219: The impact of Cash Transfers

Two weeks ago, I met with 70 ancient grandmothers under some trees outside the Ethiopian capital of Addis Ababa. All the grandmothers wore white cotton shawls and sat on the ground or on some cement blocks because there weren’t any chairs. I greeted each one formally with the few words of Amharic that I learned. In turn, the women proffered blessings onto the Stephen Lewis Foundation (www.stephenlewisfoundation.org) that provided for their sustenance and made my visit possible. All of these women were widows, desperately poor, who were nevertheless saddled with the care of grandchildren following the illness and death of their own children primarily due to war or HIV/AIDS.

This is not an unusual situation. Between 40 and 60% of all orphans in sub-Saharan Africa live with their grandparents – almost always with their grandmothers. These grandparents represent the last shred in the family safety net. If the grandparents also die, their grandchildren end up on the street or as Child-Headed Households – a new “category of family” that has tragically become part of Africa’s everyday language. By 2010, Ethiopia alone anticipates 225,000 Child-Headed Households! Obviously, it should be in everyone’s interest to keep the grandmother’s alive as long as possible in order to provide some modicum of stability, continuity, and support for these children. But very few countries in Africa have any form of state pension for the elderly, and once again, it is the poorest of the poor who suffer most.

Through the Destitute Elder’s Welfare and Development Association – the Ethiopian NGO I visited -- 1266 very-poor and very-old people receive the equivalent of $8 a month (less than 27 cents a day), one new set of clothes each year, and access to free nurse-assessments: literally drawing the line between life and death. In its first year of assistance to this organization, the Stephen Lewis Foundation paid for 100 of these grandmothers and added extra for their orphans -- including basic school supplies and a school-uniform. The reason for my assessment was to see how well the money was spent and to make a recommendation for a follow-up grant, hopefully of a larger size.

As is usually the case, I was asked to make a small speech to the beneficiaries (with translation). Knowing a bit about their background, I expressed appreciation for the grandmothers’ hard work and dedication. What these old women appreciated hearing the most, however, was how the money came to them through groups of older women in Canada who gather together regularly to hold fund-raisers, bake-sales, and craft fairs to help their counterparts in Africa – grandmothers to grandmothers. “Now we know we are not forgotten,” one beneficiary commented to me later. “Even far away, someone has heard our cry for help.”

Over and over I heard that the support given through the Destitute Elders’ Association has become an absolute lifesaver, “If it weren’t for this organization, I would be dead by now and my grandchildren would be living on the street. Eight dollars a day (75 Ethiopian Birr) comes to just one meal a day, but it keeps us alive.” one grandmother said bluntly. The others nodded in agreement. “What additional assistance do you want?” I asked. I was told that last year the organization had experimented with an income-generating project involving goats and chickens, but there was a drought so the animal feed had to be purchased from far away and this cost too much. Despite the grandmothers’ efforts, all the animals died. Those elderly women who are still able to work said that next year they would prefer to receive small loans for petty trading (for example, the buying and selling of vegetables or some cloth), the spinning of cotton, and the preparation of injera, the Ethiopian staple pancake.

On our way back to the organization’s small office, we stopped at two homes – hovels – headed by grandmothers. In the first, I met a very-elderly and partly blind widow who lives with her 7-year-old grandson. Some years ago, she also cared for an older grandson, as well, but he ran away and lost touch. “Now,” she explained, “The younger boy is my entire reason for living.” With the support she gets from the Destitute Elders’ Association, she ekes out the rent of her 1-room mud hut, in which she and her grandson sleep on the same single cot with just one blanket between them. Each month, the grandmother is able to buy a little salt, coffee, oil, kerosene (for cooking) and 5 kilograms (11 lbs) of tef (the traditional Ethiopian grain) and 5 kilograms of wheat-flour. The household meals never contain vegetables or protein – just the flour mixed with a bit of oil and salt. The grandmother said that she eats only once a day in order to give two meals per day to the boy so that he can concentrate at school and get good grades. Still, by mid-month they generally run out of food. The grandmother explained that food prices have nearly doubled since last year, so for these past few months they had to borrow from friends. Now they have a “guest” sleeping on a mat on the floor of the house – a younger woman with an infant – and this woman pays a few cents per month, too.

After we spoke for a while, the boy came into the house – his clothes threadbare and torn, but proudly carrying a small back-pack with this school materials. His face shone as he explained how much he loves school and that he has made many friends. “What did you learn today?” I asked through the translator. “I learned an English word,” the boy said proudly, pointing to his face. “Nose.” He smiled broadly and we did too, and I felt that a connection had been made. Then I decided to show him how to make his face look like a fish and other silly things. Soon he started giggling and the grandmother joined in, and then the two staff who had accompanied me started making silly faces and soon the whole room shook with raucous laughter. Seeing my camera, the boy asked to have their picture taken, and I promised to send a copy back, via the organization’s office.

Two weeks have passed since I visited this home, and I can’t get this grandmother and her grandson out of my thoughts. Amidst their hunger and material deprivation, they evoked incredible dignity, care, and even joy. Those of us facing our own tighter economic times and financial insecurity due to the Wall Street debacle can learn a lot from this tiny family. And we must also remember that they, and others like them, need our help more than ever.

The second home we visited included a 3-year old girl (see photo with Lucy) who was born with HIV. She currently receives free medicines from the government, through American foreign assistance (PEPFAR). Her mother is alive but still sickly, although she also started on treatment a couple months ago. One problem is that the medications don’t come with the extra nutrition that is needed for the pills to really work. And so, once again, that is where the Stephen Lewis Foundation steps in.

Before arriving here, the director of the Destitute Elders’ Association had told me that, if he had to choose a favorite child among all the orphan-beneficiaries, he would select this little girl. “She is all sunshine,” he explained, “even when she is not feeling well.”

To get to the family’s shack in the slum, we had to squeeze through some very narrow passageways that smelled of sewage and were slippery from the recent rains. The little girl caught sight of us and, recognizing the staff, came over to be hugged. But as we entered the one-room shack, we noticed that the grandmother wasn’t around. “Where is she?” the director asked. “She died very suddenly, just four days ago,” the mother whispered hoarsely. “We are now in mourning.” So our routine home-visit suddenly became something of a “shiva” call (the custom in Ethiopia is similar). After a while the mother spoke, “My mother’s welfare - pension from the Destitute Elders’ Association was all that we had to live on. I am young but ill, and can’t work. I worry now, how will we will survive?”

Whew!

This family, too, has been in my thoughts frequently, since we met. I know that “welfare checks” are not considered a progressive development policy because they create dependency, and they are not a quick fix. Most donors prefer to give one-time assistance, like a few goats or chickens, and then have families rely on themselves. But as we know, that doesn’t always work either. Sometimes there are situations where only direct, ongoing assistance will really make the difference. Without better nutrition and rent-money, this mother and child won’t make it. But if they are assisted, then eventually Mom may get better on the drugs and could start working again.

So why do we maintain a double standard and balk at giving cash or vouchers to the poor? In the industrialized world old people and folks with disabilities get their pensions or Social Security, and low-income children get assistance without having to earn it, so why shouldn’t the same system apply in Africa where the need is even greater? A recent study of cash transfers in Malawi, Zimbabwe and South Africa concluded that, in countries with a high HIV/AIDS prevalence, social cash transfer programs – whether paid by government or through outside donors – reduce death and have a substantial AIDS mitigation impact. They also found that, with rare exceptions, the money is spent to benefit the whole family, and isn’t wasted on alcohol or other excesses. Clearly, social transfers – that is, vouchers or cash-sustenance for basic needs plus access to free education and health care – make as much sense for the poorest of the poor in the developing world as it does in London or New York or Mississippi.

Yours truly,

Lucy

P.S. #1: Belated good wishes to our Jewish friends for a Shanah Tovah u’Metukah – a sweet and happy new year. Our own new year started off great: we heard from Sergio this week that he will be shipped to Japan (Okinawa) in a month, and we figure that any country that doesn’t start with a vowel is definitely good news! The rest of us are also doing well and send regards.

P.S. #2: Bernd became a member of the worldwide Rotary Club in Windhoek (Auas Chapter - receiving his membership pin in the photo).

P.S. #3: Finally, here are two other photos of typical Ethiopian street scenes – I especially fell in love with the Ethiopian donkeys that are much smaller than the ones we have in Namibia (and much harder working, too).