When the Point Four Program was launched by US President Harry Truman in 1949, helping the world's poorest people help themselves became the primary aim of US development assistance. While much of the US Agency for International Development's (USAID) economic development work has concentrated on policy reforms, privatization and other measures aimed at strengthening overall economies, the very poor often are unable to share in the resulting economic growth. Although starting small businesses is an important way for people to work their way out of poverty, the poorest people usually lack the resources to get started and have no access to traditional loans. However, microenterprise financing is changing that by granting poor people loans to enable them to establish and expand microenterprises. It is noted that since 1990 USAID has provided well over US$1 billion to support more than 1000 institutions around the world that provide the very poor with small loans and secure, interest-bearing savings accounts as well as services to help them develop businesses. In turn, it is recorded that USAID-supported institutions have helped more than 10 million microentrepreneurs in Asia, Africa, Latin America, and Eastern and Central Europe build better lives for their families.
In Tanzania, the international microfinance network FINCA set up shop and began training its first Village Banking Groups in June 1998, disbursing its first loans in July with a grant from the US Agency for International Development. Within 2 months, the program reached 757 low-income women and distributed loans worth US$57,183 using the group support system in which 30-50 neighbors come together to guarantee one another's loans. With the loans from FINCA, entrepreneurs quickly became involved in a range of business activities, from selling tomatoes to starting a hair salon. Located in Mwanza, in the Lake Zone, FINCA Tanzania's clients include many members of the Sukuma tribe. It is noted that in this region there are a few job opportunities in the formal economy. In 1999, FINCA Tanzania reached 3632 clients, exceeding its targets despite a difficult economic environment. In that same year, FINCA partnered with Freedom from Hunger in launching a program that offers some of its members health education and basic business training at Village Banking Group meetings.
In Guinea, jingles promoting Prudence condoms are heard on radio and television in 4 different national languages 5 times a day. This has produced an attitudinal change through an intense national media campaign orchestrated by the USAID-financed Social Marketing of Contraceptives Project carried out by Population Services International (PSI), which provides family planning information, products and services through public and private outlets for 500,000 sexually active couples. PSI's paid media campaign has sponsored call-in talk shows on women and AIDS and religion and AIDS at the rural radio station in Labe. Billboards placed in key locations remind people that using condoms helps prevent AIDS. PSI organized a team of 10 Prudence condom marketing agents in March 1992 to establish 400 nontraditional retail and 50 traditional retail and wholesale outlets for condoms. Outlets include pharmacies, restaurants, hotels, grocery stores, and nightclubs. The distributors sell the condoms at a profit. In the first 6 months, PSI distributed 2.3 million condoms. Young women want to space their children and limit the number of children, said the chief midwife for the Guinean Association for Family Well Being clinic in Conakry. Guinea's population growth rate is 2.8%, which will result in a doubling of the population in 25 years. In May 1992, Guinea's government ratified a national population policy supporting family planning. One of the primary goals is to increase contraceptive use to 25% of all couples. PSI works with the Ministry of Health and the Guinean Association for Family Well Being to integrate family planning and sexually transmitted disease prevention activities into 32 primary health care centers in Guinea's Forest Region. To combat the spread of HIV infection, PSI provides technical assistance to the National AIDS Committee to carry out AIDS information activities throughout the country, targeting the military, police, truck drivers, and students.
In 1989, USAID awarded the Philippines a 5-year, US $50 million Child Survival Program targeting improvement in immunization coverage of children, prenatal care coverage for pregnant women, and contraceptive prevalence. Upon successful completion of performance benchmarks at the end of each year, USAID released monies to fund child survival activities for the following year. This program accomplished a major program goal, which was decentralization of health planning. The Philippine Department of Health soon incorporated provincial health planning. The Philippine Department of Health soon incorporated provincial health planning in its determination of allocation of resources. Social marketing activities contributed greatly to success in achieving the goal of boosting the immunization coverage rate for the 6 antigens listed under the Expanded Program for Immunization (51%-85% of infants, 1986-1991). In fact, rural health officers in Tarlac Province in Central Luzon went from household to household to talk to mothers about the benefits of immunizing a 1-year-old child, thereby contributing greatly to their achieving a 95% full immunization coverage rate by December 1991. Social marketing techniques included modern marketing strategies and multimedia channels. They first proved successful in metro Manila which, at the beginning of the campaign, had the lowest immunization rate of all 14 regions. Every Wednesday was designated immunization day and was when rural health centers vaccinated the children. Social marketing also successfully publicized oral rehydration therapy (ORT), breast feeding, and tuberculosis control. Another contributing factor to program success in child survival activities was private sector involvement. For example, the Philippine Pediatric Society helped to promote ORT as the preferred treatment for acute diarrhea. Further, the commercial sector distributed packets of oral rehydration salts and even advertised its own ORT product. At the end of 2 years, the program had effectively spread to all 75 provinces.
The USAID-CARE Bolivia Child Survival and Rural Sanitation Project brought water to Tauca, a community on the shores of Lake Titicaca. Water is used for washing hands and vegetables which leads to better hygiene and nutrition and is crucial in view of the current cholera epidemic in South America. Farmers often start small irrigation projects for vegetable gardens. A gravity-pumped water system was designed by a CARE engineer but built of local materials by local people in the Bolivian village of Phorejoni Junco. 2 community-trained water operators and 2 health workers visit each home and inspect the sanitation system every month. Llamacachi, a model community with 77 families, has built a clinic with minimal material and labor commitments and additional money from water fees. All 17 children under the age of 5 have received health cards. Only 10% of the children are malnourished, and half of the 79 community mothers know how to prepare oral rehydration fluid for children with diarrhea. In 1989 the CARE project, funded by USAID, set out to improve the health and self-sufficiency of 48,000 people in 160 communities in the Bolivian departments of La Paz, Cochabamba, and Santa Cruz. A major objective was to better the survival rates of children under age 5 by constructing water supply systems, reinforcing community organizations and improving hygiene. In Bolivia fewer than 31% of the rural population has water services, fewer than 13% of the people have latrines, and fewer than 30% have access to health services. The mortality rate of children under age 5 is 100/1000, and 75% of those deaths are related to diarrhea or parasitic illness. The Bolivia Child Survival Project reduced infant mortality in these communities from 210 deaths to 100 deaths per 1000 children under age 5. CARE's Bolivia Child Survival Project was recently funded for 4 more years to serve an additional 160 communities, demonstrating that a sound child survival program and a focus on health depends on quality water systems.
