Gardens for Health

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Gardens for Health

Rwanda
Organization type: 
nonprofit/ngo/citizen sector
Budget: 
$50,000 - $100,000
Project Summary
Elevator Pitch

Concise Summary: Help us pitch this solution! Provide an explanation within 3-4 short sentences.

Gardens for Health enables people living with HIV/AIDS to improve their nutrition, health, and treatment adherence through sustainable agriculture. GHI provides access to land and patient capital for community gardens, seeds and tree seedlings for family home gardens, technical assistance in sustainable agriculture and nutrition, and market linkages.

About Project

Problem: What problem is this project trying to address?

Though much has been accomplished to make life-saving HIV/AIDS drugs universally available, poverty and malnutrition continue to undermine HIV/AIDS treatment (ART) in sub-Saharan Africa. Unfortunately, the majority of people infected with HIV/AIDS in sub-Saharan Africa have the limited means to acquire the quantity or quality of nutrients needed for effective treatment over the long-term. Malnutrition not only increases drug side effects but also limits the absorption and effectiveness of the drugs. It also weakens the immune system, hastening the disease’s progression. HIV/AIDS, in turn, limits the labor productivity of infected individuals, pushing individuals and families further into poverty. Though not a substitute for ART, good nutrition helps people infected with HIV/AIDS to stay healthy longer, adhere to drug therapy, and maintain a better quality of life. Yet, most nutritional support programs provide only short-term food aid. We believe that this long-term disease requires a long-term approach to nutritional support.
About You
Organization:
Gardens for Health International
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Section 1: About You
First Name

Emma

Last Name

Clippinger

Organization

Gardens for Health

Country
Section 2: About Your Organization
Organization Name

Gardens for Health International

Organization Phone
Organization Address

Rwanda

Organization Country
Your idea
Country your work focuses on
Innovation
What makes your idea unique?

The imperative for food security often overlooks the potential for food sovereignty.

International food aid, as experienced by patients receiving ART, consists of a six-month supply of flour, vegetable oil, and sugar. These staples are flown, shipped, and trucked from wealthier nations thousands of miles away. Not only does such food aid preclude agricultural production and economic development on a local level, but it also disincentivizes agricultural production and economic development on an individual level; patients who receive aid feel less obligated to grow their own food. Moreover, these rations hardly constitute the healthy nutritious diet that is vital for the chronically ill.

While most nutritional support programs offer intervention only while a patient is malnourished, GHI believes that true intervention must continue after the immediate crisis is resolved.

The GHI program empowers chronically-ill individuals with the tools to realize nutritional independence. Typically, HIV-positive individuals struggle to gain access to credit and land, and GHI assists them in securing access to both. The dividend from the program is both nutritional and financial, but is directly proportional to the hard work, investment, and ownership of patients themselves.

Do you have a patent for this idea?

Impact
What impact have you had?

Now in the second year of its pilot phase, the GHI program has had already had a significant impact:
-10 small business cooperatives formed, composed of over 4,000 members and their families
-15 ha. under cultivation, with an additional 40 ha. made available by government
-49,702 kg of produce harvested from first three seasons (amaranth, beets, cabbages, carrots, cucumbers, eggplant, mushrooms, red onion, spinach, squash, sweet peppers)
-Over $6,325 in total cooperative income generated through sale of produce in the first three seasons
-Over 900 fruit trees and moringa trees planted
-500 home gardens established for individual members
-23 members trained as nutrition counselors
-3 full-time Rwandan employees: Program Coordinator, Community Garden Agronomist, Home Garden Agronomist
-1 part-time Rwanda employee: Nutritionist
-Demonstration garden established at Rwandan Network for Living with HIV/AIDS headquarters
-Kinyarwanda educational materials on nutrition and agriculture developed in collaboration with Ministry of Health

In the 2008-2009 program year, GHI made loans of seeds, tools, and compost in-kind. However, program participants and staff realized that this form of lending denied participants the opportunity to effectively manage a budget and plan. In the 2009-2010 program year, GHI staff determined credit ratings for individual cooperatives and made loans accordingly after cooperatives completed applications, budgets, and business plans, awarding a total of $19,300 USD for community garden inputs.

Actions

Partner with the community
Our partnership with the Rwandan Network for People Living with HIV/AIDS ensures that our program respects and responds to the needs of this community in Rwanda.

Listen to the community
Feedback from cooperative leaders and members shapes the program design on an ongoing basis; we have established formal mechanisms to ensure this process. For example, the introduction of monetary (rather than in-kind) loans and maize repayment came from cooperative members.

Invest in education and technical assistance
Working with the community, GHI strives to understand the skill sets that will ensure the program’s success.

Work with local government
We collaborate closely with local government actors, and participate in broader efforts of the Rwandan government to fight malnutrition.

Results

Ultimate goal: Improved nutrition, ART adherence, and health of people infected and effected by people living with HIV/AIDS.

Cooperatives will continue to cultivate cooperative gardens, ensuring access to food and income, long after the initial investment.

Cooperatives will continue to improve the quality of their soil utilizing the sustainable agriculture.

Families will continue to plant and harvest in their home gardens, saving seed, and replanting after each season.

Families will continue to utilize cooking techniques and recipes that they learned from the nutritionist and nutrition counselors.

What will it take for your project to be successful over the next three years? Please address each year separately, if possible.

2010: Establish the viability of its financial model, expand to a new site within Rwanda, strengthen clinical ties, and identify a lending partner

Operating budget: $250k

Notes: Having implemented an extensive monitoring and evaluation system, GHI will be closely measuring the cooperatives’ ability to manage resources, meet deadlines, and maintain cash reserves. GHI’s model is comprehensive, but nevertheless limited; peer nutrition counselors will begin to refer patients to clinics and hospitals and vice versa.

Because so much of GHI’s cash is tied up in loans, we seek to move from a lender, to a guarantor, to a referrer for cooperatives with higher credit rankings. This would allow GHI to drastically expand its operations and ensure long-term sustainability. However, identifying the appropriate microfinance institution is critical.

2011: Expand to a new site within East Africa, continue explorations of staple foods production

Operating budget: over $400k

Notes: GHI is currently exploring expansion to one of Africa’s poorest countries, Burundi. In many ways Burundi very similar to Rwanda; however, it lacks much of the infrastructure (such as strong agricultural schools) that has facilitated our development in Rwanda. The program will likely look different in Burundi, as our entry point will be at a clinical, instead of a community, level. We will not be working exclusively with HIV-positive individuals, but through a rural hospital’s food security program. The move to a new country will be a powerful test for the program’s broader applicability, geographically and programmatically.

2012: Continue expansion throughout Rwanda, financed largely through a revolving fund and in partnership with the Government of Rwanda.

Operating budget: $750k

Notes: We believe that once we establish a revolving fund of $500k, we may begin to roll out a national expansion program that will eventually reach the 1,000 community support groups of people living with HIV/AIDS.

What would prevent your project from being a success?

As with any agriculture program, success in many ways depends on climate, and seasons made increasingly erratic by climate change could inhibit or undermine the program. The program is fortunate, though, because participants were granted access to marshlands, which allow for three growing seasons instead of the two rainy seasons. To further mitigate rainfall dependence, GHI has invested in irrigation systems, and the growing sites on the marshlands have endured through both rainy and dry spells. Nevertheless, the potential for poor rains or blight poses a threat with each season.

Many in this field regard the very premise of the GHI model — that the most vulnerable populations are capable of managing land and credit — as quite risky. Indeed, there are real reasons why most microfinance institutions will not lend to groups who identify as HIV-positive. Through experience, GHI has learned to mitigate risk by altering the model to include elements such as the credit-ranking system and regular evaluations of cooperative leadership and management. Individual and cooperative buy-in is critical to the model and it is possible that some groups would not benefit from training and would be unable, on an ongoing basis, to manage their resources and meet repayment deadlines.

As we explore expanding to Burundi, to a clinical setting, we must transition the program and ensure its broader applicability. We need to ensure enough flexibility to allow our model to work in a different setting, but not enough that we lose sight of our core values and expertise.

How many people will your project serve annually?

More than 10,000

What is the average monthly household income in your target community, in US Dollars?

$50 - 100

Does your project seek to have an impact on public policy?

Yes

Sustainability
What stage is your project in?

Operating for 1‐5 years

In what country?
Is your initiative connected to an established organization?

Yes

If yes, provide organization name.

Rwandan Network for People Living with HIV/AIDS

How long has this organization been operating?

More than 5 years

Does your organization have a Board of Directors or an Advisory Board?

Yes

Does your organization have any non-monetary partnerships with NGOs?

Yes

Does your organization have any non-monetary partnerships with businesses?

No

Does your organization have any non-monetary partnerships with government?

Yes

Please tell us more about how these partnerships are critical to the success of your innovation.

Our partnership with the Rwandan Network for People Living with HIV/AIDS has been critical to our legitimacy and expansion in Rwanda.

What are the three most important actions needed to grow your initiative or organization?

Beyond organizational capital, the following actions will significantly grow our organization:

1) Ensure long-term cooperative financial sustainability
We need to continue to monitor the success and failures of income generation to ensure the financial sustainability of the cooperatives in which we invest.

2) Partner with patient lender
Partnership with a microfinance institution for later-stage cooperative loans will allow us to expand our staffing and work with more early-stage cooperatives.

3) Engage with the broader sustainable agriculture movement
We realize that our program is but a small part of the larger and global sustainable agriculture movement, which is growing rapidly in the face of a global food crisis. We seek to engage and collaborate with other actors in this field to promote local agricultural development and ensure that all communities have the tools necessary to achieve food security and sovereignty.

The Story
What was the defining moment that led you to this innovation?

In 2006, Emma Clippinger and Emily Morell interned with the Clinton Foundation in Rwanda. While Emma met with farmers to gather information for an agriculture initiative, Emily visited health centers to guide a Pediatric HIV/AIDS Treatment Plan. Both observed troubling gaps: Emily saw that malnutrition undermines ART’s efficacy, and Emma witnessed that HIV-positive populations, unable to access land and with limited strength, rarely benefit from agriculture interventions.

When Emma and Emily met an association of people living with HIV/AIDS (PLWHA) who maintained a garden at a health center, they decided to help them design a nutrition-through-agriculture program. With an investment of tools and seeds, the members would benefit from nutritious food and additional income from the sale of surplus.

Having established a 501(c)(3) and raised funds for a pilot program, Emma and Emily returned to Rwanda. They formed a partnership with the Rwandan Network for People Living with HIV/AIDS (RRP+), the coordinating body for Rwanda’s 1,000 associations of PLWHA, with 85,000 members. The RRP+ monitors the activities and governance of all associations, allowing GHI to work with multiple associations.

Tell us about the social innovator behind this idea.

GHI cannot claim a sole innovator, but is the product of many collaborators.

The idea began with two Clinton Foundation HIV/AIDS Initiative interns: Emma, then a sophomore at Brown, and Emily, then a sophomore at Yale. Yet, the idea was powerfully shaped by many individuals at that early stage, including Dr. Cyprien Baribwa, Rwanda’s top pediatrician, Dr. Paul Farmer, founder of Partners in Health, and Ira Magaziner, Chairman of the Clinton Foundation HIV/AIDS Initiative. Emma and Emily were fortunate to have resources and networks which they could leverage in support of this idea.

The next stage of iterations led to the creation of the program we have today. GHI’s partnership with the Rwandan Network for People Living with HIV/AIDS established HIV-positive individuals as the primary stakeholders in the program and its planning. Cooperative leadership and members have provided critical feedback at every stage and the program has established regular meetings to facilitate and implement feedback.

Also in 2008, Country Director Julie Carney joined GHI immediately after graduating from Yale. Under Julie’s direction, the program has transformed. She has advanced GHI’s legitimacy and scope, taking actions that include implementing a monitoring and evaluation system, strengthening operations, expanding the home garden program, and firmly establishing GHI as a leading voice on nutrition in Rwanda. Julie contributes to Rwanda’s Ministry of Health Nutrition Working Group and has brought GHI’s expertise in sustainable agriculture and nutrition to other vulnerable communities, including refugee camps and orphanages.

Emma and Emily both graduated from college in 2009. While Emily has matriculated to Harvard Medical School, Emma and Julie work as full-time salaried employees of GHI. Emma and Julie received the prestigious Echoing Green Fellowship in 2009. Julie has continued to direct the program in-country and Emma has been based in the U.S., focusing on organizational development and fundraising.

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