Reframing Community Health

The photograph lured me in: the baby’s eyes in contrast to the woman’s fingers, stumps of various lengths. I had to read more. What I learned was an exciting model for community health being implemented in villages across the state of Maharashtra.

“They are not doctors. They are not nurses. They are illiterate women from India’s Untouchable castes. Yet as trained village health workers, they are delivering babies, curing disease, and saving lives—including their own.”

The article recounts the story of two village health workers, Sarubai Salve and Babai Sathe, who look after pregnant women, babies, old people, and other basic health needs of the community. Sarubai Salve has been working with the village of Jawalke for the past 24 years.

What is amazing about this story is not only the success of the community health model but also its major aim of providing dignity to women who are untouchables. These two women were once illiterate, lacked a self-identity, and were extremely poor. Through the program Jamkhed, founded by a husband and wife doctor team, Raj & Mabelle Arole, this is no longer true. In fact, they have also organized 8 women’s groups and started a revolving loan fund and business skill training.

Many groups have tried to do as Jamkhed but have not succeeded with the same results. The Aroles goal from the beginning is the key, I feel, to why Jamkhed has seen such transformations. In order to work with the poorest of the poor: “empathy, knowledge of how poor people live, and willingness to work were more important than skills and prestige.”

Today the villages where Salve and Sathe work have two prevalent illnesses: hypertension and diabetes. This is not the status quo for the majority of rural India. In fact, they are considered to be diseases of developed countries. Who would have thought that these untouchable women would be such change agents? If nothing else, this is another testimony to never draw within the lines and accept the norm as the end all be all.

Quotes and photo from Necessary Angels Article in National Geographic

Photograph by Lynn Johnson, National Geographic 2008

Social Enterprise is HARD to do

Starting a business is hard enough, but starting a business that has a social focus is even harder.  For Micro Drip, we are still very much working to refine our business model so that we can successfully sell to the Base of the Pyramid (BOP) here in Pakistan, those who live on less than $4/day.  For Micro Drip, one of the most difficult challenges is that we can have the greatest low cost, high quality drip irrigation system in the world, but ultimately success for a farmer depends on much more than our system: microfinancing, stable water source, good seed, fertilizer, storage, know-how, distribution to markets, etc.  As a result, we cannot simply sell our system off the shelf; we have to think about ways to directly and indirectly (through partnerships) address the problems that come before and after our product. 

A second difficulty that we face is the seasonality of our product.  There are two growing seasons in Pakistan each year with most farmers growing cotton during the summer season and wheat during the fall season.  Unfortunately, drip irrigation cannot be used with wheat given the density of the plants/acre.  Vegetables can be grown during both seasons and offer much higher prices, but the lack of storage and access to markets forces many farmers into cotton and wheat, which are more stable with much less risk of going bad. 

A third difficulty that we are tackling is how to motivate local sales reps in the communities that we serve.  CEMEX, a Mexican cement company, has successfully mobilized a large network of local promoters in its program Patrimonio Hoy, which helps clients who make between $5-$15/day to save money for do-it-yourself home improvements.  While there are some successful models out there, many social businesses are struggling with this issue, as it is often difficult for local sales people to make sufficient income selling a single product.  Where sales channels to the BOP already exist, it is much easier for existing sales people to add additional products to their offerings.  Unfortunately, we are not aware of any other sales channels that reach our target market that would be willing to add our systems to their existing portfolio.

In spite of the challenges, we are committed to bringing irrigation solutions to the poor farmers of Pakistan.  Drip irrigation increases crop yields by 30-100% all the while decreasing water usage by 50-70%.  This translates into more money for poor farmers and ultimately has the potential to free farmers who are imprisoned in debt and a subsistence life. 

Formalization within an Informal System

Temporary housing has been set up across the road from my office for construction workers and their families who have come in from rural Maharashtra. I am not talking about temporary apartments with electricity & water access, these are shacks with metal slates used as siding. Water is delivered in the morning for the community and if I come to the office before 8:30am I walk right by them having their morning showers! So I asked a colleague what will happen when their work is done? He responded that although the construction workers and their families would move to the next job, the whole area would soon be re-inhabited by homeless families looking to establish slum housing. First these families will sleep outdoors he said, next they will set up basic, inexpensive siding using burlap sacks, and only once it is clear they will not be kicked out will they invest in more expensive building materials like metal and wood. Eventually the slum lord will come and start to collect “rent” from them to occupy the space and keep municipal and police officials from “noticing” them. After 1-2 years once a community of people becomes established those who can afford to will start re-enforcing their homes with bricks. Like Dharavi, one of the largest slums in Mumbai, this community will operate almost entirely outside of the formal economy.

My next question – why doesn’t the Indian government pay to build low-cost housing and transfer these communities? Well it turns out the government has tried and one of the problems is that families awarded the housing sell it on the market for income and then set-up a slum dwelling elsewhere. According to my colleague the main issue with new housing is that they are not used to formalized systems for rent, electricity, building maintenance, taxes….and revert back to slum lifestyle.

Now please keep in mind this is just one person’s version, and I am sure there are nuances that I have missed, but I do find it fascinating that there can be such complex formalization within a system that operates almost entirely within the informal economy. Below is a picture I snapped yesterday on my walk to the office.

Joanna Harries Personal Blog

New Face of Farming?

During my first week in Aurangabad, I went to the agricultural fields and met a few customers of GEWP. One of them in particular, stood out. This short video captures my thoughts and impressions on that meeting.

Discovering Kerala and AyurVAID:

In this short video I share some of my first impressions of Kochi, my new hometown, and AyurVAID:, the organization I am working with. Thank you to everyone at AyurVAID: for making these first thirty days in India a great experience.

On Corruption Part-I

One fall evening in New York City, a small group of Acumen 2009 fellows got together at a small restaurant called the Istanbul Grill. The conversation quickly turned controversial (ice cold beers loosened our tongues) as the group discussed the multi-layered issue of corruption. Here is a brief recap for you.

Our class is composed of people from different parts of the world and we started off by contrasting the prevalence of corruption from the point of view of a common man. In India and Pakistan, corruption exists in all strata of society and is in your face. However in the US, one often hears about corruption only in high office or at very senior levels in corporations. An average American can live his life without actually ever offering someone a bribe.

Some of the fellows opined that bribery in India was a kind of efficiency tax and that most enterprises had factored this into their cost of operations. Others stated that bribes, regardless of scale, were immoral and should not be tolerated.

Things got interesting when we discussed gray areas. Let’s say, your company in India, frequently imports and exports raw materials and finished goods. To navigate the maze of export/import regulations and to save time, most companies hire clearing and forwarding agents. These agents charge a fee for handling paperwork, customs etc in order to get your product through the docks. The transaction is straightforward and your company gets a receipt. Your company’s accountant is happy because there is a receipt/invoice and this expense will pass an external auditor’s review. Everything is okay and life goes on, except for one little detail that gnaws at your conscience. You know that containers don’t slide through shipping docks without a little lubrication. Did you just outsource the dirty act of bribery to an agent? Hmmmm. Technically, you didn’t. You paid a fee and received a service. The agent can do anything he wants with the money. It’s not your problem. You saved time and were productive in some other part of your business.

You can argue that these things happen only in the developing world where there are millions of agents that help you deal with bureaucratic governments. Well, from a moral standpoint, how is this different from a salesperson that wines and dines clients on an expense account, just to win a contract? Yes, there are policies to limit the expenses, but why support such a corrupt policy in the first place? Why do companies on the FORTUNE 100 list pay loads of money to lobbyists (aka agents) who then take politicians on junkets and golfing weekends?

I believe that most people are part of a silent majority that participates in these institutionalized forms of corruption. Since the corrupt act is outsourced and once removed from us, we convince ourselves that our behavior is moral. However, morality, often quantified and viewed as an absolute, seems to be a trait that should be measured on a sliding scale.

A fascinating article by Marianne Betrand and Sendhil Mullainadhan reignited my memory of our discussion and forced me to write my first blog entry!

6 Rules

I spent the other weekend in Hyderabad with some of the other fellows who are placed in India. We had a great time catching up and sharing our reflections on the past couple of weeks. On the plane ride home, in the airplane magazine, I read an article about a young man who had started an edutainment business when he was 23. (He’s now 25.) He had 6 insights into starting and running a business that hold so true for much of the enterprises we are working with. I decided to share my own thoughts on my experience through these rules.

The 6 Rules are:

1. Be prepared to give at least 10 years of extremely hard work & commitment.
2. Having the right business partners with good experience on board counts!
3. Never let someone else tell you what you can & cannot do.
4. Meet someone new & learn something new every single day.
5. Things happen for a reason. Do the job with intensity & enthusiasm in success or failure.
6. Ideas are a dime a dozen. Implementation is what is crucial!

Please view the video for context/detail. Enjoy!

First few weeks, back home…

Some thoughts on returning back home and recent incidents that happened in Mumbai…

Eid al Adha

This is the second day of Eid al Adha, the Festival of Sacrifice. Take a look at my video blog to see what it’s all about…

The Number 17

Some of you may remember a 2007 Jim Carrey movie about a man named William Sparrow, who was tormented by the number 23. Once he started looking, he saw that his whole life looped around the number 23. For me, here in Delhi, it’s the number 17. It’s a 17 minute auto rickshaw ride each morning from my new home in Defense Colony to my carpool meeting spot at D.light CEO Sam Goldman’s house in East of Kailash. From there, we are joined intermittently by a D.light intern or two and any visiting D.light partners or staff to make the smoggy, horn-filled commute across the Yamuna River to our offices in Noida Sector 2.

Despite claiming an automatic time zone adjustment ability, my mobile phone clock is absolutely stuck at 17 minutes slow. Now used to this bizarre time lag, when I had to get up at 5am to make my flight down to Hyderabad this weekend to meet up with some Acumen Fellows, I automatically set my alarm for 4:43am.

As I was sitting at a D.light dealer’s electronics store in Aligarh District one night in late November, I counted exactly 17 bug bites on my feet acquired over a long but insightful day in the field. I smiled to myself as the shopkeeper explained how he prefers to sell his homemade lanterns that promise him recurring service and maintenance fees, rather than the sturdy D.light LED lights that do not. For more on the day I spent learning from D.light dealers and distributors alongside Sanjeev (D.light advisor), Rahul (D.light Salesman), and Meenaskhi (phenomenal D.light intern) please check out the clip below. I also wanted send a huge thank you to Meenakshi Chhabra, who devoted several weeks to the D.light business development strategy team during her transition between The Monitor Group and starting her MBA program next month at INSEAD Singapore. We’ll miss you!