Rising from the Ashes: A Journey of a Community Health Entrepreneur

From August 2013 to September 2015, I worked as Head of Business Development at Jita Social Business Limited (a joint venture of CARE International and Dannone Communities). During that period, I had lead to lead lots of varieties projects, like from rural market activation to health entrepreneurs development to establish micro franchisee development in Ethiopia. Due to work in diversified projects, I have gathered lots of learning and stories during that time. Today I would like to one of those stories with you.

One of the major projects of mine in JITA was CARE-GSK CHW Initiative project. The main objective of the project was to improve health outcomes of women and children below two years of age in under served and poor communities. The project was funded by GlaxoSmithKline. To make this initiative more sustainable, CARE has signed a partnership agreement with JITA with an objective to develop sustainable and economically viable business for 56 P-CSBAs (Private Community Skilled Birth Attendant) through introducing new and innovative sources of revenues, contextualization of services offered and individualized business development support. Initially we had provided a 3 days long entrepreneurship development training to all 168 P-CSBA, but in this term, we worked with only 56 P-CSBAs.

P-CSBA Rehana was one of the 56 P-CSBA with whom JITA will work. Rehana Begum lives in Dowarabazaar Upzila, she was 32 year old. She got training from CARE on how to provide MNCH services and started working as a P-CSBA from November, 2013. She is a widow and mother of 2 children. Her target customer is women in reproductive age (15 to 49 years old). In her working area, the around 1700 women were in that age limit. From the initial market assessment conduced by JITA, we found that it was quite possible to earn BDT 8000 to BDT 10000 for her. However, her income per month was only around BDT 1300/- per month. As a part of internal and external assessment of PCSBA, JITA dig down the reasons to identify why her income is not up to the minimum mark (BDT 5000). Even when we have asked her for the first time why her income is such low, she didn’t share any concrete reason with us. She just told her that its not possible for her to make more money than this. We found her really demotivated and depressed.

May be on that time, it was pretty easy for me to say that she doesn’t has the materials to become an entrepreneur. But as a development practitioner, I know there are some hidden reasons. It was true to almost all 56 P-CSBAs. To find out those reasons, I designed an external and internal assessment tools to assess their personal motivation to supporting environment along with external environment assessment.

After the assessment, we have found the following reasons –

• As she has 2 child of age, one is 3 years old and another was 6 years old that time, so it was not possible for her to go out of her house for more than 2 hours. Her Brother-in-Law and his family lived to the next house but they didn’t supported her in this regards. That’s why she spend only 2 hours in this work.
• There are around 12 villages in her working area. However, she is a widow, so she feels insecure to visit new areas. She can cover upto 4-5 villages which were nearby to her house, but to cover the other villages, she need to cross the market and she was not comfortable to cross the market. That’s why she always visit those 4-5 villages, only 30% of her market.
• As she was not roaming around her target areas and talk to people of community about the safe motherhood, so her community people are not well aware about her presence in the community and also what services she provides. She also felt shy as she didn’t do anything like this in her whole life.

After finding the above reasons, me and one of my team member Mr. Salahuddin sit together and developed an action plan for Rehana. We both have agreed that before taking any business intervention, we had to take some social mobilization interventions first to break the barriers. So we had taken the following actions to break the social barriers –

• Talked to her extended family members and motivate them to support her. We have engaged her family members in a way that they will provide the support willingly. Mainly the support she needs to arrange lunch for her children when she will be in service. It helped her to give 4-5 hours in her job daily instead of 2 hours only.
• Discussed the insecurity issue with her family members and also local elite persons and they ensured us that they will provide necessary support and protection to her. Moreover, Mr. Salahuddin went door to door with her for 1 week to ensure that she feel secure to move in her working areas.
• We arranged small yard meeting in her working areas to ensure that community members know her and the services she is providing. These yard meetings create an access to community for Rehana and also create a credibility of the her as P-CSBA. During these sessions, the local elite persons were also participated.
• With the help of local elite and local CARE staffs, we have developed community volunteer in her working areas who had informed Rehana if any women get pregnant or any households face any MNCH problems or anyone need delivery support. The volunteers were also worked as a spoke person for Rehana in the community.
• We also helped her to plan what sorts of health, hygiene and nutritional products she can sell apart from providing the services. We developed a root plan for her, so that her customers know when she will come in that area.
• We had linked her with the local pharmaceuticals wholesaler so that she can buy OTC drugs, health and hygiene products in a discounted prices and sell those products in her community.

As I mentioned, before taking this initiatives, Rehana’s average income was around BDT 1,300/-. After implementing the above mentioned actions, her brother-in-law and his family gave her full support she needs, and the local elite also gave their full support so that she can move around the community without any hesitation. And if possible, they also attended her yard meeting to introduce her to the community.

Due to the social mobilization activities, the community people now know her and as a result now she is more confident to move alone in her working areas. After intensive support of 2 weeks, she has earned around BDT 3,300/- and at the end of the month, she earned around BDT 8000/-. In next 2 months she earned around BDT 9500/- and BDT 11000/- consecutively. She had more confident that she can earn around BDT 15000/- per month if she also started selling some health and hygiene goods in that area. So she started accumulate some capital to invest in her product selling interventions and within 3-4 months, she started selling health and hygiene products like oral saline, women hygiene products in that community and earned around BDT 15000/- as she targeted.

I still remember what Mr. Salahuddin said when I talked with him about Rehana for the first time. He told me that Rehana can’t do it, as she had lacked of motivation and interest and she was happy with her current income. After 1 month of intervention, I asked Mr. Salahuddin whats his feeling right now and he told me, “Bhai the whole situation was like an iceberg. It was pretty easy to say that its not possible for Rehana. But exploring the whole problems, I understood that if I was in her position, I might not earned that BDT 1300/- even”.

From this project, one of my key learning is that providing capacity building and financial support is not enough to develop an entrepreneur (whether a micro entrepreneur or a million dollar entrepreneur). To guide him/her to develop the plan, to coach him/her to solve the problems an entrepreneur faced and mentoring him/her to develop specific skills and knowledge is ultimately help an entrepreneur to develop his/her business and shoot for his/her vision to achieve.