Coffee and Community: Combining Agribusiness and Health in Rwanda

7/31/2019 Coffee and Community: Combining Agribusiness and Health in Rwanda

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Coee andCommunity:CombiningAgribusiness andHealth in RandaBy Irene Kitzantides

Rwanda, the land o a thousand hills, is also the

land o 10 million people, making it the most dense-

ly populated country in Arica. Due to the coun-

trys rapid population growth, around 90 percent o

Rwandans depend on ever-smaller plots o land or their

ood and livelihoods, leading to poverty, soil inertility, and

ood insecurity.

But, ater an amazing recovery rom the devastating genocidethat ended in 1994, Rwanda is now a highly sought-ater

origin or specialty coee. Te Rwandan coee indus-

try holds the key to the countrys rebirth, reconcilia-

tion, and sustainable developmentand also the health

o its citizens. By combining community health edu-

cation and agribusiness development, the Sustaining

Partnerships to enhance Rural Development

(SPREAD) Project seeks to improve both the

lives and livelihoods o Rwandan coee armers

and their amilies.

March 2009

F O C U Son population, environment,and security

J une 2011 Issue

22


2/12Lessons From the First Generation of Integrated Population, Health, and Environment Projects

FOCUS on population, environment, and security

2

The Legacy of Genocide

Rwanda has experienced a remarkable recovery since

the civil war and genocide devastated the countrys

society, economy, and environment 16 years ago.

Close to one million Rwandans were killed, andone-third o the population was displaced. GDP ell

by hal in a single year, 80 percent o the population

plunged into poverty, and large areas o park, or-

est, and armland were destroyed. Between 100,000

to 250,000 women were raped during this time, the

majority o them inected with HIV (Taxton, 2009).

Te legacy o this tragedy is still apparent: Rwanda

lost a signicant portion o its trained human

resources, suered damage to its already struggling

inrastructure, and must now balance administering

justice and preaching orgiveness. Rwanda currentlyhas an estimated 1.26 million orphans and one o

the worlds largest populations o both child- and

emale-headed households (Manning et al., 2008).

Despite such immense challenges, Rwanda has

made tremendous progress in recent years. Te coun-

try is now regarded as one o the saest in Arica, and

tourists once again ock to visit its native mountain

gorillas and other natural areas. Rwanda boasts rela-

tively low levels o corruption, a unctioning central

state with strong institutions, ambitious government

policies, and one o the highest economic growth

rates in the region (UNDP, 2007). It also strives to

maintain a pro-business environment, leading to sig-

nicant interest on the part o oreign investors.

Population-Environment Challenges

Rwandas economic growth and development are

hampered, however, by its population-environment

challenges. Te country is the size o the U.S. state

o Maryland, but holds roughly double the popula-

tion (around 10.6 million) in 2010. With around

403 people per square kilometer, it is the most

densely populated country in Arica (UNPD, 2011).

Around 71 percent o working adults are classiedas subsistence or unpaid armers, which combined

with high ertility rates, leads to extreme pressure on

already scarce land (World Bank, 2011).

Tese population-environment interactions are

outpacing economic growth, leaving 90 percent o

Rwandans living on less than US$2 per day. At its

current growth rate o 2.9 percent, the population

is projected to reach 15.8 million by 2025, which

will likely intensiy over-cultivation o land and soil

inertility, thus decreasing agricultural production

(UNPD, 2011).

Food insecurity remains a real concern: Te average

plot size or arming is around 0.8 hectares, and more

than a quarter o cultivating households arm less than

0.2 hectares; the Food and Agricultural Organization

estimates that at least 0.9 hectares are required to sat-

isy the nutritional needs o a household.

Youth peer educatorslearn ho todemonstrate condomuse (Photo courtesyThe Norman BorlaugInstitute)

Family planning is very

important, because it hasalloed us to put some o our

money into savings.

Female community member

(Source: Kitzantides, 2010)


3/12John Pielemeier

Issue 22June 2011 Irene Kitzantides

3

N

UGANDA

BURUNDI

TANZANIA

AkageraNational Park

VolcanoesNational Park

GishwatiNaturalReserve

NyungweNational Park

D.R.C.

North

Province

West

Province

South

Province

EastProvince

Kigali

10 30

Kilometers

201005

National Parks

Integrated Health/Pyrethrum Zone

Integrated Health/Coee Zone




4

Reproductive Health Successes

Despite the tremendous obstacles o small land area,

high population growth, and the legacy o civil war

and genocide, Rwanda has made remarkable progress

in improving its health indicators, particularly thoserelated to reproductive health. Like many Arican

nations, Rwandans ace several barriers to amily

planning, including a traditional pro-birth culture,

religious opposition to contraception, and a lack o

inormation and services available in the rural areas

where the majority o the population lives.

However, thanks to strong government lead-

ership and support rom development partners,

increased access to a variety o contraceptive meth-

ods, and improved health care work orce training,

modern contraceptive prevalence rates made anastounding jump rom 10 percent to 27 percent

between 2005 and 2007 (INSR & ORC Macro,

2006; MOH, NISR, & ICF Macro, 2009). Te

total ertility rate (FR) decreased rom 6.1 to 5.5

in the same time period, while the inant mortal-

ity rate decreased 28 percent and under-5 mortality

rate by 32 percent.

HIV/AIDS rates, though low relative to the

region, are at 3 percent nationally, rising to 7 per-

cent in urban areas (INSR & ORC Macro, 2006).

Condom use remains low to due to cultural taboos

and lack o access, especially in rural areas, and

myths run rampant about side eects o amily plan-

ning. Diarrheal disease, malaria, maternal and child

health, and poor access to basic health services and

inormation in rural areas are still serious concerns.

Te Rwandan government understands the threats

posed by these population, health, and environment

challenges to Rwandas newound security and devel-

opment. Te countrys Vision 2020 plan delineates

the governments commitment to halving the poverty

rate and increasing the per capita GDP rom less than

US$300 to US$900 (UNDP, 2007).In support o this vision, USAID has dedicated

more than $12 million since 2000 to developing

the enormous potential o the specialty coee sec-

tor in Rwanda (USAID, 2010). More than 50,000

Rwandan coee armers have beneted rom the

growth and improvements in the specialty coee sec-

tor, increasing their incomes and improving their lives.

4

RwANDAS COFFEEINDUSTRY

Since 2000, the United States Agency or

International Development (USAID) has commit-

ted $12 million to develop Randas specialty

coee industry.

with this support, the industry has gron rom

zero exports and zero dollars in 2000 to 3,045

metric tons and $11.6 million in export revenue

in 2009making it one o the countrys largest

export earners.

Today, the U.S. and international demand or

Randas orld-renoned specialty coee

exceeds supply. Randan coee has been

eatured as a Black Apron Exclusive byStarbucks and praised as the best o the best

by Green Mountain Coee. In 2008 and 2010,

Randa hosted The Cup o Excellencethe

rst Arican country to host this orld-renoned

coee competition.

http://www.usaid.gov/rw/

http://www.spreadproject.org/speciality_coffee.php

http://www.cupofexcellence.org/


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Rwandan Coffee: Growing aSpecialty Market

Rwandas climate and altitude provides almost per-

ect growing conditions or Arabica coee, a ner

variety that etches a higher price than others. Since1917, Rwanda has exported coee, which has been

a major source o income or its rural population.

However, poor agricultural and processing practices

limited its quality.

But by 2005, this small Arican nation was gen-

erating sales o more than $3.6 million in the spe-

cialty coee market (Chemonics, 2006). USAID

assistance was largely responsible or the industrys

early success; the U.S. development agency invested

in initial easibility studies by industry experts and

provided technical and nancial assistance to con-struct more than 45 coee washing stations and

improve agricultural practices, coee processing,

business development, and management.

Since Rwandan coee armers own such small

parcels o land, which are shared with other

ood crops, the average armer grows only 150-

300 trees, as compared with an average 12,000

trees per small-holder arm in Central America

(Chemonics, 2006). USAID development assis-

tance thus ocused on orming and strengthening

cooperatives, so that armers could together garner

a higher price or their coee. Quality control and

marketing were strengthened by training world-

class coee cuppers (tasters) and establishing

relationships between Rwandan producers and

specialty importers and roasters.

The SPREAD Story: A HolisticApproach to Development

Since 2006, the SPREAD (Sustaining Partnerships

to enhance Rural Enterprise and Agribusiness

Development) Project, a cooperative agreementbetween USAID and exas A & M University, has

ocused primarily on urthering the development

o Rwandas specialty coee sector. In addition,

SPREAD has expanded its eorts to include some

technical assistance or other high-value agricultural

commodities, such as pyrethrum (used to produce

a natural insecticide) and birds-eye chili pepper.

But Rwandas arming amilies need more

than simply increased incomes to improve their

lives: they also need better health care and servic-

es, as well as education about preventive health

practices and issues like alcohol abuse that can

aect household health. USAID recognized that

the coee sector provides an ideal opportunity

to reach a sizable segment o the population that

may otherwise be overlooked. SPREAD pools

unding or economic growth, HIV/AIDS pre-

vention, and amily planning and maternal and

child health promotion, as well as support rom

the U.S. and UK specialty coee industries, to

combine its agribusiness eorts with an innova-

tive community health component.Tis unique example o integrated programming

is inspired by the population, health and environ-

ment (PHE) approach to development, which aims

to solve development problems in a holistic ashion

and build synergies across sectors that are tradition-

ally siloed. In the past, PHE projects have ocused

on integrating environmental conservation or natu-

Coee armer,Southern Province(Photo courtesyNick Fraser,.nickraser.org)




6Lessons From the First Generation o Integrated Population, Health, and Environment Projects


6

ral resource management programs with commu-

nity health eorts; the SPREAD project is one o aew that are emphasizing agricultural and economic

development, which some argue would be a pro-

ductive avenue or expanding the approach (see,

e.g., Clarke, 2010).

SPREADs Evolution

Integrating community health into the existing

SPREAD program was designed to take advantage

o a number o potential co-benets and synergies:

First, as revenues rom coee increase, armerscould spend more money on amily health ser-

vices, education, hygiene, and nutritional needs.

Second, SPREADs existing community engage-

ment structure (the coee cooperatives) provided a

ready mechanism or rapidly disseminating health

inormation and services at the community level.

Tird, meeting the armers health needs not only

helps achieve the overall goal o improving arm-

ers lives and livelihoods, but could also increase

buy-in rom the cooperative members, thus

improving cooperative development and coee

quality (DAgnes, 2007).

Rather than re-invent the wheel, SPREAD built

on existing resources, such as training, program strate-

gies, educational materials, and human resources rom

the Ministry o Health (MINISANE), Population

Services International (PSI), the International Planned

Parenthood Federation in Rwanda (ARBEF), and

community health services.

Starting in January 2008, SPREAD:

rained and mentored existing coee extensionagents (animateurs de cae) to become health edu-

cators, who reached armers primarily through

small-group education sessions and reerrals to

local health services;

Created a new system o both Youth and Adult

Peer Educators;

Facilitated the sales o PSIs Prudence con-

doms and Sur Eau drinking water purication

solution via cooperative ofces, coee-washing

stations during harvest season, and community-based distribution by coee extension agents and

Peer Educators;

Female coeearmers listen to aneducation sessionby cooperativehealth agents (Photocourtesy Nick Fraser,.nickraser.org)

The big lesson I learned

is that you cannot achieve

your coee production

objectives at 100 percentithout addressing the

health o the armers.

Cooperative leader



7/12John Pielemeier


7

About the AuthorIrene Kitzantides as a Population, Health and Environment Advisor ith

the USAID Global Health Felloship Program, based at the SPREAD Project in

Butare, Randa rom 2008 to 2010. Previously, she served as a natural resourcemanagement/environmental education volunteer ith the Peace Corps in the

Casamance region o Senegal, west Arica. She holds a Masters in Public Health

rom the University o washington in community-oriented public health practice,

and a bachelors degree in anthropology rom the University o Virginia.

7

Combining health ith

cooperative activities is a good

idea, because SPREAD is looking

at saving the entire person and

his/her amily.

Community health orker


Coordinated with local health centers to con-

duct mobile voluntary counseling and testing

or HIV, amily planning clinics, and intestinal

parasite treatment at convenient locations dur-

ing harvest season;

Integrated health messages into the weekly coee

talk-show produced by the National University

o Rwandas (NUR) Radio Salus, Imbere Heza,

supported by Coee Lieline;

Facilitated the creation o community theater

groups and competitions, or both youth and

adults, that conveyed messages about improv-

ing community health and agribusiness develop-

ment; and,

Established demonstration gardens and held

training sessions on improving household nutri-

tion with kitchen gardens.

Smaller-scale activities include supplying sae

drinking water and portable hand-washing equip-

ment to promote hygiene at coee-washing stations

and ofces; and helping two o the target coopera-

tives ulll air trade requirements through provision

o First Aid training and supplies. SPREAD also

leveraged the strengths o its local partners, working

with Aricares mobile cinema equipment to show

HIV prevention lms and with UK-based Health

Unlimited to acilitate community theater troupes.

SPREADs Success

Te health program provided its integrated ser-

vices to three coee cooperatives and one pri-

vately owned enterprise in the southern districts

o Rwanda, totaling around 11,000 coee arm-

ers, plus their amilies and neighbors as no one

is turned away. As o May 2010, SPREAD had

achieved impressive results:


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Challenges and Constraints

Integrating a sound community health program into

an already established agribusiness project is not with-

out challenges. Te overall project was structurally

separated into three programs: coee quality, coop-erative development, research, and community health.

Limited resources and high demands across all three

programs meant collaboration ell on the shoulders o

already overstretched sta, and this eort was made

even more difcult when program sta were located at

three dierent sites throughout the country with lim-

ited telecommunication networks.

Each o the unding streams had its own set o

required indicators or reporting to donors and, at

times, separate systems and points o contact, which

produced a high volume o reporting requirements.Monitoring and evaluation o integrated bench-

marks received less attention than it should have,

again due to the twin constraints o little time,

small sta, and ew resources.

Recommendations and LessonsLearned

My experience with integrating health services into

the SPREAD program leads me to oer the ollow-

ing recommendations:

Farming amilies need more than simply increased

incomes to improve their lives and livelihoods;

although more ormal study is required, project

data and qualitative input rom stakeholders sug-

gest it is easible, cost-eective, and worthwhile

or agribusinesses to combine health outreach

with cooperative extension activities.

Although coee arming cooperatives may not

be deemed high risk or HIV or other dis-

eases, the members still have high unmet need

or basic health inormation and services, andperhaps a greater likelihood o improving their

lives and livelihoods.

Funders could raise the bar o integrated

approaches by investing in evaluation, recogniz-

ing and replicating best practices, and building

the capacity o implementing partners. Funders

should be exible enough to allow implement-

ers to appropriately target interventions to best

meet local needs, which should be reected in

appropriate project rameworks and measures. Project designers and managers should include

time in the design and planning phases to think

through and articulate the overall goal, objec-

tives, and strategies, so that integration makes

operational and conceptual sense:

Look beyond unding prescriptions: Spend

time getting to know the cross-cutting issues

at play in the community, such as youth

development, gender, money management,

and alcoholall o which could impact both

health and agribusiness development.

Determine which activities make sense to inte-

grate: What new activities need to happen to

ensure optimal synergy, and what can be derived

rom other partners?

Consider structuring programs horizontally

rather than vertically: For example, a commu-

nity outreach program could be responsible or

both agribusiness and health education objec-

tives, rather than having separate agribusiness

and health teams.

Design integrated program plans, results rame-

work, and monitoring and evaluation plans and

indicators; dedicate sta and unds or appropri-

ate monitoring and evaluation; and collect base-

line data to allow or true measures o program

outcomes and impact.

9

Men are no sensitive to the

problems o overpopulation and

come together ith their ives to

plan births together.

Cooperative health agent





10

Engage with the community partners and local

health ofcials and centers to align with govern-

mental goals, build on one anothers strengths,

and reduce duplicative service delivery.

Te community-based, peer-to-peer approach isan invaluable way to reach armers with behav-

ior change communication, and strong support,

mentoring, and supervision o community out-

reach agents and peer educators is essential to

maintaining their job satisaction and ensuring

the quality and consistency o their outreach.

References

Chemonics International. (2006, April).Assessing

USAIDs investments in Rwandas cofee sector.

Available online athttp://pd.usaid.gov/pd_docs/

PNADG793.pd

Clarke, Gib. (2010, September). Helping hands: A

livelihood approach to population, health, and envi-

ronment programs(Focus Issue 20). Washington

DC: Woodrow Wilson Center. Available online at

http://www.wilsoncenter.org/topics/pubs/ECSP_

Focus_20_Clarke.pd

DAgnes, Heather. (2007). SPREAD integration rec-

ommendation report. Unpublished manuscript.

Institut National de la Statistique du Rwanda (INSR)

& ORC Macro. (2006, July). Rwanda demographicand health survey 2005. Calverton, MD: INSR &

ORC Macro. Available online at http://www.mea-

suredhs.com/pubs/pub_details.cm?ID=594

Kitzantides, Irene. (2010, May). USAID SPREAD

Project: Integrated community health program mid-

term program evaluation.Available online at http://

www.k4health.org/system/les/sites%252Fdeault%

252Fles%252FSPREAD_Health_Eval_Final.pd

Manning, Judy, Kamden Homann, & Jessica

Forest. (2008, September). Rwanda community

health needs assessment. Kigali, Rwanda: USAID/

Washington.

Ministry o Health (MOH) [Rwanda], National

Institute o Statistics o Rwanda (NISR), & ICFMacro. (2009, April). Rwanda interim demographic

and health survey 2007-08. Calverton, MD: MOH,

NISR, & ICF Macro. Available online at http://

www.measuredhs.com/pubs/pd/FR215/FR215.pd

Population Reerence Bureau. (2010). Datasheet.

Available online at http://www.prb.org/Datander/

opic/Bar.aspx?sort=v&order=d&variable=107

Taxton, Melissa. (2009, February). Integrating

population, health and environment in Rwanda.

Washington, DC: Population Reerence Bureau.

Available online at http://www.prb.org/pd09/phe-rwanda.pd

UN Development Programme. (2007). urning Vision

2020 into reality: From recovery to sustainable human

development. National human development report,

Rwanda 2007. Kigali, Rwanda: UNDP Rwanda.

Available online at http://hdr.undp.org/en/reports/

national/arica/rwanda/name,3322,en.html

UN Population Division. (2011). World population

prospects: Te 2010 revision. Available online at

http://esa.un.org/unpd/wpp/index.htm

USAID. (2010, June). Cofee in Rwanda.Available

online at http://www.usaid.gov/rw/our_work/pro-

grams/coee.html

World Bank. (2011, April). Rwanda economic update:

Seeds or higher growth (Spring Edition). Kigali,

Rwanda: World Bank. Available online at http://

siteresources.worldbank.org/INRWANDA/

Resources/Rwanda_Economic_Rwanda_Update_

Spring_Edition_April_2011.pd


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The heavily cultivatehills o RandasSouthern Province(Photo courtesyNick Fraser,.nickraser.org


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Documents

Coffee and Community: Combining Agribusiness and Health in Rwanda