Giving Where It Works – NYT.com
November 29, 2011, 9:00 PM
Fixes looks at solutions to social problems and why they work.
At Fixes, we often argue that good ideas are plentiful — but ways to keep them going are hard to find. That’s why we pay a lot of attention to sustainability, especially financial sustainability. Life is always precarious for programs that depend on government financing or charitable donations, particularly so today. So we choose many of the programs we highlight because they have found a creative new way to sustain good work, often through combining social and for-profit missions.
Most social change projects, however, can’t be turned into businesses. After all, they aim to improve the lives of the people least able to pay. Yes, social enterprises are interesting and glamorous — it’s attractive to find ways to marry altruism and profit. But let’s not kid ourselves: most of the time, it isn’t possible. Even most successful social enterprises start by relying on donations — the Grameen Bank, for example, spent 18 years accepting donor funds before it became self-supporting. The need for charitable giving isn’t going away — it’s getting bigger.
When people give, they want to know they are making a difference. So here are some tough-minded programs we’ve written about since Fixes began in October 2010, that make particularly good use of charitable dollars. Like all the ideas we’ve highlighted in Fixes, they are proven to work. All of them spend a relatively small amount now to create huge savings down the road. But these are also programs where a little bit of money can make a huge difference — some are bare-bones operations, and some of them have taken particularly big hits and are scrambling to stay alive.
This court keeps teenagers’ bad choices from ruining their lives. Too often, typical youthful delinquency — shoplifting, talking back to a police officer — can land a teenager in the juvenile justice system, where he will learn to be a real criminal. Youth Court gives first-time, nonviolent teenage offenders an alternative. They are judged by their true peers — other young people. The offender this week is usually on the jury next week. Young people can hear, often for the first time, disapproval of their behavior from their peers, not just from adults. And serving on the jury, writing letters of apology and participating in girls’ or boys’ groups has proved to help them stay out of trouble. “The idea is to take that first encounter with the law, especially for minor things, and use it to put them back on the right track, turn it into something positive,” said Carolyn Dallas, Youth Court’s executive director.
Youth Court is a bargain, saving the district thousands of dollars a year in incarceration costs and helping create citizens who will pay taxes instead of commit crimes. Yet Youth Court’s budget was cut by 40 percent this year, and its staff of five is now working part time. Including all staff and overhead, sending a teenager to Youth Court instead of juvenile justice — including support groups and other services — costs less than $500 per teenager.
A teacher in a poor neighborhood once told Kyle Zimmer that when she asked her students to bring in a book from home, three of them brought in a phone book — the only book in their house. We commonly assume that families who don’t have books are that way because they aren’t interested in reading. But very often, the reason is that they can’t afford books. Ms. Zimmer started the organization First Book to put books in the hands of low-income children in the United States. To date, it has distributed free or at low cost more than 85 million books, mostly through charitable groups that work with poor children.
If you give books to children who don’t have them, good things happen — they become interested in reading, and they read more. Having lots of books in the home is as good a predictor of children’s future educational achievement as their parents’ educational levels. But good things also happen to the publishing industry: First Book has harnessed its large network of education programs to create a guaranteed market and persuade publishers to make low-cost versions of some 2,000 titles — allowing publishers to reach the 42 percent of American children who t were not in their market before. Fifty dollars buys 20 books for a child who has none.
This is one of the most successful, influential and long-lived community health worker programs in the world. It trains impoverished women with very little schooling — many of them are illiterate — to become their village doctors. It’s been going since 1970 and has utterly transformed the villages where it works — people are not only much healthier, they are more prosperous. At its campus in Jamkhed, India, it teaches its methods to people all over India and from dozens of other countries.
The C.R.H.P. accomplishes all this — plus running a modern 50-bed hospital — on a budget that has never gone above a half-million dollars a year. The program has won all sorts of awards (most recently the Times of India Social Impact Award) but recognition has not been matched by money, and it has had to reduce the number of villages where it works. One hundred dollars will buy a village health worker’s field kit. It costs $2,500 to sponsor a whole village for a year — bringing health care to thousands of people.
Riders was the subject of our first Fixes column because of its ingenious strategy for greatly expanding health care in Africa — through motorcycle maintenance.
The group was started by motorcycle racer Randy Mamola, his colleague Andrea Coleman, and her husband, the journalist Barry Coleman, after they visited villages in Somalia where no health care worker had ever gone. They also saw graveyards of dead trucks and motorcycles — bought by the health system to solve this problem but lost to poor maintenance or want of a simple part.
Riders works in seven African countries. In some of them it provides vehicles, mostly motorcycles. But its truly innovative contribution in all those countries is that it keeps those vehicles running. Health care workers get a bike, helmet and protective clothing. They are trained to ride and do a quick check of the bike every morning. A mechanic comes to visit once a month for a tune-up. Now health care workers who used to walk for miles and see only three villages a week can visit 20. It’s comparable to a nearly 600 percent increase in the health care budget. For $30, you can buy a basic maintenance tool kit a health worker can use to keep the bike running; $100 will pay for maintaining a motorcycle for a year.
A prosthetic leg in the United States costs upwards of $7,000. But the vast majority of people in the world who need new limbs are desperately poor. Jaipur Limb, named for the Indian city of its birth, provides limbs at no cost that are specially designed for use by the rural poor — people can use them to walk barefoot, traverse uneven ground, squat or sit cross-legged. People who have spent their lives being carried by relatives come into a Jaipur Limb camp — and they leave walking. These limbs have made an overnight difference between begging and self-sufficiency for hundreds of thousands of people.
An Indian group named B.M.V.S.S. makes these limbs, runs limb camps, and trains and equips clinics around the world. Its financial support comes largely from the Jaipur Limb Project of the Rotary Clubs of Britain and Ireland, which is the way to make a tax-deductible donation from the United States. Forty-five dollars buys the materials for a new limb; total cost of a limb including overhead and labor is $100 to $200.
This center is formally opening its third site in Manhattan this week, on West 17th Street. It has been working for years in St. Luke’s and Roosevelt hospitals, treating some of the toughest patients in the city – people with H.I.V. and multiple other serious illnesses, including mental illness and substance abuse. The clinics are a medical home — a single place where people with H.I.V. can get complete health care. They can even get their teeth fixed and prescriptions filled.
Read previous contributions to this series.
The center’s staff members are not just doctors and nurses. Also important are a group of people who have no medical training at all. Instead, their qualification is that they, too, are living with H.I.V. and have struggled with drug addiction, domestic violence — all the problems their patients are going through. They build trust and comfort by listening to a patient’s problems and talking about their own experience with the same issues. Doctors and nurses can tell patients what to do to become healthy. But it’s the peer counselors who get them to do it.
The program is effective and cheap — healthier patients stay out of emergency rooms. Twenty dollars will allow two peer counselors to run a one-hour support group for patients. One thousand dollars will pay for a year’s worth of continuing education and training for a peer counselor.
This is a nationwide three-year effort to move 100,000 chronically homeless people into permanent supportive housing by July 2013.
Led by a group called Community Solutions, it works with organizations in dozens of cities to identify the chronically homeless, understand their vulnerabilities, persuade them to move into real housing and streamline the process for getting them there.
Every city has a strategy for getting the homeless off the street, but those strategies have often failed because they are uncoordinated, poorly informed and badly designed. The 100,000 Homes Campaign makes a difference by standardizing the process and helping cities teach one another how to do it. It’s now working in 103 cities.
Like the other projects on this list, this effort requires a small investment for large savings — moving people into housing linked with services they need is far cheaper than leaving them on the streets. Two hundred and fifty dollars will buy a basic mattress for a homeless person’s apartment. One thousand dollars can furnish the whole thing.
Tina Rosenberg won a Pulitzer Prize for her book “The Haunted Land: Facing Europe’s Ghosts After Communism.” She is a former editorial writer for The Times and now a contributing writer for the paper’s Sunday magazine. Her new book is “Join the Club: How Peer Pressure Can Transform the World.”