Q&A with Aaron Baum, Health Department collaborator
Aaron Baum is a doctoral student in the Program in Sustainable Development at Columbia University and a medical student at the University of Pittsburgh School of Medicine. He also collaborates with the Institute for Human and Community Development, City Health Works!, and the Millennium Villages Project.
Having been a Fonkoze intern 2009-2010, he is thrilled to continue to work with the institution to support its health initiatives.
FKZ: Can you explain the basics of Fonkoze’s micronutrient powder program? What are the advantages of piloting this program within a community-based structure?
AIB: The way I think about it is: Given some amount of funding, what is the most effective way to deliver high impact interventions to communities where the need is highest? What is the best way to deliver essential health products across rural Haiti, for example? What’s required to do so?
For a start, you’d need the product (importing it to Port-au-Prince or producing it in-country), distribution chain (transportation from Port-au-Prince to rural cities, and from rural cities to low-income villages), trained staff (to manage, implement, and monitor the program and to make sure products are not only going to where they should but are being used correctly), and, at the end of all of that, household demand. The last factor is critical and not addressed by most models. It’s not really fair to ask people living on daily sales earnings to take a day off work to walk hours to a distribution point for a product that may or may not be there when they arrive. Convenience impacts demand.
And so do other incentives, particularly when supplying preventive health products like vitamins which have few if any immediately visible benefits, despite being cost-effective and highly beneficial long term. In the developed world, we benefit from not needing to make the choice to take vitamins — our salt is iodized and our foods come enriched. Still, sometimes active choice is required and when it is, it’s hard for us to follow through — for example, we don’t exercise as much as we should and we don’t eat logically. It’s not different in rural Haiti, except there active choice is required for almost all preventive health decisions. Which means we need to change people’s behaviors. To do that, we need communities themselves to lead, and so identification of community leaders is just as key as setting up the expensive supply chain infrastructure to achieve scalable distribution in hard to reach, rural regions.
Fonkoze has already built a community-based distribution platform across 2,000 villages in the country, with all village centers linked to one of 46 rural branches. Village centers of 25-50 women already meet twice monthly in the same place, with transport linkages in place — a Fonkoze employee motorcycles twice a month to the meeting. Further, each village center elects a representative client as their “center chief”, a volunteer leader for all center meetings who represents her center in Fonkoze’s national assembly.
In these ways, Fonkoze’s community-based structure is anchored to the communities it serves, and is a ready platform for the distribution of health products and for effective, community-led education and promotion.
FKZ: The micronutrient powder project is currently being implemented in Lenbe, Fonkoze’s “experimental” branch for exploring new initiatives. How many participants does it serve? Can you tell us about any future plans for scaling up the program?
AIB: In the pilot, we are providing 526 children aged 6-59 months across 35 villages with free micronutrient powders for 9 months. We believe the pilot results will show that a microfinance-based model for the distribution of MNPs produces comparable outcomes to traditional health system distributions, but costs far less to scale up because of the existing physical and community infrastructure. After the pilot, our goal is to first reach 5,000-10,000 children in the northern region of Haiti with the products, and then scale across all Fonkoze branches to eventually reach 2,000 villages in all geographical departments of Haiti.
In addition to expanding the scale of families served, we are hoping to expand the scope of products we distribute to include many more health and sanitation products beyond MNPs alone, and we’ll be incorporating low-end mobile phones programmed with software that allows center chiefs to report supplies and sales to a cloud-based server in real-time. Further, we are developing a lean, financially sustainable business model by training center chiefs to incorporate the sale of health and sanitation goods into their existing business, so that essential products are readily available in villages at very low cost.
This entire project is linked to a larger health initiative in the experimental branch in Lenbe, where Fonkoze employs nurses who provide annual physicals and treatments for diabetes and hypertension. These nurses supervise our center chiefs, MNP inventory, distributions, and data collection. We are also hoping to find support to develop a health finance product for our members (e.g health insurance, dedicated loans for health expenses, etc.), so that our clients can have predictable health expenses when making use of the hospitals and clinics in their area.
FKZ: You served as a Fonkoze intern during 2009-2010. How did this experience influence your involvement with the project?
AIB: That experience demonstrated to me the transformative role of Fonkoze’s network in mobilizing hard to reach communities, and the logic of training lay people as leaders in their community who can provide basic, essential health services to their neighbors. I really loved my time in Haiti and I felt strongly about contributing to what is truly an amazing organization with a deep moral fiber. The January 2010 earthquake struck when I was in the Fonkoze branch office in Port-au-Prince, and I am sure that experience has impacted my commitment to the organization and its mission.
While an intern, my role was to support the director of the health department with data analysis, reporting, and grant writing. I continued to support her after returning to the US, and one of the grants we wrote was for the micronutrient powder project, which has allowed me to be continuously engaged with Fonkoze’s health department since.
At the time, Fonkoze’s health department was piloting a malnutrition screening program — essentially, training center chiefs in malnutrition case detection. By using a color-coded tape measure, these community members could identify children at critical stages of under-nutrition. Partner In Health’s community management of acute malnurition (CMAM) program partnered with us, and any identified malnourished children were freely treated at PIH. The cost of treatment for severe malnutrition was a few hundred dollars and it would save the life of a young child.
Simply by training center chiefs in a basic health intervention and asking them to mobilize the local membership to bring their children to their routine twice-monthly meeting, Fonkoze’s network could save countless lives. In fact, so many children were referred by Fonkoze that we needed to find more funds for the treatment even though it was only a few hundred dollars per child saved. In the current project, we continue to train center chiefs to screen children and have partnered with the Ministry of Health on this initiative to secure free treatment.
FKZ: As an MD/PhD student at Columbia University’s School of International and Public Affairs, how does this project relate to your course of study?
AIB: I expect that this project and future ones will form the basis for my Masters thesis in the Sustainable Development PhD program at Columbia, which integrates social and natural science disciplines in a practical way to address global poverty. I’m hoping results from this project can encourage other microfinance organizations to consider integrating health into their services — I really think Fonkoze is evidence that solidarity microfinance is not simply about loans, but about building and maintaining a community-based network that should serve as a platform for integrated rural development.
I remember when Anne Hastings called me just two weeks before the 2009-2010 medical school academic year was about to start, asking if I could start at Fonkoze immediately. I was lucky becayse the leadership at the University of Pittsburgh School of Medicine was thoughtful and kind enough to let me take the short-notice opportunity as a student. Later, they featured my experience in their alumni magazine.
FKZ: The micronutrient powder program recently won a “Data for Communities” award from Captricity to digitize its data collection process. What’s your time frame for collecting and evaluating this data? How will it help to measure the program’s success and potential for expansion?
AIB: Baseline data collection began in January 2012 and follow up data is being collected in waves across both the intervention and comparison groups. We will continue forward through December with data collection and then proceed to evaluation after the program is complete.
Captricity has developed a novel tool for organizations that use paper-based data collection methods, but transfer all their data to electronic databases for storage, like Fonkoze. Their service lets you convert your paper records to electronic files very quickly. For this project, there was an emphasis on demographic, clinical, survey, and focus group data collection — all of which needs to be processed for analysis quickly to feedback on operations and inform our plans as we expand.