Poverty reduction should be a primary goal of U.S. foreign assistance. To identify priorities and long-term goals, we consult with local communities, in-country organizations, and people living in poverty themselves.  Matagalpa Province, Nicaragua — On a mountainside in the Nicaraguan highlands, farmer Pedro Granada is counting on worms to help his young children make it through school and on to university. That’s an impressive goal for a man who just completed first grade himself a few years ago, at the age of 30.
Pedro grew up in the 1980s, when Nicaragua was embroiled in a bloody civil war. The war disrupted life for everyone, including children. He never even got the opportunity to begin primary school. Not surprisingly, this has made his life a struggle. But he is determined that things will be different for his children.
Pedro and his wife, Concepción, moved with their three children to this community of Aguas Amarillas a year ago. They’ve built a two-room house and small finca (farm) on land provided by Acción Médica Cristiana (A.M.C.). This Nicaraguan Christian nongovernmental organization has received U.S. foreign assistance through its partnerships with Church World Service and Foods Resource Bank. But this funding stream varies from year to year; currently A.M.C. receives no U.S. government assistance.
A.M.C. has been working in the Matagalpa region of central Nicaragua for many years and understands the needs in the area well. They began by offering health care to families who live far from any medical facility. But when they realized that rural families lacked access to land to grow their crops—and needed to learn the best ways to farm—they expanded their focus.
The Granadas’ finca is part of A.M.C.’s land bank project, which works with rural families to purchase plots of land. The family is buying their land directly from A.M.C., who are also teaching the Granadas better agricultural techniques.
That’s where the worms come in.
Pedro proudly shows off foot-high sprouts of coffee plants that are boxed into a small plot of land just outside the family’s house. He runs his fingers through the rich black soil, a stark contrast to the dusty ground surrounding this plot. He and Concepción are learning how to farm through lombricultura (vermiculture), using worms to produce organic fertilizer for their crops. A.M.C. provides them with “starter worms” that feed on manure from nearby goats, pigs, and pelibüey (a type of sheep). The worms, in turn, produce a rich organic matter that makes the coffee and other crops grow in this eroded area. This is especially important because natural disasters such as hurricanes and mudslides, along with deforestation for lumber and firewood for cooking, have devastated the topsoil in many parts of Nicaragua.
“Acción has been like a bridge for my family, to help us gain knowledge,” Pedro says. “I didn’t know about organic fertilizer. I didn’t know the best ways to farm. I’ve grown maize and beans. Sometimes they would do well, sometimes not. I know more now, and I’m very grateful for what I’ve been taught.”
The coffee plants need a few more years before they start producing income for the family. Right now, they’re the equivalent of a college fund for his children, an investment in their future. In the meantime, the family needs to eat now. So the Granadas are also growing crops for their own consumption: yucca, bananas, plantains, tomatoes, green peppers, sugar cane, mangoes, and citrus fruits. But these are all in various growing stages right now, most not quite ready yet. Eventually the family will be able to diversify its diet, which makes for healthier children and parents.
For the moment the family still relies on rice and beans, the staples of any Nicaraguan diet. As with many staple items in diets around the world, the price of rice has tripled over the last year.
Besides working his own farm in the afternoon, Pedro works from early in the morning at a local plantation, picking the coffee beans in the fields. He makes 40 cordobas a day—about $2.
Two dollars a day must provide for this family of five.
With rising food prices, the Granada family has had to cut back on how much they eat. If they run out of food entirely and anyone has to skip meals, it’s Concepción who does. And yet they express only gratitude for what Acción and funding from development assistance has been able to provide.
So Pedro and Concepción keep working their farm. They tend to their children, to the worms, to their coffee and other crops, looking to the future even as they struggle to live day to day.
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To benefit a country, development aid needs to be a reliable source of assistance, in partnership with recipient countries themselves.  Chinandega, Nicaragua—In northwest Nicaragua, about an hour’s drive from the Honduran border, the country’s tallest volcano, Volcán San Cristóbal, rises nearly 6,000 feet to form a perfect cone that regularly streams gray smoke into the air. At the volcano’s base lie the pasturelands of another force of nature, rancher Nubia Baca.
This determined woman now owns 60 head of dairy cattle on her ranch on the outskirts of Chinandega. But two years ago, after her husband died, Nubia didn’t know if she would even be able to keep her land, must less run a ranch. It was a smaller farm then, with fewer cows producing less milk each day.
“My husband didn’t really think you needed to invest in the farm,” Nubia recalls. “He believed in the traditional ways, that cows could eat whatever’s growing on the land.”
That meant the cows ate mainly the scrubby underbrush growing wild over much of the land. Now a vast field of alfalfa plants, tall and blooming with golden flowers, has displaced that growth. Nearby is the Cameroon grass and sugar cane. This blend of proteins and carbohydrates is more nutritious for the cows. It’s tastier, too, and yes, cows have taste preferences. Nubia’s cows are healthier and producing more milk than ever.
She learned these techniques from agricultural trainers working for Cuenta Reto del Milenio, Nicaragua’s arm of the Millennium Challenge Corporation (MCC). The MCC is a relatively new U.S. development assistance program. Bread for the World members worked to establish the program through the 2003 Offering of Letters.
With multiple year compacts, the MCC intends to provide a steady source of funding for countries committed to good governance, economic freedom, and investments in people. This differs from other U.S. aid programs, which can only commit funding for one year at a time. MCC-country programs like Cuenta can count on the money being there and plan accordingly.
Besides the training, Cuenta has provided Nubia with 30 percent of the funding to run her ranch for the past two years. She learned about the program through her involvement with Consejo de Mujeres (Council of Women), a local collection of women’s groups. As the MCC first explored what needed to be done in Nicaragua, they consulted with this group for input from the area’s women. Their feedback led to significant improvements in the project. Cuenta hired a gender specialist, Sylvia Torres, to focus specifically on the needs of women and the best ways to work with them, especially to establish small business ventures and agricultural cooperatives.
Nubia learned quickly. Initially she only sold milk straight from the ranch. As her cows’ milk production increased, she realized she could earn more if she used some of the milk to make cheese and leche agria (sour milk similar to sour cream), popular in Nicaragua. So Cuenta helped her purchase large metal milk canisters and a refrigerator for her house, where her cheese-making venture is centered. From 50 liters of milk, she gets about 30 pounds of cheese. In the verdant rainy season, her cows can produce 1,000 liters of milk every day.
The community now knows that Nubia sells dairy products from her home. Some days the line is down the block. She’s also providing employment for others. Six men work for her at the ranch; three women help with the cheese-making.
While she’s proud of her work, she wishes she’d discovered the possibilities years earlier. Both her children have left Nicaragua to live in other countries, her son in the United States and her daughter in Spain. They believed that the lack of job and economic opportunities meant they couldn’t afford to stay and raise families in Chinandega. But Nubia holds out hope that they might return and take over the ranch as she ages.
Seeing what she’s been able to accomplish, she thinks it might work better under her daughter.
“I named (the ranch) Deysi, which is also my daughter’s name. Maybe it’s meant to be hers,” Nubia says with a smile.
U.S. development assistance should be flexible enough to address the multiple needs that arise when fighting poverty.  Eldoret, Kenya—In Kenya, HIV-positive people are realizing something once they begin taking the anti-retroviral medications that save their lives: They’re hungry.
People whose immune systems are severely compromised often lose their appetites. As they regain their strength, they regain their appetites. But in Kenya, all too often these people are the ones responsible for growing the food they and their families eat. Most likely they have been so sick they’ve had to neglect their crops. Then mothers and fathers find themselves without enough food to satisfy their own needs, much less the hunger of their children.
Doctors at the AMPATH Center quickly recognized this dilemma. AMPATH (Academic Model for Providing Access to Healthcare) is a system of HIV/AIDS care and treatment centers in western Kenya. It grew out of a long-standing collaboration between Indiana University in the United States and Moi University in Kenya.
When the project started in 2001, it was treating 250 patients a year. In 2004, it began receiving U.S. development assistance through the President’s Emergency Plan for AIDS Relief (PEPFAR). Now AMPATH doctors are treating more than 70,000 patients a year, and hope to see that number grow to 150,000. Bread for the World members have worked to secure funding for PEPFAR since its incepton.
When treating their patients, the doctors realized how important nutrition is to a comprehensive treatment plan. Good nutrition can delay the development of HIV into full-blown AIDS. But the food must be available and affordable. Too often it wasn’t for AMPATH’s patients. Some of the doctors began buying food themselves to give to their patients. But of course, that’s not a sustainable solution.
So they decided to incorporate nutrition prescriptions into their treatment. AMPATH staff members assess the nutritional status of every patient, along with their household food security (the food available for the patient and each family member). This latter point is crucial, as they discovered the futility in asking an HIV-positive mother to keep food for herself when faced with hungry children. When beginning treatment, patients receive food to feed themselves and their households—fruits, vegetables, beans, corn, oil, and sugar.
AMPATH recognized that providing food for their patients can also create an unhealthy dependency on their services. So they explored the next need: livelihood programs. As their strength returns, patients enroll in business or agricultural training. For example, AMPATH is training clients to grow passion fruits with the idea of setting up a factory to make passion fruit juice, a very popular treat in Kenya.
This stage of services is called the Family Preservation Initiative, because it’s doing just that: keeping families together and helping them become self-sufficient. The majority of patients cared for by AMPATH are among the poorest in the world. Many of the patients have already lost their spouses to the disease. Though sick themselves, they are often solely responsible for caring for their own children as well as for orphaned children of family members. In the face of these needs, for AMPATH, comprehensive treatment must take on a whole new meaning and a sense of urgency.
But here’s the snag: AMPATH has had to struggle to get the Family Preservation Initiative funded. PEPFAR is intended to fund prevention, treatment, and care for those suffering from HIV and AIDS; its focus is not on livelihood training programs. For instance, PEPFAR funds cannot purchase farming inputs like seeds or systems to help with irrigation. When farming input costs triple, as they have over the last year, the program runs up against severe shortages.
“We learned from our patients that drugs alone are not enough, just as food alone is not enough,” says Fran Quigley, a Bread for the World member from Indianapolis who works with AMPATH. “For many Kenyans, they need a hand-up, not a hand-out, to learn new skills or get some farm inputs or get started on a small business that will lead them to self-sufficiency.”
AMPATH has the right approach, what they describe as “building a road and following it.”
“A holistic approach is essential to the overall success of this program,” says Steven Lewis, who created the initial AMPATH farms. “Not only are we providing people with drugs, which is one major component to actually bring them back up, they also then need school fees. They need food. They need income generation. They need to get their lives back up in order again. So, what we’re looking at is just building up their self-confidence and encouraging them to be self-reliant.”
When designed well, with more flexibility, development assistance from the United States can provide this holistic approach.
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