“Bowling Alone”? Not in Africa!

Based on more than half-a-million interviews, Robert Putnam’s Bowling Alone documents the decline of  “social capital” in America. Robert Putnam’s thesis is that over the last half of the 20th century, America’s social connectedness—measured by participation in associations, meeting with friends, socializing with families, and even bowling alone instead of in a league—had significantly declined. According to Putnam, changes in work, family structure, and the role of women within the family, among other things, contributed to the decline in social interaction.  Not so in Africa.  In all of the countries on the vast continent, close family and community ties continue to be the norm, and in the last 30 years have become life-saving.

Since the first diagnosed case of HIV/AIDS in Africa in the 1980s, millions have been infected and affected by the pandemic. Today, Sub-Saharan African remains the epicenter of the pandemic. Some studies estimate that more than 15 million people in Africa have died due to AIDS-related illness. That number equals of the combined population of New York and London.

AIDS-related deaths have left nearly 13 million children without their mothers, fathers, and in some cases, both parents. And although the international community has put a lot of effort into providing support to children affected by AIDS, only five percent of these children receive support from external sources, The vast majority of children—95 percent—are cared for by extended family, friends, and neighbors.

Most of those who provide support, like Mrs. Phakathi (see last week’s blog “The Volunteer Who Changed a Boy’s Life”) are members of the community moved to action out of concern for their neighbors, friends, and family.  For example, Bongani Orphan Day Care in Zimbabwe works with a vast network of volunteers who provide support to 13,000 children. Another Firelight partner in Zambia, Bwafwano Home Based Care Program, has trained more than 500 volunteers who work with nearly 12,000 children.

The volunteers identify the families and households in need of support. They bring food, fetch water, and sometimes cook or clean. In a household where there is a sick adult, they bathe the patient and tend to other needs. They also make sure that children are not forgotten by responding to their need for care and support. They also provide a listening ear, counseling, and referrals to health and other services.

In the absence of a social welfare system, they are “social workers plus”, filling the function of social workers, plus so much more.

In cases where the primary focus is healthcare, community volunteers serve as community health workers, filling in a critical role in extending health services to the most vulnerable and marginalized. They make sure that patients take their medication, and also provide counseling, identifying other problems in the household that need attention.

Their support is essential given the limited numbers of healthcare workers in Africa. For example, in Malawi, there is one doctor per 50,000 people—one of the lowest levels in the world. Approximately 60 nurses are trained every year, but at least 100 nurses leave the country each year to seek employment in other countries. Out of nearly 1 million people living with HIV/AIDS in Malawi, only 11 percent receive anti-retroviral treatment.

Organizations like Boston-based Partners In Health train community volunteers to serve as “accompagnateurs” or community health workers. They receive training in basic health care. They deliver long-term life-saving treatments to their neighbors, serving as the bridge between the hospital or clinic and the community. They take bring health services the last mile to reach the most remote and isolated community members. As respected and knowledgeable members of the community, the community health workers also help the hospital staff understand the context and the particular social and health problems that the patients face.

What is surprising is that paying volunteers is quite controversial in the development field. Those who oppose the payment of community volunteers argue that paying volunteers distorts their motivation, making financial incentives rather than altruism, the main driver. They also cite concerns about how much it would cost to support all those volunteers. After all, the argument goes, what makes the community response affordable is that volunteers provide the support, free of charge.

The reality is that many community volunteers are themselves poor. They walk long distances to reach the most remote of communities. If they’re lucky, they may have access to a bicycle. They give generously of their time, energy, and caring. But they also give away the few material possessions they have, including food and clothes. Most of the time, they don’t receive any kind of compensation for their time and effort.

Many of these volunteers do this work over many years, and their families are impacted by their dedication. A UNAIDS study found that community volunteerism has a negative effect on family income and results in reduced food consumption in volunteers’ homes.

Based on Firelight’s experience, we believe that community volunteers should be compensated. Our grantee-partners are delighted to know that they can use our grant funds to provide compensation to their volunteers, including stipends or in-kind compensation, like grocery store vouchers or food packages. But whenever possible, they pay their volunteers because they know what a big difference even a limited income makes in their lives.

Organizations like PIH recognize that in training and paying volunteers they are professionalizing community health services, which has the benefit of raising the quality and consistency of care, and valuing the contributions of volunteers. But in communities with chronic poverty and high unemployment, paying community volunteers also stimulates the local economy by providing volunteers a steady income that helps them provide goods and services for their own families.

So what about the cost? According to PBS NOW host David Brancaccio’s back-of-the-envelope calculations, if you cost out the PIH model for Rwanda (approx. $150/per person), it would cost a total of $3.3 billion a year to bring paid “accompagnateurs” to the millions of people living with HIV/AIDS in Sub-Saharan Africa. As Brancaccio remarked, that's about what the U.S. government paid for the Cash-for-Clunkers program in 2009. He went on to point out that if you took the amount of money used to bail out former insurance giant AIG, you could fund community health volunteers to support every man, woman, and child living with HIV/AIDS in Sub-Saharan Africa for 25 years!

And the social and economic benefits would be exponential.

Indeed, the ethos of “ubuntu”—the concept that my well-being is intricately tied to the well-being of the people around me—is alive and well in Africa. In times of crisis, it is made tangible through community philanthropy—the poor giving to the poor. It is thanks to this amazing community phenomenon that Firelight’s small grants go such a long way.

“Social capital” is a life-saving currency for millions of families and their children in Africa. Without it, many would face extremely difficult, undignified, and isolated deaths. But because of that strong sense of community connection, sick adults are cared for and know that their children will receive help long after they are gone. When fully mobilized, we at Firelight have witnessed firsthand how “ubuntu” unleashes the transformative power of community action.

So as we honor, value, and celebrate the hundreds of thousands of volunteers who are making a difference in the lives of so many who remain out of reach of international aid efforts, we should not take that volunteerism for granted, nor use it as an excuse to keep people in poverty. Instead, let’s celebrate, strengthen, and support it.

But let us also provide the resources to provide fair compensation for fair labor.

For more information about Partners In Health, go to www.pih.org. You can also read a transcript of PBS' NOW spotlight on PIH's work in Rwanda (http://www.pbs.org/now/shows/537/transcript.html)