If, When and Whom to Marry: Young Women Choosing Their Best Future of Health

28796175381_0b954aa4ae_zIt is perhaps easy to envision what should constitute quality health care for all people. What about choice in what quality health care means per person, according to what one wants for their lives?

When a person reaches the age of adolescence, they become more aware of how their surroundings and choices affect their future. When that adolescent is entrenched in a patriarchal society, the set expectations for their future more so affects their current life and health. Examples include teen pregnancy as a result of early and child marriage, lack of access to age-appropriate sexual and reproductive health education, and young women dropping out of school.

The Hunger Project is working in Africa and South Asia to shift these patriarchal mindsets and empower youth – both young women and men – to make decisions about their health and future through the Her Choice Program.

Through a community-based mentoring approach, including peer mentors, the program mobilizes relevant community actors to build local ownership over ending child-marriage. Activities aim to foster empowerment among girls and young women to take control of decision-making, and sensitize the community to value such.

Girls and communities become increasingly aware of the negative [health] consequences of early, child and forced marriage, which allows girls and young women to better participate in society and apply newly gained knowledge from sexual and reproductive health rights (SRHR) into their life choices. “If, when and whom” to marry is the primary choice in focus.

Early, child and forced marriage pervades the cycle of poverty, especially for young women: dropping out of school, teen pregnancy, limited or no household decision making capacity, poor health of young mothers and newborns, lack of decisions around one’s sexual and reproductive preferences, and stagnated economic empowerment and income generation among women. The program aims to improve access to formal education for girls by supporting girl-friendly schools and access to youth-friendly SRHR services.

035Relevant community actors are key in helping shift the patriarchal social norms to ensure an enabling environment wherein girls can make their own life choices. Women’s “self-help” groups carry out trainings and education about financial services to improve economic security of girls and their families. This helps to decrease incentive for marrying off daughters and increase women’s independent economic empowerment. Relevant community actors also include traditional leaders and supportive groups of men of all ages to help transform social and traditional norms toward inclusion of women and girls in decision-making. Traditional leaders are especially crucial in helping enforce national policies around child marriage, in not approving or overseeing child marriages in their respective communities.

By imbedding youth-friendly SRHR leadership and program activities into communities, Her Choice is influencing sustainable results. They can continue building on local assets and train additional young leaders to continue fostering women’s choice in marriage.

Do you want to marry? If so, when would you want to marry? And to what kind of person would you like to be married? Do you want to finish school before you consider marriage? Do you want to finish school and pursue work more than you want to be married? The choices – at least in some way – affect health and economic security.

There are many ways we can degrade, stabilize or improve our own health. Everyday habits like washing your hands, drinking clean water, eating healthily, to more long-term choices like getting vaccinated. Young women have a right to choose their future of health, and that right includes choosing “if, when and whom” they should marry.

 

 

PNPM Progress: A Path Towards Sustainability in Indonesia

Indonesia’s Program Nasional Pemberdayaan Mandiri (PNPM), or National Program for Community Empowerment, is a government-led, multi-donor trust-funded pilot program, which is managed by the World Bank Group (WBG) and delivered through the PNPM Support Facility (PSF). Also funded by: AusAid, CIDA, DANIDA, USAID, EU, UKAID, and the Dutch Government 

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Photo Credit: World Bank, PNPM (Peduli) Indonesia: Caring for the Invisible

 As the Government of Indonesia’s flagship community-driven development (CDD) program, PNPM strives to improve the socio-economic welfare of the poor and most marginalized groups by expanding opportunities through community consultation at all phases of the program, empowerment, and capacity building of civil society organizations (CSO). The key elements of PNPM-CDD programs include: community development, institution building, community block grants, strengthening local governance and partnerships, and technical assistance for program development

In working with numerous Indonesian and local CSOs and a handful of implementing partners, PNPM programs are currently active in roughly 6,000 sub-districts, 73,000 villages, and 33 provinces. Nearly Rp1.4 billion, which roughly equates to USD 21 million, is allocated to each village per year solely for development purposes. In the first year, PNPM programs helped nearly 12,000 marginalized individuals to build confidence, gain new livelihood skills and training, access information and public services, and to create new opportunities to participate in community life.

However, addressing the root drivers of social inclusion are not just about improving economic conditions, but about fully integrating individuals into every nook and cranny of civic life—increasing participation and breaking down social barriers by changing mindsets and reversing engrained stigmas. The Government of Indonesia realizes the marginalized are important and unappreciated assets (financial, labor, social), and often benefit less from public programs and poverty reduction schemes.

In this manner, local and national CSOs have a comparative advantage and are well positioned to empower marginalized groups to become more self-reliant and able to live dignified lives. CSOs work with a diverse range of marginalized groups in rural and urban Indonesia: female micro-entrepreneurs, street children, LGBTQ, violence against women and girls (VAWG), and people living with HIV/AIDS among others. Though CSOs have a limited financial capacity to provide services and activities such as mentoring and training, the PNPM has established grant making to mitigate the costs.

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Photo Credit: Source Unknown, PNPM Program Indonesia

PNPM programs have provided women, specifically, with business training and equipment, skills training, and loan arrangements to start businesses. As a result, women’s groups are now running laundries, phone card counters, food production, and coffee shops, for example. However, CDD programs in Indonesia could benefit from a thorough gender analysis needs assessment to identify which constraints women face particularly in a rural environment. Programs also need to collect and analyze disaggregated data between men and women, between rural and urban villages, and among communities, households, and individuals, to best target those in need and to measure participation. Affirmative action and inclusion of marginalized groups, such as women, must be addressed through quotas.

In 2015, the Government of Indonesia introduced the new Village Law, which is the new master framework for village development and community empowerment and embodies many of the aforementioned principles of the PNPM-CDD program. Although adopted and enacted to ensure sustainability of the PNPM programs, this framework also brings attention to the many challenges and implications it faces for future implementation.

Firstly, the programs must find a better, comprehensive way to measure accountability. Under the new law, the some 73,000 villages are seeing a large influx of resources from the government and outside funding agencies such as AusAid, CIDA, DANIDA, USAID, EU, UKAID, and the Dutch Government. The district governments have low capacity to monitor the cash flows and implementation of village governments. Who will provide the accountability and oversight and perform the audits? Or, who will be responsible for strengthening the oversight? The programs need a strong monitoring, evaluation, and learning (ME&L) framework—built-in accountability targets and performance-based indicators—to ensure precise development results and to prevent elite capture of village transfers.

A community-led development (CLD) approach, however, introduces such social accountability measures, supporting regularized processes such as public forums, at which local governments can demonstrate transparency and accountability and citizens can review and challenge the progress of targets and goals. CLD also supports communities to generate and access timely, locally relevant data that informs priority setting and strengthens progress tracking.

Secondly, it is important to remember that an increase in resources does not necessarily equip the villagers with the skills and expertise needed to obtain jobs and administer good service delivery. CDD projects often do not benefit everyone and takes years to trickle down to the most marginalized groups. How do we streamline this process to ensure that the most vulnerable are receiving the resources?

Lastly, although the law provides a strong legal framework for mainstreaming PNPM-CDD principles in village socio-economic activities, it does not necessarily guarantee sound implementation in practice. The PNPM-CDD programs must be sustainable and fully integrated into the local system of government. The law does not specifically address what it can impact in the short term versus what it can affect in the long term, which is necessary to ensure sustainability and resiliency. PNPM-CDD programs could learn from the CLD’s approach to sustainability and resiliency.

The CLD approach addresses sustainability and resiliency by addressing challenging factors such as climate change and population growth and how this in turn puts strong pressures on rural areas. The CLD approach calls for a process that includes actions to ensure that a program and community are resilient to climatic, political, and economic shocks. Local communities must have a regularized process of disaster risk reduction and disaster preparedness.

The PNPM-CDD programs in Indonesia are promising and making considerable progress. However, the programs can build upon this progress by introducing several key distinguishing principles introduced by the CLD approach, namely: a keen focus on facilitators as mobilizers and “agents of change” rather than “beneficiaries,” a gender-mainstreamed approach, built-in social accountability measures, timely and disaggregated data, strengthening legal existence through ME&L, and implementing sustainability and resiliency safeguards.

DC Launch of 2016 Access to Nutrition Index

Last week, the Access to Nutrition Foundation Executive Director Inge Kauer presented the most recent Access to Nutrition Index (ATNI) for 2016 at the InterAction office in Washington, DC.

The Access to Nutrition Foundation is an independent nonprofit based in the Netherlands, with the objective of assessing and contributing to the improvement of the private sector’s methods of providing global nutrition. ATNI’s founding principle is centered on the fact that the world’s leading food and beverage companies can play a leading role in improving poor nutrition and related diseases. By examining the companies’ practices, governance structure, marketing, and commitments, ATNI assigns an index number to the major food and beverage companies, providing them with an incentive to improve before the next index is released.

The first Access to Nutrition Index was released in 2013, as a tool major companies can use to benchmark their nutrition practices progress. Overall, 22 of the top companies were assessed to determine their levels of social, commercial and financial responsibility within their industry.

According to this year’s index, one in three people in the world are undernourished or overweight. Over the course of the next ten years, nutrition issues are projected to significantly increase. Obesity and diet-related diseases such as heart disease, stroke, diabetes and some cancers are at epidemic rates, affecting countries of all income levels. Recent years has shown a positive trend in corporations’ interest in engaging better with their consumers, who demand healthier products and higher levels of accountability.

The 2016 Index has additionally included a pilot study, ranking all the leading producers of breastmilk substitutes (BMS). This addition to the index addresses a controversial issue in on the nutrition agenda. ATNI’s intention was to create a transparent and accountable way to measure how corporations contribute to child rearing in developing countries. Companies were assessed based on alignment with the 1981 International Code of Marketing and of Breast-milk Substitutes.

Corporations were measured for the index based on seven indicators:

  1. Governance (12.5%) – corporate strategy, governance and management
  2. Products (25%) – formulation of appropriate products
  3. Accessibility (20%) – delivering affordable, available products
  4. Marketing (20%) – responsible marketing policies, compliance and spending
  5. Lifestyles (2.5%) – support for healthy diets and active lifestyles
  6. Labeling (15%) – informative labeling and appropriate use of health and nutrition claims
  7. Engagement (5%) – engagement with governments, policymakers and stakeholders

Based on the 2016 Index, Unilever scored highest for the ATNI overall ranking. ATNI commended Unilever for successfully integrating nutrition strategy into their core business model, with a specific emphasis on undernutrition. According to the Index, Unilever dedicated its future strategy towards a healthier profiling system, with a comprehensive response to undernutrition.

Other top performers included Nestlé, Danone, Mondelez, and Mars. The main conclusions of the 2016 Index were that progress has been made, but these large food and beverage corporations are slow to change their role in the fight for better global nutrition.

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Nestlé topped the BMS Index, but ATNI found that none of the four F&B companies and the two pharmaceutical companies included in the BMS Index were fully compliant with the International Code of Marketing Breast-milk Substitutes (The Code) or the many World Health Assembly (WHA) resolutions reinforcing The Code. As recommendations, ATNI encourages all companies to overhaul their marketing systems, except when forbidden by national laws. In independent case studies conducted by Westat in Vietnam and Indonesia, many instances of non-compliance were revealed, offering much room for improvement.

ATNIBMSATNI has now reached global recognition for their work as the first index to benchmark companies to facilitate growth and improvement. Since the first index in 2013, companies have increased their engagement with the research process, which highlights a positive trend towards improved policies and procedures.

Full details of the companies’ performances can be found on individual scorecards at accesstonutrition.org.

UNICEF Calls for Innovation

Screenshot 2015-11-12 at 4.08.31 PMThis year’s State of the World’s Children Report has been published and it is calling for innovation. While it is a fact that remarkable progress has been done towards the protection and promotion of children’s rights, an unfortunate amount of children still exist whose rights are continuously violated and are regularly experiencing the tragic repercussion of poverty and malnutrition. The State of the World’s Children Report – Reimagine the future: Innovation for every child, expresses the need for cooperation from the global community to find advanced and unconventional ways to address the age-old problem that is still affecting the lives of the innocent children all over the world, which is poverty and malnutrition.

(See table at the bottom of this post with a quick summary of statistics in Hunger Project program countries.)

Poverty begins prior to the birth of the child, increases across the life course and onto the succeeding generation. It is a cycle of deprivation. A child living in poverty does not only mean being deprived from an access to material goods, it is also a deprivation of life, health, cognitive development, education and opportunities. While an adult may experience poverty temporarily, for children, the consequence can last a lifetime.

Poverty is associated with malnutrition. According to UNICEF’s State of the World’s Children report, the poorest 20 per cent of the world’s children are twice as likely as the richest 20 per cent to be stunted by poor nutrition and to die before their fifth birthday. Stunting is one of the many manifestations of malnutrition. It is a form of growth failure. Stunting commence prior to the birth of a child. Poor maternal nutrition, inadequate feeding practices, lack of access to clean water and sanitation, non-exclusive breastfeeding and clinical and subclinical infections or diseases are causative agents of stunting. Not only poverty has an awful repercussion to a child’s health, it also deprives a child’s fundamental right to life.

Poverty also plays a huge role when it comes to a child’s cognitive development. Children living in poverty are most likely to encounter learning disabilities and developmental delays. According to UNICEF’s State of the World’s Children report, nearly 9 in 10 children from the wealthiest 20 per cent of households in the world’s least developed countries attend primary school – compared to only about 6 in 10 from the poorest households. Children who are stunted are most likely to have poor performance in school and have higher chances of dropping out. They are unable to reach their full potential because of the procured learning impediment. Some children choose to drop out of school and prefer to start working at a very young age for the reason that they are able to contribute to their family’s income.

Poverty persists to be a driving force of child marriage. Seldom families get their daughters to marry before 18 because it reduces the family expenses. Many communities also practice economic transactions like “bride price,” where the family receives money or livestock in exchange for their daughter. This practice often results to girls not being able to obtain an education. UNICEF reported that for every 100 boys in secondary school, only 76 girls are enrolled. The cycle of poverty is an often product of child marriage. Because of early marriage and pregnancy, girls are forced to drop out of school, making it harder for them to escape the awful consequences of poverty.

The Hunger Project recognizes the significance of nutrition for the eradication of world hunger and poverty. At the Hunger Project’s epicenters, health care professionals explain the basics of nutrition for both children and mothers and the importance of pre- and postnatal care to women. Women also have access to antenatal care services in the epicenter and children also have access to the epicenter nursery schools and are guaranteed to a full nutritious meal every day they are in attendance. The Hunger Project also partners with more than 100 organizations representative of governments, civil society, the private sector, philanthropic foundations and the research community dedicated to the eradication of malnutrition and poverty.

Others fail to see the correlation between nutrition and poverty. To some, it is mere financial inequity. They fail to see the bigger picture of how one factor leads to the other. Children who are living in poverty are much more likely to be in poverty later in life and is likely to shepherd the next generation to go through the same vicious way of life. Not unless the cycle is being cut, helpless and innocent children are relentlessly punished of this deprivation.

According to UNICEF’s State of the World’s Children report, all children must have an equal chance to make the most of their potential. The report features people across the world who went the extra mile and applied unorthodox approaches to further the progress. The global community must prioritize the children and fully dismantle the numerous hindrances to achieve innovation and ultimately achieve a future in which children from all corners of the world can enjoy their rights.

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Launch of I Am Malala: A Resource Guide for Educators, with Ziauddin Yousafzai

cvrart_I-Am-Malala_220x342On November 13, 2014, the George Washington University’s Global Women’s Institute launched I Am Malala: A Resource Guide for Educators in Washington, DC. The event included keynote speaker Ziauddin Yousafzai, the father of 17-year-old Nobel Peace Prize Winner Malala Yousafzai and a co-founder and chairperson of the Malala Fund. Malala and her father are Pakistani activists for girls’ education and human rights, and their cause was propelled to the international stage after Malala was shot in the face by a Taliban gunman in 2012 for openly supporting education for girls. When asked recently if she considered herself a feminist, Malala responded, “If feminism means equality for all people, then yes, I am a feminist.”

There were two panels at the launch, which included prominent guests such as Catherine Russell, US Ambassador-at-Large for Global Women’s Issues, Ahmad Shah, the founder and president of the Global Peace Council Pakistan (GPCP), Jahan Zeb, an advisor to the chair of the Malala Fund and a member of the UN Inter-Agency Network on Youth Participation in Peacebuilding, several George Washington University professors, and a George Washington University first year student.

I Am Malala: A Resource Guide for Educators is a free, online teaching guide targeted at high school, college, and university students both in the United States and internationally. Its purpose is to highlight and explain complex issues of politics, history, religion, and human rights by using lessons based on eight different themes from Malala Yousafzai’s memoir I Am Malala. This project was created through collaboration between the George Washington University’s Global Women’s Institute, Little, Brown and Company, and the Malala Fund.

In Mr. Yousafzai’s keynote address, he emphasized the pressing need for international advocacy and efforts for girls’ education. He argued that men’s involvement is crucial in changing social norms and oppressive practices towards women in patriarchal societies. He further advocated for fathers and brothers to lead this effort, stating that “some say you need courage to speak out. I say you are a coward not to speak out.” Mr. Yousafzai praised the resource guide for its ability to connect people around the world across the divisions of North, South, East, and West communities. He insisted that the book does not have political agenda, and is only to spread “the love of humanity” through Malala’s story.

The first panel with Ambassador Russell and Mr. Yousafzai focused on the policy challenges of ensuring quality education for girls worldwide. Ambassador Russell argued for a holistic approach to these obstacles, which include the safety of girls while attending school, traditional social attitudes towards girls’ education, child marriage, inadequate school facilities and resources, and various other context-specific concerns. Mr. Yousafzai and Ambassador Russell both pushed for a focus on women and girls’ empowerment efforts in conflict zones, where these challenges are intensified. Mr. Yousafzai and Ambassador Russell also emphasized the value that empowered and educated women provide to their societies because they are able to contribute monetarily to their families. Lastly, the Ambassador stated President Obama’s commitment to education for girls worldwide and highlighted that girls’ education and freedom from forced marriage not only create more vibrant, stable states, but are also internationally recognized human rights.

The second panel described the details of the resource guide and its purpose in classrooms. The authors of the guide hope that Malala’s story will fuel a broader movement for girls’ education and empowerment, and that it will foster further dialogue between the youth in Western and developing countries. Mr. Yousafzai cautioned that this movement must focus on ensuring quality education; he highlighted how easily education can be manipulated to allow indoctrination, using the Taliban as an example. However with quality education, “nations can do anything.” Overall the panelists expressed optimism in the launch of the resource guide and in transforming Malala’s story from a media phenomenon into an effective and powerful international development tool for human rights.

You can learn more about the resource guide here!

What constitutes an enabling environment for the poor to succeed in their own development?

Working paper for a National Strategy Forum, April 1994, Dhaka, Bangladesh

Purpose

The purpose of this paper is to provide a framework that will facilitate the participants in the upcoming strategic forum to identify new openings for action to provide an enabling environment for the poor. As will be shown below, the lack of a clear and shared understanding of what constitutes an enabling environment is a major obstacle to mobilizing concerted, strategic action to providing one.

We envision this forum to be the first step in an ongoing process. It will reveal openings for action that The Hunger Project and other organizations can take to provide an enabling environment. In addition, it has the potential to identify areas where the next breakthrough in thinking is required, thus pointing the way to the next strategic forum.

Acknowledgements

We would like to express our appreciation to all the individuals and organizations in Bangladesh whose dedicated work has demonstrated to the world the critical importance of providing an enabling environment for the poor. In particular, the preparations for this strategic forum has depended on the generous assistance of:

  • Mr. Fazle Abed, founder and director of BRAC, who first suggested this topic and who has advised on the format and design of this meeting;
  • Mr. Alex Counts, senior advisor in the international training division of the Grameen Bank, who wrote an initial overview analysis of the experience in Bangladesh in providing an enabling environment, and Prof. Muhammad Yunus for generously permitting Mr. Counts to assist us in this way;
  • Mr. Abdur Rab Chaudhury, MP, for his advice and willingness to facilitate the discussion;
  • Mr. Mahfuz Anam, editor of the Daily Star, whose recent round-table discussion on Pro-Poor Planning highlighted the importance of a breakthrough in thinking in how economic planners must think of the poor; and
  • The Asia Foundation, which has provided funding both for this meeting and for the follow-up actions that it inspires.

Section one: Setting the context

Empowering the poor — the key to a self-reliant future for Bangladesh

The concept of an “enabling environment” is new, and it reflects nothing less than a paradigm shift in thinking as to how nations like Bangladesh can achieve a new, self-reliant future — a future where all citizens have the chance to lead a healthy and productive life. This paradigm shift rests on two major recognitions.

First: People now recognize that the poor are the principal agents to improve the quality of their own lives.

No matter how successfully society allocates resources to help meet the needs of the poor, these are small compared to the resources that poor families will spend to meet their own needs. Therefore, to make any significant difference in the lives of the poor, public investments must “enable,” or leverage, the enormous investment the poor make in themselves.

Second: People are now beginning to recognize that enabling the poor to move out of poverty is the key to the nation’s economic development.

This represents a profound transformation in attitudes towards the poor and their role in the economy. The statement made by Mahfuz Anam at the recent round-table on “pro-poor” planning published in the Daily Star put it clearly:

“Recent examples, especially in the SAARC countries have shown that given the right type of environment in terms of credit, in terms of decision making, in terms of empowering the poor, it has been possible to prove that [the poor] are perhaps the most effective group to produce wealth…. it is perhaps the way that the poor has been looked at that is responsible for the continuation of poverty.”

Dr. Maqsood Ali underscored the new view that the poor are economic assets: “There must be a social mobilization of the poor which recognizes the intrinsic dynamism of the poor and goes straight to organizing the poor and releasing their dynamism, the hidden capability of capital accumulation potential which they have. The World Bank and IMF are saying that you have to raise growth in order to reduce poverty. Now we are saying you have to reduce poverty to raise the growth.”

This revolution in thinking comes at a propitious time — a time when Bangladesh is transforming its own structures and when international institutions are increasingly open to human-centered approaches to development.

Society’s institutions still, by and large, reflect the old paradigm. Transforming them to be useful to providing an enabling environment will require rigorous, systematic and scientific thinking and concerted, strategic action. It is the intention of this meeting to develop the framework of that thinking, and identify new openings for action.

Section two: Establishing key distinctions

It has been The Hunger Project’s experience that many meetings fail to generate any meaningful action because they fail to develop a set of sufficiently powerful distinctions. Too often, meetings about poverty alleviation produce only lists of problems, rationales, goals, targets, and opinions about service programs.

To actually make something happen, distinctions must be created that are powerful enough to cut through the unclarity, to get underneath the differences of opinion, to generate alignment on key principles and to reveal strategic openings for concerted action.

Therefore, establishing powerful distinctions for thinking rigorously about providing an enabling environment is a major objective of this meeting.

A. The Distinction “Enabling Environment” vs. “Service Delivery”

A service delivery system is the organized provision of critical services, such as healthcare, education and emergency relief to people who can benefit from those services.

Clearly, much important work is being, and must be done to improve the delivery of human services. However, this paper will NOT discuss service delivery issues. It will devote itself exclusively to the issue of creating an enabling environment.

Often these two distinctions are collapsed. When the distinctions are collapsed, the inquiry into these issues lacks the rigor, clarity, precision and discipline that would reveal pathways to effective action, and galvanize the will to take the action that is necessary.

Effective service delivery is critical, and particularly for governments. People create governments specifically to provide services that are best provided collectively rather than individually.

The notion of “enabling environment” however is new, and reflects the recognition that most human progress is not a function of service delivery, but rather of the creative and often organized efforts of people themselves.

The strategic thinking called forth when considering “enabling environment” and “service delivery” is completely different. One must consider different actors, different resources and different constraints.

In service delivery, the actors are the functionaries, the primary resources are the official budget and the pool of trained personnel, and key constraints are managerial factors: resource scarcity, planning, management and staff effectiveness.

In an enabling environment, the actors are the people themselves, and the primary resources are the talents, knowledge and resourcefulness of the people. Instead of considering what can be done “for” the poor, one must consider what can be done “by” the poor. In this way of thinking, the key constraints are social factors: unity, leadership, equity, public attitudes, and self-confidence.

Enabling Environment Service Delivery
Actors: People themselves Functionaries
Resources: Local incomes and material

resources

Talents

Leadership

Resourcefulness

Official budgets

Trained personnel

Managers

Constraints: Equity

Access to resources

Access to information

Leadership

Attitudes

Social harmony

Self confidence

Resource scarcity

Planning

Management

Staff effectiveness

When one confronts the challenges faced by Bangladesh, it is impossible to imagine meeting them with only the resources that can be channeled effectively through service delivery mechanisms. Only by unleashing the creativity, resourcefulness and determination of the entire population can the challenges be met and a sustainable future for Bangladesh assured.

The concept of enabling environment means restoring people to control over their own destiny, by putting them in control of the institutions and decision making processes that affect their own lives.

B. Definition of “Enabling Environment”

We will define “enabling environment” to consist of the attitudes, policies and practices which stimulate people to take action and enable them to succeed.

By that definition, we want to consider an enabling environment for the poor which consists of attitudes, policies and practices which stimulate the poor to take action for their own development, and enable them to have that action produce meaningful improvements in the quality of life.

For example:

  • the attitude concerning the economic value of girl children often determines whether poor girls receive education.
  • the policy of who hires and fires school teachers often shapes the degree to which local people can depend on that teacher to provide quality instruction.
  • the practices by which NGOs form local organizations can shape the degree of initiative and independence local people express in that organization.

C. What are Key Elements Within an Enabling Environment?

In analyzing what people need from their environment in order to succeed in their own actions, we can see at least four major elements:

AWARENESS: People must have a clear understanding of the issue and the possible solutions in order to take effective action.

ACCESS: Whatever training, information or resources people need to succeed in their own action must be physically available in the community, and unencumbered by social barriers that could stop people from having it.

AFFORDABILITY: In taking their own actions, the poor depend primarily on their own resources. Therefore, the poor must be able to afford what they need. To a family living in poverty, issues of price gouging, bribery and exploitation all have the same effect of preventing the family from affording what it needs.

ACCOUNTABILITY: While people themselves are the primary source of action, at some point they must trust and depend on others — teachers, health workers, well diggers and other functionaries. People must have ways to hold these functionaries to account.

D. What does this Inquiry Need to Produce?

The outcome of a strategic inquiry into an enabling environment does not need to produce a comprehensive or rank-ordered analysis. It does not need to produce a master plan or a comprehensive blueprint.

The experience in Bangladesh has proven to the world that people living in the conditions of poverty are so resilient, so creative and so determined that when they are offered ANY opportunity to improve their lives, they seize it.

Therefore, the goal of this exploration is to reveal openings for action that would result in any meaningful improvements in the environment that can provide additional empowerment of all the poor to improve their lives, and contribute to the nation.

As these openings are acted upon, further openings should appear on the pathway to providing an enabling environment.

E. In What Areas of Life is the Enabling Environment Crucial?

For those living in poverty, meeting basic human needs consumes most of one’s time, energy and resources. This inquiry will look into six key areas in the lives of the poor where an enabling environment would make a critical difference:

  • Ensuring the health of one’s family
  • Educating one’s children
  • Earning income
  • Drinking clean water and practicing good sanitation
  • Preserving the natural environment
  • Planning the size of one’s family

F. What Questions should Guide the Inquiry?

This paper will next take a look at the four elements of the enabling environment in each of the key sectors of the lives of the poor. At each point, we will address:

What’s so — what is the current situation — right now in the environment of the poor, given the progress to date and the challenges that the poor face, and

What’s missing which, if provided, would empower the poor to succeed in their own action.

We have found that rigorous clarity in addressing these two questions reveals openings for action.

G. What’s Next?

As we stated, we intend for this forum to be one step in a dynamic process. Following a detailed look in the next section of this paper into what’s so and what’s missing, we will develop a framework to seize the openings for action that get revealed, and to feed back the experience gained into the next inquiry.

Section 3: A detailed look into six key areas of life

A. Ensuring the Health of One’s Family

Bangladesh has pioneered breakthroughs in affordable and appropriate medications and in low-cost child-survival strategies. It has allocated huge sums of money to health care, yet child and maternal mortality and morbidity rates remain high. What is missing which, if provided, would enable the poor to ensure better health for their families?

AWARENESS: Many families currently do not know how to prevent and treat the most frequent and serious maladies that harm their health, such as diarrhea and acute respiratory infection. What is missing is a reliable, authoritative source of health information that reaches every family.

ACCESS: Families need access to affordable and appropriate medications, and to competent health workers. Enormous public investments have been made to train and provide health workers. It is likely that the major constraints to access now lie in a lack of accountability of those health workers to the local people.

AFFORDABILITY: Great strides have been made in making basic drugs affordable and available in the marketplace. One dangerous aspect of the present environment is that the freeing of markets makes it profitable to promote inappropriate drugs, eg: the promotion of expensive and dangerous anti-diarrheals in place of safe, low-cost oral rehydration solution. This trend must be countered both with more awareness and more local accountability.

ACCOUNTABILITY: At present, there are few, if any, existing mechanisms by which the poor can hold health services to account. What’s missing are strategies to strengthen the ability of the poor to gain accountability from local health services, perhaps through local committees, improved training of union councils and motivation of health workers.

B. Educating One’s Children

Education is a top priority in Bangladesh, and another area where breakthroughs have occurred in providing affordable, quality education. What is missing which, if provided, would enable poor families to provide their children with an education that is relevant to improving their lives?

AWARENESS: Given the tremendous promotion of education, families are now convinced that quality education will improve the lives of their children, at least for their boys and increasingly for their girls. Yet for most families, the quality of available education is poor and people are not aware of ways to improve it.

What is missing is the awareness and understanding as to how people can improve the quality of their local schools. If families were made aware of steps that could be taken to improve the quality of local schools, they would be more empowered to demand that they be taken.

ACCESS: Quality primary education is not currently available in most villages. The “technology” of providing quality non-formal primary education exists, as demonstrated by the BRAC schools, and is within the means and talents of every village. What is missing is the system of training and supervision that could enable every village to access this technology and establish such schools.

AFFORDABILITY: Bangladeshis demonstrate their determination to provide their children with education, even to the extent of spending enormous amounts of money on private tutors. While the poor cannot afford private tutors, they can afford the kind of quality nonformal primary education that has recently been developed. What is missing, therefore, is not the technology to make education affordable, but the structural changes that will give people the power and accountability to implement that which is affordable.

ACCOUNTABILITY: Currently, accountability for the quality of education lies with the delivery system providing it. What is missing is any systematic way for local people to directly exercise the responsibility for the quality of local education. This requires a structural shift towards stronger local government that works in partnership with parent committees. To truly be accountable for quality education, local bodies need ways to “grade” the performance of schools, and the authority to fire teachers who do not perform up to standard.

C. Earning Income

What is missing, which if provided, would empower poor families to securely earn incomes sufficient to meet their basic needs and contribute to national growth?

AWARENESS: As mentioned in the introduction, it is not the awareness among the poor that needs to be transformed, but the mindset of the elite. What is missing is a massive education campaign among the elite to transform their thinking about the poor and create the environment for pro-poor economic policies.

In the meantime, much has been done and can be done to directly empower poor families to raise their incomes. Progressive NGOs have pioneered ways to make the poor aware of new pathways to increased income through self-employment.

ACCESS: To raise their income, people need access to credit, productive resources, a marketable skill and a reliable market for their production. The experience of the Grameen Bank and other organizations have shown that even with one factor – credit – people are greatly empowered to better seize even the smallest market opportunities.

At present, credit, training and market support opportunities for the poor are primarily provided by NGOs, which are not accessible to every family. What is missing is either a way to expand the scale of these NGOs dramatically (and Bangladesh already is home to the largest NGOs in the world) or new strategies to make the techniques NGOs have pioneered accessible to any self-help association of the poor.

AFFORDABILITY: The greatest setback to income security for the poor comes because of financial setbacks such as illness, disaster, theft and wedding costs. What is missing are strategies to ensure that all the poor are able to provide their own first line of defense against setbacks through membership in self-help, risk-sharing groups.

As the second line of defense, the nation and the world community have shown resolve in working to prevent and prepare for larger setbacks such as natural disasters. Yet local people are not sufficiently empowered to do their own planning. It is local-level planning and action that can make the biggest difference the fastest when emergency strikes.

ACCOUNTABILITY: The transformation in thinking about the productivity of the poor will produce a new set of accountabilities. In the old paradigm, the poor are seen as a “burden” to the mainstream economy, and NGOs and other agencies are set up as an alternative to “service” the poor within economic environment that is not hospitable to the poor. In the new paradigm, those who make economic policy must be held to account by the self-organized economic activities of the poor. Larger alliances must be encouraged that give poor families a meaningful voice in economic policy decisions. Those committed to this shift in paradigms must find a way to hold themselves to account for causing it.

D. Drinking Clean Water and Practicing Good Sanitation

Water-borne disease continues to be the biggest killer of children. Major expenditures have provided a greater supply of clean water, but proper sanitation is far from being achieved. What is missing which, if provided, would enable poor families to ensure that they live in a hygienic environment?

AWARENESS: Most families know that they need clean drinking water, but many are not currently aware that clean water must be used for all personal uses (hand-washing, dish-washing, cooking). Many families do not understand the need for sanitation; there is a particularly dangerous notion that it is not important for children. What is missing is a far more rigorous and disciplined approach to empowering people with this information.

ACCESS: Significant progress, both in the public and private sector, has been to make tube wells and the equipment for sanitary latrines available. Where people lack access now, it appears to be most often the case that they lack the awareness or organized clout to access what is already there.

AFFORDABILITY: Affordability does not appear to be the major factor in enabling the poor to meet water and sanitation needs. Existing subsidy schemes and lowering costs in the private sector, have made clean drinking water and sanitation affordable.

ACCOUNTABILITY: One way to look at the challenge of village sanitation is to observe that no one is accountable for it. Awareness alone is not sufficient. In communities where sanitation is solved, it is always the case that strong penalties exist for violating sanitation standards. What is missing, beyond awareness, are strategies to create local accountability for sanitation, including the power to apply meaningful penalties.

E. Preserving the Natural Environment

No one has a greater stake in environmental preservation than do the poor. No one’s livelihood is more closely tied to the health and sustainability of the natural environment than is that of poor families. Among nations, Bangladesh is perhaps most aware of its environmental limits. What is missing, which if provided, would enable poor families to restore and preserve their natural environment?

AWARENESS: Just as with income, there must be a transformation in public attitude from seeing the poor as a “danger” to the environment to seeing the poor as the most committed and able to restore and preserve the environment. It has now been proven time and again that it is the practices of the rich that are the most environmentally damaging, while the more traditional lifestyles of the poor often reflect thousands of years of wisdom in the preservation of the environment.

What is missing is the same campaign as with income — a campaign to transform the thinking of those who shape policies, from seeing the poor as a burden to seeing them as the principal actors to ensure a productive, sustainable future for Bangladesh.

In addition, at the family level, there are new technologies and approaches which would empower poor families to make even better use of their resources, such as improved stoves, bio-gas and intensive organic farming techniques. As is the case in other sectors, what is missing are the channels of information that will reach every family.

ACCESS: In recent history, the poor of the world have been pushed increasingly to marginal and fragile areas of the environment, and have lost traditional rights as the protectors and preservers of forests, fields and water resources. Anti-poor attitudes, conventional practices and policies of modern economic development have reduced access to natural resources by the poor. What is missing are a new set of policies and practices that recognize the poor as environmental protectors (rather than the “threat”) and that restore traditional rights and improve access to resources.

AFFORDABILITY: The conventional approach to economic planning does not factor in the projected cost of continued environmental destruction, and certainly does not account for the lost productivity of the poor as the resource base erodes. The falseness of the delusion that we can “afford” environmental destruction is perhaps most revealed in Bangladesh.

What is missing is a “pro-poor, pro-environment” approach to planning that will redirect budget resources in ways which empower, and even employ, the poor to restore and preserve the environment.

ACCOUNTABILITY: Several NGOs in Bangladesh have pioneered approaches to place accountability – and the economic benefits – for environmental preservation back into the hands of the people with the greatest stake in the matter – the poor.

F. Planning the Size of One’s Family

Bangladesh has recently received international acclaim for reducing total fertility rates even among the poorest people. What is missing, which if provided, would enable poor families to limit their family size to that which is consistent with good health and a sustainable future?

AWARENESS: Progress is being made with awareness: an estimated 70 percent of Bangladeshi women would like to avail themselves of family planning, and about 40 percent of them do. What is missing that would fill the gaps?

  • The awareness component of the “gap” between 70 and 40 percent may be primarily due to attitudes of husbands.
  • The awareness component of the “gap” between 70 and 100 percent can perhaps best be addressed through expanding general female education.

Further analysis is needed of what messages, if in the environment, will close the remaining gaps the quickest.

ACCESS: Another component of the gap between the 70 percent demand and 40 percent usage is simple availability. Initiatives are underway to create “depots” of contraceptives at the village and deliver them door-to-door. Strategies to accelerate and universalize these approaches are currently missing.

AFFORDABILITY: Given the current high-degree of subsidy, affordability does not seem to be a current or prospective issue.

ACCOUNTABILITY: The family planning institutions in Bangladesh are large and well-funded. No institution, however, is large enough to “deliver” family planning services to every household. What is missing is that these institutions do not yet hold themselves responsible for creating an enabling environment in every village.

Section four: What’s next

Fomenting a process of inquiry and action

The intention of this forum is to make a difference for the future of Bangladesh. The high quality and broad range of experience of the leaders participating in this strategic forum should permit it to alter the perspective of all of us. It should allow the distinction of enabling environment to be drawn with such clarity and power that new possibilities continue to be revealed within each participant’s own work.

Following the meeting, The Hunger Project will take the insights gained and work in partnership with government and other NGOs to launch initiatives at the district level to provide what’s missing. We certainly hope other organizations will do the same.

The actions taken out of this meeting will not only contribute to creating an enabling environment; they will also reveal the next areas where a breakthrough is required. For example, the actions that can be taken by existing institutions will likely be insufficient to provide the enabling environment that the poor of Bangladesh need and deserve. Most institutions in society were not designed to provide an enabling environment. In fact, they were designed consistent with an earlier paradigm that does NOT see the poor as “able” and their functioning reinforces the old paradigm.

Structural transformation, therefore, will undoubtedly be required. The individuals who are committed to providing an enabling environment will either have to create new institutions, or transform the ones they are in.

Transformation cannot be accomplished by “outsiders” – it can only be accomplished by those who are directly involved in the action. Therefore, the experience gained in the months following this meeting should lead to participatory forums among those who are committed to bringing about the next level of transformation in specific sectors of society. For example:

MEDIA: The media establishment is currently best suited to bring awareness to the elite of society, and certainly the above discussion calls for significant changes in the thinking of the elite. One next step could be a forum to produce coordinated strategies among progressive NGOs and the media to achieve this transformation in thinking.

MEDIA FOR THE POOR: The above discussion highlights the need for expanded information flows to the majority of Bangladeshi citizens. Perhaps there is even a “market” for this information — the poor have shown great willingness to spend money on education and information that is relevant to their lives.

A next step could be a strategic forum to create an entirely new media “for the poor” to provide them with empowering information, and to help transform destructive attitudes towards family planning, dowry, child marriage, sanitation, appropriate technology and violence against women (to name a few).

GOVERNMENT: The “enabling environment” of the future demands far more local (versus top-down) accountability within the administrative services. Bangladeshis are exploring ways to strengthen local government and initiate bottom-up approaches to planning. Perhaps multi-sectoral forums are required to cause these changes.

POLITICS: The eminent economist Prof. Amartya Sen and others have pointed out how democracy serves the cause of human development. At some point, those who are involved with empowering the poor and those involved in the political process could come together to devise strategies to put “empowerment of the poor” onto the political agenda.

BILATERAL AND MULTILATERAL ORGANIZATIONS: International and foreign government agencies play an important role in Bangladesh’s service delivery systems. They need to ensure that their activities contribute to an enabling environment.

Individuals in these organizations may wish to sit down with local organizations to ensure that programs strengthen local institutions, rather than simply replace them with new, costly service delivery systems. New ways must be created to shift the resources of international organizations from funding expensive expatriate experts and contractors, and increasingly build capacities run and managed by Bangladeshis.

NGOS: Bangladeshi NGOs have pioneered service delivery and local empowerment mechanisms which are being emulated around the world. At the same time, NGOs must continue to identify and alter practices which work against an enabling environment for the poor to take charge of their own local associations.

PRIVATE SECTOR: Bangladesh is rapidly developing its industrial sector, yet this growth has not been infused with a pro-poor strategy. To do so, industrialists and those who work with the poor may need to create strategy forums among people with the experience and clout to transform the input-side of industries. For example, initiatives can be taken in the garment industry that would greatly expand opportunities for the poor while increasing the value-added component of the Bangladesh economy.

Conclusion

The people and institutions of Bangladesh have shown extraordinary resilience and ingenuity, particularly in recent years. Bangladesh has pioneered important breakthroughs in human development, and is now spearheading the creation of an enabling environment for the poor to succeed in their own development.

As this enabling environment emerges, it will unleash the productivity and potential of tens of millions of people, whose energies will create a new future for Bangladesh.

The Hunger Project, in Bangladesh and around the world, is honored to be the committed partner of the Bangladeshi people in calling forth the breakthroughs that will create a sustainable future for Bangladesh, and for all humanity.

The Hunger Project is not a relief or development organization, but rather a strategic organization committed to the sustainable end of world hunger. It is guided by the mandate to identify what is missing in the human component of ending hunger, and to launch initiatives to provide it.

The common element in many consultations with Bangladesh’s development experts, is that what is missing is an enabling environment for the poor to succeed in their own development. Bangladesh has pioneered many of the elements which now go into the concept of “enabling environment”, but what is missing is a clear, rigorous and widely-shared understanding of this concept that can shape the direction and programs of the institutions of society.

Participants

Government

  • Dr. Abdul Moyeen Khan, Minister of Planning
  • Dr. Sheikh Maqsood Ali, Convenor, Taskforce on Poverty Alleviation
  • Mr. S.M. Al-Husainy, Chairman, Swanirvar Bangladesh
  • Mr. Sultan-uz Zaman Khan, Chairman, Securities and Exchange Commission
  • Dr. Fariduddin, Secretary of Social Welfare

Academics

  • Dr. Shamsher Ali, Vice Chancellor, Bangladesh Open University
  • Prof. Shamsul Haq, National Professor
  • Mrs. Hasna Moudud, environment
  • Dr. S.A.L. Reza, Director General, BIDS

Members of Parliament

  • Mr. Abdur Rab Chaudhury (BNP), will moderate forum
  • Mr. Abul Hasan Chowdhury, Son of the first President (AL)
  • Mr. Fazle Rabbi Chowdhury (JP)
  • Mr. L.K Siddiqui, Vice chairman of party (BNP)

Journalists

  • Mr. Mahfuz Anam, Editor, Daily Star
  • Mr. Gias Kamal Chowdhury, Chief Correspondent, BSS

NGOs

  • Mr. Fazle Abed, Founder and Executive Director, BRAC
  • Dr. Qazi Faruque Ahmed, Executive Director, PROSHIKA
  • Dr. (Mrs.) Fatema Alauddin, Family Research and Development
  • Ms. Angela Gomez, Nijera Shekhi
  • Mr. Nazrul Islam, Palli Karma Sahayak Foundation
  • Prof. Muhammad Yunus, Managing Director, Grameen Bank

Business

  • Mr. Kafiluddin Mahmood, United Leasing
  • Mr. Salman F. Rahman, Beximco Group of Industries
  • Donor/International Agencies
  • Mr. Nick Langton, Representative, Asia Foundation
  • Mr. Manzoor Ul Karim, Unicef
  • Mr. Karl Schwartz, USAID

Members of the Global Board of Directors of The Hunger Project

  • Ms. Joan Holmes, President
  • Mr. Robert Chester, Chairman
  • Dr. Peter G. Bourne, President, Global Water
  • Mr. Ramkrishna Bajaj, Head, Bajaj Group of Industries
  • Dr. Ebrahim Samba, Director, WHO Onchocerciasis Control Program
  • Dr. M.S. Swaminathan, Chairman, M.S. Swaminathan Research Foundation