ENDING GLOBAL POVERTY

A GUIDE TO WHAT WORKS

STEPHEN C. SMITH

PALGRAVE MACMILLAN         2005

PART V

 

PART II

ESCAPING THE POVERTY TRAP:

HOW THE POOR ARE GAINING THE KEYS TO CAPABILITY

 

Even in the poorest regions of the world, far from the major growth engines of the global economy, and in the face of many handicaps, good work is being done to help the poor gain the keys to capability and escape from poverty traps. Part II of the book takes a close look at innovative and inspiring programs in areas such as the Andes, Sub-Saharan Africa, and rural South Asia that remain outside the mainstream of the world economy.

Up to this point, we have looked at what poverty is, why it can be a trap, who the poor are. But what exactly is a poverty program? Many definitions are possible, but the one I use casts a fairly wide net: A poverty program is an intentional and systematic attempt to change the status quo (or equilibrium) in a way that reduces poverty.

Keep in mind that identification of effective or innovative programs is not a science; it relies on a combination of statistical and case study methods tempered by judgment. Moreover, there are many other excellent poverty strategies. Although chosen carefully, programs featured in this book are not necessarily superior to many others that are not covered. Instead, these cases are intended to be illustrative of the broad range of promising work now being carried out, and to encourage thinking outside the box about what could be done to meet some of the less-obvious needs of the poor.

Chapter 3: Health, Nutrition, and Population

Our hopes for ending global poverty depend on better health for the poor. Health begins with safe water. But water is all too often scarce, far away, contaminated, or a combination of the three, threatening our efforts.

SOUTH AFRICA:

SAFE WATER AND HEALTHY CHILDREN

 

In rural South Africa, the poor often live one or two miles or more from sources of water, which must be drawn from streams, or, for the lucky, drawn from hand pumps, although either method is physically straining on tired women, who are generally the ones who fetch the water. Risks of cholera and other diseases found in contaminated water are high. Needless to say, the poor cannot afford the piping and power pumps (even if they could get electricity) that are used by the rich. So the women must trudge twice a day to collect water, wasting desperately needed hours. You can often see their children following sullenly behind. When a little older, the children themselves must fetch the water. These children have generally never enjoyed the playground equipment that we take for granted.

The solution: enter Roundabout Outdoor with its ingenious invention, the Roundabout Playpump. The company developed a low-maintenance merry-go-round (also called a roundabout) for children to spin around in, started and sped up with their feet: the kind of playground staple many of us remember from childhood. But the spinning action is used as power for pumping water out of a well dug nearby, which is then sent up to a water tank a few meters above the ground. The design has an innovative way of converting the circular motion of the toy into up-and-down motion for drawing water using only two moving parts. The children get a playground toy that they really delight in. the Playpumps are often placed in schools, giving children an additional incentive to attend (at least they like the recess time). The children help their families and communities get better access to water simply by having a good time. Children at play may be one of the great renewable resources of the world. The only problem is convincing the kids to get off the Playpump when it is time to come home.

• The pump is effective to a depth of about 100 meters, and at 40 meters is considered remarkably efficient – significantly better than what a hand pump could deliver with great effort.
• The Playpump costs about $5,000 – an investment that is quickly returned just from the time saved in fetching water.
• Many Playpumps have been financed through grants. The project was a winner of a $165,000 World Bank development marketplace award.
• Over 500 Playpumps have been installed to date, and over 200,000 South Africans have benefited.
• Though maintenance costs are low, these are not trivial to impoverished villagers. Maintenance is financed with small advertising billboards on the sites.
• The project is clearly something that can be replicated in many parts of the world in thousands of villages, and interest is growing in transferring this new technology to other countries in Africa and Asia.

 

FIGHTING HIV/AIDS:

THE AIDS SUPPORT ORGANIZATION, UGANDA

Now the leading cause of death of working-age adults in the developing world, if unchecked AIDS may condemn Sub-Saharan Africa, the hardest hit region, to grinding poverty for at least another generation. In 2004, some 42 million people worldwide were infected with HIV, with over 34 million of these in Sub-Saharan Africa. There the prevalence rate is now estimated at 8.8% of the adult population, with women representing 55% of the infected. The impact of the disease is approaching that of the bubonic plague of Medieval Europe.

The World Health Organization (WHO) estimates that, by 2002, nearly 22 million people had died from AIDS since the disease was identified in the 1980s, with the large majority of deaths occurring in Sub-Saharan Africa. Throughout the region AIDS is now the leading cause of death of adult males in economically active years. Although infectious childhood diseases still kill far more people in developing countries, AIDS strikes those who have successfully run this gauntlet of child killers. Their societies need the energies and skills of precisely the part of the population most afflicted.

• In the developing countries as a whole AIDS is primarily transmitted by heterosexual intercourse. In addition, infected blood and needles, both by drug abusers and in hospitals, and perinatal transmission (from mother to fetus) play significant roles.
• In low-income countries average survival once AIDS symptoms set in has been less than one year.
• Lifesaving drugs are still not available to the overwhelming majority of the infected in Africa and South Asia because of limited availability of low-priced drugs, slow implementation, and inadequate health system infrastructure to get the medicines to patients in these countries. In the absence of these drugs, treatments have generally been limited to aspirin, antibiotics for infections, and cortisone for skin rashes.

Some NGOs are responding to AIDS with innovations that have resulted in a significant humanitarian and poverty alleviation impact. Uganda was the first country to be hit hard with an AIDS pandemic, but, partly through the work of NGOs, the country became a model for how to contain such an explosion of HIV and to treat its victims with dignity. The AIDS Support Organization, or TASO, has played a crucial role in treatment, family assistance, and counselling. It has been instrumental in prodding government into action, and helping Uganda respond to AIDS.

A Uganda-based and locally governed NGO, TASO was founded by Noerine Kaleeba in 1987, after her husband died of AIDS contracted through a blood transfusion. Its goal is to help people to “live positively with AIDS.” Patient testimonials suggest that the counselling makes a big impact on how people live after learning they are HIV positive. Some of these patients have themselves become activists in the organization, and many other TASO staff and volunteers are also people living with HIV/AIDS.

Uganda-based TASO was the first indigenous NGO in Africa to respond to the needs of people living with HIV/AIDS, and it has received accolades for its pioneering and successful efforts to disseminate AIDS education to the local grassroots levels and relieve the suffering of AIDS patients. TASO won the King Baudouin International Development Prize in 1994. Recently TASO has garnered much attention, with visits by U.S. Secretary of State Powell in 2001 and by President Bush in2003.

• The AIDS Support Organization has played a crucial role in Uganda’s long fight against AIDS, in the fields of treatment, family assistance, and counselling, as well as general education. Although entirely indigenous, it has received substantial outside funding.

The case for fighting AIDS is slightly different from that of fighting the major childhood killers. In both cases, there is a moral imperative to help when people are needlessly suffering. With small children our obligation is primarily humanitarian. If there were a tradeoff between saving children and adults given limited funds, many would support saving the children. We can afford to do both. Indeed, the two cannot be separated. With adults with HIV/AIDS the case for action is not only humanitarian but is also an investment in reducing future need for aid. Adults who have survived childhood diseases are the ones the children and the elderly count on for support. If Africa loses people entering the prime of their bread-winning years, children and the elderly will become even more destitute, making it that much harder to break out of poverty traps. Moreover, AIDS has tended to strike those with more education and higher productivity – thus having a disproportional impact on economic development. In many parts of Africa today, teachers are dying of AIDS faster than new teachers can be trained. Keeping an HIV+ person with basic education productive as she enters the earning years is a better way to raise national incomes and general well-being (or keep then from falling) in countries such as South Africa than most other investments.

Good work on AIDS is going on now throughout Africa. An excellent recent model developed by church groups in Zimbabwe is to utilize volunteers to visit and provide basic care for AIDS orphans in the homes where they live, which can be homes of child-headed households, foster parents, grandparents, or other relatives. These visits provide a much needed combination of emotional and material support for these orphans. But AIDS must be prevented in the first place. And modern methods of family planning need to be introduced.

POPULATION AND FAMILY PLANNING:

CARE MAKES PROGRESS IN ETHIOPIA