Community-based Health Care in Africa

IRIN News reports on a new study by the Lancet that analyzes the possible benefits of allowing community health workers to administer certain drugs to deal with problems of hemorrhaging and infection that lead to many maternal deaths in Africa. You can find the study here.

Thousands of women die each year in Africa from complications of childbirth. Many aren't able to get to medical clinics for help (too far away, too costly, too difficult to travel, etc.). They perish for lack of medicines and lack of care. And so the idea is to bring at least some help to them. Community health workers are one way to get needed supplies and at least some primary health care to people living in rural areas.

How might this work? CHWs might be employed by provincial or national ministries of health, but a different model would to be create social enterprises designed to fill this niche. A social entrepreneur would train health care workers and send them to rural areas to meet local needs. Governments might contract with these private-sector providers to operate in a particular area, doing a particular set of tasks. Another model would be for villages savings and loan organizations, or local cooperatives, to contract with these health care providers. If the former model was adopted, governments would enter a public-private partnership to provide a social service; in the latter case, a private-sector alternative to public sector care would, no doubt, need to satisfy some accredidation or certification process and would be paid for directly by the people receiving the care.

The concern would be that the rural poor are not being treated by more educated, or better trained medical professionals. Of course though, they're oftentimes not being treated now, so the choice is not really between higher quality care and lesser quality care; it's between some care and no care. And some care is almost certainly better than none. One challenge in implementing such a program would be to create appropriate incentives for national ministries of health to give up some control over the provision of health care and allow for more entrepreneurship in this realm. But, allowing coops and other extant rural organizations to contract with private-sector providers for such services could be both a cost-effective and a life-saving health care alternative. (The photo is one of mine from an orphanage in Botswana).

- Karol

Indego Africa at ASEF

Focused on action rather than just talk, and bringing together an overflow crowd of hyped-up social entrepreneurs, the first ever Africa Social Enterprise Forum (ASEF) yesterday at the Desmond Tutu Center in NYC was a rocking success.

Indego Africa had a blast. Matt waxed poetic on a "Structural & Legal Considerations" panel. Mike Foresta - the youngest member of NYC's Regional Board - manned our table in the Enterprise Lounge and sold Indego Africa's first Laptop Sleeve, a product concept that he and the women developed together during his visit to Rwanda in July. I did a little "speed mentoring" and then just wandered around and enjoyed the social enterprising buzz.

A tremendous thank you to Jerryanne Heath, Magogodi Makhene, the ASEF Executive Committee, and AngelAfrica for organizing such an important conference that will impact the social enterprise community - and Africa - for years to come.

ENJOY THIS VIDEO OF INDEGO AFRICA AT ASEF2009!

- Ben

Trade versus Subsidies

Earlier this week Rwanda's President, Paul Kagame, had an editorial in the Washington Post. In it, he suggests that "we may be on the verge of a new partnership" between Africa and the US, one that recognizes each side has something of value to offer the other, as opposed the traditional relationship of dependency.

President Kagame has been promoting "trade not aid" for some time now. He makes the case that increased US-Africa trade will be a win-win and calls on African states to do more to take advantage of AGOA. He focuses on the vital role the private sector plays in driving economic growth and prosperity and acknowledges that African countries have not done a good enough job supporting this sector. He even connects the dots and argues that the private sector is essential for building "capable, reliable, and transparent societies."

Where I disagree with President Kagame is on his call for US taxpayers to increase our funding of the Export-Import Bank and OPIC (the Overseas Private Investment Corporation). The Export-Import Bank provides financing to US exporters to help them sell more products and services in overseas markets. President Kagame notes that the Chinese government guarantees 30 times more loans to Chinese investors in Africa than does the US. He believes that increased investment would lead to more profitable opportunities for American firms. He may be correct, but this doesn't necessarily mean that the US government/taxpayers should subsidize these activities. (Coincidentally, the New York Times ran an article the next day that talks about some major problems associated with China's ExIm lending in Africa).

Presumably President Kagame does not like US agricultural subsidies, so why are export subsidies different? We can imagine that he'd view them differently because they have the potential to help his citizens, whereas US ag subsidies do not. But subsidies are subsidies: one group is helped/favored at the expense of others. In the case of exports, US exporters are helped by US taxpayers. Nigerian, Tanzanian or Sri Lankan exporters may not have a comparable benefit yet they have to compete against the US producers for market share. Many people are critical of our protection of US cotton growers, should we be similarly critical of our protection of US tool manufacturers? While export subsidies are often sold as a way to "level the playing field" what they really do is create a plateau -- one that's difficult for many developing-world entrepreneurs to climb.

- Karol

Is Federation Really the Future in East Africa?

The Economist is mildly encouraged that the East African Community (EAC) may turn into a viable and valuable "European-Union style federation."

Tanzania, Kenya, and Uganda created this version of the EAC in 1999. Rwanda and Burundi joined the group in 2007. The member states have agreed to create a customs union and common market (by 2010). They're also talking about creating a common currency. The ultimate goal would be a political federation along the lines of the EU that would create common policy on a host of issues.

A customs union and common market are especially useful for Rwandans. As a landlocked country all Rwanda goods (except those shipped by air) have to travel through Uganda or Tanzania and/or Kenya to get to a port for shipment. Being part of the EAC means that Rwandans now pay lower tariffs to move their goods through neighboring countries. This will help to make Rwandan products more competitive on world markets. It's probably also useful for these countries to work together to improve the transport infrastructure. Moving more products more quickly will also help with competitiveness. As the article points out, because the Rwandan government seems intent upon improving its relations with Congo there may also be opportunities to take Congolese commodities and process them (add value) then ship these out via EAC ports, further diversifying the Rwandan economy. This is essential if the country hopes to continue its relatively good track record (over the past decade) for economic growth.

But what about a political federation? Would an EU-style federation help reduce corruption, ease ethnic tensions, improve the rule of law and press freedom, all of which are crucial issues to tackle if these countries hope to grow more? This is far less clear. Although inclusion in the EU seems to have helped Eastern European countries to reduce corruption and improve the climate for doing business it's not clear what the incentive for change would be in the EAC. In Eastern Europe, countries had to amend their legal codes, their regulatory structure, and their approach to dealing with public sector corruption in order to be let into the EU club which, in turn, gave them access to EU grants and financial support. There's no comparable incentive (or sugar daddy) for the EAC countries.

But whether political union comes or not, we can still applaud efforts to promote regional integration and closer economic ties between these neighbors -- more regional trade will be a key to future growth.

- Karol

Emmanuel's Enthusiasm

My two favorite things about Emmanuel Mukomeza - one of Indego Africa's fantastic Orphans of Rwanda interns and a student at Rwanda's School of Finance & Banking - are his confidence and energy. For instance, at our very first meeting together in Rwanda, before I could get a word in, Emmanuel was carefully explaining to me his proposed keys to success: (1) preparation, (2) sound management, (3) strong decision-making, (4) ownership of projects, and (5) vision. Can't disagree with those! Emmanuel tackles his training sessions for Indego Africa in financial management and computers with an unreserved zest, and even after watching him interact with the women at our partner coops for just a few minutes, you know his enthusiasm is contagious. On that note, Emmanuel drafted a blog post that he'd like to share with all of you:

Life Transformation with Indego Africa

by Emmanuel Mukomeza

Sept. 10, 2009

Empowerment of women is the key to the development of Rwanda because women are seen as the heart of every family. Mothers spend most of their time attending to their children and household needs, unlike men who tend to spend most of their time in bars drinking alcohol. Empowering women means better standards of living and welfare of families. However most times these women are financially handicapped.

With Indego Africa the dreams of Rwandan women have become a reality. Indego Africa has found a sustainable solution to their financial problems by equipping Rwandan women with skills and providing a market for their products in the United States. Equipping these women with computer skills, literacy training and the ability to manage their finances then empowers these women and improves their competence. There is a saying which goes “to give a man food means you have given him food, but showing him how to fish means you have given him life.” That’s the sense with Indego – empowering women means giving them the potential to earn a living and live a decent life.

Mutekereze, a woman from Covanya cooperative located in Nyamata, is one of the beneficiaries of Indego Africa Project. She remarked, “since Indego Africa started to support our cooperative, my life has completely changed. I have managed to earn a living and support my family. I sent my children back to school. Indego provides a market for our handcrafts, which also encourages us to work hard. Yes I am happy with Indego Africa.”

In this dot.com generation, these women have not been left behind by the growing technology. Instead Indego has made computers available to both Cocoki and Covanya cooperatives so that in the future they can record their transactions electronically. With each step, the women gain more confidence and strive to expand. For instance, a recent visit of a Kigali trade show gave motivation and created excitement among these women who now want to participate as exhibitors in the next coming trade show.

Indego is now growing drastically in all parts of Rwanda, from Kigali to Bugesera and now Covamanya in Kayonza about 35kms from Kigali.

With Indego dreams have become a reality.

Click here to watch Emmanuel's teaching skills in action!

Rwanda Tops List of Reforming Nations!

Most days I take a look at Google News to see the latest from Africa. Last week I opened the page expecting to see one particular item at the top of the list but . . . I was wrong; the story I hoped to see was missing.

There was a story about cheetahs being the fastest land mammals (I thought we already knew this) but NOTHING about Rwanda topping the list of nations around the world that have reformed their laws and regulations to make it easier and less costly to do business. Ugh.

Oh well, here's a link to an overview of the 2010 Doing Business report by the World Bank/IFC. The Doing Business authors note that: "most reforms recorded in 2008/08 were part of longer-term efforts to increase competitiveness and encourage firm and job creation by improving the regulatory environment for businesses. And most took place in developing countries." (emphasis added).

The best reformer, worldwide, was Rwanda, which made positive changes in 7 out of 10 categories that the study tracks. For example, the study claims that entrepreneurs can now start a business in the country in 2 steps that take 3 days (would love to test this one out, I'm a little skeptical but ready to be proved wrong). The government has been focusing on improving its commercial law for years now and has changed regulations related to credit, use of collateral, bankruptcy, and liability for company directors in order to make investors feel more secure--which should help spur investment of course, both domestic and foreign. Assuming that all these reforms actually translate into on-the-ground differences for business people and entrepreneurs in Rwanda this is great news and something to celebrate as the country continues to move beyond its tragic past and towards a future that is brighter for all its citizens.

Improvements to business regulations won't, by themselves, solve the country's problems, but they are especially important steps to take on the path to development. Rwanda officially qualifies as a different kind of African "Cheetah."

- Karol

Africa Social Enterprise Forum on Sept 26th in NYC

Indego Africa is proud to announce its participation in the Africa Social Enterprise Forum (ASEF) on Saturday Sept 26, 2009 at the Desmond Tutu Center in NYC. ASEF is the first major event of its kind to focus exclusively on social enterprise in Africa, and with 200 participants, 30 speakers, speed mentoring, an enterprise lounge, and $4 billion in social investment capital, we have no doubt that it will prove to be an incredible event.

REGISTER TODAY!

ASEF is Day 2 of the 2009 AngelAfrica Enterprise Conference, a two-day annual event which showcases investment, economic development and entrepreneurship in Africa’s private and social sectors (full conference packet for both days here).

In addition to Indego Africa's Founder & President Matt Mitro, confirmed speakers include:

• Craig Newmark, the Founder and creative force behind Craig's List;
• Elizabeth Scharpf, Founder & Chief Instigating Officer, Sustainable Health Enterprises;
• Antony Bugg-Levine, Managing Director, Rockefeller Foundation;
• Cindy Ko, Director of International Expansion, Endeavor;
• Jacob Lief, President & Founder, Ubuntu Education Fund;
• John Simon, Visiting Fellow, Center for Global Development and Former US Ambassador to the African Union;
• Nick Sowden, Director of Business Development, ToughStuff (and Indego Africa collaborator); and many more.

Hope to see you there!

- Ben

(PS - above photo is of Gloriose Mutesi, a master weaver at Cocoki.)

Taking Stock of African Enterpreneurs

There's a very nice post at the New York Time's Freakanomics blog on three African entrepreneurs and what they are doing to create value.

Magatte Wade, founder of Adina for Life, a beverage company, is profiled. She is highly critical of traditional foreign aid in Africa but highly supportive of the notion that African entrepreneurs can build sustainable, viable businesses by appealing to cultural, creative consumers in the US and elsewhere.

Jon Gosier is helping to support African technology companies with venture capital he supplies. He's hoping to launch a number of technology start-ups in Uganda. Interesting, local technology firms have to overcome something of a bias, an idea that they aren't to be trusted--trust is a vital component of a thriving commercial society.

And finally, Ketty Opoka runs an NGO called Meeting Point to support people in Uganda living with HIV/AIDS. She's the social entrepreneur of the group and her mission, while a bit different from those of Magatte and Jon, shares this with them: all three are responding to needs and desires of others creatively and spontaneously and, in the process, helping to build stronger communities.

- Karol

An Inspiration

The founders of Indego take inspiration from a very special woman whose story I would like to share with you. As a child she lived in a rural area and her family did not have electricity or running water or an indoor toilet. One of her jobs was to carry water to the house for her family’s needs. She learned to sew on a manual foot-powered sewing machine. Her father worked long hours and tried to add to their meager income by farming late at night a rocky hilly little plot of land. She attended a rudimentary one-room grammar school with children of all ages in one small classroom with only one overworked teacher. Despite being smart at math and language and skipping a grade, her family could not afford for her to attend secondary school so she was forced to drop out at 14 and move to the city to clean and cook for others and tend their children. She worked hard, and eventually found a way to start her own small micro-business cooking for others. She taught her children about hard work – always having chores at home and working at a variety of jobs at an early age. But she constantly insisted that they study and work hard at school. She somehow knew that education was the key for them to improve their lives. Her hard work, sacrifices and determination paid off for them - her children and grandchildren were able to obtain university degrees and go on to very successful lives.

At this stage you might have guessed that this story is about one of the remarkable women at the Indego coops in Rwanda. Her story and perseverance IS very similar to theirs; but she doesn’t belong to one of our coops, and has never been to Africa. The only real difference between her life and the women at the Indego coops is that she lived in the U.S. where a hard-working talented person has the opportunity to overcome obstacles. Unless they receive a Hand-Up from Indego the women in Rwanda will not likely find opportunities to change their lives merely through hard work and talent.

The woman in the story who has provided so much inspiration to the founders of Indego? I just visited with her last week in the hospital. She is now 90 years old and in poor health and weakening every day, but still fighting hard to regain her strength. Despite her poor health and very limited income she still takes time to ask about the women in Rwanda and make donations to Indego. This remarkable inspiring woman is my mother, Olga Mitro.

-Tom