Malaria Education

At this point a woman seated across the circle from Presi­dent Aminata stood up.¹¹ Djeneba had been quietly watching the group’s interactions. Djeneba was the group’s animator, the staff member of a local NGO who had arrived in Kou- Ioukoura the previous year tasked with forming a Saving for Change group if the community was interested.

The members of Benkadi were the women who had been most excited to try out the new group saving idea. Many were slightly better off or more socially connected in the village, better positioned to risk trying the new idea.¹² Most had already pooled money together before in smaller cash “merry­go-round” groups called tontines, the traditional rotating sav­ings associations common in Malian villages. In a tontine, members contribute a set amount of money to a pool that goes home with a different member in turn at each meeting. The simple mechanism enables its members to gather a usefully large sum of money for major purchases such as school fees or business investments, while requiring only small contribu­tions at a time—particularly useful where members lack safe places to store growing cash savings and where the options for credit are nonexistent or perceived as usurious.

The Saving for Change idea sounded to them like an improvement on the basic tontine, turning weekly contribu­tions into interest-garnering savings and allowing for flex­ible loan requests in different amounts and timeframes, a major difference from the rigidity of the tontine schedule.

Importantly, the Saving for Change model still kept all money management within the group.

The animator, Djeneba, remembered how exciting it had been when she started training groups. For the first six months of their weekly meetings, she led them through dis­cussions so that they could decide on their responsibilities as members and come up with group rules guiding inter­est rates and fines. They set a collective goal (to divide their group fund, which would have grown larger from interest collected over the year) and elected a president, key holders, and a cashbox keeper. During this planning time, they were regularly saving their shares, so by the second month of meet­ings they had saved enough capital to begin lending. The first loans were a big relief to the cashbox holder, who immedi­ately saw the benefit of disbursing the savings into the hands of members, diversifying the responsibility for protecting the money (and generating interest income too, of course).

After a few months of weekly savings meetings and monthly lending meetings, the group handled more and more of the process itself, with Djeneba receding into the background. The key to group survival would rest on the animator’s abil­ity to ensure that group members had confidence in them­selves and the motivation to make the group work so that it could continue to operate without her.¹³ After six months, Djeneba reduced her visits to every other week, and after nine months, the group rarely had any need to look to her for help solving a question, so she visited just for the monthly extended loan meetings.

Now, a year later, the meetings seemed to run themselves. Djeneba usually visited only quarterly, when she recorded data about the group for her NGO, a Malian nonprofit that collected records on its Saving for Change groups for Oxfam America, which oversaw the overall program. The compiled data helped Oxfam America monitor the group’s progress and improve the program over time. Right now, though, Djen- eba was halfway through a three-month additional training program for the group, a seven-session malaria prevention course. Malaria is a primary cause of death in young children in Mali and a leading cause of illness and its resulting loss of labor and income for all Malians.¹⁴ Many a group member’s business dream had been diverted when a malaria emergency forced a borrower like Tabika to spend loan capital on medi­cines or when exhaustion from the illness prevented a woman from implementing her plans. Most group members had sur­vived the deaths of siblings or children. Because of the disease’s impact on their lives, many savings group members already had a strong understanding of malaria, but they welcomed the informed explanations from the NGO-trained animator.

After greeting the women, Djeneba launched into her training on malaria prevention, following a curriculum devel­oped by Freedom from Hunger, Oxfam’s partner in Saving for Change. Instead of lecturing, she used the facilitation skills she’d practiced to generate dialogue. Djeneba encour­aged the women to brainstorm and discuss ideas, allowing them to use their own judgment to evaluate why something like an insecticide-treated bed net would help protect from malaria-causing mosquitoes. Djeneba added that better nutri­tion and prenatal care could help make pregnant women, infants, and children stronger and more able to survive a bout of malaria, though not prevent it. She stepped in to dis­pel myths, such as that eating certain foods repelled mosqui­toes. She asked the women what preventive tactics they used now and why.

“Is prevention better than treatment? Does the medi­cine always work? Can you always afford the medicine?” she asked the women, putting each question up for debate. “Who is most at risk for malaria?” Djeneba reminded them that infants and young children are most likely to die from malaria and that pregnant women who get infected are also at risk for anemia, low birth weight, or difficult births. Her goal was not to force everyone to always use bed nets but to ensure that the women learned enough to make educated choices about malaria prevention and treatment.

As she wrapped up, she told them that next month she’d discuss how to treat a bed net with insecticide so that they could do it at home, which is cheaper than buying a pretreated

net. Djeneba thanked the women for their engagement and let them know she would stay after the meeting if anyone wanted to talk to her.