Pro Mujer in Nicaragua Hosts Inaugural Velasco & Patterson Society “Encuentro”

By Josh Cramer-Montes, Director of Communications

EN·CUEN·TRO    [En-KWEN-tro]
From the verb encontrar
1. m. (reunión) a meeting, encounter: un encuentro entre amigos / a meeting among friends

On March 5^th and 6^th, key Pro Mujer supporters from around the world came together to participate in an inaugural trip for the Velasco & Patterson Society’s (VPS) in-country Encuentro series. Named after Pro Mujer’s Co-Founders Lynne Patterson and Carmen Velasco, VPS is a diverse group of philanthropic leaders dedicated to raising awareness of and financial support forPro Mujer’s work, enabling impoverished Latin American women to break the cycle of poverty.

Pro Mujer staff, clients, VPS members and supporters.

VPS’ Encuentros are a series of in-country meetings where key supporters are able to visit our operations, interact with staff and clients, and see how their donations are being invested.  Our donors truly are investors;numerous studies have shown that women reinvest 90% of their income in their households. In this way, empowering women creates a multiplier effect.

The daughter of a Pro Mujer client comes to a communal bank meeting with her mother.

Joining us on this trip were longtime Pro Mujer supporters, including: Stanley Eisenberg and his partner Mary Jones; Renate Rennie, Chairman and President of the Tinker Foundation; Gail Bradley, representing John and Jacque Weberg of The Weberg Trust; Mark McMahon and his partner Roberto Moreira; Claudia Valle, General Counsel and Compliance Officer for Citi Nicaragua; and her colleague Enrique Gasteazoro Elizondo from Citi’s Public Affairs and Corporate Social Responsibility division.

Nicaragua was the first country outside of Bolivia (where Pro Mujer was founded in 1990) that Lynne Patterson and Carmen Velasco selected to advance their mission of helping empower Latin American women living in poverty. They founded Pro Mujer in Nicaragua (PMN) 15 years ago, and since then, the organization has disbursed more than US$122 million dollars through 487,000 small loans to Nicaraguan women entrepreneurs, who borrowed an average of $250. Over the course of two decades, PMN has provided Nicaraguan women with 64,460 educational workshops covering a variety of subjects including communications skills, sexual and reproductive health and domestic violence, and has performed 77,767 health consultations.

Pro Mujer nurse Maria Teresa Centeno

While PMN has done a great deal to advance the wellbeing of economically marginalized women and their families, there are many more women who still need to be reached. Nicaragua is the second poorest country in the Western Hemisphere after Haiti; 48% of its 5.7 million inhabitants live below the poverty line, and a staggering 80% subsist on less than $2 per day.

As in many other developing countries, women comprise the majority of Nicaragua’s economically marginalized population. Of the 70% of the population that works in the informal sector – which includes jobs such as selling fruits and vegetables on the side of the road, running a convenience store out of a home – 75% are women. A relatively high proportion of Nicaragua’s homes have a woman as head of household: 39% of urban homes and 28% of rural homes.

A Pro Mujer client.

Despite the many hardships facing its people, there is something almost mystical about the country, a feeling I had the first time I traveled there and one rekindled during this visit. Perhaps it’s the vibrant and persevering spirit of Nicaraguans in the face of those challenges,as well as the rich culture, warm climate and beautiful landscape.

The first day of our trip begins with inspirational welcome remarks by PMN Country Director, Gloria Ruiz. Although she is just over 5’0 tall, Gloria hasa large presence and is a leader in the truest sense of the word. She faced poverty and gender discrimination as a child, and eventually earned a degree as an Agricultural Engineer, a male-dominated profession in her country. Gloria is a mother to three grown children, a grandmother to a new grandson, and has been married for 28 years. She joined Pro Mujer 15 years ago as its first credit officer and todayshe is Country Director. Gloria is truly an inspirational force with whom to be reckoned; you can read more about her inspirational journey in this International Women’s Day profile piece from Nicaragua’s El Nuevo Diario.

A communal bank leader in León counts her group’s loan repayments.

Following Gloria’s presentation, we head over to our Leon center. Dr. Gabriela Salvador, MD, MPH, our Director of Health and Human Development who oversees our global health program, gives the group a presentation on our health pilot program and explains how Pro Mujer is addressing the increasingly serious issue of chronic disease. These diseases include hypertension, diabetes, sexual and reproductive health problems, and breast and cervical cancers, and are pandemic within the segment of the population we serve.

Dr. Marta Garcia in one of the consultation rooms of the Pro Mujer clinic.

Afterwards, we move next door to the new wing of the center, a beautiful, colonial-style building with a lush garden in the center, 20-foot ceilings and beautiful wood paneling and detail throughout.

The new wing (behind the three large wooden doors and the two garage doors to the left) of the Leon center made possible by Pro Mujer supporters.

Here we meet with local team members to learn their personal stories, how they came to work for Pro Mujer and how the lives of their clients, as well as their own, have changed. Their stories are both funny and moving, but one speaker really stands out. Elsa Soza is an Expansion Specialist who has been with Pro Mujer for eight years. She relates the story of how she was born into poverty and abuse. As an adult, that abuse changed hands and continued until she was finally able to break the cycle a little over a year ago. You can read her first-person account as told to the group by clicking here.

Gloria Ruiz leads the discussion between Pro Mujer supporters and international staff members (left) and local employees (right).

Eight client leaders then shared their personal testimonies, telling us about the challenges they faced when they first came to Pro Mujer and how much their lives have changed since.

Communal bank leaders share their stories of challenges and triumph.

All of these women were born into poverty. Many had limited access to education, were victims of domestic violence and were raising their children alone. Despite these obstacles and as a result of their hard work and perseverance, their children are attending university and becoming doctors, lawyers and engineers. This new generation, the one they helped raise and educate, will be the generation that helps rebuild Nicaragua.

As Mark pointed out, “It was funny to note that several of the women never even talked about what they use the loan money for, but what it (Pro Mujer) has brought them.” It was everything else that they received – the safety and supportive environments of their communal banks and the interactions they shared with their fellow members, workshops in business development, communications skills and women’s rights, and the recurring theme that they are a worthy investment – that was really important to them.

Some of the things clients said were truly powerful:

“They didn’t give me money; they gave me ideas, strategies to help myself.”

 “Thanks for showing us that we can help ourselves.”

The evening closed with a traditional Baho, a dinner of typical Nicaraguan food including beef, plantains and yucca wrapped in banana leaves and steamed. Traditional music played in the background and we sat down to share a meal with the client leaders and staff.

On the morning of Day 2, we found ourselves shadowing one of our mobile credit officers, Rosa María Ramirez. Rosa is about 25 years old and beams with positive energy. She spends her day crisscrossing the rough, rural roads around Leon on a dirt bike in order to attend to her clients.

Rosa María Ramirez begins her day.

Pro Mujer credit officers traverse rough roads day in and day out. Now imagine it during the rainy season.

Some of the areas where these credit officers go are isolated and dangerous and they try their best not to stand out, which is why they don’t wear anything that says Pro Mujer. Even though they don’t carry money, bandits often think they do. To ensure their safety, credit officers call in or send a text message every time they depart from and arrive at a communal bank meeting.

Our first visit of the day is to a communal bank called Divina Pastora. The group consists of approximately 20 women who are in their 25^th loan cycle, which means that they have been with Pro Mujer for approximately 12 years. They are particularly proud of the fact that they have been with Pro Mujer for so long, as they are among the pioneering women of microfinance in Nicaragua. It is a particularly special day for them as Lynne and Carmen will be sitting in on their meeting.

It’s always heartwarming to see how our client’s faces light up when they actually meet Lynne and Carmen. For many of our clients, they are like mythical figures that they’ve only heard about in stories. When we arrive, we are greeted with a red and white tape that Lynne and Carmen are to cut. Carmen makes a joke and tells the group, “I bet you didn’t think we were real!”

Carmen and Lynne cut the ceremonial ribbon for the beginning of the Divina Pastora’s meeting.

VPS member Mary Jones bonds with a client.

After the meeting we have a chance to ask the women questions and learn more about their experiences. At the end of our time with them, the women of Divina Pastora share homemade candies with us and send us on our way with sandwiches and something to drink for the journey ahead.

From L to R, VPS member Stanley Eisenberg; Lynne Patterson; Jason Wu, Director of Development, Individual Giving and the person who oversees the Velasco & Patterson Society; Carmen Velasco; and Stanley’s partner, Mary Jones.

Our last visit is to a client named María Concepción Moran.  I first heard María Concepción’s story last June, when my colleague Yolanda Bravo sent me a blog post of an interview she did with her. The post, which you can read here, is a first-person account as to how her life changed as a result of a housing loan she received from Pro Mujer. I remember the before and after pictures and I knew her story well, but I must admit that sitting in her backyard and listening to her tell her story in person  is far more powerful.

 María Concepción in the convenience store she runs out of her home.

Neighborhood children stand outside of her store.

Like so many women we spoke to on this trip, she talks of the hardships of growing up poor. As an adult, she and her husband lived in homes made of plastic and cardboard boxes that she and her children would pick out of the trash to use for walls and a roof.

What María Concepción’s home used to look like.

For years they lived in miserable conditions. The slightest drop of rain would come straight through the roof. When the torrential rainstorms of Nicaragua’s wet season would arrive, the cardboard roof would often collapse and the dirt floors of their home would turn into rivers of mud. Things only got worse when her husband was laid off from work and their only source of income was what she made from ironing clothes.

A friend told her about Pro Mujer. After attending an informational session in 2010, she took out her first loan of $133. She used the proceeds from the loan to buy goods to open a small store in the front of her house.  Since then she has expanded her store and put up concrete walls.

Today, María Concepción’s life – and that of her family – is brighter. When asked how she has changed, she responds, “I have more confidence and now my husband respects my decisions.” She used to be afraid of the rain but this year she chuckles and says that she’s looking forward to the rainy season so she can laugh at it under her new roof. “For my family and me it was one of the happiest moments…to know that we were not going to get wet anymore when it rains.”

Then, María Concepción throws us all a curve ball. Just when things seem to be going so well for her, she tells how us how a Pap smear performed at one of our health clinic came back positive for pre-malignant uterine cancer. Fortunately it was detected early and the prognosis seems relatively good. In fact, she was going in for surgery the following week.

From L to R, Gloria Ruiz, María Concepción’s son, Lynne Patterson, María’s husband and daughter, María Concepción and Carmen Velasco stand in front of the family’s brick walls.

Just before we leave, María Concepción’s daughter (center) asks for a group picture to remember the visit.

It was an emotional visit but one that left us all feeling very happy. It was incredible to see how with the right opportunities, one client’s life can change completely.

The VPS’ first Encuentro left us all hopeful for the future. We were able to learn from one another and it was a true testament to what we can accomplish together. As the American cultural anthropologist Margaret Mead once said, “Never doubt that a small group of thoughtful, committed, citizens can change the world. Indeed it is the only thing that ever has.”

Stay tuned for more information about the next Encuentro. For more information about the Velasco & Patterson Society or to learn how you can get involved, please contact Jason Wu at 646-626-7000, x108 or via email at jwu@promujer.org

All Photos Courtesy of Pro Mujer.

Voices from the Field – Reflections on 12 Days in Peru

By Josh Cramer-Montes, Director of Communications

Saturday/Sunday – Newark > Lima > Arequipa

It’s 7:30 AM on Saturday and I’m in the back of a taxi speeding down the highway towards Lima following an overnight LAN flight. The sky is a hazy gray, a common occurrence as a result of the subtropical desert climate meeting the cool waters of the Pacific Ocean.

As I approach the neighborhood of Miraflores, I see groups of surfers on my right, bobbing around in the ocean waiting to catch the next big wave. To my left are steep, 100-foot rocky cliffs with modern buildings perched at their summits. It’s a scene reminiscent of Southern California. In the face of the country’s booming economy, a surge in national pride and a culinary tradition taking the world by storm, one can easily forget about those left out and the poverty that lies beyond.

I’m in Peru for a series of site visits, meetings and events that will have me crisscrossing the southern part of the country and visiting more than half a dozen cities over the course of the next 12 days. It’s my first time here and I’m particularly excited to see the fourth of our five country operations in action.

Monday – Arequipa > Pedregal > Arequipa

My watch alarm goes off at 6:00 AM and despite not having my customary first cup of coffee to jolt me awake, I hit the ground running. Naldi Delgado, Director of Pro Mujer in Peru, and I are teaming up to give a short presentation to a group of visitors from one of our partner organizations, Global Partnerships (GP), a non-profit social investor. The group, headed up by Chris Megargee, GP’s Director of Community and Corporate Relations, is in Peru to see our operations first hand and meet some of the 245,000 strong, hardworking women we serve across Latin America.

GP is one of the organizations – along with PATH and Linked Foundation – that partnered with us for our health pilot program in Nicaragua. This pilot seeks to tackle the increasingly-serious issue of chronic disease among our target population (hypertension, diabetes, sexual and reproductive health and cancers, specifically breast and cervical) and one that has broad implications for people worldwide.

After the presentation we board a van for the hour and a half ride that will take us through the desert to the small rural town of Pedregal. Here we will have the opportunity to see our Jornadas de Salud; a series of health campaigns that consist of RVs retrofitted to suit our needs as mobile health clinics.

Complementing these clinics are staging areas where additional services are provided by ophthalmologists, optometrists and obstetricians, among others, at below-market cost or free of charge depending on the service. Pro Mujer in Peru has four of these mobile clinics that travel to different regions each month. Each of these campaigns lasts a few days and we don’t close shop until every last person – clients and the general public alike – gets seen by trained medical personnel.

Children from the local kindergarten take a break from their school day.

Pro Mujer staff provides patients who are waiting to be seen with preventive health education.

The focus of these campaigns is the screening of chronic diseases. Other tests offered include blood pressure, BMI (body mass index) and breast exams.

The PMP team and I – including Country Director Naldi Delgado (center) - in front of one of our mobile health clinics.

For many of our clients, primary health care services are often out of reach. Frequently, the public health care system in their communities is either limited or non-existent, forcing many to travel long distances in order to access them. Once there, they join dozens if not hundreds of people also waiting to access the same services and there is no way of knowing if they will be seen by a doctor or required to come back at another time.

Throughout this process, our clients are forced to grapple with the crucial decision of remaining at their place of business in order to earn much-needed income or forgo a day’s wages and spend money on transportation to a clinic when they are asymptomatic. As a result, preventivemedical attention falls by the wayside until a client is sick, and by then the situation can be debilitating both physically and financially.

A few blocks from the town center where the campaign is taking place, we go to visit a Pro Mujer client at her place of business. Ángela Mamani Sulla is a 29-year old married mother of three who has a big smile and sunny disposition that makes her look years younger.Ángela runs a small convenience store which also houses the family’s living quarters.

She joined Pro Mujer in February of 2010 after being invited to join the “Sacred Family” communal bank. A communal bank is a group of 20-30 women who come together to take out a loan as a group and receive Pro Mujer’s services – finance (small loans, savings, insurance), business training and health care. They select a name for their group, elect a President, Secretary and Treasurer and guarantee one another’s loans as a group. In the event that one member can’t make a payment, the others make the payment for her until she is able to get back on her feet. As a result of this group guarantee, communal bank members only invite friends and neighbors who are credit- and trust-worthy.

Ángela’ s first loan of US$183 allowed her to improve and expand her family’s living quarters, double the size of her business and diversify the products she sells. It is truly inspiring to hear her story and see how far she has come in a relatively short amount of time.

One final picture before saying goodbye to Ángela and her daughters.

As we say goodbye to Ángela and head back to Arequipa, I realize it’s been a long day of traveling and everyone is wiped out. Tomorrow we head to Mollendo, a small port town of about 30,000 people on the Pacific coast in the southwestern part of Peru.

Tuesday – Arequipa > Mollendo > El Fiscal > Arequipa

The next day we board the bus at 7 AM and over the next two and a half hours, we descend more than 6,500 feet on roads carved into the sides of mountains with spectacular, lunar-like landscapes.

The beautiful but barren scenery on the drive from Arequipa to Mollendo.

We get to our Mollendo center in time to watch the members of the San Camilo communal bank organize themselves and run their loan repayment meeting. They are a warm and welcoming group and after their meeting is over, they take time out of their day to answer some of our questions. Every time someone asks the group’s President, Secretary or Treasurer a question, they stand to respond. It’s a simple act, yet one that speaks volumes. When many women first come to Pro Mujer, they are unable to speak in front of a group or even look someone in the eye. One can only imagine the circumstances that cause them to have this reaction.

The members of the Communal Bank San Camilo process loan repayments.

Within the group, we meet women (and a few men) who run businesses such as dance schools, selling AVON products (a common among our clients in a number of countries), convenience stores and restaurants, among others.

By the end of our time with them, we are all laughing and joking. For however brief the exchange, they’ve allowed us into their world and I’m always touched at the close relationships we are fortunate enough to share with our clients. The reason for this is that we provide so much more than a financial transaction; Pro Mujer is a transformative experience. It is an experience of personal growth where a client realizes her rights, her self-worth and begins the process of harnessing that awakening not only for herself, but her family and community. That sense of trust, support and community, that “we’re all in this together,” doesn’t just end with our clients, it extends to our team and beyond.

In a small file room, I come across a touching sight; the folder of a group of women who named their communal bank (#65) in honor of one of our Co-Founders, Lynne Patterson. It’s sandwiched between “Light and Hope” (#64) and ”Useful Hands” (#67).

From Mollendo, we hop back in the van for the next stop on our journey – El Fiscal. El Fiscal is a small town that has the Pan-American Highway running through the middle of it. El Fiscal caters to truckers and travelers through endless side-of-the-road businesses that offer everything from food and drinks to autoparts, among other things, for their long journeys.

The communal bank group Sarita Colonia is waiting for us to arrive. They’ve finished up their meeting but remain together as a group in order to receive us. We take turns asking them questions about their lives, their businesses, and El Fiscal. Dr. Alfonso Medina, our Health Manager for Peru, gives a talk about the importance of taking care of one’s health and making sure all of one’s exams are up to date. At the end of our session, the group brings out a traditional piqueo de camarones (a buffet if you will, of fried river shrimp complete with head, tails and everything in between) served in our honor. Camarones are the lifeblood of the women in El Fiscal. It was particularly touching that they went out of their way to host and feed us.

Dr. Alfonso Medina talks about the importance of monitoring one’s health.

Despite my best attempts to blend in, a client cheekily points out that I’m heads above the rest.

Pro Mujer staffers and visitors from Global Partnerships around the traditional Peruvian piqueo organized for us by the women of Sarita Colonia.

Wednesday – Arequipa > Lima

Wednesday found us celebrating the opening of one of our newest neighborhood centers, Paucarpata. In conjunction with the opening, Pro Mujer staffers held another health campaign for clients and members of the general public who had gathered for the event.

One of our newest centers in Arequipa, Paucarpata

Juan Carlos Torres, our Financial Services Manager, welcomed everyone with some remarks. Toasts were had and I was then given the honor of cutting the ceremonial ribbon while Naldi used a hammer to break the celebratory bottle of champagne christening the center.

The Pro Mujer Peru team and their mascot Julia.

Performing the ceremonial ribbon-cutting next to center manager, Fernando Paca

Naldi Delgado, Peru’s Country Director christens the Paucarpata center with a ceremonial whack of the champagne bottle.

After the ceremony, we tour the center and learn about the services that are provided on site. There is a medical consultation room staffed by a full-time obstetrician and a unique new service for clients, a BCP (Banco de Crédito) teller machine that allows clients to withdrawal loan disbursements from their bank accounts, deposit savings and pay utility bills safely and conveniently.

During the visit we have an opportunity to watch a new solidarity group (similar to a communal bank but with fewer members), receive its very first loan disbursement. The women are all very proud to be part of one of the first groups in the center, and to have us sit in on their meeting.

Fernando Paca and members of the solidarity group perform a pachamama ceremony, blessing their loan disbursement in the hopes that their money will multiply and bring them success.

This client thought that I would somehow bring some good luck to her funds if I handed them to her. After a few words of well-wishing, I handed them over – but I may have held onto them a few seconds more than she expected!

Following the opening of the Paucarpata center, it’s time for Naldi and me to head to the airport to board another LAN flight to Lima for more meetings.

The view of Misti volcano on the outskirts of Arequipa.

Friday – Lima

This morning we have a series of meetings with key people from the Universidad del Pacifico (UDP); Naldi’s alma mater and one of Peru’s top schools. A few months ago, UDP featured Naldi in a fantastic and inspirational video as part of its “Responsible Leaders” campaign highlighting outstanding alumni. Definitely worth checking out.

Later on that evening, Naldi and I participate in a live, sit-down interview with Peruvian journalist Cecilia Valenzuela for her show, “Mira Quien Habla” (“Look Who’s Talking”) on Willax TV. We’re here to discuss Pro Mujer’s work in Peru and throughout the region. To watch the interview (in Spanish), please click here.

Cecilia Valenzuela, Naldi Delgado and myself after the interview.

Saturday through Monday – Lima > Arequipa > Puno >Arequipa > Lima

I’m up early to fly to Puno, a city on the shores of Lake Titicaca, the world’s highest commercially navigable lake at 12,421 feet above sea level. I’m warned that altitude sickness can make one very ill here, but fortunately, the only symptom I experience is insomnia…wide-awake–at-4 AM insomnia.

I’m in Puno for additional site visits for upcoming projects (more on that in Part 2 of this post) and while I’m here, I’m taking advantage of stopping by our national office and meeting the 40-plus member team. It’s here that I run into Dr. Medina and Juan Carlos Torres, among others. Once again, I feel a beautiful sense of camaraderie that says, “Hey, we’re in this together.”

My time in Puno – and Peru – is quickly coming to a close and in less than 24 hours, I’ll begin the long journey back home. Only two weeks have passed, but the non-stop activities make me feel like I’ve been gone a lot longer – so much so that my colleagues joke that if I spent one more day, I just might be eligible for Peruvian citizenship.

Tuesday – Lima > Miami > NYC

As the plane takes off and I gaze out the window over the landscape, I begin to reflect on the past few weeks.

No matter which of our operations I visit, I’m always inspired by my fellow colleagues. Working at Pro Mujer is a commitment to a cause. It is not a 9 to 5 job and it’s not one spent behind a desk. It is a laboratory where one is constantly overcoming challenges (earthquakes, torrential rainstorms that close airports – more on that in my next entry—blackouts, logistical issues, etc.) and trying new things to find solutions. When something doesn’t work, we recalibrate and change course on a dime.

Why? Because the women we serve depend on it. Poverty is a complex issue with no silver bullet. To be a woman, to be poor and to be indigenous in Latin America is triply challenging, and serious barriers are placed in front of you from Day 1.

While relative poverty varies by country, the culture of poverty among the women we serve is the same. Enduring financial struggles and discrimination, doing double duty as both a mother and a father, and wondering what curve-ball tomorrow will bring are universal.

Access to health care (as a mentioned earlier) is limited or non-existent – this is a main factor perpetuating poverty, as poverty and health are inextricably linked. Because of traditional gender roles, many women are expected to take care of children and family members, often on their own because their partner is either physically or emotionally absent. These gender roles also limit their access to education and training, which then limits their opportunities for employment. They are frequently limited to jobs in the informal sector which is why so many open their own small businesses in or near their homes. Maintaining a business in the informal sector limits, or excludes altogether, access to traditional financial services. In the end, it’s a cycle that often passes from one generation to the next.

Despite all the challenges they face, these women are strong, hardworking and perseverant. Women like Janeth, Luisa and countless others march forward, moving themselves and their families ahead. With the essential tools and support that we provide, I’m confident that their road will be a little easier, and that a brighter future for them and their families is just over the horizon.

All photos taken with my trusty iPhone.

Pro Mujer Inaugurates Its 71st Health Clinic in Bolivia

By Gustavo Trigo, Head of Marketing and Communications for Pro Mujer in Bolivia with contributions by Adriana Villaseñor, Communications Manager, Pro Mujer International

Thanks to a generous donation on behalf of the German government by Ambassador Phillip Schauer, on October 8^th Pro Mujer in Bolivia (PMB) opened a new health clinic in its San Borja center bringing the total number of neighborhood centers with health clinics to 71.

Our newest clinic currently provides health services to more than 900 clients and their family members in the city of San Borja and the town of Yucumo, a region composed of several rural and primarily indigenous communities in the Bolivian Amazon. In total, we expect to serve approximately 3,600 people.

Pro Mujer's San Borja center.

Ambassador Schauer traveled to San Borja accompanied by PMB representatives including PMB’s Director of Health, Caroline de Hilari. With the leaders of San Borja in attendance, the Ambassador highlighted the important work being carried out by the German government in Bolivia and the ties of friendship that have united the two nations for years. He also congratulated Pro Mujer for the work its work in promoting health and the development of women from the most impoverished communities in the country.

The German ambassador to Bolivia shares a few words with those in attendance, including Pro Mujer clients, staff, and journalists.

After a few words of welcome and thanks to local civic leaders, Ambassador Schauer proceeded to perform the ceremonial ribbon cutting, inaugurating the clinic.

As part of the celebration, a reception was held featuring traditional pastries of the region. Afterward, attendees enjoyed a performance by a dance troupe made up of members from the communal bank, Las Poderosas, or Powerful Women.

Caroline de Hilari and Ambassador Phillip Schauer with the dance troupe that performed at the event.

This represents another step forward in the implementation of Pro Mujer’s health strategy, which aims to be high-impact, sustainable and help prevent chronic diseases such as diabetes, hypertension, obesity, sexual and reproductive health problems, and breast and cervical cancers.

From January to November of 2011, PMB provided a total of 145,812 medical interventions (consultations) through 71 clinics serviced by full-time doctors and nurses. These trained medical personnel come to the center 2-4 times per week, according to the needs of each clinic.

These consultations, the majority of which are provided to clients free of charge, form part of the more than 300,000 interventions that Pro Mujer has provided throughout the region in 2011.

To learn more about how Pro Mujer is addressing chronic disease in Latin America, please click here.

Addressing Chronic Disease in Latin America: Pro Mujer’s Health Pilot Program One Year Later

By Jana Smith, Project Manager, Health and Human Development Services with contributions by Dr. Gabriela Salvador, MD, MPH, Director of Health & Human Development

BLOG UPDATE (NOVEMBER 8, 2011) – To listen to Dr. Salvador talk about how Pro Mujer is addressing chronic diseases in Latin America, click here to listen to her on an EarthSky.org podcast.

BACKGROUND ON PUBLIC HEALTH ISSUES IN LATIN AMERICA AND WORLDWIDE
While maternal and child health interventions reach a relatively broad demographic in Latin America through the public health care sector, there are still no solutions to address the increasingly serious problem of chronic diseases such as hypertension, diabetes, sexual and reproductive health problems and breast and cervical cancers, among other illnesses.

Growing urbanization throughout the region has led many to lead a more sedentary lifestyle and greater consumption of fast food resulting in shockingly high figures of obesity, and by extension, chronic disease, especially in poor segments of the population. To combat these conditions, prevention or early detection is vital, since most of these diseases are “silent;” this is complicated by the high opportunity costs associated with access to care for women from impoverished communities who work in the informal sector. These women support themselves and their families with daily sales, and therefore must decide between lost income and preventive healthcare, the value of which may not be fully recognized until an illness has reached an advanced stage.

In addition to health implications, these diseases have tremendous economic implications for both developed and developing countries. According to a report published by the World Health Organization in April of 2011, non-communicable diseases cause 60% of deaths worldwide, killing 36.1 million people annually. “Non-communicable diseases will evolve into a staggering economic burden in the coming years…It’s a huge impediment to the mitigation of poverty” said David E. Bloom, Professor of Economics and Demography at Harvard University’s School of Public Health in a June 2011 Bloomberg interview.

PROJECT HISTORY
Pro Mujer began its operations in Nicaragua in 1996 and was the first replication of the Pro Mujer model after its founding in Bolivia in 1990. In 2005, Pro Mujer in Nicaragua (PMN) began offering health services with great success, particularly in terms of the usage of Pap smears and contraceptive methods. However, its lack of focus on chronic disease, its per service fee structure, and minimal commercial value prevented the program from achieving greater coverage, impact, and long-term financial sustainability and permanence.

In 2009, Pro Mujer decided to begin an ambitious project to rework its health model in Nicaragua. The aim of this innovative health pilot was to provide clients with comprehensive and affordable primary health care services while addressing the increasingly-serious problem of chronic disease. Between October of 2009 and October of 2010, PATH provided technical expertise in analyzing the market and developing key health elements of the program while Global Partnerships provided funding to launch the pilot which officially started in October/November of 2010. In addition, the Linked Foundation provided and continues to provide, invaluable support and funding.

A Pro Mujer neighborhood center and home to the organization's Nicaragua health pilot program.

Together, the team determined that the adjusted model would aim to comply with four key criteria: market responsiveness, potential for health impact, operational viability, and economic sustainability.  Program design was divided in six phases: structured interviews with industry experts, assessment of health-related needs and opportunities, operational assessment of Pro Mujer, market assessment to determine attractiveness of package for clients, pilot design and a financial assessment.

THE PILOT MODEL
After extensive research and analysis, Pro Mujer rolled out the newly-designed model in October of 2010 at one of Pro Mujer’s community centers in León, Nicaragua. Clients were then able to receive a high-quality, low-cost health package for just US$2.40 a month. The preliminary results have been astonishing and the lessons learned have great implications for Pro Mujer’s operations in other countries as well as other regions around the world.

Dr. Martha Garcia runs the health clinic at the Pro Mujer center in León, Nicaragua.

This comprehensive health package includes:

• A focus on prevalent conditions with an emphasis on chronic disease:  Early detection of hypertension, diabetes, obesity, sexual and reproductive health problems, breast and cervical cancer, among other diseases, are critical. These conditions were selected due to their prevalence in the target population and a lack of successful attention in the public sector.
• An upfront fee: The full cost of the package was priced and paid for in two or three annual installments at the time of loan disbursement.  Removing the link between the moment of usage and payment has been shown in many studies to increase access, especially for low-income populations.
• Services and Delivery:
  
• Screening package:  This component includes a systematic delivery of tests (Pap smear, body mass index, blood and urine exam, glucose test, blood pressure, and breast exam) for early detection of key conditions. Screenings are conveniently scheduled during loan disbursement meetings to lower opportunity costs since clients are physically present at Pro Mujer centers at this time.
• General physician consults:  Clients can utilize these consults to receive interpretations of screening results, follow-up on detected conditions, or for preventive or curative primary care at their discretion. These services are delivered in clinics at Pro Mujer centers and visits are scheduled to remote rural areas to ensure access for all clients.
• Referral system: Pro Mujer facilitates access to specialists, laboratories, and other key services by negotiating discounts for its clients through strategic alliances.

A Pro Mujer client in Nicaragua receives a consultation.

• Health education: The health curriculum was redesigned using a new, informal education methodology focused on healthy habits and the importance of early detection.  Its implementation was accompanied by intensive staff training. These health trainings are delivered by trained credit officials during loan repayment meetings to ensure that all clients are reached frequently and to keep down costs for clients.

PRELIMINARY RESULTS

Indicator	Nov 2010 -July 2011	% Positive
Screenings	4,673	29.4%
Consults	4,687	N/A
Pap Smears	2,196	5.5%
Clinical Breast Exams	3,222	3.5%
Glucose Tests	3,587	15%
Blood Pressure Measurement	5,893	6.8%
Body Mass Index	2,830	67%

When market research was conducted to measure client satisfaction, 81% said that they were satisfied with the package and 78.5% believed that the package was better than comparable services available in the market. Financial analysis shows that the pilot is in line to cover both full direct and indirect costs within a year as projected.

KEY LESSONS LEARNED
Despite much initial success as shown, the pilot has taught Pro Mujer a great deal about delivering preventive services through microfinance using a business model that will benefit the pilot and the other Pro Mujer country operations as well as other industry players.

Breaking paradigms. Health care is often thought of as a very specialized field which requires specialized staff. Experience throughout the world has shown that non-health personnel can be very effective at transmitting key health messages. Pro Mujer’s pilot has shown that coverage, efficiency, and in the long-term impact, is greatest when loan officers – who already have close relationships with clients – deliver health training.  On the other hand, health services are often thought of as a social service.  Pro Mujer has learned that the marketing and sales techniques of its front-line staff are key to making a primary care service attractive to clients.

A Pro Mujer credit officer provides a health training session on kidney disease prevention prior to facilitating the financial aspects of a communal bank or lending group meeting.

Listening to clients.  Constant monitoring of customer satisfaction has enabled Pro Mujer to adjust the package and plan for more significant changes. Although clients have expressed their satisfaction, preventive packages only have short-term commercial appeal for people who do not have conditions. It is vital to constantly improve the value of the package and surpass client expectations. Payment mechanisms are also key. Although the shift away from a per service fee structure service greatly increased usage, clients prefer to pay for the package in monthly installments along with loan repayments instead of lower, individual loan disbursement amounts.

A Pro Mujer meets with Dr. Garcia

Training is key. It is important to thoroughly train all staff, including those in both health and financial, in health education, social marketing and strategy. Training programs to clients are crucial to raise awareness of the value of early intervention and provide tools to improve lifestyle choices.

Rural delivery is a challenge. Not only is service delivery naturally a greater challenge in remote areas, but administrative procedures such as appointment scheduling and test delivery are also complicated by decentralized service delivery. It is necessary to “piggyback” when possible, carefully monitor and adjust processes, and look towards technology to facilitate access and improve efficiency in the future.

Benita Montalvan, a Pro Mujer credit officer, endures rough terrain in order to deliver preventive health education and facilitate communal bank meetings.

LOOKING FORWARD
Pro Mujer is currently planning the second phase of the pilot with the lessons learned from the first phase.  Measures are being taken to improve the payment mechanism, as requested by clients, to make the package more accessible. This has been one of the key points of constructive criticism and it is therefore expected that this change will help ensure continued purchase of the package.

In light of the high prevalence of obesity detected through the screening component, Pro Mujer is analyzing how to incorporate nutritional counseling into the service package and investigating ways to reinforce the practical tips delivered in training sessions so that they lead to concrete behavior change.  It is also believed that the services of a nutritionist would add commercial value to the package.

Market research reflects a great demand for medication, specialty consults, and dental care.  Pro Mujer is looking into different options to facilitate access to these services, whether it is by strengthening current alliances or developing new relationships with partner organizations. These high-demand services would increase clients’ willingness to pay and also enable Pro Mujer to incrementally offer a more complete primary care package to its clients. In order for clients to be able to complete specialized treatments that Pro Mujer’s package cannot cover, the organization is evaluating the incorporation of a capped health loan for existing clients.

As we continue to evolve as an organization, this pilot health care program will be instrumental to advancing our mission in support of Latin America women who are living in impoverished communities.

 

“I’ve Survived Cervical Cancer”

In the latest issue of Global Health magazine, Joy Marini, Director of Corporate Contributions for Johnson & Johnson - a Pro Mujer partner since 2009 – blogs about how bundling microfinance with health services can save lives.

Business Loan Saves Woman from Cervical Cancer
September 20, 2011

“I’ve survived cervical cancer. I am here today because of the impact Pro Mujer has had in my life.”

Reading that quote, you might not realize Pro Mujer is actually a women’s development organization that uses microfinance as one of many tools to connect women with small loans to start businesses and gain greater financial independence. But Edelma Altamirano, a Nicaraguan woman who first came to the organization seeking seed money for her own small business, ended up with a new investment in something much more important – her health.

Edelma Altamirano, a Pro Mujer client from Nicaragua

How would a woman get a microloan and a health screening from the same organization?

To read the article in full and find out, please click here.