An innovative and scalable approach, individual or small group health financing by microfinance institutions can expand existing options for the poor. We examined productivity losses, direct health costs and health financing methods among microfinance clients in Bolivia, Benin and Burkina Faso. Health costs and lost productivity for households were substantial. Microfinance institutions offer advantages in developing health financing options: global reach, expertise in loans and savings and their mission to facilitate household financial stability. Health financing products, including savings and loans, hold considerable potential to benefit clients but require careful design to optimise value and minimise risk. Copyright © 2012 John Wiley & Sons, Ltd.