by Timothy Smith, International Medical Corps Communications Manager, with contributions from Jane Ohuma, International Medical Corps Eritrea Country Director and Elhadi Abdulla, International Medical Corps Eritrea Community Development Coordinator
As hundreds of thousands of internally-displaced persons (IDPs) and refugees have returned to Eritrea over the last three years, they and the receiving communities have been faced with numerous interrelated challenges: drought, malnutrition, destroyed primary health care infrastructures, low health status and a depressed economy.
Early relief work in Eritrea, by necessity, has emphasized nutrition and primary health care programs. But as populations resettle and Eritrea emerges from the lingering effects of war, longer-term strategies for promoting health and rebuilding health care capacity have included programs that also address food security, vulnerability, social inclusion and access to economic opportunity.
International Medical Corps, an international humanitarian relief agency, entered Eritrea in 2000 to provide medical assistance via mobile clinics to more than 50,000 people displaced from their communities by the war. As the fighting has abated, International Medical Corps doctors and nurses have shifted to providing care to Eritreans returning to their homes – including those who fled to Sudan during the 30-year war for independence – 98 percent of whom have been settling in the breadbasket Gash Barka region in the southwest.
Gash Barka contains some of the most fertile land in Eritrea, but it has been devastated by war and more than three years of protracted drought. Eritrea’s economy is based largely on subsistence agriculture, with 80 percent of the population making its living from farming and/or herding. Yet, according to the United Nations Consolidated Appeals Process, in some years of the drought Eritrea has produced only about 20 percent of its annual food requirement.
Gash Barka was at the center of Eritrea’s border dispute with Ethiopia and remains littered with landmines and unexploded ordnances. Not surprisingly, the war also caused widespread destruction of the health infrastructure. Of the 62 health clinics operated by the Ministry of Health at the time of the war, 36 were damaged, most of them in Gash Barka.
International Medical Corps’ goal in Gash Barka has been to make sustainable improvements in the accessibility and quality of primary health care services. It was apparent, however, that the creation of sustainable health care programs and the re-establishment of vital coping mechanisms required an intricate combination of medical training, community education, infrastructure rehabilitation and, additionally, financial empowerment of the local population to ensure self-reliance.
So in April 2002, to complement its primary health care, capacity building and community-based care initiatives, International Medical Corps and its funding partner, the U.S. Bureau for Population, Refugees and Migration, set up a pilot micro-credit project. The goal was to assess the reintegration needs of returnees and IDPs in selected communities, and to subsequently assist in establishing small income-generating activities that would create job opportunities for vulnerable families and regions. By supporting the productive, commercial and service enterprises in the area, International Medical Corps would help create favorable conditions for local community participation in the community health program as well as in overall development and rehabilitation activities.
The main objective of the micro-credit project was to provide the required finances to start-up or resume income generating businesses through the creation of a revolving fund and related administrative and management structures. At the same time, it provided basic skills for business promotion and development of management capabilities for small entrepreneurs.
Community members were involved in every phase of the project, from assessment, planning and design to implementation and supervision. Loan recipients were organized into credit groups to encourage collaboration and social integration, as well as to share the responsibility of repayment. As a condition, credit groups had to start saving their own money before they could receive credit. Credit groups were overseen by Village Credit Committees, which were composed of locally respected people who evaluated loan proposals and helped resolve credit-related issues.
Instead of investing in a particular economic sector, such as agriculture, International Medical Corps strove to support businesses owned by its target beneficiaries.
“It was important to support the general economic recovery of the region, but it was particularly important that our development programs work directly with and for the most vulnerable,” explains Nancy A. Aossey, president and CEO of International Medical Corps. “That meant building businesses based on their individual needs, assets and experience.”
Still, because of the preponderance of farmers and herders, most loans were disbursed to agro-pastoralists, although some were made to retailers as well. Furthermore, to link the project more directly with health care capacity-building initiatives, International Medical Corps gave priority to community-based health workers as well as other volunteers in the community-based development activities. It also put particular emphasis on vulnerable groups, such as women. To encourage reintegration and prevent division within the community, International Medical Corps made loans available to both returnees and residents who had never left their communities.
Over the following six months, nearly 270,000 Eritrean nakfa were disbursed to 49 credit groups in three communities: Alighider, Aklalat and Dressa. As of December 2003, with some allowances for market situations and harvest schedules, 95 percent of the program’s loan principles had been repaid – with 8 percent interest. In addition, all 49 of the businesses succeeded and remain in business today.
Also, in August 2003, support from Stichting Vluchteling (Dutch Refugee Foundation) enabled International Medical Corps to add a complementary micro-credit project in other communities. Employing the same approach, 400,000 nakfa were disbursed to farmers in Guluj, Gergef and Tebeldia for animal fattening and other agricultural activities, including the establishment of seed banks and grain banks to strengthen the capacity of communities to endure droughts and other threats to food supply. As of December 2003, only four months later, 99 percent of the loans had been repaid, again with interest. The same collected amount is being distributed again for new clients to start small income-generating activities.
“Considering these projects operated in some of the most difficult economic conditions,” continues Aossey, “a zero default rate testifies greatly to the power of people to make things happen at the individual and community level.”
It should be noted, however, that the success of International Medical Corps’ micro-credit projects in Eritrea is perhaps best illustrated not by their repayment rates, but by what high repayment rates imply: successful businesses. And considering the majority of these businesses involve agro-pastoral activities in a region plagued by food insecurity, the corresponding effect on health is easy to deduce. Sustainable improvements in income-producing, agro-pastoral activities directly address the country’s staggering problem of malnutrition and simultaneously create more favorable conditions for participation in the community health program.
Micro-credit is frequently seen as a development initiative, although it can also be a powerful tool in the transitional phase from relief to development. It works synergistically with primary health care programs; creates more favorable economic conditions; builds social networks; empowers vulnerable populations; and promotes self-sufficiency. And with high repayment rates, micro-credit projects themselves can be virtually self-sustaining.