You cannot work in Northern Kenya and not be witness to the protruding ribs and distended stomachs of malnutritioned children. Yet it is still difficult for me, as a mother, to comprehend what it must be like to wake up each day and fight to feed your children. All across the arid lands of Africa (40% of the continent), women like Nkaroni wake up every day and worry about food for their children. Some philanthropists would say that the intractable cycles of drought, conflict and famine are so immense in these areas, and the solutions so expensive and risky, that they are not worth the investment. Some donors prefer to invest in more “cost-effective” solutions that lead to a vision of First World success, where university educated entrepreneurs start businesses that employ hundreds. “Poor women in urban environments are just a better investment,” one potential donor told me.
This is why BOMA fights for the Nkaronis of the world. Every day we compete for donor funds that will fund training, mentoring and seed capital grants that replace short-term solutions like food aid with business income. Some donors tell us that you can’t simply give poor people money. Instead, they say, we should make loans so that our participants “have some skin in the game.” But if our women squandered the seed capital grants that we give them to start a business, then why are 97% of our businesses still in operation at three years? BOMA women are earning a sustainable income and providing for their children. Businesses are distributing profits and accumulating savings within two months of start-up, a statistic that no micro-lending program can claim. With the right training and mentoring support, poor women, we argue, are a great investment of donor funds.
So our battle is more than a fight for foundation grants and big donations. It is a fight to challenge fundraising trends like “impact investing” that ask program participants to pay for the programs benefiting them, either through interest payments or pay-it-forward strategies. We compete for funds in a world where rich women philanthropists invest millions of dollars in women leaders, fancy award ceremonies and documentaries, but leave the communities that surround them still destitute.
That is why I am so inspired by the work of Dr. Paul Farmer, the anthropologist and physician whose public-health initiatives in Haiti were documented in Tracy Kidder’s best-selling book, Mountains Beyond Mountains: Healing the World: The Quest of Dr. Paul Farmer. Farmer is widely recognized for fighting the HIV/AIDS epidemic in Haiti and Rwanda, and is the founder of Partners in Health (PIH), an organization dedicated to providing comprehensive health care to poor communities around the world. (PIH’s co-founder, Jim Yong Kim, is now head of the World Bank.)
In a speech at Yale Divinity School last spring, Farmer said that in the mid-1990s “we started fighting for access to care. There’s only one standard of care, only one intervention that’s going to alter mortality in HIV infection, and that’s these drugs. And it was a long struggle. It was a huge debate. Our peers—policymakers, international health experts, even physicians, I’m a little embarrassed to say—were saying, ‘Well is it really cost-effective or sustainable to use these drugs in resource-poor settings?’”
Farmer had to fight against the “religion of cost-effectiveness.” He believes that poor patients are entitled to the same level of care as rich ones. And he believes that this fight is not just about healthcare. It is about poverty and social justice.
So I take heart when foundations tell us that our model is not “high-impact” because we don’t have a revenue strategy. Or foundations tell us that they’ll fund us this year, but next year they want to see us do something different (why?). Or funders that tell us that they wish we had a strong story-telling component to our model (Hello? Have they paid any attention to what we say and how we say it?). Most of these funders want to see success in First World terms. I once had a fairly sophisticated donor tell me, “I’m really not interested in saving a bunch of starving people. I’m not interested in a program that has poor people selling stuff to other poor people.” Another donor told me, “Why don’t they just move?” This person had obviously never been to the slums of Nairobi, where most rural migrants end up.
Donations to organizations like BOMA, which works on the front line of extreme poverty, used to be about charity and humanitarian empathy. Now too many donors seem to be focused on cost-effectiveness and a return on investment. In a world of limited donor funds, I understand this trend, but we’ve lost something in the process. When Farmer sees someone who is suffering he would say that we must do whatever it takes to relieve the suffering of that one individual. He said, “For me, an area of moral clarity is: You’re in front of someone who’s suffering; and you have the tools at your disposal to alleviate that suffering or even eradicate it; and you act.”
So that is what we do. We act. We may not receive the big multi-year grants or the big awards, but we can offer what many of these programs cannot: impact. We have measurable outcomes that prove our program of income diversification works. It is one of our best tools in the fight against the ignorance and prejudice of donors who think that poor people cannot be trusted with cash.
Oh, and that issue of cost-effectiveness? We’ve got that too. But it’s not what we stand for. Our number one commitment is to help those who suffer the most. And maybe someday we’ll find that foundation or philanthropist that says to us, “We value every human life, even the poor ones that live in impossible circumstances. We’ll join you in this fight and we’ll be with you until you get the job done.”