Sunday, October 22, 2006

Grameen Bank Wins Nobel Peace Prize

The Nobel Peace Prize will be awarded this year on Dec 10th to Mohammed Yunus, a Bangaladeshi economist and the organization he founded, called the Grameen Bank. This is wonderful news on two fronts. It is a well deserved award for Mr. Yunus who has spent almost thirty years spreading a truly revolutionary idea of the sustainability and benefit of providing credit to the poorest of the poor. It is also high level recognition that ending poverty is a fundamental prerequisite for bringing world peace.

Health workers have long known that poverty is one of the root causes of ill health. Maurice King published what became one of the classic texts about Primary Health Care in 1966. Called Medical Care in Developing Countries-- a Primer on Poverty, this book presents the symposium held in East Africa and attended by a group of his colleagues interested in what could be done practically to extend health care beyond the hospital.

At the time, Dr. King was a medical microbiologist teaching at Makerere University. A locum for a colleague in a remote region of Uganda called the Karamoja, brought him face to face with the wider implications of poverty for health. Medical assistance to the developing world up till that time consisted mainly of bulding hospitals and providing physicians, thus replicating the Western model.

Maurice King's experience in the Karamoja convinced him that a different approach was needed. At the symposium he presented a paper showing how health units served patients drawn from within 5 km. of the institution, rarely further. This was also true of the teaching hospital in Kampala, which was intended to serve the entire country. He postulated that most patients were walking to health units and 5 km. was the distance most patients were willing to walk. Mothers carrying one child and leading another were unlikely to be able to cover much more than 3 km.

I have searched in vain for a decent, informative link about Dr. Maurice King and regret I have been unable to find one. I did find one BMJ article that gives you some sense of what he is up to in his 8th decade.

It took a while and much discussion around the world before some of the ideas first launched in Makerere could be fleshed out and shared in all regions. By 1978 in Alma Ata, the capital of what now is Kazahkstan, the principles and practices of Primary Health Care were discussed, hammered out and agreement reached. This created a global committment to achieve Health for All. Primary Health Care (PHC) was identified as essential health care, scientifically sound, socially acceptable, universality accessible, with full community participation, while encouraging self reliance, social and economic development. It was to be provided at a cost that was affordable.

It was recognized that the greatest challenge would be to provide primary health care for the poorest, those in fact who were the least expensive consumers. The initial goal was to complete this mammoth task by the Year 2000. This proved overly ambitious but by 2000 significant progess had been made, lessons had been learned and efforts were pointing in the right direction so there was substantial regrouping and efforts since 2000 have been much more focused.

Mohammed Yunus had a similar epiphany to the one experienced by Maurice King, but his was an economic epiphany that occurred during the Bangladesh famine of 1974. He saw how rural women were trapped in a vicious cycle of poverty by the demands of moneylenders. He began providing what he called "seed grants" for corn seed at reasonable rates to enable the women to repay their loans. Later groups of women pooled their small amounts of cash in order to be able to provide small loans to one or two women at a time.

Over time guidelines for ensuring the process of providing credit to the rural poor were worked out. Many of the loans were for as little as 5 USD, which could be enough to buy a goat or a couple of chickens in order to get started. When a woman, because of illness or family problems, was unable to repay her loan, others in her group gathered round to assist her. As soon as the first loans were repaid, the next women in the group received their loans.

One of the most startling results of these small loans was the repayment rate, which even early on reached 90 - 95%. This far exceeded the results of financial institutions lending to much bigger enterprises. In fact it was unheard of in the loan business.

Today micro credit clients are estimated to be as high as 92 million world wide. In Uganda, our community health volunteers have been greatly interested in such schemes and have thus adapted some of the same principles in order to purchase bed nets. After learning how useful bednets aree for preventing malaria, a group of 8 volunteers in one parish decided they should all get one. Each month they pooled 1000 Uganda Shillings (approx. $1) to a fund to purchase bed nets which cost 12,000 UShs. Once they had their plan, the health worker who supervised them approached the store and was able to get a reduction to 8000 UShs for bulk purchase. Within 8 months, all of the volunteers in the group were able to purchase their own bed net.

If one practices community health in the developing world nowadays one needs to know about microcredit and income generating. It is a steep learning curve for many of us, but the successes and the impact such efforts have on health of people make it an eminently worthwhile task.

Bangladeshi are pretty excited about the Grameen Bank winning the Nobel Peace Prize and have been even more excited about Mohammed Yunus' ideas. You can see a wonderful set of pictures of what is possible in Bangladesh at Drishtipat Group blog. Microcredit schemes in other parts of the world have not been around as long but micro credit functions exuberantly throughout Africa, South America and South East Asia as well as in Bangladesh and has now been extended to men as well.

As a health worker, I would like to extend congratulations and thanks to Mohammed Yunus and the Grameen Bank. His efforts have helped us move Primary Health Care forward and push poverty back.

Photo: M.Yunus credit AP



Anonymous Ruth said...

Very interesting post. John Stackhouse,( a Canadian journalist) in his book "Out of Poverty and into something more comfortable", describes similar incentives in various third world countries. His thesis can be summarized in saying that poverty can only be eradicated when people have some control over their lives.

6:48 PM  
Blogger Liana said...

What a wonderful post. Have you read Jeffrey Sachs' The end of Poverty? I'd love to know what you think of it...

7:20 PM  
Blogger Borneo Breezes said...

Ruth- I haven't read Stackhouse although I have heard of him. But I will check him out, thanks. I like his succinct summary. Nice to have your comments.

Liana - Thanks. I have read Jeffrey Sach's book and really appreciate the level of interest he has captured for poverty. Pumping $75 per person into health just like that in a place like Uganda or Kenya seems too impractical. Big projects and big money doesn't seem to have trickled down to rural folks. I am more taken by how much you can really do to improve things significantly with very little working directly with the disadvantaged.

12:00 PM  
Blogger Arabella said...

Hi, I found this post when googling Maurice King's book which I came across in a library and was astonished by. I am a GP from UK currently working on a project to develop primary care services through a community centre in India and I was fascinated by your posting. Thank you for your information.

1:31 AM  

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