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Livelihoods of low-income families
– Some reflections on micro-enterprises as a livelihood option

After working with over 100 families on livelihood issues, engaged in different micro-enterprises, we are now looking at how do these micro-enterprises become sustainable livelihoods while enhancing the quality and life of the people we work with. A few thoughts about our approach, about what are we hope to achieve, and about what we want to promote through these micro-enterprises.

Let us remind ourselves once again about the nature of the enterprises the families are engaged in. While, ‘enterprises’ or ‘businesses’ are administered to earn profit to increase the wealth of their owners, our surveys have shown, what these women do are neither ‘enterprises’ nor ‘businesses’ in the classical sense of the terms.

– They are subsistence activities which mostly help in their survival (or meeting their daily needs, if all goes well). We call it ‘livelihood activity’.
– The capital is very small in most cases.
– They are mostly conducted among family members and friends within the neighbourhood.
– They are based on ‘trust’ and ‘hope’, rather than ‘records’ or ‘business projections’.
– They are more trade-based, rather than skill-based.
– They are integral part of the person’s personal life. For instance, the workers are mostly family members, the resources are mostly family-based, the dependents are mostly family members, and the whole purpose is to add to the family’s kitty – money for education of children, life-style expenditure of spouse (such as drinking alcohol, jewellery, clothes, etc.), or social occasions expenditure. This can be contrasted to businesses/ enterprises where workers may be hired, resources are raised from the market and profits increase the wealth of the share-holders.

These distinctions have very important implications for our training and approach. What we are addressing through these livelihood initiatives are not business issues, but more of family and community (or neighbourhood) issues. Adopting mainstream business strategies and models for these will fall short as the context is very different. While the market is the parameter for the scope, functioning and purpose of the business, the family relationships, the neighbourhood linkages, the development state of the community in which the woman lives are all issues which will affect her livelihood.

Just to give an example, if a proprietor of a big business, say a large retail chain, falls ill, the business does not get affected instantly. But in case of a subsistence livelihood, the whole livelihood collapses. If family members/ neighbours are fighting in the proprietor’s family, his/her client base need not get affected. But if the family members/ neighbours of a person running a livelihood activity are not in good terms, it can greatly affect the person’s business as client base is largely local. If the economy of an area drops either due to disasters/ general economic downturn, it need not affect the big business, because it can always shift its market or bear losses briefly, while that is not the case for subsistence livelihoods which will collapse.

A key to the subsistence kind of livelihoods is the family & neighbourhood relationships and environment. The focus has shifted from the market to the home and neighbourhood. What we are saying here is that, if the person is doing well on the home front and the neighbourhood in terms of relationships and stability, then it provides an enabling environment for the livelihood activities to take place. We know this because many of the livelihood activities which fail are because there was no family support, or there was a health or some other emergency in the family, or the neighbourhood was not able to provide enough income for the activity. How can our approach then address this reality?

I see it at two levels:
i) Address the relationships part of the livelihood (the family, the neighbourhood), with an emphasis on values in relation to self, close family, extended family and the community.
ii) Address the needs part of the neghbourhood which can be addressed through the livelihood, again with an emphasis on values such as leading a better life, improving social conditions, peace, etc.

How do we translate this in our trainings? How does this affect our methodology of training? How does the current EDP, EAP, follow-up trainings address this reality? Some food for thought…

– Naveen I. Thomas

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Our tryst with medicines
– The investigations of a community worker

Vani earns her living, working as a domestic help in different houses in Bangalore. Her husband, a daily wage earner working in the construction industry, abandoned her and her children two years ago. She now works double time to ensure that they don’t go hungry, and that her children can go to school. Her younger son developed severe stomach pain some time ago. She did a round of the doctors, including the state-run hospital. Each day of absence from work meant a cut in her wages. In a bid to balance her work, income, taking care of her older child and taking the younger one to hospitals, she had to finally settle for a clinic close to her house. The boy was finally responding to treatment, but by then she had lost all her savings, and could not afford to buy the prescribed medicines.

We met Vani at this stage, when she approached our organisation for help, through a women’s Self Help Group which we had organised in her area. It was an all too familiar story for us. We had heard it over and over again – child after child, woman after woman, family after family slipping into poverty because of high medical costs, especially the costs of medicine. A closer look at the prescriptions she carried revealed the pathway to ruin – overpriced, irrational and unscientific medicines taken consistently over a period of time. When we told Vani that half the medicines that she had bought for her child were irrational, and that the other half could be bought at a fraction of a cost if she chose other trusted manufacturers, she was very agitated. She wondered how the doctor who treated her child could prescribe these medicines even after knowing that they were on the brink of bankruptcy.

How indeed? Was she a victim of the deeply embedded doctor-pharma industry nexus? Did the doctor not know the generic equivalents of the costly branded drugs he had been prescribing? Were these medicines prescribed because the doctor’s continuing education about new drugs was from the marketing literature provided by medical representatives of different companies? These questions and many others which arose as we worked in the community led us to investigate a bit more into the drug industry.

Our first shock came when we realised that the all-important issue of policy making in medicines was not handled by the Health ministry, but by the Chemicals and Fertilizer Ministry. This explained the vast difference in the goals of the Pharmaceutical Policy 2002 and the National Health Policy 2002. And it perhaps also explained why health care was the second-most leading cause of rural indebtedness in India, with medicines constituting 50 to 80 percent of health care costs (Medicine Prices and Affordability, AIDAN, March 2009).

The second shock came when we realised that the prices of the same type of medicine in India varied drastically, sometimes as much as 20 times more than the lowest-priced one. For instance, Risperidone 2 mg, a medicine used for psychiatric ailments which cost only Rs.1.69, was priced at Rs.27.00 by another company (16 times). Letrozole 2.5 mg – a medicine used in cancer treatment, which was priced at Rs.9.90 by one company was priced at Rs.181.50 by another (18 times). Sildenafil citrate 100 mg – a medicine used for Erectile Dysfunction was priced at Rs.29.16 by one company, while another company priced it at Rs.584.00 (20 times). With the way medical knowledge has been constructed, if a doctor chose to prescribe a costlier medicine, the patient had no way to determine if a cheaper equivalent was available in the market. That made us wonder why there was no rule which made it compulsory for medical practitioners to prescribe medicines by its generic name. Our research shows that it is already happening in India, in Chittorgarh, Rajasthan.

This discovery also led us to the whole issue of pricing of medicines in our country. We found out that even the so-called free market countries of the EU and UK have some form of control over medicines, such as price controls, volume controls or cost-effectiveness controls. On the other hand, in India the case was different, with the number of medicines under price control steadily declining over the years. Even if individual medicines were under price control, manufacturers found a way around it to get out of price control. In this situation, the very least the Government could do was to bring in price regulation on atleast all medicines in the National List of Essential Medicines based on therapeutic class rather than on individual drugs. Why has this not happened yet? Well, our investigations are still proceeding, and we are searching for the answer. If you get to know why, or how it can be done, do let us know.

– Naveen I. Thomas

Headstreams is registered under the Karnataka Societies Registration Act, Section 12A and 80G of Income Tax Act, and FCRA, Regd Office: #2200, HAL II Stage, Bengaluru - 560008, India