A Proactive Approach to Mitigating Cardiovascular Disease

By Dr. Osvaldo Sosa, Health and Human Development Manager, Pro Mujer in Argentina (PMA)

In mid-May, we launched a four-month long campaign with the aim of developing a better understanding of the health-related challenges our clients face and providing screenings for cardiovascular diseases. The goal of this campaign, which was implemented in our 15 community centers, was to mitigate our clients’ risk factors, help them improve their quality of life and foster self-sufficiency.

According to the latest study on risk factors from Argentina’s Department of Health, high blood pressure is the primary cause behind 62% of strokes and 49% of incidents of coronary disease in this country. This data shows that high levels of cholesterol are responsible for 59% of incidents of heart disease. Diabetes raises this number by 15% and further explains 13% of chronic dialysis cases.

Non-communicable diseases i.e. hypertension, diabetes, cancers, etc. can be prevented by controlling these risk factors. Focusing our efforts on cardiovascular diseases (the second leading cause of shortened life span among women in Argentina) constitutes the most cost-effective and advantageous strategy for prevention. These diseases make up 60% of the burden on the state health care system.

With this in mind, we monitored three key risk factors associated with these diseases – blood pressure, glycemia, and height and weight (Body Mass Index or BMI). During the first 45 days of this health initiative, we conducted more than 1,000 screenings for approximately 8% of current PMA clients. Initial BMI results show that:

• 42% of clients are obese (BMI>30)
• 32% of clients are overweight (BMI between 25 and 30)
• Only 26% of clients have a normal height/weight ratio (BMI <25).

Thirteen percent of our clients were found to have high blood pressure and 16% have above-average glycemic indices.

If we combine these risk factors, we can see that 5% of clients are at high-risk (three high-risk factors), 17% of clients are at medium risk (two high-risk factors) and 53% of clients are at low-risk (they have one high-risk factor).

As a result of these findings, we have begun working on a preventive health education program to promote healthy eating and lifestyle choices, and it has been well-received by our clients. In the medium-term, our goal is to reduce these high-risk factors, while our long-term objective is to make a positive impact on the quality of life of our clients and their families.

At the very least, our goal is to help those in the high-risk group to reduce their risk factors, and allow them to move into the medium-risk group, meaning that some of those measured would end up in the normal range.

The activities realized with this group include:  

• Provide incentives for clients to receive medical consultations and periodic monitoring for high-risk cases
• Complement the work of Credit Officers and Wellness Promoters by having health consultants present at Pro Mujer community centers
• Share recipes and recommendations for healthy eating
• Train clients on how to perform self-breast exams and take blood pressure measurements at home, among other practices

All of these activities are being standardized, and along with the Pap and breast exam campaigns, we hope to see improvements in client health indicators by the end of 2011. This will allow us to develop more strategic initiatives in 2012 to improve the health of our clients and their families, and in this way improve their quality of life.

Proactividad para la Prevención de Enfermedades Cardiovasculares

Por el Dr. Osvaldo Sosa, Gerente de Salud y Desarrollo Humano, Pro Mujer en Argentina

A mediados de mayo lanzamos una campaña de tamizaje con el fin de conocer más a fondo la situación real de la salud de nuestras socias y desarrollar tácticas de prevención y control de las enfermedades cardiovasculares. El objetivo de esta campaña, la cual fue implementada en 15 centros comunitarios de Pro Mujer, es disminuir los factores de riesgo, mejorar la calidad de vida de nuestras socias y generar una cultura de auto-cuidado.

Según el último Estudio de Factores de Riesgo del Ministerio de Salud de Argentina, la presión arterial elevada explica el 62% de los casos de trastorno cerebral vascular y el 49% de la enfermedad coronaria en Argentina. Los datos consignan que los niveles altos de colesterol son responsables del 59% de las enfermedades del corazón, así como la diabetes engrosa este porcentaje en un 15% y explica además el 13% de la diálisis crónica.

Las enfermedades no comunicables tales como la hipertensión, diabetes y el cáncer, pueden prevenirse siempre y cuando se actúe sobre los factores de riesgo. Enfocándonos en las enfermedades cardiovasculares (la segunda causa de años productivos perdidos por muerte prematura en las mujeres de Argentina) es la estrategia más efectiva y oportuna para la prevención y control de estas enfermedades. Estas enfermedades representan el 60% de la carga en el sistema de salud.

Con esto en mente, monitoreamos los tres factores de riesgo asociados con estas enfermedades- presión arterial, glucemia, peso y talla- con el que se determina el Índice de Masa Corporal (IMC). En los primeros 45 días del proceso se efectuaron más de 1,000 controles a socias, lo que representa aproximadamente un 8% de las socias registradas en Pro Mujer Argentina a la fecha. Los primeros resultados del IMC que se obtuvieron muestran que:

• El 42% de las socias controladas presenta obesidad (IMC >30)
• El 32% de las socias tiene sobrepeso (IMC entre 25 y 30)
• Solamente un 26% de las socias presenta valores normales de peso y talla (IMC<25)

Asimismo encontramos que 13% de las socias presentaron presión arterial elevada y un 16% cuenta con glucemia por encima de lo normal.

Al combinar estos factores de riesgo se concluyó que 5 % de nuestras socias de Pro Mujer presentan alto riesgo (tienen tres factores de riesgo elevados), 17 % de nuestras socias presentan mediano riesgo (tienen dos factores de riesgo elevados) y 53 % de las socias presentan bajo riesgo (tienen un factor de riesgo elevado).

Con estos resultados, empezamos a trabajar en un programa de educación de salud y la promoción de estilos de vida saludables, lo cual ha sido bien recibido por nuestras socias. En el mediano plazo, nuestro objetivo es reducir se está trabajando en reducir los factores de alto riesgo, mientras que a largo plazo buscamos tener un impacto positivo en la calidad de vida de nuestras clientas y sus familias.

Por lo pronto, nos hemos enfocado en reducir los factores del grupo que mostraron alto riesgo para en el corto plazo poder moverlas al grupo de mediano riesgo.

Entre las actividades realizadas se encuentran:

• Incentivar la Consulta Médica al Generalista.
• Derivación de los casos de alto riesgo a la consulta médica y control periódico
• Presencia en nuestro centros de una Asesora de Salud, acompañando la tarea del Asesor de Crédito y de las Promotoras de Bienestar
• Entrega de recetas de alimentación saludables
• Capacitación en auto cuidado
• Capacitación para la toma de presión en su hogar, entre otras acciones.

Con todas estas acciones sistematizadas y consolidando la información junto a las campañas de PAP y examen de mamas, se espera tener al final del año 2011 una mejora en la salud de nuestras socias, lo que permitirá desarrollar en 2012, acciones directas y dirigidas que mejoren la calidad de vida de la socia y su familia.

Making Dream Homes a Beautiful Reality: Meet Maria Concepción, a Micro-Entrepreneur from Nicaragua

By Yolanda Bravo, Marketing and Communications Manager for Pro Mujer in Nicaragua

As a non-profit, women’s development and microfinance organization, one of our many goals is to help our clients achieve a better quality of life whether it be through access to financial services, or through education, training or health care. To advance this goal, Pro Mujer in Nicaragua has added a new product to its package of services – home improvement loans.

Through our “My Beautiful House, A Dream Achieved” campaign, this program helps our clients realize their dreams and make much-needed home improvements, expand their homes to alleviate overcrowding (often times multiple generations live under one roof) or build an entirely new home for themselves and their family members.

In keeping with the Pro Mujer model, this supplementary loan is linked to a primary income-generating business loan and complements our other non-financial services which include business and empowerment training, preventive health education and high-quality, low-cost primary health care.

Currently, it is offered in three of our six neighborhood centers – León, Chinandega and Masaya – with plans to expand access to this service to our more than 29,000 clients nationwide. In addition, there are three levels of home loans – one for minor improvements, another for expansion and a third for major construction.

General pre-requisites for all three types of loans include:

• Client must be in excellent financial standing with no personal late payments to their communal bank association or late payments as a communal bank association to Pro Mujer for at least:
• 1 loan cycle, which typically runs 4 months, for minor, home improvement loans.
• 2 loan cycles for home expansion loans.
• 3 loan cycles for major home construction loans.
• Client must have an established business for at least 12 months.
• Client must not have more than 2 loans with other microfinance organizations.
• The home must not currently be used as collateral for a bank or other organization.

Home Improvement

This loan helps clients finance minor improvements such as converting walls and/or roofs from plastic to brick or establishing links to utilities that provide running water. Loan amounts range from US$250 to $600 and are payable in biweekly or monthly installments for a maximum of 1 year.

• Additional qualifications include:
  • Home is owned by a client or an immediate family member such as a husband/wife/partner, son or daughter, sister or brother or mother or father.
    • If the home is owned by an immediate family member and not the client, there is a 1-year minimum residency requirement for the client.

Home Expansion

Clients looking to expand the footprint of their homes can use this loan to build additional walls and/or rooms to better accommodate its residents. Minimum and maximum loan amounts range from US$400 to $2,500 and are payable in biweekly or monthly installments of up to two and a half years.

• Additional qualifications include:
• If the home is owned by an immediate family member and not the client, there is a 1-year minimum residency requirement for the client and the owner must co-sign the loan.
• Independent of the client, there must be one or more sources of income in the immediate family residing in the home.

Major Home Construction

This category is geared towards clients who are looking to begin construction on a completely new home or complete construction already in process. Minimum and maximum loan amounts range from US$700 to $5,000 and payable in biweekly monthly installments of up to four years.

• Additional qualifications include:
• If the home is owned by an immediate family member and not the client, there is a 1-year minimum residency requirement and there must be 2 co-signers to the loan, one of whom can be outside the immediate family.
• Independent of the client, there must be one or more sources of income in the immediate family residing in the home.

So far this new product has been very well-received by our clients. Since its launch, 156 clients have taken advantage of this service, benefiting them and their approximately 600 family members as well.

One such client is Maria Concepción, a 38-year old Pro Mujer micro-entrepreneur from the city of Chinandega. She has been with Pro Mujer since the beginning of 2010 and has received and repaid loans in increasingly-responsible amounts over eight loan cycles through her communal bank association “Estrella Lunar” (Moon Star). Below is her story of strength and perseverance as she told it to me.

María Concepción runs a small store out of her home in Chinandega, Nicaragua.

“My life has been tough. My parents were very poor and we lived in a house made of cardboard wrapped in plastic and sustained by four eucalyptus trunks. During my childhood I suffered many humiliations as my parents were strict and wouldn’t let me out or have friends. They scolded me for everything and sometimes we didn’t have enough to eat.

At the age of 16, I went to live with my current husband but we were both very poor. We lived on a plot of land that he owned and built a small house supported by branches and covered with plastic. Shortly thereafter, I had my first child and each day our economic situation became worse. With one child our expenses increased and our (living) space became smaller. Then I had my second child and my husband went to work as a day laborer in the fields and his salary was very little. With the money he earned, we had enough for food and little by little we saved money to buy plastic and we collected sticks to make our home a bit bigger.

Prior to taking out a housing loan with Pro Mujer, Maria Concepción's home used plastic, branches and cardboard for walls.

As our children grew older, we started partitioning the rooms with plastic so that everyone had their own little room even if it was plastic. Our house was already too small for four people. The roof of our house had holes everywhere and when it rained, all of the water would come in. The interior of our house was pure mud and all of our things would float. We slept on chairs and woke up exhausted and completely wet because of all of the water that would come in. One of our neighbors mocked us and humiliated my children and me for the precarious conditions in which we lived.

Given our tough situation, my daughter and I started washing and ironing clothes for other people so we could cover some of our costs. Around that time, I began experiencing strong pains in my back and stomach so I was unable to continue washing and ironing clothes.

One day my mom’s neighbor told me about Pro Mujer. I decided to join because they did not ask me for many prerequisites. I obtained my first loan of C$3,000 córdobas (US$133), but I did it behind my husband’s back because he didn’t like having debts. With that first loan, I set up my store and that’s how I started my own business with the loan that Pro Mujer gave me. I planted four tree trunks in the front of my house, added a sheet of metal to protect me from the sun and rain and started a small convenience store in order to have a bit of money aside from my husband’s salary.

As I finished repaying my first loan, I obtained my second credit to further improve my store. However, now I had to tell my husband because my business was thriving. At first he was upset with me but then he began to attend the training sessions to support me. When I asked for my third credit which was bigger than the previous one, he told me to take it and not to worry. If it became difficult to pay it back, he would help me. And that’s how I received my third loan.

Once I finished my third credit cycle, I applied for a home improvement loan from Pro Mujer and we started to build our house, but this time it wasn’t going to be plastic, but out of bricks and cement. For my family and for me, it was one of the happiest moments of our lives to see our house built, knowing that we weren’t going to get wet when it rained. Also, we had never lived in a house made of concrete.

One of the new walls in Maria Concepción's home.

I believe that the housing loan is a gift that Pro Mujer gives clients because no other institution provides you with two loans solely relying on your word that you will repay. I am grateful to God for having put Pro Mujer in my path, because without the support of Pro Mujer I would have nothing that I have today.

I have also benefited from the training sessions. The health workshops have helped me to learn how I should take care of my health and that of my family’s. These sessions made me aware of the importance of my health. I had not had a Pap smear in a long time, but now that I’m part of Pro Mujer, I began to get them again. They detected lesions and I am currently in treatment. The trainings also helped my husband change his attitude. Now he supports the decisions I make.

My future plans are to continue obtaining more loans with Pro Mujer to improve my home, install tile floors and expand the kitchen. Above all I would like to continue working hard so that my children can continue their studies and one day complete a college education. With my savings I would like to buy a washing machine so I no longer need to do the wash by hand.

I thank Pro Mujer for all the support that it has given me and for believing in me. Thank you for changing my life.”