Blog FeedProtecting Health to End Hunger.
Safeguarding health helps families feed themselves.
When Freedom from Hunger’s Credit with Education program came to her rural town in Ghana, Dorcas Aidoo was one of the first women to join a group and take a loan. ”I wanted to free myself from poverty,” she said. Dorcas was one of the 800 million people surviving on roughly one dollar or less per day and facing chronic hunger for herself and her four children. Eight years later, she has made solid progress. She now earns enough money to feed her children nutritious food and send them to school. She has expanded and improved her roadside stand to sell more products, and she even sets aside $56 per month in savings.
However, Dorcas knew it would take more than money to make a lasting difference in her life. Too often she had seen businesses collapse, wage-earning jobs disappear and savings depleted when illness struck.
Consequences fall doubly hard on women.
They not only lose precious income-earning days due to their own illnesses; they also stay home to care for ill children. Seeking medical care is a special burden because the cost of healthcare, including the cost of transportation to the clinic, comes on top of lost earnings. So when Dorcas talks about freeing herself from poverty and feeding her children, she also talks about protecting the health of her family and herself.
In the November issue of Uncommon Sense, I cited some studies showing the impact of health problems on the poor. In fact, ill health and injuries are the most common reasons for families to stay poor or fall back into poverty and hunger. Let me repeat a shocking statistic from our study in Benin and Burkina Faso, two countries bordering on Ghana-an average of 30 percent of the income of poor, rural families goes to treatment of malaria.
One disease takes nearly a third of their income!
Clearly the chronically hungry poor need more than money; they need to know how to prevent malaria. Most rural West Africans do not know that getting bitten by a mosquito is the one and only cause of malaria. Think how hard it would be to persuade people to sleep under a mosquito net if they don’t know that mosquitoes are the cause of malaria. It is hotter to sleep under a net, and a bother to put it up properly. Why bother? Unless you know that if you don’t, you will get malaria and get very sick and maybe die, especially if you’re very young or pregnant and malnourished. It’s pretty basic education. And it’s vital … meaning, it saves lives.
Who is going to do this education for better health?
This is a long-standing question for the international development community.
Why not all those field staff of the microfinance organizations all over the world? Microfinance contracts based on groups of mostly poor, mostly women, create an infrastructure of service delivery to the poor. Tens of thousands of microfinance field officers fan out across the developing world every day to meet these groups in their own communities. Why not use this infrastructure to deliver more than microfinance? Value-added microfinance is becoming a well-established tool for supporting the self-help efforts of the poor, even people so poor they are chronically hungry. And local microfinance institutions have discovered they can make good money from valued-added microfinance.
Seizing the opportunity offered by group microfinance
Freedom from Hunger saw the opportunity and developed it into Credit with Education, in which the field staff of the MFI provides both financial and educational services and, increasingly, linkage to other services and products offered by other, nonfinancial service organizations. Freedom from Hunger has built Credit with Education institutions from scratch in Bolivia, Honduras and Uganda and has trained whole credit union federations in Benin, Burkina Faso, Mali and Togo in West Africa, and individual credit and savings cooperatives in the Philippines and Ecuador, and rural banks in Ghana and the Philippines to offer Credit with Education as a profitable new line of service targeted to mostly rural groups of poor women. Currently (June 2008), Credit with Education providers serve more than 775,000 women in 14 countries.
Evidence from extensive field research
Considerable evidence from extensive field research in the 1990s shows the impacts of Credit with Education for the women who participate and for their families, especially their young children. Summary analyses of the various studies (MkNelly and McCord; MkNelly and McCord; MkNelly and Watson)[i] show the following general impacts:
- Effects of Financial Service: women have more income and assets; households have better consumption-smoothing and shock-coping
- Effects of Education: women learn essential information and put much of it into practice regarding breastfeeding, child feeding, diarrhea treatment, immunization, family planning, and HIV/AIDS prevention and coping
- Combined: women’s empowerment is bolstered; children’s diet and nutrition improve; client satisfaction and demand increase
More recent studies show positive impact on women’s business practices, repayment performance, and loyalty to the Credit with Education provider (Karlan and Valdivia)[ii], as well as improved knowledge and practice essential for malaria prevention and treatment(Gray et al.)[iii]
Dorcas provides her own evidence
Over the course of her eight years in Freedom from Hunger’s program, Dorcas has participated in a variety of health education topics that have improved her own health and that of her family.
“I have learned about malaria and it has helped me protect my children. I can now recognize when the malaria is coming and quickly take my child to the doctor. I also learned about diarrhea-to protect my food from flies so we do not get sick,” Dorcas says. This single change in her behavior can have an enormous impact. Diarrhea is the most common illness in the developing world. ”I also learned that breastfeeding prevents diarrhea.”
Dorcas and other women in her loan group have become informal ambassadors for Credit with Education. “I tell women about my own life experience-that I can feed myself and my children, that we are healthy, and my business is growing.”
[i] MkNelly, Barbara, and Mona McCord. Credit with Education Impact Review No. 1: Women’s Empowerment. (October 2001); MkNelly, Barbara, and Mona McCord. Credit with Education Impact Review No. 2: Economic Capacity and Security (Sept. 2002); MkNelly, Barbara, and April Watson. Credit with Education Impact Review No. 3: Children’s Nutritional Status. (October 2003) - Davis, CA: Freedom from Hunger http://www.ffhtechnical.org/resources/research-and-evaluation/impact-studies/.[ii] Karlan, Dean and Martin Valdivia. Teaching Entrepreneurship: Impact of Business Training on Microfinance Clients and Institutions. New Haven: Yale University, 2006 <http://karlan.yale.edu/p/TeachingEntrepreneurship.revision.final.pdf>.[iii] Gray, Bobbi, et al. Microfinance Against Malaria: Impact of Freedom from Hunger’s Malaria Education When Delivered by Rural Banks in Ghana. Davis, CA: Freedom from Hunger Research Paper No. 8 (January 2007) <http://www.ffhtechnical.org/resources/research-and-evaluation/impact-studies/microfinance-against-malaria-impact-of-freedom-from-hunger-s-malaria-education-when-delivered-by-rural-banks-in-ghana/>
