Meet RESULTS, “one of the best-kept secrets in development”

Regular, everyday Americans at the halls of congress

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>>Authored by Sabina Rogers, Communications and Relationships Manager, Microcredit Summit Campaign

In a 2013 article, New York Times opinion writer, David Bornstein, wrote that RESULTS “remains one of the best-kept secrets in development.” RESULTS (and RESULTS Educational Fund, from which the Microcredit Summit came and into which the Microcredit Summit Campaign operations have been merged) is a grassroots advocacy organization founded in 1980. It has international affiliates in the UK, Canada, Australia, France (and Belgium), Japan, Korea, and Mexico; and the RESULTS family coordinates advocacy efforts to remarkable effect.

Never heard of RESULTS? Recall the poverty measurement legislation in the mid-2000s that requires USAID to direct at least 50 percent of their microenterprise funds to those living on less than $1 a day? Legislation that also prompted the creation of USAID’s Poverty Assessment Tool? That was RESULTS and allies.

The U.N. International Year of Microcredit in 2005 and the Nobel Peace Prize for Muhammad Yunus and Grameen Bank? That was RESULTS volunteers and the Microcredit Summit Campaign lobbying year after year for consideration. (FYI: The Year of Microcredit was established by the UN in 1998, the year after the 1997 Microcredit Summit, through the efforts of the Bangladesh Ambassador to the U.N., in recognition of the Summit’s 2005 deadline.)

Maternal and child legislation that would put the U.S. on track to help end preventable maternal and child deaths globally and ensure key reforms so every dollar we invest has greater impact? RESULTS has lobbied for maternal and child health funding year in and year out for 32 years, and child death rates have plummeted from 40,000 a day in 1984 to 16,000 a day today. More recently, RESULTS helped craft the Reach Every Mother and Child Act of 2015.

Pressuring Congress to preserve the Earned Income Tax Credit (EITC) and Child Tax Credit (CTC), which are our country’s most successful anti-poverty programs for children? That was RESULTS.

Bornstein reported that World Bank President Jim Kim said, “RESULTS has such a lean and efficient model that nobody knows about them. They’re incredibly dedicated and very knowledgeable about the issues. It’s remarkable how much they’ve done and how few people have any idea about it.”

RESULTS (the 501(c)(4), non tax-deductible arm) and RESULTS Educational Fund (the 501(c)(3), tax-deductible arm) work hand-in-hand to produce cutting edge research to back up policy demands, which RESULTS volunteers take to Congress and other countries’ national parliaments, the World Bank, and bilateral donor agencies such as USAID to influence policy.

RESULTS takes on issues that are on the leading edge of policy and advocacy and brings them into the main stream.

Last year, RESULTS volunteers pushed Congress hard during the appropriations process and succeeded in reversing a total of $495 million in proposed cuts to global poverty focused programs and instead increased funding for these programs by $70 million. This in a political climate where partisanship is reaching its zenith and Congress is widely regarded as broken.

Citizens in the U.S. and all over the world have had a hand in making change through the RESULTS model for 35 years. RESULTS will soon be launching a new five-year strategic plan, and it will continue to advance an advocacy agenda in the financial inclusion space, helping to accelerate toward the end of extreme poverty by 2030.

As Larry Reed and Joanne Carter explained in their April 29th letter, “Financial inclusion and pathways out of poverty are a central part of this [strategic] plan and a critical part of reaching the 2030 goal. The powerful holistic financial inclusion model that the Campaign has been developing and driving with partners will become a centerpiece of RESULTS’ advocacy agenda on economic opportunity.”

In his acceptance speech for the Congressional Gold Medal in 2014, Muhammad Yunus credited RESULTS with having been “the most critical partner for microcredit,” as Bornstein put it. And, they were a critical partner because of the power of a 1000 volunteers raising their voice together to advocate for important policy changes. Yunus recounted a story from his early days as a PhD student in the U.S., walking the halls of Congress and recognizing the importance of citizens standing up for what they believe in.

Let’s close with this look back at a keynote address by Muhammad Yunus at the 2010 Regional Microcredit Summit in Nairobi. He tells the assembled delegates “This is the age of making ‘impossibles’ possible. It is us who decide,” he said, and it is us — citizens — who need to contribute to making change possible. Yunus exhorted us “that we can all work together rather than complaining about lousy government, saying they can’t deliver. There’s no way they can deliver — no matter what — unless we as citizens come together and do it as individuals, together.”

This is the credo upon which RESULTS is founded. RESULTS is making a difference in the world by influencing political decisions — both in the halls of your government as well as in implementing organizations — that will bring an end to poverty.

#tbt: Digital services to reach the unreachable at the 2013 Summit

Reaching Deeper_Speakers_641x280

Speakers in the “Reaching Deeper and Lowering Costs: The Path ahead for Digital Services” plenary session at the 2013 Partnerships against Poverty Summit in Manila, Philippines. We learned how mobile devices can help provide better options to those who are reliant upon riskier, costlier options.

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Highlighting technology innovations in the microfinance sector, the plenary session “Reaching Deeper and Lowering Costs: The Path ahead for Digital Services” at the 2013 Partnerships against Poverty Summit was moderated by our very own Sabina Rogers, filling in for Karen Dávila, noted Philippine broadcast journalist.

It was a fun session, using visual aids to represent certain aspects of a value chain for delivering mobile and financial services. A house represented the client and the start of the digital transaction value chain; then images showed the mobile interface for conducting transactions; a sari-sari represented an agent kiosk; a net represented both communications networks as well as financial networks; and a bank stood in for a variety of types of financial institutions.

Speakers were asked to make use of the array to help them illustrate where the companies and organizations the represented fit into the value chain.

Reaching Deeper_Gordon Cooper+Raj Singh-Khaira_341x227

Gordon Cooper, Head of Emerging Market Solutions, APCEMEA, VISA, and Raj Singh-Khaira, Vice President, RM & Consumer Services, FINO PayTech

Nadeem Hussein of Tameer Microfinance Bank (Pakistan) led off the discussion demonstrating how Tameer had a role in supporting a number of points along the value chain overall from understanding the consumer landscape to developing mobile transaction interfaces including working with agents, and all as a financial institution.

Raj Singh-Khaira of FINO PayTech (India) and focused on the need for institutions like his to diversify their involvement in a number of ways along the value chain because “the market is not mature enough for us to be just this one component…the agent kiosk in this example.” He pointed to the wide array of services FINO provides to achieve this diversity including a number of types of savings products, insurance, and some loans.

FINO serves over 67 million clients and employs more than 50,000 agents. Technology is important to help reach this kind of scale as opposed to manual transactions. He also mentioned the ability to better track and secure transactions through the use of digital means of transacting.

The role of VISA was presented by Gordon Cooper. “Visa is a Network, a network service provider. It’s all about interoperability,” cited Cooper; continuing, he described a project VISA launched several years ago which focused on finding one key way VISA could contribute to increasing access to formal financial services for low income individuals.

The result: launching mVISA in Rwanda, a mobile transactions platform (see this video). He focused on the necessity of interoperability, which refers to the ability of one financial service provider’s platform to link up with others’ platforms in order to enable customers on different networks or in different financial systems to transact. Increasing interoperability as a means to support wider access will be one major focus for VISA in the digital area.

Napoleon Nazareno of Smart Communications, one of the largest mobile network operators working in the Philippines, echoed Khaira. Smart is not isolated to only providing mobile phone connectivity, but also goes beyond to touch on all aspects of the value chain. Beginning more than a decade ago, Smart launched a small mobile banking service platform. By partnering with financial service providers over the years, this has now grown into a full-fledged mobile microfinance service platform.

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Ian Radcliffe, Director, WSBI-ESBG

Ian Radcliffe of WSBI illustrated their role in supporting the actors involved in the value chain as direct service providers. Their core activity is advocacy, but apart from that, they also deliver training and consultancy services to providers.

He highlighted an initiative begun about four years ago, to understand what it would it take to double the number of savings accounts among poor people. This launched the WSBI savings account program, which is now working with banks in 10 countries to develop and improve agent banking models and mobile banking models now, too.

Nazareno summarized the session nicely at one point during the presentations, pointing to the power of digital channels for reaching the financially exclude citing recent national survey in the Philippines.

He said, “80% of the households in the Philippines don’t have a bank account. On the other hand, 90% of Filipinos have a cell phone,” which highlights the viability of using mobile devices to provide financial services to those who would otherwise remain excluded. Mobile devices can help provide better options to those who are reliant upon riskier, costlier options, and, ultimately, ones that would stand in the way of their journey out of poverty.

Reaching Deeper_audience_408x326

A participant at the 2013 Summit was having a great time.

Partnerships against Poverty Summit Banner with logos
Watch the full video of this plenary

Swedes, chimps, and you and me on sustainable development

Hans Rosling shows how the child mortality rate declined at a phenomenal rate across the globe between 1964 and 2012.

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>>Authored by Sabina Rogers

Earlier this year at the World Economic Forum (WEF), Hans Rosling opened his presentation, “Sustainable Development: Demystifying the Facts,” with three questions for the audience about the state of global development (about extreme poverty, measles vaccination, and population in 2100). He was testing their knowledge in order to illustrate how preconceived ideas will do us wrong.

He had done this test before. Rosling conducted studies with Swedes, Americans, and chimps about the state of global development. The chimps were asked to choose a banana that is associated with 1 of 3 possible answers, and they got the answer correct 33 percent of the time. In essence, they were bound to be right 1 time in 3; the humans were not as lucky. Basically, according to his study, chimps in a zoo have a better chance of choosing the right answers at random to questions about the state of the world than the average Swede and American does.

It is detrimental when we underestimate the progress that has been made just in the last 15 years. In 1964 (the date he starts with his child mortality chart), the world was clearly divided into two worlds: the developing world with large families and high child mortality and the developed world with the opposite. Today, there really is just one world, with a few outlying countries, mainly in Africa.

It’s also a world of inequality within countries. Take India, for example. “If someone comes from outer space and wants to see the world,” says Rosling, “and [they] have only one day to visit, they should go to India. Because they can see everything in India: the most fantastic success [and] progress being made, but also remote, rural areas where still, extreme poverty is rampant — but decreasing.”

This is where the post-2015 agenda has to focus the world’s energy and money: the still marginalized, the remote and hard-to-reach areas. This is why we at the Microcredit Summit Campaign are championing six financial inclusion strategies (our “six pathways“) that we believe hold the greatest promise in helping to end extreme poverty at the frontiers — at the margins of society in economic, social, and geographic terms. The six pathways offer a means to reduce the cost of delivery (mobile money), help the poor build assets (cash transfers linked with savings), tackle the challenge of a weak health infrastructure, and more.

But, this isn’t just about practitioners and donors. With the launch of the Global Goals for Sustainable Development, we are seeing a massive media campaign targeted at you and me. It is a media campaign designed to get people excited and believe in the possibility of achieving the SDGs. Each goal has been reworded to express greatly simplified concepts. No numbers. No percentage signs. Just simple framing: No poverty, no hunger, good health, and so on.

It is also is designed to put “we the people” in the driver’s seat of this “next generation” of development. This is good because we are going to need everyone behind this agenda to fund it and traditional “aid” funding will not suffice. Tax revenue must contribute to the estimated $172.5 trillion price tag (over 15 years). The MDGs cost $915 billion in total. That’s $114 billion per goal compared to more than $10 trillion per goal for our post-2015 agenda.

In an interview on NPR’s Goats and Soda blog, Paul O’Brien of Oxfam America said, “It’s not just about more aid and donors doing more. This is going to be about sustained political will by governments to use their own money to tax corporations more effectively and make sure the money from their natural resources goes to poverty reduction.” This is the same conclusion in Who Pays for Progress?, a report from RESULTS UK about how to finance healthcare in new middle income countries. And, we can only do this if we understand what Rosling is trying to show us with his charts: “We can make the world much better. The long-term trend is going in the right direction.”

I would add, don’t underestimate what a world united by a set of global goals can achieve.

Watch Hans Rosling’s presentation at the World Economic Forum

Here is Rosling’s first question for WEF attendees:

In the last 20 years, the proportion of people living in extreme poverty has…? A. almost doubled, B. remained more or less the same, C. almost halved.

The answer was C (though the numbers of extreme poor may not have decreased in absolute terms). How many got it right? 61 percent of respondents from the WEF were right; in an online survey he conducted, 23 percent from Sweden and 5 percent from the US answered C.

How many of the world’s one-year-old children are vaccinated against measles? A. 2 in 10, B. 5 in 10, C. 8 in 10.

Again, the answer was C, and 23 percent of WEF got it, 8 percent of Swedes, and 17 percent of Americans.

How many children will there be in the world in 2100? A. almost 4 billion, B. 3 billion, C. 2 billion (with no increase from 2000).

26 percent of the WEF audience answered the correct answer, C, 11 percent of Swedes, and 7 percent of Americans. Rosling’s chimps surveyed answered correctly 33 percent of the time.

What does this mean? When you answer worse than random, it means that the problem is not lack of knowledge, the problem is that you carry preconceived ideas, which makes your score worse than chimps.

The whole point of this exercise queued up his presentation (starting at 6:33) on the state of child mortality between 1964 and 2012 (hint: the vast majority of countries are doing amazingly well). He showed how child mortality today in Bangladesh (8:52) is better than the state of child mortality in Italy in 1964 and that even the worst off families (women with absolutely no education) are, today, where the better-off and most-educated Bangladeshis were in 2001.

Hans Rosling shows why the concept of “developing countries” (those with less than US$12,000 per capita) doesn’t have much meaning anymore — for a happy reason. We have great reason to be optimistic about ending extreme poverty by 2030.

The main reason for optimism is the evidence of the past…the long term trend is going in the right direction.

Insufficient and greatly uneven progress on the maternal health MDG

Millennium Development Goals: 2015 Progress Chart
Published articles to date: Introduction | MDG 1 | MDG 2 | MDG 3 | MDG 4

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The United Nations recently issued The Millennium Development Goals Report, 2015, the latest assessment of progress towards the eight MDGs. In short, they have had mixed results. This article is part of a blog series reflecting on the MDGs and the U.N. report. These are produced in partnership with our colleagues at RESULTS, a grassroots advocacy organization. They are lobbying for bipartisan legislation in the Senate that can impact the lives of mothers and children worldwide. (See the Fact Sheet.)


>>Authored by Marion Cosquer and Sabina Rogers

MDG 5: Improve maternal health

Target 5.A: Reduce by three quarters, between 1990 and 2015, the maternal mortality ratio

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Click to enlarge. Source: The Millennium Development Goals Report, 2015

In 1990, 380 pregnant women were dying for every 100,000 live births. As of 2013, the global maternal mortality ratio has decreased by 45 percent to 210 women per 100,000 live births. The highest gains were seen in South and Southeast Asia with a 64 percent and 57 percent reduction, respectively. Developing regions overall achieved a 46 percent reduction. Maternal survival has been aided by a one-third increase in childbirth attendance by skilled health personnel. Thus, the news in the U.N. Millennium Development Goals Report for MDG 5 is promising.

Nonetheless, progress towards improving maternal health so far falls far short of the targets set under MDG 5 and has lagged far behind the other MDGs. Additionally, global figures tend to mask regional inequalities. For example, there were 510 maternal deaths per 100,000 live births in sub-Saharan Africa compared to 190 in South Asia and 140 in Southeast Asia.

Progress in raising the proportion of births delivered with skilled personnel has been modest over the last 15 years, reflecting the lack of universal access to care. Indeed, one in four babies still being delivered without skilled personnel and wide disparities are found among regions. For example, there is a 52 percent spread between the largest rural/urban disparity across regions:

  • In Central Africa, 32 percent of births were attended by skilled personnel compared to 84 percent in urban areas.
  • In East Asia, there is no difference between urban and rural areas.

Sub-Saharan Africa and South Asia pull down the developing region average. Overall, 56 percent of births in rural areas are attended by skilled health personnel compared to 87 percent of births in urban areas.

From The Millennium Development Goals Report, 2015

Click to enlarge. Source: The Millennium Development Goals Report, 2015

Target 5.B: Achieve, by 2015, universal access to reproductive health
After 25 years of slow progress, only half of pregnant women in developing regions receive the minimum of four antenatal care visits recommended by the World Health Organization. Once more, coverage levels in sub-Saharan Africa and South Asia trail the other regions. Sub-Saharan Africa has barely increased from 47 percent to 49 percent of pregnant women; South Asia has the lowest coverage at 36 percent (though it increased from 23 percent). Moreover, despite having doubled contraceptive use [1] in sub-Saharan Africa from 13 to 28 percent, sub-Saharan Africa still trails all other regions.

From The Millennium Development Goals Report, 2015

Click to enlarge. Source: The Millennium Development Goals Report, 2015

Proven health-care interventions can prevent or manage the complications that cause maternal deaths, such as hemorrhage, infections, and high blood pressure. These complications are concentrated in sub-Saharan Africa and South Asia, accounting for 86 percent of all deaths worldwide in 2013. Use of contraceptives also contributes to maternal health by reducing unintended pregnancies, unsafe abortions, and maternal deaths.

The report tells us that contraceptive use has risen in all regions and 90 percent of users were using effective contraceptive methods. However, the unmet need is still high (24-25 percent) in sub-Saharan Africa and Oceana. Other developing regions hover around 11-14 percent unmet need, and the overall use in those regions is significantly higher than in sub-Saharan Africa and Oceana.

The adolescent birth rate shows a mixed story. While the global rate for developing regions has fallen by half (from 34 to 17 births per 1000 girls), it hides poor progress in Africa and Latin America and the Caribbean. Indeed, in three regions (Southeast Asia, the Caucasus and Central Asia, and North Africa), some of the gains in the adolescent birth rate from 2000 reversed in 2015. Moreover, progress in East Asia was stagnant over the last 15 years.

The report calls for urgently needed intensified efforts to delay childbearing and prevent unintended pregnancies among adolescents. By increasing opportunities to go to school and for paid employment, we would see an overall improved maternal and child health as well as reduced poverty, greater gender equality, and women’s empowerment.

Maternal health in the post-2015 development agenda

The new Global Goals for Sustainable Development, which are set to be approved at the Sustainable Development Summit September 25 to 27, encompasses a broader, more ambitious and inclusive health goal. Goal 3 seeks to “Ensure healthy lives and promote well-being for all at all ages.” Indeed, it seeks to reduce the global mortality ratio to fewer than 70 deaths per 100,000 live births. Under Goal 3, countries will agree to ensure, by 2030, universal access to sexual and reproductive healthcare services, including for family planning, information and education, and the integration of reproductive health into national strategies and programs — for which the microfinance sector can be a key partner.

The report concludes on the inequalities in data availability on maternal health among and within regions. The lack of data is a key factor contributing to the unfinished MDG agenda, hampering efforts to establish priorities on national, regional, and global health. In the post-2015 period, it is imperative to have better and more data, especially concerning registration of births and deaths, in order to set adequate policy priorities, target resources more efficiently, and measure improvements.

In order to build on the successes of the MDGs and achieve Goal 3 of the SDGs, the 18th Microcredit Summit will focus on integrated health and microfinance as one of the six pathways out of poverty. Empowerment of women — which can help reduce maternal mortality more quickly and efficiently — will also be an important theme.


Footnote

[1] “Contraceptive use” is defined concerning women aged 15-49, married or in union, who are using any method of contraception

Post MDG-4: Integrating health services to reduce child mortality

Millennium Development Goals: 2015 Progress Chart
Published articles to date: Introduction | MDG 1 | MDG 2 | MDG 3

Lea en español *** Lisez en français


The United Nations recently issued The Millennium Development Goals Report, 2015, the latest assessment of progress towards the eight MDGs. In short, they have had mixed results. This article is part of a blog series reflecting on the MDGs and the U.N. report. These are produced in partnership with our colleagues at RESULTS.


>>Authored by Carley Tucker and Sabina Rogers

MDG 4: Reduce child mortality

Target 4.A: Reduce by two-thirds, between 1990 and 2015, the under-five mortality rate

From The Millennium Development Goals Report, 2015

From The Millennium Development Goals Report, 2015

The numbers appear heartening. According to the latest assessment on the Millennium Development Goals (MDGs), deaths of infants and children under five have greatly reduced. The under-five mortality rate has declined by more than half, from 90 to 43 deaths per 1000 births. Moreover, the annual rate of reduction in child deaths has more than doubled since 1990, and the rate has accelerated the most in Africa.

We learn that 4 out of every 5 of children have received at least one dose of the measles vaccine, preventing 15.6 million deaths between 2000 and 2013. In all, some 48 million children under five are alive today because of smart investments and increasing access to cost-effective health programs over the last 15 years.

This is good news for children around the world; however, underlying these advances is news that the achievements are not equitably distributed regionally, between rural and urban areas, nor socioeconomically.

Across all regions, progress toward MDG 4 has been “fair” to “excellent.” Furthest from reaching the target, though, are those living in sub-Saharan Africa and South Asia. While sub-Saharan Africa has had the largest decline in child mortality rates, it still experiences half of all child deaths in the world. Of the 10 countries with the highest number of under-five deaths, 5 are in Africa: Nigeria (#2 at 750,000), DR Congo (#4 at 305,000), Ethiopia (#5 at 184,000), Angola (#7 at 169,000), and Tanzania (#10 at 98,000). See the full list in this infographic from Humanosphere.

Children living in rural areas are 1.7 times more likely to die than those living in urban populations. Child mortality is 1.9 times as prevalent among poor households as among wealthy. Those whose mothers lack education are 2.8 times more likely to die than if their mothers had reached the secondary or higher level. So, of the 16,000 children under five who die each day — mostly due to preventable causes such as pneumonia, diarrhea, and malaria — they are likely to be from poor, rural, and uneducated households.

Have we really made substantial progress achieving MDG 4 when young kids in rural and poor communities continue to be the ones more likely to die before their fifth birthday? Allowing this population to fall behind will only exacerbate the vicious cycle of poverty. In order to make permanent advances in reducing early deaths, global development actors need to narrow in on rural and impoverished areas, especially in sub-Saharan Africa and South Asia.

Where do we go from here?

Recognizing the need for a renewed effort towards improving health of the poorest households, the Microcredit Summit Campaign has identified integration of health and microfinance programming as one of its six pathways strategies key to ending extreme poverty. Poverty is both a factor contributing to and consequence of illness and disease, so it is not enough for clients to have access to financial services. The microfinance sector must look for ways to integrate healthcare to their microfinance services. Microfinance institutions (MFIs) can provide health services directly or through linkages with healthcare programs.

Campaign believes that microfinance services provide an optimal place for healthcare. Many MFIs are reaching very rural communities — to say nothing of savings groups, which are primarily a rural financial tool. MFIs have developed trust relationships with families; they meet regularly with clients and can, therefore, pass along information like how to care for their children. In addition, since many MFIs serve regions in Africa and South Asia where child mortality rates are the highest, a strong focus on healthcare will allow these organizations to directly combat this issue in the most afflicted regions.

Microfinance clients must also have access to good healthcare in order to run their businesses, and a healthy lifestyle begins at birth. In the “Healthy Mothers, Healthy Babies: Kalinga kay Inay” project, microfinance clients are learning simple but important lessons like the food and nutritional supplements that pregnant and young women need and the importance of giving birth in a health facility. They are attending community health fairs organized by CARD MRI and partners, receiving free gynecological exams, urinalysis, and vitamins and supplements to improve their chances of delivering a healthy baby.

70 percent of maternal and child deaths now concentrated in just 16 countries, health and non-health investments such as sanitation, education, infrastructure and gender equality can potentially double the impact on lives saved.

70 percent of maternal and child deaths are now concentrated in just 16 countries. Investments in sanitation, education, infrastructure, and gender equality can potentially double the impact on lives saved. Go to the Newborn Survival Map to learn more.

Integrating health and microfinance services will also support the efforts of the new Global Goals for Sustainable Development, which are set to be approved at the Sustainable Development Summit September 25 to 27. The ambitious Goal 3 (“Good health and well-being”) includes ending preventable deaths of newborns and children under 5 years of age by reducing child mortality to 20 or fewer deaths per 1000 births by 2030. It also seeks to reduce by one third premature mortality from non-communicable diseases through prevention, treatment, and promotion of mental health and well being.

There also efforts underway in the United States to maximize future investments by US Agency for International Development (USAID). To reach the goal of ending preventable child and maternal deaths by 2035, USAID has set bold, intermediate goals of saving 15 million child lives and 600,000 women’s lives by 2020. RESULTS, a grassroots advocacy organization, is lobbying for bipartisan legislation that will provide strong congressional oversight and ensure that “returns [are] measured in lives saved and healthy, prosperous communities.” (See the Fact Sheet.)

“We now have the chance to end these needless deaths in our lifetime,” said Joanne Carter, executive director of RESULTS and RESULTS Educational Fund (our parent organization). “The science shows we have the tools. That means in 2035 a child born in the poorest setting could have the same chance of reaching her fifth birthday as a child born in the richest.”

Post-MDG 1: Focusing the lens on those still in extreme poverty

Millennium Development Goals: 2015 Progress Chart
Published articles to date: Introduction | MDG 1 | MDG 2 | MDG 3 | MDG 4

Lea en español *** Lisez en français


The United Nations recently issued The Millennium Development Goals Report 2015, the latest assessment of progress towards the eight MDGs. In short, they have had mixed results. This article is part of a blog series reflecting on the MDGs and the U.N. report. These are produced in partnership with our colleagues at RESULTS (our parent organization).


>>Authored by Sabina Rogers and Maeve McHugh with support from Anushree Shiroor from RESULTS UK

MDG 1: Eradicate extreme poverty and hunger

graph_MDG1

From The Millennium Development Goals Report, 2015

The overall number of people living in poverty in developing countries fell by more than half since 1990. The rate dropped to 14 percent in 2015 and the absolute number to 836 million people. There has also been significant progress made towards curbing hunger worldwide.

Target 1.A: Halve, between 1990 and 2015, the proportion of people whose income is less than $1.25 a day

Looking at the regional distribution of data, poverty reduction was concentrated in eastern and southern Asia thanks to immense poverty reduction measures in China and India. Progress is less apparent in other regions. In sub-Saharan Africa, 40 percent of the population still live in extreme poverty, and in western Asia, extreme poverty is actually expected to increase between 2011 and 2015.

The mix of progress and failure provides some guidance to the Sustainable Development Goals (SDGs). Namely, they must continue the campaign around eradicating extreme poverty while also confronting challenges that hinder progress in the regions that have seen marginal improvement.

While the world met its goal of halving the proportion of people living in extreme poverty, we must now look with a narrower lens at those remaining in extreme poverty. We must ask what changes must be made to the policies that did not succeed.

Full and productive employment

Target 1.B: Achieve full and productive employment and decent work for all, including women and young people

From The Millennium Development Goals Report, 2015

From The Millennium Development Goals Report, 2015

This target faced various challenges. First, the global labor force grew, and continues to grow, faster than employment opportunities. The global working-age population that is employed actually declined 2 percent between 1991 and 2015. (The 2008-09 global economic crisis certainly didn’t help.)

Youth (15-24 years) are especially affected by unemployment, with three times as many unemployed than adults. Young women are especially affected by unemployment and have few employment opportunities. They face unequal access to work as well as unequal pay, inadequate social protection, and unsatisfactory access to assets. These factors all contribute to women’s overall greater vulnerability of living in poverty.

Additionally, the situation is precarious for both those living just above the $1.25 a day line and those working in vulnerable employment conditions (i.e., unpaid family workers and own-account workers). Half of the developing regions’ workforce live on less than $4 a day, necessitating improvements in social protection programs and policies that see beyond extreme poverty. We need to take into account what comes after.

Halving hunger

Target 1.C: Halve, between 1990 and 2015, the proportion of people who suffer from hunger

From The Millennium Development Goals Report, 2015

From The Millennium Development Goals Report, 2015

Progress has alternated between slow and rapid declines in the proportion of undernourished people since 1990. Current estimates indicate that approximately 795 million people are undernourished globally, and for the developing regions, the proportion of undernourished people is projected to drop to 12.9 percent, or 780 million, in 2014-2016.

The vast majority of undernourished people live in developing regions. They experience various risks of food insecurity, namely natural disasters, volatile commodity prices, rising food and energy costs, and periods of economic stagnation, among other difficulties.

Addressing child health, specifically, is an important challenge to tackle in order to end hunger. While the proportion of underweight children under the age of five has been halved, the absolute numbers are still high at 90 million. Furthermore, sub-Saharan Africa and Southern Asia are home to nearly 90 percent of all underweight children.

Looking Forward

SDG 1The world has made immense progress in improving the lives of millions of people since 1990. While MDG 1 can be called a qualified success, the targets must remain a linchpin in the post-2015 agenda. Sustainable Development Goal (SDG) 1 is to “End poverty in all its forms everywhere.” However, the SDGs, which are to be approved at the U.N. General Assembly next month, need to address the shortfalls in reaching the MDGs within regions and the individual factors that combine to cause people to slide back into poverty.

SDG 2SDG 2 proposes to “End hunger, achieve food security and improved nutrition and promote sustainable agriculture.” While the MDGs considered only one aspect of undernutrition in children (i.e., underweight), we now have a better understanding of other forms. We know that stunting, wasting, micronutrient deficiencies, as well as overweight and obesity are all important factors to track. These indicators in the SDGs are more reliable than “underweight” alone in predicting growth, development, and well-being of children.

The World Health Assembly (WHA) has also set targets to reduce multiple forms of malnutrition by 2025. If we want the world to commit resources and take action to meet these targets, indicators must be built into the proposed SDGs to track these multiple forms of malnutrition the WHA is seeking to address.

However, early signs point to the inclusion of merely one or two undernutrition indicators as was the case with the MDGs. This will lead to a very limited body of data with which to understand progress in achieving SDG 2 and an inadequate basis on which to measure and predict children’s growth, development, and well-being. Indicators on reducing stunting, wasting, anemia, and overweight that come under SDG 2 as well as promotion of exclusive breastfeeding during the first six months of infancy within SDG 3 will give a much more accurate picture of actions being taken, and progress made.

Looking beyond 2015 and the MDGs, it is clear that microfinance has a role to play in supporting achievement of the SDGs. It can be a tool to generate sustainable growth and ultimately create self-sufficiency for poor and vulnerable households.

When proper targeting is employed…

When integrated with important non-financial services like health…

When coupled with government programs like conditional cash transfers…

When the business model measures “success” in terms of their client’s well-being…

When these measures are taken, then microfinance institutions can work directly with individuals living in the very conditions the SDGs are aiming to address. Those living in extreme poverty or fighting hunger can use microfinance as a tool to mitigate the risks they face and seize opportunities to build lasting and positive change in their lives.

A deep dive into the Millennium Development Goals Report

Millennium Development Goals: 2015 Progress Chart
Published articles to date: MDG 1 | MDG 2 | MDG 3 | MDG 4

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>>Authored by Sabina Rogers, Communications and Relationships Manager

The United Nation’s (U.N.) Inter-Agency and Expert Group on MDG Indicators recently issued the latest assessment of progress towards the Millennium Development Goals (MDGs) in a 75-page report. The Millennium Development Goals Report, 2015 is a rich document presenting data on each of the eight goals. In short, the MDGs have had mixed results, and the headline of one billion people lifted out of extreme poverty (living on less than US $1 a day) is almost entirely a result of the massive gains in China and India.

The 2015 MDG report presents the successes and shortcomings in the areas reducing poverty, increasing employment, and eradicating hunger. In the foreword, U.N. Secretary General Ban Ki-moon extolled these successes while conceding that “inequalities persist and that progress has been uneven.” Specifically, few countries met their poverty alleviation targets, and women and other vulnerable groups still tend to be excluded in what gains there were. Maternal and child health is still a very serious problem around the world (especially these 17 countries), including the Philippines, where we have a project with Freedom from Hunger and CARD MRI whose express purpose is to address this problem.

In just a few weeks, world leaders will convene in New York to finalize the Sustainable Development Goals (SDGs), the successors to the MDGs. (Here is the SDG agenda for the U.N. Summit.) What is most important for the international community to consider is what worked with the MDGs and why. Moreover, we should take inspiration from the fact that the MDGs did reshape our world. Ban Ki-moon says it best:

“By putting people and their immediate needs at the forefront, the MDGs reshaped decision-making in developed and developing countries alike…Reflecting on the MDGs and looking ahead to the next fifteen years, there is no question that we can deliver on our shared responsibility to put an end to poverty, leave no one behind and create a world of dignity for all.”

In the coming weeks, we will be publishing articles reflecting on each MDG and the assessment as presented in the 2015 report from the U.N. These are produced in partnership with our colleagues at RESULTS (our parent organization), a non-profit that supports a movement of passionate, committed everyday people who use their voices to influence political decisions that will bring an end to poverty. RESULTS grassroots volunteers have been instrumental in so many (often unsung) ways over the years to bring about the successes that we do see in the 2015 report.

We will present the first post in that series tomorrow morning. In the meantime, check out this fantastic visualization of the MDG data from the Institute for Health Metrics and Evaluation.


Published articles to date:

Financing healthcare in new middle income countries: Lessons from Kenya

Release of "Who Pays for Progress?"

Report authors Steve Lewis and Evelyn Kibuchi presented their findings on the report, Who Pays for Progress? at the Third Financing for Development Conference in July. They were joined by representatives from the World Bank and other global organizations as well as Yvonne Chaka Chaka, UNICEF Ambassador and Princess of Africa Foundation. Photo credit: Steve Lewis/RESULTS UK

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>>Authored by Theo Fievet, State of the Campaign Report Intern

A step to climb

Despite economic growth over the last decade, healthcare outcomes in Kenya remain weak. Rates of maternal mortality and stunting among children have barely changed…

— World Bank, Financial Report (Kenya), June 2014

Is a vibrant, fast-growing economy enough to improve the performance of the public health sector? A case study in Kenya published recently by RESULTS UK and partners KANCO and WACI shows that the correlation between economic growth and public health is not simple, nor automatic. Even though Kenya’s growth in recent years averaged 6 percent per annum, 25 percent of the population still lacks quality healthcare.

Kenya’s improved economic performance helped the country cross the line separating low-income countries (LIC) from lower-middle-income countries (LMIC), and this shift in status has a considerable impact on Kenya’s situation on the international stage. Kenya’s new standing as a MIC threatens its income from international aid and donations. The country faces a contradictory situation: while its economic position has improved, the country’s health sector remains typical of an LIC. For example, only 28 percent of infants are fully immunized.

The Government of Kenya is working to on a plan for universal health coverage (UHC), providing all citizens with the health services they need and saving them from financial hardship. According to the World Bank, Kenya’s rate of “out-of-pocket” expenditures (the amount paid by the patient’s household) was greater than 50 percent. For poor families, this often means selling business assets or pulling their children out of school. Kenya’s challenge is to figure out how to revolutionize a health system to include even the poorest Kenyans, while international aid possibly decreases in the coming years.

In the report, Who Pays for Progress?, the authors (Steve Lewis and Evelyn Kibuchi) suggest that a balance between domestic resource mobilization (DRM, otherwise known as taxes) and official development assistance (ODA) will be the way toward a sustainable and independent healthcare system.

Alliance of public funders

RESULTS UK argues in the report that cooperation between internal (domestic) and external (international) actors is necessary since both solutions have inconveniences that the other can counterbalance.

ODA could and has declined and follows unpredictable trends. Australia, for example, decided to cut 70 percent of its aid for developing countries. International aid institutions such as the World Bank and GAVI (the Vaccine Alliance) have a variety of complex criteria from which it is difficult to determine what will be the final aid amount disbursed. Furthermore, relying on DRM instead of ODA provides greater maneuverability for countries because ODA is often conditional and subject to donor priorities. Kenya cannot risk being totally dependent on the varying ODA and its requirements.

On the other hand, ODA that is earmarked for healthcare comes with direction on how to be spent; it is thus a way to assure funding is provided for health services. Tax income, meanwhile, may be siphoned off for debt repayment or subject to a lack of political will or a lack of trust in health sector efficiency. Furthermore, while DRM currently accounts for 55 percent of Kenya’s budget, it covers only a fraction of many of the country’s healthcare needs.

Finding the most sustainable way to finance UHC

In the medium-term, ODA may fall faster than Kenya is able to increase tax revenue. In 2012, Kenya collected 15.9 percent of their GDP in tax revenue (World Bank data). According to the UNDP, this number needs to increase to 20 percent to smooth the transition from a donor- and tax revenue-financed health sector to a tax revenue- and loan-financed health sector. This is a sustainably financed health sector.

The report recommends tax reforms that combat illicit financial flows in order to a) facilitate predictability of tax income and prioritization; b) create a sense of participation to appear responsible to donor nations, which will then be obligated and/or encouraged to continue their aid; and c) gain recognition in the international finance markets for replacing grants with loans.

In the shorter term, responsible health spending (regarding the implementation of UHC) requires that ODA has to be invested in a profitable way. Investment could occur directly in some key aspect of the health sector regarding maternal health, delivery or child nutrition, as “every dollar invested in nutrition to reduce stunting yields a benefit of more than $16” [1]. Investment could also take place indirectly, for example, to reform and modernize Kenya’s tax system, as “an OECD pilot project in Kenya found that every $1 invested in tax administration, $1,650 was returned” [2].

The report concludes that Kenya should work toward a tax system suitable to an LMIC country. Kenya is not unique in its transition from an LIC to an LMIC, and this report can easily be adapted to other countries that fall in between these two categories. A close look at this group of countries would benefit other countries who are on the way to being in the same position between LIC and MIC.

Read the full report.

Footnotes

[1] “Who Pays for Progress?” page 13

[2] Page 30


Related reading

Getting the ultra-poor on the “economy train”

BRAC group meeting

BRAC group meeting

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>>Authored by Yanira Garcia and Sabina Rogers of the Microcredit Summit Campaign

More than one-fifth of the world’s population lives on less than US$1.25 per day (the “extreme poor”), and most of those people live in rural areas. Due mostly to geographic constraints, it is difficult and costly to reach this population with financial and social services. Having poor infrastructure and few tools, they are stuck in a perpetual cycle of poverty.

This is a problem just begging for a solution. How about six financial inclusion strategies — our “six pathways” — that show promise in ending extreme poverty? Specifically, how about BRAC’s Graduation Approach? In 2002, BRAC set out to help the ultra-poor living on less than 80 cents a day to move up one level of poverty and to develop an approach that could tackle the geography obstacle. (Read Shameran Abed’s blog post to learn how BRAC developed Graduation Approach.)

Exciting results from impact assessments

In June, Science magazine published the results of six randomized controlled trial (RCT) impact assessments of BRAC’s Graduation Approach. The RCTs were conducted in Ethiopia, Ghana, Honduras, India, Pakistan, and Peru among 7000 households and provided the following complementary approaches:

  • Productive assets
  • Training and regular coaching and household visits
  • Access to savings and health services
  • Consumption support

At a half-day event in June at the World Bank, “Creating Sustainable Livelihoods for the Poorest,” the Consultative Group to Assist the Poor (CGAP), Innovations for Poverty Action (IPA), and J-PAL disclosed results from these six RCTs.

The RCTs showed that the Graduation Approach is a cost-effective, clear pathway out of poverty. Specifically, attendees learned that it can help drive a sustainable transition to self-employment and ultimately have large lasting impacts on the standard of living of the ultra-poor. “There will be growth in the economy,” stated Esther Duflo, “and the ultra-poor are not on the [economy] ‘train’ and would never get on the train [without help]…The Graduation Approach would push them onto the train.” (Dr. Duflo is co-director of J-Pal and professor of economics at MIT.)

Eligible households were identified through a participatory wealth ranking process as well as through household visits. On average, participant households had higher incomes, increased savings, greater food security, and improved health and happiness. These effects were consistent across multiple contexts and implementing partners.

Additional outcomes from the study include the following:

  • Daily consumption was not negatively affected over time in the selected sites after the program had ended. The authors suggest increased consumption is a result of increasing self-employment activity.
  • Household members were able to afford two meals per day more often.
  • Households continued to increase their productive assets (most in the form of livestock) as well as their savings after the program had ended, with the exception of Honduras. (Participating households in Honduras suffered an unexpected illness that killed all of the chickens, causing the study to be incomplete.)
  • In Bangladesh, where women were targeted, land ownership increased by 38 percent.

The Graduation Approach had the largest impact on ultra-poor households in Bangladesh, Ethiopia, and India. Researchers suggest that income diversification may have been a leading factor. In addition, cost-benefit calculations confirm that long-run benefits for the ultra-poor outweigh the graduation program’s overall cost.

Policy lessons for scale-up and replication

The RCTs also provide us with important policy lessons for scale-up:

  • For the Graduation Approach to have a lasting impact on ending extreme poverty, the support and action of governments and policymakers is essential.
  • It is possible to make sustainable improvements in the economic status of the poor with a relatively short-term intervention.
  • The positive results to date indicate that this approach can have a profound impact on improving the lives of the world’s ultra-poor.

Scale-up of the Graduation Approach is underway and will reach thousands of households in the coming years. Mariana Escobar, deputy director general for the Department for Social Prosperity in Colombia, spoke about Colombia’s pilot that started two years ago.

In Colombia, the Graduation Approach has helped repair the lives of the victims of the internal conflict and victims of sexual violence. Ms. Escobar explained that these results demonstrate to policymakers and governments that the extreme poor can make good economic decisions when they are given the right tools.

Edgar Leiva (Secretary of Technical Planning, Directory of Public Policies for Paraguay), Hugo Zertuche Guerrero (Director General of Geostatistical Information of PROSPERA in Mexico), Camilla Holmeno (Senior Economist with the World Bank in Ethiopia), and Fiona Howell (Senior Social Assistance Policy Advisor with the National Team For the Acceleration of Poverty Reduction in Indonesia) shared their respective country’s perspective on the Graduation Approach. On a scale of low to high, policymakers were asked to answer the questions below.

Q: How high was the impact evidence to decide to start a program in your respective country?

A: All of the policymakers answered “high.”

Q: How influential was visiting the site and seeing it in person to starting a program?

A: All of the policymakers answered “high.” Edgar Leiva (Paraguay) explained that his government started a pilot program two days after visiting Colombia’s pilot program.

Q: What was each country’s biggest challenge in implementing the program?

A:

  • Camilla Holmeno (Ethiopia): both cost and complexity.
  • Edgar Leiva (Paraguay): maintaining the positive attitude of workers in the program, which helps create a sort of magic and is so important to the success of the program.
  • Hugo Zertuche (Mexico): budget constraints due to recent decrease in oil prices as well as cross-program competition (and a perception that Zertuche’s program was poaching resources from other programs).
  • Fiona Howell (Indonesia): existing structures and system and coordination among the Ministries.

Q: What is the number one research question you would like to know the answer to?

A:

  • Camilla Holmeno (Ethiopia): test different types of packages with varying levels of transfer across Ethiopia.
  • Edgar Leiva (Paraguay): how closely tied the Graduation Approach is to the psychology of people.
  • Fiona Howell (Indonesia): how we can integrate the urbanized poor into the economic system.

Additional questions for future research were posed in the closing section of the event:

  • Which components of the Graduation Approach drive results? Through this study, CGAP and Ford Foundation learned that household visits allotted for 30 percent of the cost of the program. Are household visits necessary?
  • How do the impacts of the Graduation Approach evolve over a longer time span?

Watch the event recording

Related reading

The Nepal microfinance sector’s earthquake response

“2015 Nepal depremi” by Hilmi Hacaloğlu.
Licensed under Public Domain via Wikimedia Commons.

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>>Authored by Sabina Rogers, Communications and Relationships Manager

In a country with poverty that is already among the highest in the world, the devastating earthquake in Nepal this April caused more destruction and destitution than could have been imagined. The Nepal earthquake, estimated to have been a magnitude of 7.8 to 8.1, caused more than 8,800 deaths and 23,000 injuries. You can read all about the subsequent aftershocks that, in any other situation, would be major events in and of themselves. There is also a great deal of coverage of the toll this has taken on Nepali families and the international response. (Watch this video from The Guardian.)

Major destruction identified using satellite imagery by the crowd-source platform Tomnod. Last updated April 29th, 2015. Source: AidData at the Center for Development Policy

Major destruction identified using satellite imagery by the crowd-source platform Tomnod. Last updated April 29th, 2015.
Source: AidData at the Center for Development Policy (http://labs.aiddata.org/aiddata/nepal)

Recent data shows that it will cost over $6.6 billion and at least five years to rebuild the country, according to Nepali government officials. More than one million people may be stranded in extreme hardship for quite a long time. Local microfinance institutions have been working hard to triage their clients’ needs and thinking longer-term about the best response to this disaster.

RMDC logo-no text

RMDC made a Campaign Commitment in 2014

We have been in communication with Jyoti Chandra Ojha, CEO of the Rural Microfinance Development Centre Ltd. (RMDC), which is a wholesale lending organization in Nepal. Ojha has provided us with the information below concerning the Nepal microfinance sector’s response to the disaster.

The earthquake seriously affected 14 districts in Nepal, and microfinance clients are among the hardest hit. From preliminary information collected by RMDC and its members, here are the statistics of those affected:

  1. No. of MFIs affected: 29 (only 4 are highly affected)
  2. No. of branches of the 29 MFIs: 142
  3. Members/clients affected: 129,000
  4. Member deaths: 126
  5. Homes of members destroyed: 163
  6. Branches of MFIs damaged: 7
  7. Houses of Staff damaged: 90
  8. Staff deaths: 1
  9. Portfolio affected: Rs 2.44 billion
  10. RMDC Portfolio affected with MFIs: Rs. 1.29 billion

These details provide a snapshot of the disaster caused to Nepal’s microfinance sector by the April earthquake. On the basis of preliminary analysis, RMDC and their members are in the process of finalizing the following action plan:

Settlement of the survivors affected from the disaster

  • Providing soft loans to rebuild homes: temporary for short-term needs and then planned homes for the long-term
  • Managing the livelihoods of the affected families
  • Managing daily necessities
  • Health and education

Creating conducive economic environment

  • Devising to revive the old economic and farm activities
  • Identifying appropriate local based microenterprises
  • Skill development trainings

Financial Resource management

  • Rescheduling/ writing off of the affected farm and microenterprise loans
  • Providing new loans at lower interest rates
  • Additional Rs. 2 billion will be required to finance in the affected districts

Technical Support

  • Disaster management training
  • Workshop on rehabilitation of affected MFI branches
  • Developing new microenterprises
  • Skill development trainings

RMDC welcomes your support and assistance in carrying out this action for the disaster affected families of Nepal. Contact RMDC today:

Rural Microfinance Development Centre Ltd.
Putalisadak, Kathmandu, Nepal
P.O.Box: 20789
Tel. No.: 977-01-4268019/4268020
Fax: 977-01-4247702
Email: rmdc@wlink.com.np
http://www.rmdcnepal.com/

“Collapsed buildings in earthquake-hit Chautara, Nepal” by DFID – UK Department for International Development
Licensed under CC BY 2.0 via Wikimedia Commons.

How you can donate to the ongoing response effort

You can send individual donations to GlobalGiving’s Nepal Earthquake Relief Fund. Additionally, Save the Children has a dedicated Nepal Earthquake Relief Fund. A list of organizations accepting donations for relief efforts is available from William & Mary’s Reves Center for International Studies.

Related reading

Measuring client health outcomes using simple indicators

A local community health volunteer trained and supervised by Bandhan, an Indian MFI, meets with members of a local self-help group and their families. (Photo courtesy of Johnson & Johnson)

A local community health volunteer trained and supervised by Bandhan, an Indian MFI, meets with members of a local self-help group and their families. (Photo courtesy of Johnson & Johnson)

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>>Authored by Sabina Rogers, Communications and Relationships Manager

More than two years ago, we set out with Freedom from Hunger to develop and test a standardized set of health indicators as part of a Campaign Commitment we co-launched in 2013. This has culminated with the release of Healthy, Wealthy and Wise: How Microfinance Institutions Can Track the Health of Clients. The report describes our experience in selecting and pilot-testing a set of indicators. It will help you choose the right indicators for monitoring client health outcomes over time. And finally, the report summarizes key recommendations for developing “standardized” client outcome monitoring indicators.

We hope financial services providers and others will use our “health outcome performance indicators” (HOPI) to assess the health and well-being of clients and their families. We believe that wide usage of the HOPI would create short- and long-term value for practitioners (both health and financial services), social investors and donors, raters, and other actors. “Health” is a basic need that crosses all borders and all demographics, making the HOPI compelling measures for understanding client outcomes for financial service providers.

Four MFIs pilot tested the HOPI in 2014 (see below), and we shared results from ESAF’s and Equitas’ experiences in India in a webinar in March.

Financial Service Provider Country No. of Clients being served by FSP No. of clients participating in health indicators survey
ESAF India 450,000 700
Equitas India 1,344,361 551*
CARD Philippines 1,828,052 472
ADRA Peru 17,039 95

*Equitas had completed 234 surveys by the time we began data analysis. Therefore, the HOPI report only covers analysis for the first 234 data points

The HOPI measure 6 dimensions: poverty, food security and nutrition, preventive health care, curative health care, water and sanitation, and attitudes. The results from these four MFIs highlighted the added value of health indicators when combined with poverty measurement in helping MFIs understand client well-being. For example, the food security measure was useful to detect vulnerability; while very few clients in Peru fell under any of the poverty lines, 40 percent of them scored as food insecure.

We also found that whether clients treat their water was most frequently associated with poverty levels. However, to correctly interpret this measure, this dimension should not be used without assessing household drinking-water sources as well.

The curative health care dimension results were particularly informative and the questions have broad applicability across contexts. Results from the four MFIs showed that up to 60 percent of clients didn’t seek treatment because of costs. In Peru and the Philippines, we also learned that clients were not very confident in their ability to cover future health costs or to receive adequate medical care.

Because it’s so context-specific, the preventive health care dimension is the most complicated, yet it is also very important to include because it could be predictive of future health outcomes. As we look at adapting to new countries, national health surveys will be the most useful source for indicators.

While collecting the data was fairly simple, the bigger test will come from an organization’s ability to analyze and interpret the data so that action can be taken. In the pilots, we provided technical support to the four MFIs to analyze the data, but that level of input is not likely to be sustainable. Therefore, we are now developing an easy-to-use, Excel-based data collection and analysis tool for distribution later this year. If you are curious, then, about the health outcome performance indicators, here is what you should know:

  • They are practical to measure and monitor client health over time (annually or as part of other monitoring tools such as the Progress out of Poverty Index®).
  • They can be reported by clients in a monitoring survey.
  • They can be benchmarked to other regional, national, and global health goals and data.
  • They are reliable and are subject to change over time.
  • They will be relevant and useful for FSPs to measure and improve measures of program impact on client health and well-being.
  • They will provide donors, investors, government, health actors, and others with important information to guide decisions about support and social investment.

If you would like to learn how you can adapt the HOPI to your institution’s needs, contact Bobbi Gray (email) or DSK Rao (email).

Related reading

Engaging men and boys for gender equality

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Adolescent girls in a BRAC Tanzania program. Photo credit: BRAC Tanzaniz

Adolescent girls in a BRAC Tanzania program. Photo credit: BRAC Tanzaniz


>>Authored by Sabina Rogers, Manager, Communications and Relationships

If we are to achieve the World Bank’s goal of ending extreme poverty by 2030 — or even our own goal of helping 100 million families lift themselves out of extreme poverty — we have to tackle the issue of gender inequality. The recent review of microcredit RCTs shows, on average, a surprising lack of positive effect on women’s empowerment.

Though, there are some promising findings. For example, it seems that the effects of microcredit diffuse across multiple outcome, so it’s hard to detect what the actual effect is on women’s empowerment. Also, the study in Mexico found some small but significant increase in female decision power.

Are we satisfied with “small but significant”? Microfinance has long claimed that it was empowering women; indeed, the third core theme of our campaign, approved alongside the original goal in 1997, is “empowering women.” If the RCT review is to be taken at face value, let’s now ask ourselves what can we do better, or, what are we not doing that we should?

Engaging men and boys

A 2007 report prepared by the World Health Organization in collaboration with Instituto Promudo, Engaging men and boys in changing gender-based inequity in health, (an analysis of data from 58 evaluation studies) suggests that the problem may be that we are excluding men in the equation.[1] The report summarizes the situation thusly:

The social expectations of what men and boys should and should not do and be directly affect attitudes and behaviour related to a range of health issues. Research with men and boys has shown how inequitable gender norms influence how men interact with their partners, families and children on a wide range of issues, including preventing the transmission of HIV and sexually transmitted infections, contraceptive use, physical violence (both against women and between men), domestic chores, parenting and their health-seeking behaviour.[2]

If microcredit programs (microfinance institutions, savings groups, and other organizations in the world of “microcredit”) wish to empower their target beneficiaries, namely women, what are they doing to counter these social expectations?

A new campaign launched by UN Women in 2014 called HeForShe is calling on us to unify our efforts. “HeForShe is a solidarity movement for gender equality that brings together one half of humanity in support of the other half of humanity, for the benefit of all.” Emma Watson, better known as Hermione Granger in the fabulous Harry Potter movies, is Goodwill Ambassador for UN Women and the face of this campaign.

“We want to end gender inequality,” Watson said, “And we want to try and galvanize as many men and boys as possible to be advocates for change. And, we don’t just want to talk about it. We want to try and make sure its tangible.”

What actions do we need to take?

If you just look at intimate partner violence (IPV), for example, studies show that men perpetrate their first act of sexual violence before the age of 18 and many men will not stop at just once. Further, IPV “is more common in settings where social norms condone or ignore men’s sexually coercive or aggressive behaviors (Katz 2006; Schwartz and DeKeseredy 2008)” [3] and it is shaped by gender inequality, harmful paradigms of what it means to be “masculine,” and experiencing violence as a child.

Therefore, while we obviously need to work with men, it is essential that boys are included in programs, opening an honest dialogue discussing issues of gender and masculinity. The key features of successful interventions, according to the WHO report, are as follows:

  • Use positive and affirmative messages;
  • Encourage men to reflect on the costs of hegemonic masculinity to men and women;
  • Are evidence-based and theoretically informed, i.e., they use formative research, begin with or develop a theory of change, and carry out ongoing monitoring and evaluation;
  • Recognize that men are not homogenous and develop interventions that reflect men’s different life experiences;
  • Use an ecological approach that recognizes the range of factors shaping gender roles and relations; and
  • Use a range of social change strategies — community education, community mobilization, media, policy development, and advocacy for implementation.[4]
Photo credit: Giorgia Bonaga & Shamimur Rahman

Photo credit: Giorgia Bonaga & Shamimur Rahman

The key findings from the 2007 WHO report are as follows:

Well-designed programs with men and boys show compelling evidence of leading to change in behavior and attitudes. They even come to question violence with other men and their health-seeking behavior as a result of relatively short-term programs. But, how effective were they? Two-thirds were effective or promising and the final third were unclear.

Programs rated as being gender-transformative had a higher rate of effectiveness. It appears that (perhaps unsurprisingly) deliberate discussion of gender and masculinity and clear efforts to transform such gender norms were more effective than simply acknowledging gender norms.

Integrated programs and programs that embedded in community outreach, mobilization, and mass-media campaigns show more effectiveness in producing behavior change. Unsurprisingly, informing and engaging social institutions, gatekeepers, community leaders, and other influencers were key to the success of gender equity programs

However, relatively few of these programs are scaled-up or long-term. Indeed, only about 10 of the 58 programs included in the review represent long-term efforts to engage men and communities or scale up the relatively limited scope and short-term interventions.

What does this means for microfinance institutions, NGOs that support savings groups and self-help groups, and other financial service providers that aim to empower women? Is it realistic to ask a financial service provider to engage men and boys in a “well-designed” program in order to effect behavior change and gender equality? Is this something that they can take on?

Tell of your experience in the comments below.


How you can get involved

There is a great deal of research into such solidarity-based initiatives — both programs and government policies — beyond the 2007 WHO review of evaluation studies that is building on our knowledge base. We encourage you to take a look at Instituto Promudo’s resource library and the HeForShe Action Kit  (it’s available in 7 languages; here it is in English). And follow HeForShe on Twitter (@HeForShe) and Promundo (@Promundo_US).


 

Related reading


Footnotes

[1] The WHO report focuses more on whether the evaluated programs have taken a gender perspective into account in their work with men and boys and how and whether these programs have been able to measure changes in the attitudes and behavior of men and boys as a result of the intervention. The review assessed the effectiveness of programs seeking to engage men and boys in achieving gender equality and equity in health. The research was driven by the following questions:

What is the evidence on the effectiveness of programs engaging men and boys in sexual and reproductive health; HIV prevention, treatment, care and support; fatherhood; gender-based violence; maternal, newborn and child health; and gender socialization?

  • How effective are these programs?
  • What types of programs with men and boys show more evidence of effectiveness?
  • What gender perspective should be applied to men and boys in health programs?
  • Does applying a gender perspective to work with men and boys lead to greater effectiveness in terms of health outcomes?

This review suggests several key questions as the engaging of men and boys moves forward:

  • How can programs take a more relational perspective, integrating efforts to engage men and boys with efforts to empower women and girls?
  • What is the evidence on the impact of such relational perspectives?
  • In which cases is working solely with men and boys (or solely with women and girls) useful and in which cases is working with men and women together useful and effective?
  • What is required for programs to be able to scale up and sustain their efforts?
  • What are the common factors, conditions or operating strategies of the programs that have been able to scale up or sustain themselves?
  • Which programs should be scaled up?
  • What kinds of structural changes and policies have led to or could lead to large-scale change in men and masculinity?

[2] World Health Organization (2007). Engaging men and boys in changing gender-based inequity in health: Evidence from programme interventions . Geneva. P. 6. http://www.who.int/gender/documents/Engaging_men_boys.pdf

[3] Dean Peacock and Gary Barker, “Working with Men and Boys to Prevent Gender-based Violence: Principles, Lessons Learned, and Ways Forward,” Men and Masculinities, 2014.

[4] Ibid.

Accessible and affordable microinsurance with Afua Donkor

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We are pleased to bring you this #ThursdayThrowback blog post, which was originally published in Resilience: The State of the Microcredit Summit Campaign Report, 2014. Afua Boahemaa Donkor, executive director of Star Microinsurance in Ghana, explains how they have developed microinsurance products that are simple and affordable for the poor.


>>Authored by Ana Hecton, former intern, and Sabina Rogers, Communications and Relationships Manager

SOCR 2014_front-cover_EN_270x348

You can read a transcript of her interview here.
Read the full report here.

The 2014 State of the Campaign Report features various actors in the microfinance sector that are taking steps to help their clients lift themselves out of poverty. In this interview Afua Boahemaa Donkor, executive director of Star Microinsurance in Ghana, talks to DSK Rao from the Microcredit Summit Campaign about how microinsurance works and how it can benefit the poorest. Ms. Donkor also discusses the challenges in providing coverage for the poorest.

Star Microinsurance in Ghana started in 2008 as a specialized microinsurance subsidiary of the Star Insurance Group. Star Microinsurance works to design microinsurance products, looks for distribution channels, and provides the back office administration of the products.

“Microinsurance is supposed to be suave. When I say that, it means that it has to be simple, accessible, understandable, fundable, and efficient.”

— Afua Boahemaa Donkor

Star Microinsurance aims to make their insurance accessible to all people, those living in the city and those living in remote areas. The microinsurance products that are offered by Star Microinsurance are “made very simple, the premiums are set to be very cheap, affordable, so that the informal person, in the rural sector, can afford to have insurance products.”

Star Microinsurance collaborates with rural banks, MFIs, and post offices where the product is located. The rural banks and post offices are spread all throughout Ghana, therefore being highly accessible to all people no matter their location.

The challenges that face microinsurance

When talking about microinsurance and selling it to those living in poverty, Ms. Donkor says that it is hard for people to grasp the concept that they are paying for a possibility that may or may not occur. For those living in extreme poverty, possibilities of the future or what could happen is not a high priority. The demand is for what they need right here, right now. Thus, trying to sell microinsurance to people whose concern is focused solely on getting through that day is very difficult. In fact, “insurance in general is a very difficult thing to sell whether to an educated person or an uneducated person because it is an intangible good we are selling.”

What we know of the impact of microinsurance

ei76 infographic en

A systematic review of the impact of microinsurance (2013) produced by the ILO’s Microinsurance Innovation Facility. Source: http://www.impactinsurance.org/emerging-insights/ei76

Partnership building to reduce the Philippines’ maternal mortality rate

health-education_HMHB-PH_Oct2014_Courtesy-of-CARD-MRI

Women learn about family planning techniques while they wait for their exams at October’s community health fair.

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Pathway

Microfinance savings and/or borrowing groups linked with health education, health financing, and health product delivery


>>Authored by Camille Rivera, Senior Program Associate, and Sabina Rogers, Communications & Relationships Manager

HMHB_CMYK_English_BeveledWith the 2013 Partnerships against Poverty Summit in the Philippines, we wrote a new chapter in the evolution of the Microcredit Summit Campaign. The 16th Microcredit Summit focused on how public-private partnerships could combine expertise from the field of microfinance with other areas to develop more efficient and sustainable services for the extreme poor.

We have since created one such collaboration in order to address the problem of stubbornly high maternal mortality rates in the Philippines. While the country has experienced strong economic growth in recent years and the government has instituted a national hospital insurance scheme, PhilHealth, maternal mortality is at 221 per 100,000 live births. The Philippines are far off track of their maternal mortality MDG of 52 deaths per 100,000 live births.

It is a long way to go from 221 to 52 in the next few months, but when offered the opportunity to scale up in a short period of time our integrated health and microfinance methodology, we (with Freedom from Hunger) jumped at the chance. In partnership with a local partner CARD MRI (the largest social development organization providing micro-financial services in the Philippines) and with the financial and strategic support of Johnson & Johnson, we are implementing the Healthy Mothers, Healthy Babies project (HMHB, or “Kalinga Kay Inay” by its name in Tagalog).

Photo credit: Cassie Chandler

Photo credit: Cassie Chandler

How it works

The idea is simple: offer free health check-ups and behavior change education on health topics to pregnant and lactating women to create positive health outcomes. By the end of 2015, CARD and other MFIs will educate 600,000 women to improve maternal health and safe deliveries of infants, birth outcomes, and reduce preventable maternal death; and 8,000 pregnant or lactating women will be directly connected to relevant services and products. CARD and partners have held two community health fairs so far, and for many of these women, it was their very first gynecological exam.

At these health fairs, CARD sets up tents to give shade to those waiting outside. Inside the building, as the women wait for their preliminary exams (and, if necessary, ultrasounds), they learn about family planning. The volunteer health providers (doctors, OB-GYN, midwives, and others) write prescriptions for those who need medications, and BotiCARD (a CARD MRI institution) fill them for free in a tent set up outside.

CARD has found their collaboration with local government and public health units to be vital in getting higher-than-expected turnout to the fairs as well as for identifying local health providers for CARD members. Local administrators of PhilHealth have joined our January health fair and provided services to 179 health fair patients ranging from members’ renewal enrollment, new enrollment, membership updating, and printing of members’ data information.

Making these changes lasting changes

More importantly to us, through this endeavor, we are working to improve the scalability and sustainability of delivery of health education and related services to millions of women and children in the Philippines. Inspired by the 2013 Partnerships against Poverty Summit, the Campaign’s role in the HMHB project is to reach beyond the traditional microfinance actors and facilitate a partnership-building process for the “MFIs for Health” consortium, a group of 18 MFIs who are banding together to increase access for their communities to health-related products and services.

A doctor provides free checkups as part of a health outreach program in the Philippines. Photo by: CARD MRI

A doctor provides free checkups as part of a health outreach program in the Philippines.
Photo by: CARD MRI

We are talking with several foundations, corporations, and associations to identify specific ways that they can work with us and MFIs for Health to increase access to and improve delivery of healthcare services. The Zuellig Family Foundation (ZFF) and JPHIEGO in the Philippines are two organizations that have joined forces with our alliance — whether formally or informally. They have facilitated introductions to local government units (LGUs) and the Integrated Midwives Association of the Philippines to recruit healthcare providers as volunteers for the health fair and get their help spreading the word to their patients. In fact, ZFF and CARD are working with the Rural Health Unit (RHU) in the Visayas to coincide the RHU’s “Buntis Congress” (Pregnant Women’s Congress) with CARD’s April community health fair. Through this coordination, we are pooling resources and thus gain a larger potential impact for the community.

April is the Month of MicrofinanceLearn more

April is the Month of Microfinance
Learn more

This strategy behind HMHB, to facilitate partnerships between microfinance actors and players in other sectors, parallels efforts to create more integrated approaches to solve the most pressing needs of the extreme poor. In this case, we are addressing maternal and child health; in Ethiopia, it could be fistula and, in India, it could be non-communicable diseases.

Because MFIs meet regularly with large numbers of clients, they serve as an ideal platform to convey health information and services to clients who often build relationships of trust with their loan officers, as well as other members in their group. These exchanges can also have a replicator effect as clients are encouraged to share the information with their family members and others in their community.

By forging partnerships across sectors and bringing in non-traditional actors to microfinance, the Campaign is maximizing the best aspects of each player and (hopefully) helping the Philippines reduce their maternal mortality rate to 52 deaths per 100,000 live births.

Relevant resources

Millennium Development Goal 5: Progress and challenges in maternal mortalitySource: The Institute for Health Metrics and Evaluation

Millennium Development Goal 5: Progress and challenges in maternal mortality
Source: The Institute for Health Metrics and Evaluation

Empowering communities one Esther at a time

Esther Chebet is a Community Knowledge Worker. She says, "It has made such a difference in my life. From a poor woman whom people say, 'Who is she?' to now, 'There is CKW!' I’m so proud to be a CKW and serve the community willingly."   Photo credit: Grameen Foundation

Esther Chebet is a Community Knowledge Worker. She says, “It has made such a difference in my life. From a poor woman whom people say, ‘Who is she?’ to now, ‘There is CKW!’ I’m so proud to be a CKW and serve the community willingly.”
All photos courtesy of: Grameen Foundation

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>>By Sabina Rogers, Communications and Relationships Manager

Esther Chebet is an inspiration to her neighbors. She is a valuable resource to her community, and they know it. Kids call out to her on the street: “CKW!” Men respect her knowledge and opinions. Women come to her for help fixing problems and resolving disputes.

With International Women’s Day on Sunday, March 8th, I’d like to take this opportunity to appreciate Esther and many women like her — community health workers in India who are working with ESAF to screen their clients for high blood pressure and health professionals in the Philippines who volunteer their time for Community Health Fairs organized by CARD MRI — who are on the front lines in the fight to end extreme poverty.

This is Esther Chebet’s story: one woman who is making a huge difference in her community.

A farmer in rural Uganda, Esther received training as a Community Knowledge Worker (CKW), from Grameen Foundation. She was the star of a webinar hosted by Grameen, telling her story and showing us how one woman can help create an economically empowered community.

She has multiple roles in her community in rural eastern Uganda: farmer, seamstress, volunteer domestic violence counselor, teacher and Grameen Foundation Community Knowledge Worker.

In her role as a Community Knowledge Worker (CKW), Esther visits her neighbors — a large number of whom are women — and helps them solve problems with their crops and livestock. She uses her mobile phone to access an agricultural database with information on relevant, local best farming practices, weather forecasts and market price information. This enables her neighbors to treat diseases like banana wilt and to get better market prices for their produce. As a result of this support, farmers are able to earn on average 38 percent more money from their crops. [1]

Below follows my attempt to capture the Q&A from her video chat, though answers are paraphrased.

Does work as Community Knowledge Worker (CKW) empower women?

Yes, it empowers women. In our culture, men used to say women were property. As a CKW, I’m a women’s right activist. I train women on their rights and they’re now doing things they never could before.

For example, before, women couldn’t take coffee to market. She could grow it but not sell it. Now with my training, women are going and selling their coffee. They’re now so happy. They say, “We sell our coffee, we show a receipt of that transaction.” They grow their own crops and sell it!

What is a typical day as a CKW?

I wake early at 5 AM, then I prepare breakfast for family. At 7am I visit my banana plantation and then feed my animals. After doing my housework, from about 2 PM to 5 or 6 PM, I go visit the savings group members and other people, educating them on what they can get out of becoming a savings group member or answering people’s questions about their farms. Then I come back to prepare supper and rest.

Can you tell a difference in your farm from your work as a CKW?

Yes, after I went through the training, I started gathering manure and built a system of preserving water. Now my banana trees are always green because I always have water for them. Production is up.

Can you give an example of a woman you helped?

I helped a woman who came to me because her poultry were getting sick.

She said, “I hear you’ve got information.”

“Yes, I have; what is the problem?”

“My poultry are doing poorly and my hen is dying.”

I told her to use seltzer water and aloe vera; she did that and now the poultry is doing fine. Then she shared this information with other women who are planting aloe vera for their use.

One man asked me about spacing of coffee. We did a demonstration with him at his plantation. This year, he’s going to have so much coffee.

What is the problem you see most frequently on your neighbors’ farms?

The main thing is a banana bacteria wilt, but through my help as CKW, it’s improving. We, my community, worked together to cut down every affected plant, and now there is no more affected plant. Plus, every farmer knows that it if happens, if the bacteria comes back, it’ll be bad for him, so immediately, they cut down the affected banana tree.

How were you selected to be CKW?

I was elected by my neighbors. Three of us were nominated for election: 2 women and 1 man. We were sent out of the room so they could talk about us, and after about 5 or 10 minutes, they called us back in. They said, “We choose Esther.”

When I was elected, I was happy! They said, “We selected Esther because she is confident, she can speak to many people, and she is willing to serve the community.” Most of the time, I speak the truth. So that is why I was elected. Without knowing exactly what I’d be doing, I was so happy that I would be serving community members. Willingly!

What’s the most interesting thing you’ve learned as CKW?

I’ve learned the correct amount of manure to use as fertilizer. I’ve also learned how to make my own drugs for treating my animals, plants, and many other things. I make insecticide for my plants and vegetables using local ingredients.

Esther's daughter with avocado

Tell us about building a barn for your cow. You said you got a lot more milk when you built the barn.

Since I built the barn, the cow stays dry and warm when it rains. Since then, the milk production has increased to 5 L in the morning and in the evening 4 L. I sell each liter at 1,200 Ugandan shillings. I sell the morning milk, and my family drinks the milk from the evening.

What is your biggest challenge as a CKW?

Farmers don’t adapt to the message quickly. Among 20 farmers who saw example of a granary I built, only 6 started doing it. They ask for the information, but they see it is hard to use it and some don’t persevere. But, when farmers who keep at it and it works for them, they give testimony of it working and tell others to go talk to Esther

Also, sometimes people neglect you because you’re a woman. They say, this is information for men.

When you train men, do they ever resist information just because you’re a woman?

Esther's manThey like it, but mostly, the people who accept the information are women. Then women tell them, “This is good information from Esther.” Then the man or the husband can come and ask, “Is it true this information?” I say, “Yes, it’s true; I came to your home and talked to your lady.” Then the men ask for more information.

I’m now in my third year of being a CKW, and people are more accepting than they were at the beginning. Men are now coming to trust me; coming to me to ask for information.

How do other women in your community feel about you being a leader?

They feel good because of the information I can give them like women’s rights and creating a savings and credit group. Women have learned to save money and loan it to others in the group; some years from now these women are going to have happy families because they no longer have to ask their husbands, “Ah, please give me something with your money…haha” and so on. No. Now women are able to buy what they need with their own money.

I have nine savings groups that are operating strongly. They say thank you for this knowledge, and they’re sending their kids to school with money they’ve saved or profits earned from businesses financed by the group.

How has being a CKW improved your status in the community? Do people treat you differently now?

It’s changed my status from who I was then, a poor nobody, to who I am now three years later. Men are respecting me. Sometimes I’m a counselor; they call me in to help resolve a problem or counsel families. Kids call out to me, “CKW!” That’s how I’m known now, as “CKW.”

How has being a CKW changed your life?

It has made such a difference in my life. From a poor woman whom people say, “Who is she?” to now, “There is CKW!” I’m so proud to be a CKW and serve the community willingly.