 

Based on this research, MSC developed a comprehensive framework to guide future investments and program design that provides evidence-backed approaches to layer women’s economic empowerment with health and nutrition services. 

The Gates Foundation commissioned the project. 

MSC conducted research with BURO Bangladesh on agri-allied customers in four climate-vulnerable regions: Satkhira, Rangpur, Tangail, and Cox’s Bazar. The study assessed the direct and indirect impacts of climate change on livelihoods, customers’ coping and adaptive strategies, and their use of financial services to manage climate risks. It also explored their transactional behaviors, and demand for financial products. Based on the findings, we recommended ways for BURO and other MFIs to strengthen services and enhance customer resilience to climate change.

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From reactive coping to adaptive resilience amid climate change

India’s smallholder farmers struggle with growing exposure to climate risks driven by erratic rainfall, prolonged droughts, and unseasonal weather patterns. These challenges lead to yield losses, which increase input costs and reduce incomes. Climate-smart agriculture (CSA) practices, such as drip irrigation, solar pumps, and biodigesters, offer a pathway to resilience. However, adoption remains constrained due to high upfront costs, limited access to affordable financing, and perceived risks among regulated financial institutions.

MSC was engaged to unlock microfinance and regulated lending for CSA and address these challenges. We were tasked to develop standardized financing products, build feasibility evidence, and support financial institutions to lend for prioritized CSA practices.

As the lead technical partner, MSC conducted a comprehensive landscaping of CSA technologies and mapped key solutions to priority crops and geographies. The team identified suitable borrower segments, aligned them with relevant CSA technologies, and assessed associated credit and operational risks for financial service providers.

MSC adopted our repurpose, rejig, and reinvent (3R) framework to transform existing microfinance products into climate-smart financing solutions. We conducted rapid institutional assessments to onboard four microfinance institutions (MFIs), helped align program objectives, and supported the execution of memorandums of understanding. This was followed by portfolio and value chain analyses, along with field visits to assess borrower demand. These insights informed the development of CSA financing product notes, operational processes, and service-level agreements between MFIs and CSA solution providers.

MSC also enabled partnerships between the MFIs and technology providers and conducted focus group discussions and key informant interviews for demand-side assessment and document insights. The project helped pilot the CSA financing products and laid the foundation for standardization and wider adoption across regulated financial institutions.

The initiative enabled scaling CSA lending through evidence generation and integration into MFI systems. The project generated a consolidated knowledge base on CSA financing practices. It highlighted scalable models and institutional pathways for wider adoption. In addition, dissemination engagements enabled stakeholder alignment on practical pathways for mainstreaming climate-smart agriculture financing across regulated financial institutions.

The International Sustainable Energy Foundation (ISEF) commissioned this project.

Adaptation finance worldwide remains significantly under-supplied relative to the scale of climate risk faced by low-income households and small enterprises. While public and concessional finance continue to play an important role, they are insufficient on their own to meet growing needs. Financial institutions often lack the evidence, product frameworks, and market intelligence needed to identify viable opportunities, understand the adaptation needs of clients, and respond to the real and perceived risks of serving vulnerable populations.

FSD Kenya, with support from the Gates Foundation, engaged MSC to lead a six-country initiative to address this gap across Sub-Saharan Africa. The initiative sought to strengthen the evidence base for inclusive climate finance. It was initially launched in Kenya and Mozambique as Phase 1 and later expanded to Ethiopia, Nigeria, Rwanda, and Tanzania as Phase 2. The initiative also sought to understand how financial systems could better support low-income households to adapt to climate risks and identify viable pathways to scale private-sector engagement.

MSC designed and piloted a livelihoods-centric analytical framework to support this initiative. The framework linked climate risks, adaptation pathways, and household financial needs to potential financial sector responses. The methodology combined livelihood segmentation, adaptation-to-finance mapping, financial-gap analysis, and a structured taxonomy to assess where financial services could play a meaningful role. Across the six countries, MSC conducted desk research, stakeholder consultations, and market analysis to identify priority livelihood segments, household adaptation pathways, and the financial and non-financial constraints that shape resilience.

A key feature of our work was cash flow analysis of selected adaptation solutions and livelihood strategies to assess business viability, investment readiness, and points of market failure. This helped distinguish where financing gaps reflect weak commercial viability or high risks, where they stemmed from product design or delivery constraints, and where blended or catalytic approaches may be required.

The project generated country diagnostics, market-frontier maps, and actionable recommendations to catalyze commercial finance for locally led adaptation measures. The outputs from our work identified promising product pathways, policy and technical assistance levers, and financial institution pipeline opportunities. These also provide a replicable framework that donors, financial institutions, and ecosystem actors can use to shape more inclusive and climate-responsive adaptation finance markets.

FSD Kenya commissioned the project with the Gates Foundation’s support.