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Ciudad Saludable (healty City) is a NGO that develops micro-enterprises focusing on waste management in Lima. Founded by Albina Ruiz, Ciudad Saludable encourages and helps “recicladores” to organize themselves and create their micro-organisation. It has created 150 new jobs and Albina Ruiz pays a special attention to the self-estime and the dignity of the workers. Beside the trainings they give to the micro-entrepreneurs, Ciudad Saludable offers a technical and legal support and they developed an innovative microfinance system to finance the creation of micro-enterprises. After a successful experience in Peru, Albina is currently thinking how she could replicate her model in other countries such as India.

For more info, read Ciudad Saludable’s profile


Fair Street - Ciudad Saludable from Angalio Productions on Vimeo.

Our Peruvian report takes place in Lima where we met Albina Ruiz, founder and manager of Ciudad Saludable. Throughout our interview with Albina, we were really impressed by her enthusiasm and by her optimistic vision of the future. After this meeting, we have headed towards “El Pino”, one of Lima’s poorest neighbourhoods. There, we observed the work of the microentrepreneurs who drive all over the area with their tricycles to collect waste. The impact of Ciudad Saludable’s work is striking: despite the obvious poverty and the improvised buildings, we visited a clean neighbourhood dotted with green areas where it feels nice to move around.

Problematic and context:

Waste management is a major issue in Peru. The funding that the different governments allocate to this matter are insufficient and are mostly concentrated on the richest neighbourhoods. The demographic explosion in the main cities has also worsened the situation. The Peruvian households alone produce 20.000 tons waste daily. Among this waste, only 60% are collected and 35% treated appropriately. In the poorest areas where private associations do not intervene, some streets look like open sky dumps, the air is unbreathable, and the waste negatively impacts the hygiene and the health of the communities.

The inefficiency of the public services in the destitute areas is mainly caused by the lack of integration of the poorest populations within the legal system and the lack of political will to tackle the problem head on. Often without declared address and valid ID documents, the state does not have the opportunity to control the destitute citizens. Also, many politicians believe that the poor are not able to pay for a collection service. Once in a situation of free rider, the municipalities do not have enough means to cover all the areas and the waste excess start accumulating quickly in different places of the area.

The materials accumulated in these dumps represent a source of revenue for the poorest people. Improvising themselves “recicladores” go around these open sky dumps looking for plastic or paper that they can resell for a small amount of money (+/- $2 per day) to an intermediary who sells these materials to a recycling centre. These “recicladores” work in really bad conditions, without gloves, protection masks and working pants. Moreover, the “recicladores” are regularly persecuted by the local police who do not accept their activity. Finally, as they work alone during the night, the “recicladores” are often victim of the violence of the local gangs.

The initiative:

Ciudad Saludable (Healthy City) is an NGO which favours the development of microenteprises that collect and recycle waste in Peru. Ciudad Saludable regroups “recicladores” formally by organising them within microenterprises. Practically, Ciudad Saludable helps them in the legal work needed in the creation of a company, provides them a logistic support and enables them to finance the tools needed for their activity by giving them access to microcredit at very attractive conditions. This relatively simple model has revolutionised waste management in Peru and has improved the living conditions of millions of destitute people.

The organisation of the “recicladores” has several advantages: firstly, by regrouping the output of their daily labour, the “recicladores” together a larger amount of waste that they can directly sell to a recycling centre at a much better price, not using any intermediary. This quantity effect is enhanced by the Ciudad Saludable’s financial support that enables them to acquire tools increasing their productivity such as trucks, motorised tricycles.

Secondly, by providing appropriate equipment (helmet, gloves, working pants…) to its “recicladores”, Ciudad Saludable allows them to collect waste in better hygiene and safety conditions and in greater dignity. Ciudad Saludable gives a great importance to the self-esteem and the dignity of its workers. Therefore, they have to buy their own equipment through a system of microcredit developed in collaboration with Scotia Bank. In this context, they are not assisted but buy themselves the tools that will improve their condition.

On the field, the microenterprises collect the waste of the households that have accepted to subscribe to the services of Ciudad Saludable. The cost of the subscription is $1 per month. To encourage the people of the neighbourhood to contribute, Ciudad Saludale does a lot of sensibilisation stressing the interest of waste collection and the positive impact of a clean neighbourhood on children’s health. Ciudad Saludable also rewards the “good contributors” by creating green areas close to their houses. Today, the payment rate in the areas where Ciudad Saludable is working is over 60% and that rate is constantly increasing.

The creation and the assistance of micro-entreprises is Ciudad Saludable’s main program. However, Ciudad Saludable has other fields of activity: they offer consultancy services to different cities in Peru to help them improving their waste management. They have also created an innovative program enabling the production of gas using the excrements of pigs that feed themselves of organic waste.

Finally, Ciudad Saludable has developed a master in environmental management in collaboration with “l’Universidad Católica del Peru” in Lima. The goal of this master where Albina Ruiz and some of her collaborators teach different classes, is to generalise waste management solutions in Peru.

In the mid-term, Albina Ruiz’s objective is to replicate her model of micro-entreprises to all cities of Peru and to other countries in South-America. Deeply affected by a recent trip in India, Albina Ruiz also made a priority of adapting her model to that country.

The entrepreneur:

Albina Ruiz, the founder of Ciudad Saludable, grew in the Peruvian Jungle. Aged 18, she leaves to Lima where she is shocked by the amount of waste in the streets and by the air contamination. She quickly decides to fight this plague and launches several cleaning campaigns within her university.

Then, she will do her thesis on the management of micro-enterprises and the environmental management in the poor areas of Lima. This thesis will trigger a lot of interest among her teachers. This enthusiasm will encourage her to put her theories into practice and she decides shortly after to create Ciudad Saludable. Her model and her innovations have been awarded numerous times ; among others, Albina has been elected “Schwab Social Entrepreneur of the World Economic Forum”, she has received the “Skoll Award for Social Entrepreneurship” and she is an Ashoka fellow.

Social Impact:

The 13 micro-enterprises launched by Ciudad Saludable employ 150 people. Ciudad Saludable operates in 60 Peruvian municipalities, enabling the collection of 100% of the waste in the areas where it is active. By collecting waste and favouring the adoption of respectful behaviours, Ciudad Saludable’s different micro-enterprises have improved the living conditions of 4 million people.

Ciudad Saludable’s work has also had a huge influence on the Peruvian government. Recently, the company has been an important actor in the creation of the first General Law on solid waste in Peru.

Finally, through its master in environmental management, Ciudad Saludable has enabled more than 5,000 students to master in the field. Today, all these students have the skills to be the actors of the environmental change initiated by Albina Ruiz.

Financial impact:

The micro-enterprises are managed by destitute people living in the neighbourhoods where they operate. These people generally do not have access to the loans of “classic” banks and find it therefore very difficult to finance the purchase of additional material. To tackle this problem, Ciudad Saludable has developed a microcredit program with the Canadian Bank Scotia Bank. As Albina found the normal interest rates proposed by the microcredit institutions way to high, (between 30 and 40% annually) Albina created a special fund that Ciudad Saludable guarantees with a deposit of $30,000 at the Scotia Bank. With the guarantee to be reimbursed and not having to deal with the follow up of the loans, Scotia Bank offers credit at a much lower annual interest rate (12%).

In 2006, Ciudad Saludable has obtained a $615,000 grant from the Skoll Foundation after having received the “Skoll Award For Social Entrepreneurship” awarding the quality of the innovations. This grant enabled Ciudad Saludable to gain scale, to improve the quality of its support to the micro-enterprises and to accelerate the expansion process to other countries of South America.

Ciudad Saludable, by developing innovative solutions, has met the challenge to create “healthy cities”. Now surrounded by a skilled and optimist management team, Albina Ruiz wishes to extend her model to all the Peruvian cities and to export it abroad.

CRECER (Credito Con Educacion Rural) is a microfinance institution based in La Paz, Bolivia that focuses its activities on the development of rural communities in Bolivia. Using the “Village Banking” model, CRECER offers financial services combined with education programs to the most destitute Bolivian women. Changing the lives of more than 97,000 families, CRECER aims to build a financial network that the people at the base of the pyramid can access.

For more info, read the CRECER profile

Fair Street - Crecer from Angalio Productions on Vimeo.

Our sixth company visit takes place in La Paz, Bolivia where we have been warmly welcomed by the staff of CRECER, a microfinance institution. After a very interesting interview with CRECER’s management team, we went to “El Alto”, the poorest neighbourhood of La Paz, to meet microentrepreneurs and observe CRECER’s work on the field.

Problematic and context:

Providing access to capital to the people at the base of the pyramid is a key element to help them in getting out of poverty. Whereas the majority of the most destitute depends on loan-sharks that charge interest rates close to 10% per month, an access to credit at decent interest rates is a first step in their economic development.

Before the invention of microcredit at the end of the 70’s, the poorest populations in the developing countries could not have access to traditional credit as they could not comply with the lending conditions of the traditional financial institutions (proper ID, warranty, minimal deposit…). In addition, their financial needs were too limited to cover the cost of a classic financial operation and therefore did not appear as an attractive segment. Nevertheless, in most cases, these people owned small income generating activities but could not expand them as they lacked access to capital. In Bolivia, where 60% of the population lives under the poverty line, it meant that more than half the country could not develop an economic activity.

The apparition of microcredit allowed poor families to obtain small credits. Whereas traditional banks had always considered the poorest as insolvent, the reimbursement rate went over 95%. As a profitable industry generating a positive social impact, microcredit has met a skyrocketing growth in the last decades. From microcredit, it has enlarged to microfinance and now offers the marginalised populations a range of diversified financial services (credit, savings, insurance…)

Microfinance mainly targets women for two main reasons. Firstly, it has been proved that the impact of microfinance on the whole family is stronger when the loan is given to the woman. Secondly, as we already mentioned it in our reporting on Coronilla, women discrimination is a widespread phenomenon in Bolivia. They are still the target of domestic violence and do not enjoy the same level of recognition than the men. If it is encouraging to see that this situation has significantly improved in the last years, a lot still needs to be done.

The company:

CRECER (Credito Con Education Rural) is a microfinance institution that focuses its activities on the development of rural communities of Bolivia. Today, the company has more than 90.000 clients in the different Bolivian departments.

CRECER uses the “Village Banking” model. Concretely, CRECER works with “bancos communales” (village banks) constituted of groups of 8 to 30 women. CRECER’s credits to these “banco communales” can reach $800 but generally are around $300-$400. The members of the group self-manage the credits they receive and split the credit among themselves in function of their needs. However, whereas the women split the loan among themselves, the group shares the responsibility as a whole.

In addition to its banking operations, the innovation that makes CRECER special (even if it is not the only MFI to function this way) is that its financial services go hand in hand with an education program. All the women that receive CRECER’s loans have to attend training sessions that are aimed to enable them to better manage their microenteprise but also to deal better with other aspects of their daily lives such as health, children education, women rights…

This combination of financial and educational services is at the heart of CRECER’s model. People at CRECER are convinced that the association of these two activities is the best way to reach a sustainable rural development. In addition, with regards to their pure financial performance, they are convinced that the education program has a positive influence on the reimbursement rate.

Within its financial services, CRECER has recently started to offer individual credits and micro insurances. Up to now, these products have met great success. CRECER also gives a strong importance to the savings services; the members of the “bancos communales” must indeed save a part of the revenues they generate so as to have saved 20 to 50% of their initial credit at the end of the credit cycle. This obligation has two objectives: on the one hand, it constitutes an additional insurance for CRECER to be reimbursed and on the other hand, it teaches women how to better manage their patrimony.

Social Impact:

CRECER, by providing capital to more than 97.000 families has a positive impact in different ways.

Firstly, by offering credit and insurance services, CRECER enables the most destitute to be less vulnerable to external shocks. These populations are indeed particularly sensitive to events such as an illness, robbery, earthquake… as they have huge consequences on the families and their limited financial resources. Without efficient financial services, these families are brought down to a level of poverty from which they can take years to recover. In this case, CRECER’ services represent a safety net for these families that helps them in facing bad times with more serenity.

Secondly, by allowing thousands of women to become economic actors, Crecer enables them to empower, to affirm themselves and to increase their influence within society.

By providing credit, CRECER helps the poorest in developing their activity and therefore increasing the revenues they get out of it. This has a positive effect on food security, education, health and increases the probability that they can get out of poverty.

Through its association of financial and education services, CRECER increases the knowledge of many women in Bolivia which has a positive effect on the way they manage their household and educate their children. The trainings on savings combined with the obligation to save at least 20% of the amount they borrowed makes women aware of this matter and forces them to manage their budget on a conservative way.

Finally, at the macro level, CRECER’s actions also stimulate job creation and the integration of new actors into the economic system.

Financial impact:

As the majority of the MFIs, CRECER benefits from the support of several financial actors. Generally, these financial institutions are actors from the “North” that want to finance MFIs from the “South”. The close to perfect reimbursement rate and the professional management of MFIs are attractive arguments for investors. In addition, the reduced amount of intermediaries enables to generate a direct impact on the living conditions of the people at the BoP.

CRECER is supported by different Investment Funds (Oikocredit, Incofin, Alterfin, Blue Orchard,). In this case, Fair Street focused on the financial support it received from Alterfin a Belgian organisation and Blue Orchard, a Swiss organisation. As the demand for microloans is huge and the need for development urging in Bolivia, the support of such institutions enables CRECER to grow rapidly and serve a higher amount of clients while not endangering its solidity. Within CRECER, the impact is of such external investors is considerable as each $500,000 loan enables them to reach 1.200 additional families.

Alterfin is a Belgian Social Investment Fund that mainly invests in MFIs and cooperatives. Alterfin has provided two credits to CRECER at the LIBOR rate +3%: one of $600.000 and another of $700.000. Alterfin was one of the first organisations to support CRECER.

Blue Orchard is the largest financing institution for MFIs worldwide. It is based in Geneva, Switzerland and has recently invested in CRECER through a $2m loan (biggest loan CRECER has ever received). This loan has a 3 years period. Given the size of Blue Orchard and the size of its loans, CRECER hopes this collaboration will last long in the future.

Throughout the years, CRECER achieved to position itself as a solid and professional institution. As it received an A- rating and different awards for its strong social impact, it represents a very attractive target for the funds mentioned here above. CRECER will soon expand its offer to credit cards and savings management to build a financial network that is even more accessible for the socially and economically destitute people.

Coronilla is a company based in Cochabamba, Bolivia, that produces gluten-free pastas and snacks. Coronilla’s objective is to have a positive impact on all the actors of its value chain. Therefore it buys its raw materials at a fair price to local suppliers, its workforce is composed of 75% of women with 10% with  of the employees that are disabled and it offers optimal working conditions. Discover the interview of Martha Wille, the entrepreneur that insufflated her social fibre to Coronilla.

For more information, read Coronilla’s profile

Fair Street - Coronilla from Angalio Productions on Vimeo.

After the fascinating discovery of the solar cookers, Fair Street made a second reporting in Cochabamba, Bolivia. We had indeed the chance to meet Martha Wille who manages Coronilla, a family business created more than 40 years ago. Through her actions, Martha made of Coronilla the perfect example of a company that beneficiates to all the actors of its value chain.

Problematic and context:

Coronilla addresses problematic that are directly linked to the political and social situation of Bolivia. Even if a progressive opening to market economy has improved the economic situation of the country, Bolivia remains today the poorest country in South America with strong inequalities between urban areas where 60% of the population is poor and rural areas where this figure rises to 80%.

The bad living conditions of the Amerindians (60% of the total population) is one of the main issues in Bolivia. Evo Morales’ accession to power triggered a lot of hope among this segment of the Bolivian population. Nevertheless, many still live in precarious conditions. As homeland for the majority of the Indian population, the Bolivian Altiplano, region of high plateau at heights of more than 3000 meters is particularly poor. There, people essentially live from agriculture, first sector of activity of the country, and earn unstable and little wages.

If it is the case of many poor countries, the situation of women in Bolivia is particularly worrying. In the 90s’, this problem was even considered as one of the plagues of the country. A study made in 1994 showed that close to 70% of the women endured domestic violence. Today, Bolivian women still suffer important discrimination compared to men. With their main task being house caring, they have a limited economic power and are therefore strongly depending on their husband. This isolation, combined to wife-beating prevents women from taking part to the development as they are too busy defending themselves.

At the root of the women marginalisation stands their low level of instruction that reduces their emancipation possibilities.

Fortunately, in the last 10 years, the situation of women has become a central preoccupation in Bolivia and many initiatives and laws that aim at improving their situation have appeared but a lot still needs to be made.

The company:

Founded in 1972 by Guillermo Wille, Coronilla has been a pasta producing company from its beginning. In the mid-90s’, the export market strongly contracted, putting the enterprise close to bankruptcy. Martha Wille, daughter of Guillermo Wille redynamised the company by diversifying the product range. If Guillermo Wille already paid attention to the well being of its employees, it is with Wartha that the second life of Coronilla as a social enterprise really started. Today, the company produces pastas and snacks mixing quinoa and a traditional andine cereal that makes them gluten-free.

Coronilla wants to fight poverty by having a positive impact throughout its value chain. As CSR (Corporate Social Responsability) is a relatively unknown concept in South America (even less in Bolivia), Coronilla wants to be a pioneer. In its buyings, the enterprise purchases its ingredients (quinoa, rice…) directly to destitute local producers, negotiates in their own language (Quechua or Aymara) and offers them price stability.

The employees also have a very important place in the company’s strategy. 75% of the employees are women and 10% are disabled. The working conditions are optimal in terms of hygiene and security and the enterprise provides its employees with the possibility to study or to follow complementary training. Finally, Coronilla offers support to the working families so they can put their children at school.

As there is very little demand for organic food in Bolivia, Coronilla only focuses on exportation. Today, the company exports to 11 countries in North America, Europe and Oceania.

The entrepreneur:

Daughter of Guillermo Wille, Coronilla’s founder, Martha Wille was influenced by the social convictions of his father and incorporated them to the family business. As manager of the family business and being extremely attentive to the well-being of its employees, Martha wants all the employees to feel part of the Coronilla family.

After being elected social entrepreneur of the year 2005 by the Schwab foundation, Martha was invited to participate to the World Economic Forum in Davos where she met many other social entrepreneurs. As a follow-up to the exchange of ideas taking place there, Martha’s next challenge is to launch a foundation « the Guillermo Wille Foundation » that will work on the to replication of Coronilla’s model by giving advice to Bolivian companies and encouraging them to adopt CSR policies.

Social impact:

Buying its ingredients to local producers following Fair Trade principles, Coronilla provides a stable source of revenues to 1500 families allowing them to maintain a certain life standard.

As Martha told us during the interview, by providing a respectful and blossoming work environment, the company wants to have a positive impact on the lives of its 65 employees. After the production manager noticed that an employee had developed a skill at resolving the problems that occurred on the production chain, the company encouraged her to attend a two year engineering program. Today, this employee enjoys a much higher wage that allowed her to provide her children with higher quality education.

The economic autonomy aquired by women working at Coronilla facilitates their emancipation.

Financial impact:

Since 1997, two organisations have contributed to Coronilla’s development

The first, SEAF (Small Enterprise Assistance Fund), has invested $400 000 (mix of capital and debt) through its fund « fondo Capital Activo de Bolivia », to finance its needs in working capital. More than the supply of capital, SEAF support helped Coronilla in improving its accounting practices and in transforming into a stock corporation. SEAF essentially professionalised the company. Coronilla bought back SEAF’s shares in 2004.

After SEAF’s help, Coronilla still only used 20% of its production capacity in 2004 and the enterprise needed capital to keep growing. Back then, Coronilla obtained a loan of €350 000 from the Dutch organisation Cordaid. This loan allowed Coronilla to double its exports within the same year. Today, Coronilla’s exports are close to $1 000 000 using 50% of the productive capacity. If the company has met a high growth in the last 5 years, it still enjoys important growth potential that should enable it to spread its fixed costs better and increase its margins.

By continuing to create value for all its stakeholders (producers, employees, shareholders and clients) Martha Wille is convinced that Coronilla is meant to be a major company in Bolivia.

Headquartered in Cochabamba, Bolivia, Sobre La Roca was founded 12 years ago by Ruth Saavedra to produce and sell solar cookers to farmers living in rural areas. Using solar energy to cook favours the protection of the environment by reducing C02 emissions and deforestation. The ease of use of the solar cooker also allows women to save a lot of time that they can then allocate to productive activities.

For more information, read Sobre la Roca’s profil

Fair Street - Sobre la Roca from Angalio Productions on Vimeo.

Our first reporting on the Bolivian soil takes place in Cochabamba. We came to Cochabamba earlier than expected to meet Ruth Saaverda, our entrepreneur, before she was leaving on holiday for one month. This interview has been incredible: in addition to our interview with Ruth, we had the chance to attend a demonstration of the product in the Bolivian countryside. After a three hours-long journey through muddy roads, we got to a community of miners where we discovered the numerous advantages of the solar cooker.

Problems:

The environment: Families living in rural areas in Bolivia usually do not have a proper access to gas and electricity. As a consequence, they are forced to use firewood to cook. UNICEF estimates that in developing countries, more than 80% of the wood is used to cook.  On average, this translates into a yearly consumption of 100kg of wood per month per family. This intensive use of wood, in addition to emitting destructive gazes such as CO2, participates considerably to the deforestation in these countries (10% of the deforestation could be avoided thanks to the use of solar cooking).

Women emancipation: Cooking can strongly complicate the life of women, if they do not have the appropriate technology. Women in rural regions are often forced to walk several hours per day to bring wood back home. This harassing task prevents them from working and to participate to the economic and social life.

Context:

In Bolivia, 40% of the population lives in isolated rural zones and is not properly served in energy. Moreover, as their access to technology is limited, the people situated at the « Base of the Pyramid » generally use rudimentary cooking methods. The Bolivian Altiplano, where Sobre La Roca’s activities are concentrated, is an ideal location for the use of solar energy: it is at more than 3000 meters of altitude and enjoys 300 sunny days per year.

The company;

Headquartered in Cochabamba, Bolivia, Sobre La Roca was founded in 1997 to produce and distribute solar cookers to the Bolivian farmers living in rural areas. The solar cooker is a thermal box constituted of different mirrors that reflect solar rays within the box. The good insulation of the box enhances heat conservation enabling temperatures of 150°C and therefore making it possible to cook all kind of dishes. Solar cookers are easy to build which allow Sobre La Roca to sell them at the attractive price of €50.

Sobre La Roca has also developed complementary activities. It has launched awareness campaigns on the ecology. It also offers trainings to teach Bolivian families how to use the solar cooking and to improve their food habits. The company is in a growth phase: if up to now, Sobre La Roca has already sold 5000 solar cookers and educated more than 2400 women, it should reach the number of 10,000 solar cookers sold by the end of 2009.

The entrepreneur:

Ruth Saveerda de Whitfield is a Bolivian social entrepreneur living in Cochabamba. Convinced of the potential of solar cookers, she dedicated her life to Sobre La Roca that she founded 12 years ago. The first years of Sobre La Roca have been very difficult. During this period, Ruth did not hesitate to visit to the most isolated regions of Bolivia and to meet local communities to promote her product. In 2004, as the company was close to go bankrupt, Ruth and her husband conceded huge sacrifices which allowed Sobre La Roca to survive. Believing that “real” value relies in Sobre la Roca’s mission, they went until selling their wedding valuables.

Social Impact:

The use of the solar cookers contributes to the environmental, social, sanitary and economic development. Firstly, solar cookers favour nature preservation as 500 cookers enable the preservation of 5000 acres of forest per year without any CO2 emissions. Secondly, solar cookers, given the time savings they allow, enhance the women social and economic emancipation. They can indeed allocate time to other activities instead of spending hours to collect wood and watch out the cooking of their dishes. Lastly, cooking with solar energy increases the nutritive value of the meals as it leaves more vitamins within the ingredients giving them a higher nutritive power.

Beyond its product, Sobre La Roca has a positive social impact throughout its value chain. The basic elements of the social cookers are built in a prison of Cochabamba as part of a reinsertion program for prisoners

Financial impact:

E+Co’s support: During the first years, Ruth Saveedra financed Sobre La Roca with her own money. Her launching strategy consisted in offering 10 solar cookers to different farmers in order to measure their social impact and to promote the product. Then, the company grew through auto financing; the profits generated by the sales of its cookers were reinvested and allowed it to grow but at a limited pace.

After 7 years, Sobre La Roca had sold 2,500 cookers. However, the financial situation of the company became not sustainable as it had to renew its infrastructures with no capital to do so. The social investment fund « E+Co », believing in Sobre La Roca’s future and potential, backed the company with a $20,000 loan refundable in 3 years. This loan enabled Sobre La Roca to increase its production capacity and to reach a larger proportion of customers. The total impact of the loan is striking as it triggered a 300% growth of the production and gave the possibility to Sobre La Roca to convert into a small enterprise owning its own infrastructure.

E+Co’s support has been decisive in Sobre La Roca’s economic development and in the extension of its social mission.

The use of microfinance: The price of the solar cooker is 50€. While being affordable, this price remains too high for some people at the « Base of the Pyramid ». To cope with this situation, Sobre La Roca, collaborated with E+Co and created a fund that proposes micro credit loans. Moreover, Sobre La Roca is currently building a strategic alliance with FIE, a leading microfinance institution in Bolivia, whose broad network of agencies will ease the access to capital for many people and consequently ease the acquisition of solar cookers.

Sources:

Interview with Jorge Gronda, founder CEGIN and SER System

www.solarcooking.org

www.adesolaire.org

www.eandco.net

Through the use of his CEGIN clinics and his SER system, Doctor Gronda aims at providing quality healthcare to the people at the base of the pyramid. By treating over 40 000 patients, CEGIN contributes to the development of the most marginalized communities of the Jujuy Province in Argentina. As labor force is the main working tool of the farmers in rural regions, access to healthcare constitutes the basis of economic and social development.

For more information, read CEGIN’s profile


Fair Street - CEGIN from Angalio Productions on Vimeo.

After problems faced by cartoneros, education and water access, Fair Street’s third report puts forward a doctor who seeks to provide the poorest of people with access to healthcare.

Problem: healthcare

In our previous report, we focused on the essential role played by education in economic and social development. Health must be considered as a second fundamental factor in constructing a sustainable future. One cannot imagine a country adopting a development policy which does not seek to improve access to healthcare services. For rural populations, whose workforce is often the main production factor relied upon for agriculture, good health is an essential basis for any progress to be achieved. In far-off regions, particularly, women and children suffer from difficult living conditions; one of the UN Millennium Development Goals is to reduce by three quarters the maternal mortality ratio by 2015. The Juyjuy Province is especially affected by this problem, with a maternal mortality ratio ten times higher than in France.

Context:                                                                                                 

In Argentina, over half of the population does not have access to social security. But even those whose work status allows them to enjoy social security benefits often choose in addition to subscribe to a private health insurance. This is because of the inefficiency of the public healthcare system, and for this two main causes are identified. First, it is decentralized and managed at the level of provinces, which leads to strong differences between regions in Argentina. Moreover, as the State is unable to offer a complete set of solutions, workers unions tend to create their own obra social (social security), which also causes irregularities and many organizational problems. The Argentinean population thus has two options: either to resort to private healthcare systems, usually too expensive for the populations at the base of the pyramid; or to use available public services and consequently accept its inefficiencies and waiting lines that can last up to several days. But this time spent waiting prevents the patient from working, and providing for the needs of his family.

The company:

CEGIN (Centro Ginecologico Integral) is a medical center founded in 1989 which specializes in the provision of medical services to poor women from rural areas. The CEGIN center manages to offer quality services at half of the market price! In order to achieve such results, their strategy is based on the use of the economies of scale. The medical industry is faced with very high fixed costs (equipment, infrastructure…), whereas the additional cost of a new client is actually relatively low. The CEGIN center therefore targets a very large number of patients in order to spread its fixed costs. By working many hours and treating a large volume of patients (40 000 total), the center can thus guarantee a quality service whilst achieving lower rates of consultations. Rather than offering free services, the CEGIN approach is to charge the patient a low — but fair — cost. They have come to realize that the patient feels more dignified that way, and in consequence is treated with greater respect by doctors.

Five years ago, Jorge Gronda launched the SER system within the CEGIN center. It is a membership card that patients can purchase for 10 pesos (€2) per year which gives them access to the 60 CEGIN medical practices. By presenting this SER card, patients enjoy preferential rates in CEGIN centers that charge less than half of the market price for medical services (for example, an ultrasound scanner costs 20 pesos in CEGIN centers, instead of 50 pesos normally). The main idea behind the SER card, beyond increasing access to healthcare, is to create a network that will later allow its members to enjoy various advantages. By creating this network, and taking advantage of its high amount of members, the SER system can have a considerable influence on shopkeepers in the Jujuy Province. Currently, card holders already enjoy discounts in some pharmacies, and in the long term, Jorge Gronda’s ambition is to develop a system of “social franchise”, and extend the SER card’s field of action to various fields such as food, construction and transports. His aim is that necessary fundamentals for a decent life be accessible at low cost for all the people living at the base of the social pyramid.

The entrepreneur:

Jorge Gronda is a doctor originally from the Jujuy Province. First active in the public sector, he left it over 25 years ago to found CEGIN. Tired of the public healthcare system’s many gaps, he launched the CEGIN initiative with two motivations: first, he wished to offer quality healthcare to those at the base of the economic and social pyramid; and second, he wished to reduce the distance between doctors and patients. Jorge Gronda’s has earned much recognition and gratitude for his work. He was first elected Entrepreneur of the Year by the Schwab Foundation in 2005, he then received the United Nations Development Prize, and he was finally invited to share his vision of the future at the Davos World Economic Forum in 2008.

Social impact:

The social impact of CEGIN and the SER system is obvious, and can be summarized as follows: to allow the people at the base of the pyramid (by definition, those who do not have access to social security) to have access to quality healthcare. Nowadays, over 40 000 people are followed by the CEGIN clinics (including 20 000 through the SER network). Over 10 000 biopsies are carried out each year in CEGIN clinics, which is estimated to have prevented the development of more than 300 cancers.

Nonetheless, Gronda does not limit himself to the provision of healthcare services. Instead, he takes an interest in acting out of consideration for the poorest of people. During his interview, Gronda insisted several times on the important role of the SER card. First, people pay in order to subscribe for this card, therefore valuing it more than if they received it for free. This requirement has a direct impact on the level of the care they receive, as they are more inclined to share information on their health that facilitates the work of their doctors. Second, belonging to the SER networks and enjoying quality healthcare services considerably increases the self-esteem of people suffering from social exclusion. Thanks to the satisfaction of SER clients, Gronda has never had to publicize his system. The pride they take in being part of this network encourages people to talk about it in a positive way, and this word of mouth has proved to be an essential contribution to the development of CEGIN.

Financial impact:

 Support from a fund: Gronda is currently attempting to finalize negotiations with a European fund. Because of a confidentiality clause, we are unfortunately unable to divulge its name. The financial contribution from this fund should allow the consolidation and extension of the SER network. The objective is to extend the number of members from 20 000 to 50 000 over the next five years. According to Gronda, such financial support from an external organization is necessary in order to achieve this objective.

Use of microfinance: 80% of health problems can be resolved with an SER card and the consultations at half price that it allows. However, some serious problems require much more expensive surgery. In these cases, CEGIN uses the benefits of micro-credit in order for its clients to afford these operations. The most common operations they have to carry out cost on average 3 000 pesos (€ 600 +/-). A micro-credit fund financed and managed by CEGIN allocates credits equivalent to the costs of the required operations. These credits are usually reimbursed in ten regular payments. Gronda is a pioneer in the use of micro-credit for health purposes; considering that health is a basis for development, he believes that it is essential for people to have access to capital in order to extend their access to healthcare. For the worst cases that micro-credit cannot finance, CEGIN is trying to set up a micro-insurance system. Statistically, these cases only represent one in a 100 000 patients, so Gronda is trying to take advantage of the “strength in numbers” effect of the SER network; the small contributions of all members of the network would finance the treatment of exceptional cases.

The SER system rests on a fundamental financial principle: diversification. Members of the network are at the base of its success and development. That is why, by extending the network, Gronda is consolidating it. With more members, the various risks are diversified and the global risk is reduced. This diversification that reduces the system’s profile of risk also plays an essential role in financing both the workings of micro-credit and the development of a micro-insurance system.

 

Sources:

 Interview with Jorge Gronda, founder CEGIN and SER System

Llobeta Robert, Recuperando la salud, Grupo Editorial Lumen, Buenos Aires, 2007

www.oms.org

www.undp.org

www.schwabfound.org