Site Visits: February 2010

Note added February 2024: We recently removed the photo albums that had been included on this page. As part of our value of considerateness, our goal is to share photos of people only if they gave informed consent for their image to be used. We had not developed an image policy at the time of the site visits, and we wanted to remove those older photos that likely did not meet our new, higher standards.

In February 2010, GiveWell co-founder Holden Karnofsky visited two of our recommended charities:

This page presents his notes, along with available audio, video, and pictures.

Holden's reflections (as opposed to observations) from the trip are also available in a series of blog posts:

GiveWell Site Visits - Feb 2010 in a larger map

General note on photographs

When photographing large groups of people in crowded areas, I got the permission of the appropriate person (for example, the nurse at a health center) and then held up the camera for a while and waved at people to make sure they knew I was taking pictures. If anyone objected (I think this happened once) I put it away. For photographs of individuals, I got explicit permission and gave them time to pose. I never asked anyone to take a particular pose (though a lot of people, especially children, were interested in taking poses of their own).

I have not made any effort to "express" any kind of message with these photographs - the goal was just to show what I saw. To show buildings, views out of the car, markets, etc. I generally just took enough pictures to cover everything I was looking at (which is why some pictures seem to be of a random corner of a room).

Table of Contents

Small Enterprise Foundation

Part 1: Driving around Tzaneen

Notes:

I spoke at length with John de Wit at dinner on Sunday the 13th and while driving to the field on Monday. Where previous investigations of the Small Enterprise Foundation (SEF) had focused on its answers to our key questions about impact/cost-effectiveness/room for more funding, these conversations were more general and focused on the background, structure and operations of SEF. We did not record the conversations. Pictures are from the drive.

John worked for several years for microfinance programs within the Get Ahead Foundation, a general purpose charity. He was bothered by the fact that he once came back from a meeting feeling energized and smart and then realized "I'm not sure if we actually accomplished anything." Thought his work was too focused on financial sustainability - didn't pay enough attention to things like retention rates. He started SEF to do the work he had been doing with more of a focus on social impact (particularly retention rates).

SEF operates in 4 zones. Each has 6 branches. Each branch has a branch manager. Each branch has 6-7 development facilitators (DFs). When SEF comes to a village, first they do poverty ranking via DFs (to figure out which people to target). Then the DF serves as the person whom people come up to and ask if they can join; DF explains that they need to find 4 non-family friends they trust and explains what they're going to do. DFs decide who can join and they train them in the ground rules. They evaluate the state of their business to decide what size loans the clients can get. They manage meetings. Once a DF has signed off the Branch Manager does the formal recognition of groups, auditing things like "How well do they know each other?"

Where do these DFs come from? SEF advertises in newspaper, via pamphlets & radio. 400 people show up. Usually, ~100 are eliminated for not having a 12-grade degree or for having a degree with no "hard" content (math, quantitative). Then SEF explains the job and the pay and has a tea break and 100 more leave. Then there's a math test that eliminates another 100. Why all this emphasis on math? Because they're trying to figure out whether the education was actually substantive. Myers Briggs-like personality test is applied. Seeking people with high "compliance" and high "dominance." That cuts the candidate pool down to 50. Then there's a reading comprehension assignment, 2 very difficult passages by Muhammad Yunus; some people are smart but too arrogant to read them over and understand them. Finally SEF takes 30-40 people and give them a two-week test where they go into the field and find the answers to q's like "What makes a good group?" 60-70% pass and are hired as DFs.

DFs are usually from rural villages. They are not sent to the same villages they are from - it's been learned that that's a bad idea. People knew them growing up and know how to manipulate them. They get poor results. (What does John mean by poor results? Low repayment rates? No, SEF repayment rate has historically been too high to use for performance management. Retention rate. Arrears. Growth vs. budget (how many groups did they add vs. how many were they supposed to)).

DFs make 5000 rand (about $650) per month. For context, SEF's janitor makes 3k rand and would make a lot less if it weren't for SEF. 1000/mo is minimum wage for farm workers. Branch managers make 9-10k and they get a car. Promoted from DFs, but must show more "dominance" on personality test among other things. It's been learned by HR person after HR person that a great DF doesn't necessarily make a great Branch Manager.

"Penetration rate" only 6% of households. Savings would reach a lot more.

SEF tries hard to make sure people put money back into business and borrow for business. Not only telling clients what the loans are for, but having a process where the DF asks how the loan is going to be used and what the business plan is and checking back on every first and second loan to see how it was used. Would feel terrible about charging such high interest rates for consumption smoothing. John used to be confident that everyone was putting it back into the business. Now he's not so sure but thinks it's "maybe as much as 50-70%." I raised the possibility that maybe it's OK if they're not. He said interesting. Owns Porfolios of the Poor but hasn't read it.

John doesn't speak the languages spoken in the villages. DFs (and most SEF staff) do.

Part 2: Small Enterprise Foundation loan group meeting (untargeted program)

Audio:

Notes:

This was the biweekly meeting for all the village's SEF members. About 30 people were present, from several different lending groups. This village had the Micro Credit Programme (MCP) program, as opposed to the Tšhomišano Credit Programme (TCP) program which targets poorer clients.

Everyone sat on the ground except for the SEF "officers" (clients who are elected to be treasurer, secretary, etc.), John, me, the Development Facilitator (picture DSCN1812), and the Branch Manager (DSCN1810).

There were only 3 male clients. All of them were officers. There was one female officer. (DSCN1807 was the best I could do to get the officers from where I was sitting). John explained to me that males tend to get elected as officers and also often end up doing all the talking as women defer to them. That's why there is a limit of one male per group in MCP, and no men at all are allowed in TCP.

The main activity of the meeting appeared to be going through each group and figuring out what payments were due, what fines were due, etc. and collecting them.

I asked a few questions after the meeting. Most were answered only by one of the officers, though for a couple I/John insisted on getting answers from multiple people. I asked if anyone had "employees," which John helped to translate, and nobody did unless you count their children.

Part 2.5: Micro Credit Program Client - Barber

Audio:

Notes:

After the meeting, I got into a conversation with a male client who spoke particularly good English (so the conversation didn't require help from John or the Development Facilitator, who were occupied elsewhere). I didn't talk to him for long or get to ask him lots of questions as with later clients.

He is one of the officer clients. He says he has a very successful barbershop business funded by SEF loans, and that it has helped him to build a new house with a red window. I later took pictures of the house and of his barbershop (included).

I tried to ask how having more capital allows him to make more money. He explained that he has to pay for clippers, treatments, etc. I asked if he had ever had to turn away someone for a haircut because he didn't have enough materials and he didn't seem to understand what I was asking.

Part 3: Walking around Micro Credit Program Village I

Audio:

Notes:

The above are pictures and audio from when we were walking around the village between the MCP meeting and visits with clients.

Part 4: Micro Credit Program - Client 1

Audio:

Notes:

I interviewed one of the Micro Credit Program (MCP) clients in her home, with the help of John and the DF for translation. She sells beadwork and clothing well outside the village - she travels far in order to sell them (takes the bus). She seems to have a very distinct notion of "money from SEF" vs. "money not from SEF," which was explained to me as follows: she uses the money from SEF to buy stock (i.e., supplies) to make clothing and beadwork, and then with the profits she first sets aside SEF repayments, then buys more stock, and if there is anything left over she can buy something else. She pointed to her fridge and television as "things she had gotten with the money from SEF."

Her daughter (pictured) helps her to make clothing and beadwork. They say they work very hard. I asked why more people aren't in SEF and they answered that they're lazy; you have to work hard to be in SEF.

She has been a SEF client for a long time (I don't remember how long) and says she has never missed a payment. She knows her group members because they live near each other.

She has taken loans from a moneylender; sometimes she needs the money quicker than she can get it from SEF. But she doesn't like taking loans from a moneylender because the interest is too high, about 40 rand for every 100 rand borrowed per month.

I didn't ask much about the other family members. There are a good number of people in her household. Her daughter has 2-3 children.

I asked some questions about standard of living and pretty much all clients (in both the poverty-targeted and untargeted programs) gave the same answers:

  • All have a television (and therefore, I assumed, electricity)
  • None have Internet
  • All eat maize meal ("pap") often, vegetables often, and meat occasionally (when they can afford it)
  • None reported trouble paying for doctors' visits. They usually go to free clinics.
  • The adults get sick once or twice a year. The children get sick more often (I don't remember how often but it was often) with diarrhea, fever, etc.

Part 5: Walking around Micro Credit Program village II

Notes:

Pictures from when we were walking around the village between client interviews.

Part 6: Micro Credit Program - Client 2

Audio:

Notes:

This client sells snacks outside the village (picks them up at shopping center; travels to sell them). She also sells live chickens to community members.

Like Micro Credit Program (MCP) Client 1, she has been an SEF client for a long time, says she has never missed a payment, and blames laziness for others' not being in SEF. She has never taken a loan from a moneylender. She knows her group members from church.

She also has a lot of people living with her, including her husband, who talked to us in English for some time afterward - he has a salaried job in another town and seems very enthusiastic (eager to tell us) about his job. The picture of the man is him.

Part 7: Walking around Micro Credit Program village III

Audio:

Notes:

Pictures from when we were walking around the village between client interviews. I tried to interview the Development Facilitator but had a lot of trouble communicating with her; my questions for her were harder to translate than my questions for clients had been.

Part 8: Chief Operating Officer

Audio:

Notes:

I had lunch with SEF's Chief Operating Officer. He reports to John de Wit and everyone else (high up enough) reports to him. He basically "runs" SEF and has been trying to get to the point where John's involvement can fall.

He says that if it weren't for SEF, he'd probably have his own for-profit business, stressing that he doesn't see profit and social good as mutually exclusive.

He says SEF is kind of like McDonald's in that there's a formula, the formula works, and when things start breaking you have to just dig down and figure out what part of the formula is going wrong and pound on it until things straighten themselves out. The formula is basically: (1) recruit good development facilitators (2) make sure they understand what they're supposed to do (3) they recruit clients making sure that the clients have good groups of people they trust (4) they assess clients' businesses to figure out how much loans they can handle (5) they make sure the repayments come in. The result is client growth in line with targets, few missed payments, and low dropout rates - when any of those indicators starts to "break," that's when you look into things.

Human resources presents one of the biggest challenges; it's very hard to find talented people.

I mentioned that the clients I'd seen didn't seem to be continually hiring and expanding their businesses. He said there are a small number of people who experience huge success, usually because they have a really good niche like catering for weddings, but that they are definitely the exception. Most people continually take out loans and continually run about the same size business.

He thinks it's definitely a legitimate concern that people could be taking out loans against their own best interests. He says the best way to make sure it isn't happening is to make sure that people are both repaying loans and staying in the program. Concedes that 18% (the target dropout rate) isn't so super low as to make one completely confident that things are working.

Says that many microfinance institutions are probably similar to SEF in terms of structure, operations, auditing. Where he says SEF is different is in the focus on retention rates, which a lot of others don't even look at and which he sees as very key to ensuring that they're doing social good not just achieving sustainability.

He has spent a ton of time in the field because he used to be lower in the hierarchy. He says he can understand quite a bit of the local language, though that isn't to say he can speak it.

I said to him that one thing I would worry about is that DFs are basically judged entirely on growth in clients, repayment rates, retention rates - therefore their incentive is to get people to join and really pressure them to stay in. Could they be pushing people in against their own interests? Could there be a dynamic similar to that of payday loans? He thinks the comparison to payday loans is no good - payday loans are for people with salaries and are super short-term, i.e., there's no question that the people can pay and they just end up losing money. By contrast, with SEF you need to take that money and use it productively to be able to pay back. That said, he thinks the concern I raised is valid, but to him retention rates are where the truth really comes out because you can't really keep a client in the program if they don't want to be in it.

Part 9: Internal audit manager

Audio:

Notes:

He started with SEF over ten years ago. He grew up in a village similar to the ones that SEF works in, but moved out to a township to be with his uncle because his mother was having too much trouble taking care of him. Sees that as the seminal moment that led to his getting a much better education and successfully passing grade 12, which made him an attractive job candidate. His siblings did not move out to the township and have not done as well.

He spends most of his time in the field and is fluent in the languages used in the field.

He was originally hired into the admin department and eventually moved over to internal auditing, which he now runs. The idea of this department is to do the same things that branch managers / zone managers / regional managers do - check up on meetings and development facilitators to see that everything is running as intended - but since they're not judged by the performance of the groups they're reporting on, they don't have the same potential incentives as regional managers to exaggerate how well things are going.

He says that "incidents" (i.e., Development Facilitators (DFs) being caught really breaking the rules) happen but are rare. I asked whether he thinks it's possible that a DF, having been caught by an auditor, might offer money directly for the auditor to hush things up. He said he hadn't heard of that happening and kind of doubts it would because (a) the auditors always work in pairs, making it harder to pull this off (b) auditors make a lot more than DFs (I don't remember whether he said this or whether it just happened to occur to me as he was talking). However, he does know of one time when an auditor was left alone in the room with a DF who had been caught, and the auditor was male and the DF was female and the DF made some gesture "like to hug him," but that's as far as it went.

Part 10: Regional Manager

Audio:

Notes:

Started with SEF over 10 years ago, right out of school, as a development facilitator and worked his way up in the ranks. Now he's the regional manager for Limpopo and reports directly to the Chief Operating Officer.

His job is basically to check up on the zone managers, branch managers, development facilitators and see whether things are running as intended. Spends tons of time in the field and speaks the languages fluently.

We got into the question of whether people are borrowing against their own interests - I asked him the same question along these lines that I had asked the Chief Operating Officer. He said pushing people to join and stay in SEF is a good thing. I asked whether he thinks everyone should be in SEF and he said yes, pretty much. I asked why he thinks so few people are in SEF and he responded, "why do so few people go to church every day?" Everyone should, right? Just one of those things. He said he didn't see how being in SEF could harm someone. I said they could just be losing money on the deal and paying too much interest; he said the interest rates weren't that high; I said it was ~80% a year and he said I must be wrong; the interest rates aren't that high.

Part 10.5: Research & Development Staffer

Audio:

Notes:

On 2/16, my second day with SEF, I was scheduled for more staff interviews, but I asked John de Wit if I could go back into the field instead and see clients of the Tšhomišano Credit Programme (TCP) program, which targets poorer people. (At least one of the staff members I had spoken with had said I should try to see TCP clients if at all possible). John arranged for me to drive to a TCP village with a staff member from the Research and Development department. Unlike the people I had traveled with the day before, this staffer seemed to have excellent command of both English and the local languages, so it was possible to talk to clients without several stages of translation.

The two of us spoke quite a bit in the car on the way there and on the way back, and recorded much of it. This staffer's role is to help plan and test pilot programs, including the "money box" program (in which clients are given a lockbox to store their own savings in, rather than saving via the post office) and the new business training program, which is in development. He explained the need for the business training program with a very interesting anecdote (at the beginning of the audio): he was speaking to one client about her business and discovered that she was selling products for the same price she had paid for them, implying that she was losing money overall when transport costs, loan servicing costs, etc. were factored in. She was covering the difference using her social grant from the government, without being aware that her business was running at a loss. This is a case he "just happened" to catch, and he wonders how many more there are.

Part 11: Tšhomišano Credit Programme Client 1

Audio:

Notes:

She has two businesses: selling live chickens and selling sweets, both to community members. Overall, the conversation was pretty similar to those with the Micro Credit Program (not poverty-targeted program) clients: she has been a member for several years, has never missed a payment, and appears to have a fairly similar standard of living. Something I did on this day that I didn't on the previous day was ask her to tell me how many people she lived with and who lives in each room. While her home is concrete and fairly big relative to the homes I'd be seeing later in the trip, there are a lot of people living there and not a lot of space per person. She moved into the concrete home before joining SEF.

Part 12: Walking around Tšhomišano Credit Programme village

Audio:

Notes:

The first client I had spoken to, who was our initial point of entry into the village (and let us park our car there), followed us to speak with the other two clients. I took pictures [removed February 2024] of the village on the way and saw homes that ranged quite a bit in size/quality.

Part 13: Tšhomišano Credit Programme Client 2

Audio:

Notes:

She makes sorghum beer (an alcoholic drink) and other cold drinks, and also sells pillowcases and blankets to people receiving social grants (she initially said she had dropped the latter business, but later in the conversation said it was still going).

Like the others, she has a home that is made of concrete and that is not particularly small, but has a lot of people living there. There is one mud hut on her premises - it's her original home, which she moved out of prior to joining SEF. Like the others, she reports never having missed a payment, and her answers to the "standard of living" questions were similar as well.

Part 14: Tšhomišano Credit Programme client 3

Audio:

Notes:

She sells sorghum beer and snacks (for schoolchildren) to the people in the community, and bed comforters (duvets) to people receiving social grants. Like the others, she reports never having missed a payment, and her answers to the "standard of living" questions were similar as well, although the structures on her premises are not made of concrete like those of the others.

Part 15: Moneylender in Tšhomišano Credit Programme Village Market

Notes:

We had talked to a lot of clients about whether they used a moneylender or knew anyone who had (I think the woman who sold clothes was the only one who had personally used a moneylender before; most of them saw the interest rates as too high). I wanted to meet a moneylender. So we asked around and found that any local moneylenders were unlikely to be in their homes; they were likely to be in the village market, where people were collecting their social grants.

So we went to the village market and asked/looked around. Eventually we found a moneylender, clearly not local to the village (the only other white person I'd seen there), sitting in a van. He was hesitant to have his picture taken and I didn't ask about recording the conversation.

He told us that he had purchased the moneylending business from someone else a few months ago, that it was a bad business and that he was thinking of getting out. He showed us his repayment sheet, with repayments highlighted in blue - it was at most 20% of the loans. We asked what he charged and it was around 30% interest per month total, with most of that coming from charges that the moneylender said he was required to charge due to government regulations. We asked what he did if people didn't repay and he said "Nothing ... there's really nothing you can do."

According to the person who was showing me around/translating, moneylenders in South Africa take bank cards or social grant cards as collateral. This moneylender did not say anything about doing that. Later in the trip, my tour guide in Soweto told me that this practice is illegal, which may explain why the moneylender didn't talk about it.

At the end of the conversation he did consent to have his picture taken with me.

VillageReach

Part 17: Leah Hasselbeck

Notes:

After finishing with SEF, I flew to Pemba and met Leah Hasselback from VillageReach (VR).

The VR trip wasn't as much about interviewing clients/staff as the SEF trip was, so there isn't as much connection between what I was looking at and what I was talking about. Leah and I talked a lot about VillageReach throughout the trip, but I only recorded our first conversation and much of that was off the record. Notes from our conversations follow.

How VillageReach started. Blaise Judja-Sato (currently on the VillageReach Board) and Craig Nakamura (currently on its staff) worked together at a satellite company, Teledesic, and through this work Blaise knew Graça Machel (former First Lady of Mozambique). After a series of floods in Mozambique, Graça Machel called Blaise for help thinking about how to improve the local health infrastructure, leading to Blaise and Craig's investigating the area and founding VillageReach. They came up with the idea to move from a collection- to delivery-based system. They also came up with the idea of VidaGas (a for-profit gas delivery company that VillageReach incubated), and convinced the Ministry of Health to switch from wood- to gas-powered refrigerators.

Through personal referrals, they found two key local staff who are still with them:

  1. Maria, who focuses on helping them communicate with the Mozambican Ministry of Health.
  2. Durao, whom they hired to train the Field Coordinators (logistics specialists). Field Coordinators were hired away from the government by VillageReach.

So Craig and Blaise trained Durao, who trained Field Coordinators, while Maria helped them convince the Ministry of Health to try their new system. That led to the pilot project and study.

Afterwards, the government agreed to adapt the new system, but eventually abandoned it.
What has happened since Cabo Delgado project. Blaise has moved to the Board. Craig now focuses on "social business," which means he consults on VidaGas and is also looking for opportunities for social businesses to help in other projects. The rest of the staff has been filled out (more below).

VillageReach has been continuing to advocate, with help from Maria, for the Ministry of Health to implement the delivery-based system as a national standard. Leah described this as a series of meetings with higher and higher level officials until they finally got an audience with the Minister of Health. They were also "coalition-building," i.e., trying to get endorsements from USAID and other major funders to get more momentum behind the model.

When we spoke to them in mid-2009, VillageReach was essentially planning to re-enter Cabo Delgado on a very small scale, essentially paying all the costs to re-implement their model.

But an announcement has recently been issued endorsing the VillageReach model as the preferred model, which VillageReach sees as an enormous victory. The agreement is now that VillageReach is going to fund the training and mentoring of field coordinators, but that's it - if a province wants to switch over (it is recommended but not required, at least not in an enforced way, that they do so) they need to pay other costs, including Field Coordinators' salaries. By contrast, in the pilot project VillageReach paid for Field Coordinators and for new fridges. (Vaccines themselves were supplied with other funding such as GAVI funding.)

So far three provinces, including Cabo Delgado, have asked VillageReach to go ahead, and VillageReach has enough funding to go ahead with those three but not more. They have their hands full with the three for now; in a month they expect to have the capacity but not the funding to move forward with more. So they are not actively pushing the others, and in fact Leah is worried about what will happen if they go ahead on their own. I asked Leah how things would have been different if not for GiveWell and she said VillageReach would have delayed on the first three provinces because they wouldn't have had the funding for them. And grantwriting/fundraising would have been higher priorities.

We will need to see a specific budget, but my basic sense is that "funding" refers mostly to people who will be trained by Durao and will train Field Coordinators (one in each province) and a local version of Leah to do higher-level monitoring and evaluation, as well as travel/per-diem/fuel expenses for these staff and for trainings.

Leah is one of the two "Program" people (John Beale is the other) and she's basically what Blaise and Craig used to be - her job is to go around and think about how the logistics work and how to improve them. One of the things she was discussing with people on the first day was adding rapid diagnostic tests (RDTs) to the new logistics system, which means they will be delivered instead of collected. They are doing this partly because they're getting funding from the Elisabeth Glaser Foundation and have to do something related to AIDS, but Leah thinks this is a logical thing to be doing anyway to test/stretch the model, and she thinks RDTs are a reasonable thing to be working on because there's plenty of supply of them (thanks to PEPFAR and RBM) and plenty of logistical problems getting them out to the health centers. (Vaccines are a perfect fit because there are no shortages of supplies - Leah credits GAVI partly for this - yet there are enormous challenges in terms of the cold chain.) One of the challenges of adding RDTs to the system is the challenge of evaluation - the vaccination coverage survey is very expensive and it isn't affordable to do a comparable one for the diseases RDTs work on, and also there's just a general limit on how many indicators a Field Coordinator can reasonably be trained/expected to collect.

Leah is assessing the current health system infrastructure and making notes relevant to implementing the VillageReach model. She notes that hospitals don't seem to have any records of how many RDTs they use, which is going to make it difficult to set appropriate supply levels.
As we've been told before, VillageReach's other projects are fully funded and not core to VillageReach; Mozambique is where it's allocating unrestricted funds. I didn't ask much/anything about those other projects. Leah says that VR will only have 8 months of reserves given current plans to commit a lot of unrestricted funding to Mozambique, and that they are slightly nervous about this.

VillageReach staff/structure. The full org chart for Seattle is included as a picture.

  • Allen has replaced Blaise as CEO. Allen was a corporate lawyer for Microsoft who originally got involved with VillageReach as a volunteer (helping with legal issues, as I understand it). At some point VillageReach decided they needed someone to replace Blaise as CEO and announced a search and Allen entered. The search was very long, included a headhunter, and consisted of intensive interviews about people's plans/suggestions for VillageReach. Leah thinks Allen is very good at recognizing people's strengths and weaknesses and has done a good job (a) getting the word out about VillageReach, mostly by getting speaking engagements at conferences; (b) articulating an organization-wide vision for VillageReach.
  • Leah is essentially what Craig used to be - high-level investigations into an area, thinking about what can be improved, and high-level auditing/training. Leah started as a volunteer, responding to VillageReach's posting asking for someone to help them put together an evaluation.
  • John is a former marketer for Qualcomm and came on as a communications/marketing volunteer. He now leads fundraising and is the "right-hand man for organization-level strategy and new business development."
  • IS = information systems. I didn't ask about James.
  • Tom Martin is primarily in charge of HR (both local and in Seattle).

There are currently two staff in Mozambique: Maria (focused on advocacy) and Durao (training/mentoring of Field Coordinators). Formerly, Field Coordinators were VillageReach employees, but now they're government employees.

Part 18: Pemba Hospital

Notes:

On Wednesday the 17th when I flew into Pemba, we visited the Pemba Hospital where Leah wanted to discuss what data VR was hoping to have them collect. I took pictures on the way and at the hospital.

Part 19: Health Center 1

Audio:

Notes:

The next day we drove some distance to a slightly more remote health center. Audio is available of my conversation with the nurse there, who is also pictured (DSCN1952 and others). He reported being responsible for collecting his own supplies, via motorcycle, and it seemed from the conversation that stockouts were reasonably frequent (he reported a recent one with tetracycline). Durao checked the vaccine refrigerator and found it to be in good working order, but found at least one vaccine that had gone bad, looking at the indicator that indicated it had gotten too hot. I also took pictures of the surrounding area and people. The health center was fairly crowded with women waiting in line with their children.

We watched one consultation. The mother reported malaria-like symptoms and the doctor gave a rapid diagnostic test, but we didn't stay the 15 minutes to hear the result.

Part 20: District Health Center Day 1

Notes:

After seeing the above health center, we drove to the town of Macomia and visited the district health center, which is larger than a standard clinic. Though it was open, it was almost empty; Leah explained that people usually come to health centers in the morning, and doesn't understand why they don't come later in the day to avoid crowds.

I took pictures of the surrounding area, including the district party office (with the picture of the Mozambique President) and the containers of Vidagas (I thought it was interesting that I saw Vidagas everywhere I went so I constantly took pictures of Vidagas containers).

Part 21: Village

Audio:

Notes:

After visiting the district health center, we made a long drive to a village that we chose because it had a health clinic and was reasonably possible to reach. We took lots of photos and video of the road, which was very rough and required very slow, very alert driving (constantly swerving to avoid water and potholes). I think it took a couple hours to reach the village from Macomia (which itself had taken a couple hours to reach from Pemba).

At the village, I had a short interview with the village nurses (pictured in DSCN2032 alongside a District Hospital professional who had accompanied us to the village - he is on the right). Audio is included. Durao again found a working refrigerator but took out a couple of vaccines that had gone bad.

The pictured water pump has never worked: the government built it in the wrong place. There is another pump relatively nearby, though.

Little boys were excited to pose for pictures throughout the trip, but the ones in the village were most excited and that's why we have so many pictures of them (and even pictures of me showing them pictures).

The house with the satellite dish is not in the village, but on the way back.

Part 22: District Hotel and Restaurant

Notes:

We stayed at the most expensive hotel in Macomia (it was ~$30/night for the two prime rooms, which had private bathrooms, and less for the other rooms that VillageReach staff stayed in). Leah explained that it was expensive because of the private bathrooms and because it had electricity via a generator. However, there was no running water and the power was shut off at 10pm.

We ate lunch, dinner and breakfast at the district restaurant. Each meal was a small amount of meat with a large amount of plain carbohydrates (rice or maize meal). My breakfast of baby goat intestine and my lunch of baby goat with rice are pictured. I also took pictures of the town market.

Part 23: District Health Center Day 2

Notes:

After staying overnight in Macomia, we went back to the district health center to see it when it was busy. It was completely packed. We went to the PAV (Expanded Program on Immunization) room and watched doctors giving vaccines. According to Leah and Durao, the doctor was giving the vaccines correctly.

I told Leah I was very worried about proper administration of vaccines because VillageReach's evaluation couldn't capture such a problem (it looks at vaccination coverage rates but not infant mortality). She said that the Ministry of Health tends to do a good job training doctors on how to give vaccines but that it's a valid concern. I said I was particularly worried about giving vaccines that had gone bad, like the ones Durao had found. She said that one of the advantages of the VillageReach system is that Field Coordinators are taught to confiscate bad vaccines, but she also appeared worried about this issue and asked both Durao and a fellow Seattle staff member (via phone) about the idea of adding an indicator to the management information system about confiscation of bad vaccines.

Part 24: Health Center 2

Notes:

We visited another health center on the way back, very briefly. No medical staff were present.

Part 25: Car Breakdown and AIM

Notes:

On the way back to Pemba, our vehicle broke down. Nobody knew what the problem was (just that there was smoke and a smell coming from the hood), and we had no cell reception. After about 5 minutes, a pickup truck pulled over and two Americans walked out speaking Portuguese. They turned out to be from African Inland Missions, and gave me and Leah a ride back to Pemba, where we were able to get cell reception and arrange pickup for the other staff. I did not record the conversation we had in the car; what follows is a conceptual transcript from memory.

HK: So where are you guys from?
AIM: Originally we're from the states. Right now we live up there, you know by Macomia?
HK: Macomia, really, wow, what are you doing up there?
AIM: We have a radio station.
HK: Really how'd you get into that?
AIM: Oh we've just been looking for different ways to spread our message of salvation through Jesus. You see, a lot of people up here are Muslim and they're very hostile to Christianity. So if you try to give them the message directly they'll have all this peer pressure to turn you away. But by the radio, it's just something to listen to. Now we're not only about that stuff, we also try to broadcast generally helpful information and lessons about AIDS and the like. We've offered to NGOs before, why don't you give us stuff for the radio station and we'll broadcast it? And they can never get it together. Tried with Aga Khan, we tried with someone else. They couldn't get us an A4 once a month of information to broadcast.
HK: So what organization are you guys with?
AIM: Africa Inland Missions. There are other missionaries here, from Arco. We really disapprove of what they're doing. They're out in Pemba basically paying people to convert. And they brag about their numbers, it's all a numbers game to them - we got this many people to attend services and this many to convert. To us it's not about that. You can't be paid to accept Jesus, you have to really believe. That's why we go out there and we really live among the locals and try to make friends with them and understand them. It's too bad we didn't run across you guys sooner - we could have set you up to have dinner in someone's home.
HK: Wow. And you guys speak the local language?
AIM: Yes. In fact we made ourselves learn the local language before we learned Portuguese so we wouldn't have Portuguese to fall back on.
HK: How did you get started here? Were there others here before you who made introductions?
AIM: That's right.
HK: So do you guys get out to the villages much or are do you stay in the district?
AIM: We go to the villages, mostly in the coastal areas like to interview people for the radio show.
HK: Do the people in the villages want to move to the town?
AIM: Well I don't know all the villages. But I'll tell you that on the coast, no. For a bunch of reasons. One is that the Mwani, who live on the coast, wouldn't mix well with the other tribes. And for a lot of people wouldn't want to move to the town because it's intimidating and where they live is what they know. But there are other people who will try to go there. They hope they can get a job there and make more money.
HK: The town we're talking about now - is that Macomia?
AIM: Yes. A town like Pemba, people will move there only if they have a job in hand, with the government or an NGO.
HK: Have you ever heard of someone from here just going out to Pemba with no job, to look for one?
AIM: Maybe. If they're coming from the town and they have a grade-12 education. Even that is unusual.
HK: And without grade-12?
AIM: No, I don't think so. And you can't get that kind of education in a village - only in the town. The schools in the villages are awful. The teachers are absent or drunk half the time.
HK: So can you tell me a little more about the people around here? What do they do all day? What are they like?
AIM: Well speaking very broadly and making a lot of generalizations: there's 3 tribes. The Mwani are fishermen. Muslim. They're kind of the equivalent of West Coast people. Very kind of relaxed - if there are no fish today we don't eat today. That kind of attitude. They live in the villages and if you asked them what their life plans are they wouldn't really know what you're talking about.
HK: They just take it a day at a time?
AIM: Yes. They're worried about eating today. Not thinking about tomorrow. I hate to say it, but you really can't ... you can't trust them with money, you know what I mean? They're not cut out to do work in a larger economy, to get jobs.
HK: Wow.
AIM: I think a big part of it is the school system which is a huge problem. That's one of the things that I think was better under colonialism. If you talk to people who went to the schools run by the Portuguese, their Portuguese is excellent.
HK: And these people who went to Portuguese-run schools - would you say you can trust those people with money?
AIM: Yes. Much better.
HK: So how about the other tribes?
AIM: The Makonde are warriors. They're the ones who fought in the war of independence and the civil war and as a result, a lot of them are getting pensions for the rest of their lives. I don't think that's a good thing. They're basically alcoholics - they drink all day. Then there's the Makua. They're farmers. Those are the ones who work hard and have a little more hope to get jobs.
HK: Do you know of any NGOs out here that you have a high opinion of?
AIM: Hmmmmmmmm. I really wish I could say yes. But no. Frankly I'm not very impressed with NGOs. All their staff are living high on the hog. How are you supposed to help these people when you're just driving in and out in your trucks and staying in the best hotels in Pemba? I really wish I could give you an NGO recommendation but ... I can't think of NGOs that are really bringing about big changes.
HK: What about small changes? Are there NGOs that are making life better for any of these people that you've seen?
AIM: Not that we've seen. There is a lady around here ... she provides an expensive hotel and services for tourists ... and she has been building some wells. She's really here for money but she's also helping some. Really glad to see her building wells.
HK: Well, if you were to start an NGO around here, what would you do? What do you think are the most promising things to focus on to make people's lives better?
AIM: I'll tell you the two biggest problems people have around here. One is elephants. The elephants ruin the land for farming and people are very upset about it. It's a big source of complaints. The other problem is water. Some of these people have to go so far for water.
HK: That's because of no wells or broken wells?
AIM: Broken wells. Half the time they don't even work the day they're built. Or they break down over time. Someone's got to come here and dig more wells. That's the #1 thing we'd tell an NGO to focus on. Wells.
HK: Good to know.
AIM: Education is also a major major issue. Not sure how to fix it.

Part 26: VidaGas

Notes:

After returning to Pemba, we visited the offices of VidaGas. I interviewed the Chief Operating Officer (audio is included), but covered very little because we had no translator (the translator, Durao and the driver were waiting with the broken down vehicle).

VidaGas buys gas in Maputo, transports it to Pemba, seals it in containers, and delivers it to retail shops, hotels, and the Ministry of Health. It has 1-2 trucks dedicated to delivery in northern Mozambique.

VidaGas's largest customer is not the Ministry of Health, but the Pemba Beach Hotel, a luxury resort that Leah says is popular with soccer players (substantially more expensive than where we were staying). I asked what the Hotel had been using before VidaGas and was told that they had been cooking using wood fires (the same form of heat that had been used for refrigerators by the Ministry of Health).

Part 27: Pemba

Notes:

The next day, Leah left and I hung out on my own in Pemba. Before she left, she took a video of me taking pictures of kids - it's very representative of how that picture-taking usually went.

I couldn't pay for my lunch because the credit card machine and the ATM were both broken, so the hotel let me have lunch on credit. I then walked into the town center to get cash, and took pictures along the way. I saw ARCO, the missionaries that AIM mentioned.

Other

Part 28: Soweto

Notes:

I flew from Pemba to Johannesburg on Sunday (2/21) and stayed at a bed and breakfast in Soweto. The next day, I took a bicycle tour (I was the only person on the tour besides the guide); pics and video are included.

We walked through one of the very poor areas. It was generally filthy (literally strewn with trash) and extremely crowded, with tiny steel shacks next to each other - seemed to me like a much more unpleasant place to live than either the SEF village or even the areas where VR was working (although on the flip side, people in Soweto had access to transportation, electricity, good schools, etc. as they were very close to much wealthier residences). I took pictures of the interior of a "hostel," a residence provided by a mining company for miners.

Soweto had very drastic changes from wealthy to poor to wealthy in a short amount of distance. All of the pictures are from walking and biking.

Source URL: https://www.givewell.org/research/site-visits/south-africa-and-mozambique-feb-2010