Within the culture of poverty, nongovernmental organizations (NGOs) are challenged with how to initiate progressive development programs. Salama SHIELD Foundation (SSF) has worked in sub-Saharan Africa for over 27 years, with an original mandate to address HIV/AIDS concerns in one Uganda district that, in the mid-90s, had the highest incidence and prevalence of HIV globally. Implementing an approach to development based on participatory-action research principles, it garnered the trust of community members over many years of development work. SSF came alongside the community to revitalize a social–cultural institution of mentors (ssenga and kojja), which was lost at the height of the pandemic. Through long-term intervention and ethnographic research, the determinants of risk and vulnerability for HIV transmission were identified: young women in search of water, mobile market traders, long-distance truckers, cattle loaders, and commercial sex workers. Poverty, coupled with a peasant worldview that is characteristically resistant to change, threatens the resolve and resources of any NGO. Yet in this instance, an integrated response solution was offered through a microfinance scheme, which to date has provided loans to over 1,500 women. Yet, given the basic needs expressed by the women, HIV testing and counseling was also introduced, along with a water, sanitation, and hygiene (WaSH) intervention that has been adopted in homes and villages throughout the larger community. A core component in making this possible was the role of progressive, persuasive, and imaginative female leaders who mobilized other women into action through self-selected base community groups. Water harvesting facilities have been introduced, along with the necessary waste management, hygiene, and disease-preventive practices. WaSH interventions can successfully be sustained when participatory development processes are introduced, trust is securely established, and social entrepreneurs are nurtured and supported through a process of progressive change.
Impoverished women living in southwestern Uganda cannot satisfy basic water needs. They ask, “How can we access safe water, take our children to school, secure nutritious food, and address the ravages of chronic disease?”
Living in the “dry corridor” of Uganda, where famine and drought is common, water sources are not safe.
Personal suffering is exaggerated by an entrenched belief that life is limited, with a cultural mindset that is distrustful of change. Externally offered opportunities (e.g., microfinance) are resisted, making progressive change difficult.
NGOs need to establish enduring and trusting relationships with these communities. This trust can be strengthened by offering microfinance opportunities that incorporate WaSH systems.
Individuals can be identified in the community who are forward-thinking, persuasive, and considered leaders, such as social entrepreneurs who mobilize women through a process of progressive change.
NGOs needs to remain true to their mandate and resolute in providing ongoing support, counsel, and advice as community members search to find better pathways out of poverty, and where WaSH is easily accepted.
Salama SHIELD Foundation (SSF) is a nongovernmental organization (NGO) that has been present in the Lyantonde District of Uganda for over 27 years. By virtue of its participatory-action research approach to development,1 SSF has secured and sustained the trust of community members. Many of the persons and families engaged in SSF’s educational and HIV prevention programs remain at risk for, or are affected by, HIV/AIDS. SSF’s previous and ongoing ethnographic research into the determinants of risk for HIV/AIDS identified poverty, gender inequity, and limited access to potable water as some of the primary factors. To address these root causes of HIV/AIDS risk and vulnerability, SSF initiated its Finance for Life Program, through which it continues to provide opportunities for un-bankable women to apply for and receive small loans to embrace and engage in worthwhile income-generating activities. Given the stories of suffering communicated by these women, who live in resource-limited rural settings, it became clear that their burdens were comprehensive in nature and scope. Their concerns were not limited to poverty but primarily linked to their expressed need to address the challenges of preventable diseases, access to potable water, education for their children, and food security. It was in the context of these larger concerns and stories shared with SSF’s team members that SSF intentionally incorporated an HIV/AIDS prevention component and water, sanitation, and hygiene (WaSH) initiative into the Finance for Life Program.
Economic researchers have posited that the success of the WaSH program—in the context of SSF’s microfinance program—is largely attributable to a cautious trust achieved within subset community groups, that is, the self-identified groups of women applying for and receiving loans.2 They also identify the long-term trust secured in their relationship with SSF. SSF staff travel to the remote, rural villages where loan recipients live, working alongside them to provide mentoring and support.
SSF does not presume to satisfy all of the women’s needs in health, shelter, food security, education, finance, and water, but it can—as an organization committed to participatory development—identify the resources and capacities embodied within the women themselves and work with them to implement practical, problem-based solutions. These solutions are borne out of dialogue-fueled events, called conceptual events, held with groups of women.3 Diverse groups of women meet with community leaders, SSF representatives, and local government to reflect on the challenges, the root causes of these problems, and, over time, are drawn into a participatory process of co-constructing practical solutions that they can implement. This is not a top–down strategy. It is an authentically bottom–up social reasoning process that is practical, contextually aware, and culturally sensitive.
The case study described here is only one example of what is possible when vulnerable women are given an opportunity through small loans to extricate themselves from the poverty cycle. With a renewed mindset made possible through a loan incentive, the women have broadened their opportunity bases and accessed their own personal resources, demonstrating a surprising resilience and responsiveness to address the health concerns of their children and families. They easily come to accept the need for WaSH in their homes. This emerging hope is predicated, we argue, on the strength and capacities garnered in base community groups—subsets of women who are nurturing, supportive, and accountable to each other.
Through this participatory process, SSF came to identify the critical importance of strong female social entrepreneurs. These individual women, in a cultural context of fear and suspicion, mobilized others to take this leap of faith in accepting loans as groups of women and committing to implementing WaSH in their homes. The outcomes of this program evidence more than just enhanced WaSH opportunities, resources, and capacities; gender equity is also a welcome consequence, with a reduction in sexual and gender-based violence in the home. Women now receive greater respect from their husbands and other community members for what they are seen to be accomplishing in advancing the health and economic well-being of their homes, families, and larger communities.
Rationale for SSF’s Integrated, Participatory Development Model
An enduring critical question with respect to “development” assistance still remains largely unanswered:
How is it possible to positively modify risk behaviors in social settings experiencing bad governance, entrenched poverty, ravaging infectious disease (e.g., HIV/AIDS), and limited access to safe drinking water and where vulnerable persons in communities believe that they will never be afforded a productive future?
In nearly three decades of working alongside vulnerable communities in sub-Saharan Africa, SSF has confronted this challenging question, and in the process, co-created an approach to development assistance that offers sustainable solutions.4 SSF’s is a story of enablement leading to empowerment—the compelling result of successful partnerships with other NGOs, government, corporate business, traditional and faith leaders, and affected communities—to advance progressive solutions. The participatory development model that emerged is working and needs to be replicated throughout sub-Saharan Africa and the developing world.
There are five guiding principles and core assumptions that underscore SSF’s approach to development:
- SSF subscribes to the Indigenous African philosophy called mbuntu, meaning we are who we are (our being) because of our presence and accountability to others in community (our belonging).5 Made famous by African leaders like Nelson Mandela and Desmond Tutu, mbuntu underscores what we have come to endorse as foundational requirements in advancing authentic development.
- SSF believes that the platform for sustainable development requires strengthened, secure, and supportive communities, where the concerns voiced by women, men, and youth are respectfully heard. As such, authentic development can only build on the struggles, stories, and opportunities experienced in base communities, where trust is earned, established, and eventually legitimized.
- SSF believes that integrated development programs are comprehensive in nature and ineffectual if simply project-driven or silo-focused. Instead, our Salama for Life programs are synergistically linked throughout the duration of our program process, which entails conceptualization, implementation, and evaluation.
- SSF believes that the technical skills needed to achieve sustainable impacts and solutions require effective cross-cultural communication. SSF staff have the ‘know-how’ to bridge differing views, where Indigenous knowledge necessarily merges with scientific evidence. For example, SSF has worked alongside traditional healers,6 faith leaders,7 and local mentors in HIV prevention efforts, where the shared capacity to transcend worldviews led to the success of the initial HIV/AIDS programmatic intervention.3
- SSF recognizes the essential leadership skills in individuals who mobilize into action reluctant members of their community and who envision better futures in spite of the structural violence and resistance that exists in their current reality.8,9
Incorporating HIV Prevention and WaSH Initiatives
The microcredit revolving loan (MCRL) program is SSF’s signature initiative.
Impoverished women are given loans through the support and accountability structures of self-formed base communities.10 The money provided by funders is loaned out to the women, who engage in various income-generating projects. In general, these include seasonal crop production; trade and commerce; animal husbandry, fisheries, and poultry; small scale manufacturing; food stalls; and, domestic services. SSF’s effective interest rate is about half of the rates charged by other microfinance institutions in the area. There is a virtually unprecedented 100 percent repayment rate for these loans. The only loans not fully repaid happened due to clients’ death. All savings are owned collectively by all the women borrowers. The loan structure and organization is managed by SSF.
SSF Program Officers travel by motorcycle to support the women’s base communities in managing these loans. While in these remote villages, they conduct HIV/AIDS education and provide support for those women who are HIV positive. They encourage them as a group to go for testing and offer hope for more positive futures. For example, Hanifa Namuli has worked for SSF for over 18 years. She is HIV positive and is a model of how to survive in incredibly difficult circumstances. As such, Hanifa was named SSF’s Ambassador of Hope, and her story provides the content for a monograph currently being written on her life, titled When I Came to Understand. She often attends sessions in the remote villages together with members of the MCRL team.
All of SSF’s HIV/AIDS interventions are built on a mentoring model that was revitalized at the height of the HIV/AIDS pandemic. In the mid-90s, Lyantonde Town Council had the highest incidence and prevalence of HIV.11 SSF’s participatory interventions revitalized the respected traditional institutions of ssengas and kojjas—paternal aunts and uncles who supported their nieces and nephews by providing crucial knowledge on sexual health. SSF’s mentors receive training in HIV/AIDS prevention and double as recipients of loans and proponents of WaSH initiatives in the community.
Incorporated within the Finance for Life (MCRL) program, SSF program officers raise awareness of WaSH procedures and organize learning sessions on food preparation and hygiene practices, handwashing, and safe water management. For example, the SSF team instructs women in the building of drying racks, pit latrines, tippy taps (a jerry-can filled with water attached to a tree permitting hand-washing after latrine use), and water harvesting. Some of the women in the microfinance program also organized themselves to invest in a water tank where they stored rainwater for domestic use.
SSF previously dug three boreholes in the community of Lyantonde Town Council. One borehole, located at the perimeter of the Community Development Center, services 150 families per day. Each 20-liter jerry-can of clean water is sold for less than USD$1.00. SSF also constructed commercial water tanks (between 10,000 and 15,000 liters) at six schools in Lyantonde District and provided handwashing facilities to 35 schools to increase WaSH practices among students. The SSF field team regularly follows up on these WaSH programs to ensure positive behavioral change and efficient water use.
Case Study: Scovia’s Story
The following case study follows the story of one woman who practically implemented WaSH initiatives after receiving loans through the MCRL program. A parallel case study is presented in the “On the Ground” section of this volume in A Voice from the Field. Both women could be considered social entrepreneurs.12 Their stories underscore the importance of recognizing the entrepreneurial and social capacities of rural-based women—women who were originally un-bankable, but when provided with opportunity, demonstrated immense practicality and innovation in responding to the comprehensive health and development needs of their families.
Namaddu Scovia (hereafter Scovia) is 38 years old. She is married and has seven children with her husband, Serugo Vincent, who owns a bicycle shop in Lyantonde.
Scovia has been a member of Lwamayongo Bakyala Twezimbe group since December 2011. She dropped out of school at an early age to marry Vincent, and they lived a hard life as peasant farmers. Living in a swampy area infested with mosquitoes, they suffered from many diseases due to poor hygienic conditions and having to drink unsafe water, which was shared with cattle from neighboring areas. They lived on a very small piece of land and could not grow enough food for their family. What her husband was earning as a bicycle repairer was not enough to meet the family’s needs.
Scovia heard about the microfinance program when she was invited by her local Chairperson to attend a village meeting in July of 2009. At this meeting, SSF staff introduced the microfinance program to community members.
Scovia was not among the first five members of this group who received loans, but joined the group after three loan cycles in December 2011. Her base community group has since expanded from five to 11 members, with each woman implementing a different income-generating project.
To date, Scovia has received seven loan cycles amounting to USD$1,117.65 (UGX3,800,000). Her first loan cycle started in December 2011, when she received UGX300,000. In December 2015, she received UGX700,000, and her most recent loan in August 2016 provided UGX1,1000,000. She has mainly engaged in farming and rearing goats but also recently set up a retail shop in her home. Additionally, she bought two bulls through these loans. Unfortunately, both bulls died due to an unknown disease. In spite of these hardships, she has saved USD$40.00 (UGX134,600) that she plans to use to purchase more assets.
Scovia informed the SSF team that after only three loan cycles, she has been able to move into a new home:
With the money I have borrowed through the SSF microfinance program, we were able to buy a plot of land and put up a new house. This has helped me to set up a retail shop and get many customers…we have also been able to expand my business of selling bicycle spare parts. I am now able to pay school fees for my children. I eat well, sleep comfortably, and am very happy. However, I am still interested in getting more loans to enable me to expand my business…and for my retail shop set-up in our home, which will be an additional income to the money earned by my husband.
Scovia’s husband commented that they were only able to acquire these assets because they have been working together as a family. He explained that they had benefited greatly from the loans, as they were able to buy more pieces of land, saying:
With the SSF loans, we were able to buy two acres of land and planted eucalyptus trees, bought 1.5 acres of additional land and planted a banana plantation. I realized that we had to obtain another business close to home. We discussed it and decided to open a shop in our home. This was all possible due to the dialogue events we attended—events organized by the SSF team in our village where we learned we needed to work as a family if we would progress. These events have not only helped us, but these dialogues have also helped other community members who are not in the micro-credit program. Those other people try to copy what others in the program are doing, in order to be successful and for their families to progress as well.
Scovia went on to say:
We have been able to put up sanitation facilities, like the drying rack where we put our utensils, cups, plates, and other items after washing them such that they are not contaminated. We have pit latrines with covers and have also taught our children the hygienic practices of washing their hands with soap after visiting the latrine…and a tippy tap just outside the latrine with soap, as taught to us by the SSF team. We have even taught our children to use ash to sprinkle it in the latrine as a way of disinfecting the latrine as well as covering the pit after use. We learned all this through the microfinance program. You find our children encouraging each other to observe this handwashing practice. We have also a garbage pit where we throw the waste. After some time, the wastes are later transferred to our gardens as compost manure. We also have an energy-saving stove. We have learned that we have to boil our water before drinking it and store it in a clean and covered container, unlike before when we would just drink it straight from the jerry-can.
When asked about the advantages of having sanitation facilities, Scovia’s husband responded:
Having a latrine protects the family from getting diseases like diarrhea, typhoid, and cholera, unlike when we just defecated anywhere. If you have a latrine with the cover, then you will not get those diseases and will have good hygiene in your home. If you don’t have a pit latrine and get visitors, you can be embarrassed when they have nowhere to go. We try to avoid defecating everywhere to avoid getting diseases and thus avoid spending our small monies on medical bills.
Scovia was asked about health issues and how the microcredit team has assisted her family in making informed decisions. Scovia explained that HIV/AIDS and sexually transmitted infections are two of the topics addressed by the microcredit team during monthly loan repayment meetings. She said this was why the members had requested HCT (HIV Counselling and Testing) outreach during the disbursement of loans, so that they have the opportunity to get tested and know their status. Scovia informed us that SSF had also organized community outreach events in their villages, where they brought government health workers to educate and carry out HCT support services. This was the first time Scovia was tested. She was tested a second time when she had to go to Lyantonde hospital for antenatal services; testing is a requirement for entry. Scovia’s husband has also been tested once. When asked whether he and his wife had ever been tested together, he laughed and said:
If they test my wife during antenatal care, then I don’t need to test because I can know whether we have the HIV or not when she informs me. I trust my wife and I am also faithful to her in that I always return home every day after work at 8:00 pm.
The team informed the couple about the importance of testing as a couple instead of basing their risk on what one of them says or is told.
The SSF team asked Scovia about issues pertaining to sexual and gender based violence (SGBV). She informed them that these were not so common these days due to the dialogue forums organized by SSF where couples were given an opportunity to voice their concerns and suggest ways to overcome communication challenges between husbands and wives. According to her, this was the reason why there are now few cases of SGBV and fights in the home.
Despite their achievements, Scovia and her husband still face challenges in accessing clean and safe water. In their village, there is still no bore hole. The closest water source is 1.5 kilometers away. It is not clean or safe, and is shared with animals. This compromised water source also dries up during the prolonged dry season, as evidenced when the SSF team visited the water source and saw that it was very low. Scovia informed them that in such instances, her family seeks another water source on a wealthy man’s land about two kilometers away. The scarcity of water and the distance required in accessing it puts the lives of children and women at risk, especially in the evening hours when they are more vulnerable to rape or attack.
Scovia plans to renovate her house and set up a rainwater harvesting tank of about 6,000 liters, so that she can start harvesting water for home use and sell the excess as a way of earning additional income.
During her final farewell, Scovia said:
I appreciate the good working relations with the SSF team, the mentorship given to us that has enabled us to progress and work as a family unit, and the trainings and dialogue forums that have helped us in planning and organizing our homes, acquire more assets, and most importantly educate our children. I did not get a chance to complete my education, but with the microcredit program in place, I know my children will complete their education. The microcredit program is a program that brings together different aspects of life, like water, sanitation, hygiene, environment protection, HIV/AIDS, STIs, and education of children. Equipping us with new skills has made us work harder than before, and allowed us to make new friends. We have learned the importance of working together. We would not have been able to achieve all that we have if we had not been given this opportunity by SSF, which has changed the quality of our lives.
Scovia’s case provides an example of how vulnerable and at-risk women have advanced WaSH initiatives in their homes and communities. WaSH programs integrated within the microfinance program can be evaluated as largely successful in light of the economic benefits accrued for members. More research needs to be done to identify the social benefits and impacts on the larger community emerging from these individual cases. These impacts go beyond the economic benefit to the borrowers; in nuanced and subtle ways, the larger community is affected for good.
These success stories require more rigorous evaluation protocols to measure the impact and outcome of SSF’s participatory development agenda. Indeed, the SSF staff requires evidence of WaSH behaviors implemented in the loan recipient’s home. Without evidence of a latrine, tippy tap, or drying rack, and the demonstration of efforts to harvest water, a loan would not be given to an un-bankable woman or groups of women in their organized base communities.
Introducing WaSH into resource-limited environments is a challenge. Lyantonde is often listed as being in the “dry corridor,” indicating the location’s propensity for water shortages and famine. Yet Scovia seized an opportunity and self-initiated a practical process to ameliorate her water concerns—without heavy-handed external intervention. Training events alerted her to the need for WaSH to secure the health of her children, but the practical steps to construct WaSH facilities in her home were built through her own determination, capacity, and a fierce willingness to overcome the odds. She mobilized resources, financial and otherwise, and acted on what she had come to realize is an important, life-saving practice. The loans made it possible for her to advance a variety of income-generating activities, but surprisingly, the need to meet the water and hygienic needs of her family appeared to come first.
Future research can build upon such cases. As the microfinance program expands to other villages and identifies potential base community groups, baseline measures (qualitative and quantitative) of WaSH conditions in the home, village, and community will be required. Then, after the introduction of SSF’s participatory intervention, WaSH impacts and outcomes should be measured over time. As fluid and resilient as this intervention currently is, it would seem that SSF’s integrated approach to development—mbuntu-based, participatory, and synergistic in addressing a variety of basic needs—demonstrates merit in accomplishing sustainable WaSH solutions. This can occur only in instances where NGOs realize and respect that there are, inherent in the capacity of local communities, certain individuals who embody the leadership skills, courage, and direction to foment creative and innovative changes in their homes and larger communities. The question is, what is it about these innovators and entrepreneurs that garner larger impacts for not only themselves but the larger community?
All of the women in SSF’s programs were originally considered un-bankable and impoverished, and yet with the opportunity provided through small loans, many have been able to accomplish much more. As individuals who dared to overcome a fear of change, they demonstrated that they could become accountable agents of progress furthering a WaSH agenda that enhanced the well-being of their families. Sustainable development must be intimately linked to the energy mobilized by Indigenous social entrepreneurs. Our role as NGOs is simply to come alongside and provide resources that they do not have access to (e.g., scientific knowledge and best practices), as together, we advance trusting relationships that permit meaningful progress to occur.
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