Yet, these conditions are preventable and/or treatable. In rural areas throughout the world, people living in poverty lack access to powerful, simple and inexpensive health-promoting products. Even when they have the money to buy products such as insecticide-treated nets, ORS, home water-treatment tablets, antibiotic ointments, contraceptives, or even soap, they are often difficult to find on a reliable basis.

MBH will primarily target rural and underserved communities where access to basic health services and products is inadequate or non-existent. Inadequate access means physical distance from the nearest source. Impediments to access can also result from poor quality or higher prices, which are common in many rural markets. Even where public dispensaries are near, limited supplies or “stock-outs” can effectively deny access to critical health-protection products. Lack of consumer education on health products is another important impediment to access, as demand for products is often hampered by ignorance of their value or even of their existence.

The multiple benefits of MBH will affect families and communities in several sustainable ways; it will reduce disease and death by significantly improving access to proven disease prevention and health-promoting interventions at the same time as educating families in their use and will explore making health products affordable by offering layaway or installment purchase plans for higher-cost items. Finally, MBH will also significantly improve livelihoods in the following ways:
1) Providing a reliable source of income as a Mamasante for thousands of women.
2) Keeping families healthy and enabling income-earners to work.
3) Reducing costs for medical treatments by reducing the incidence of illness.

MicroBusiness for Health could clearly function well in urban and peri-urban areas. However, the initiative is being especially tailored to work in rural areas in order to reach a major portion of this underserved population. MicroBusiness for Health and its Mamasante entrepreneurs is initially being piloted in Ghana. Upon successful completion of this phase with a small group of Mamasantes, MBH will roll out in a phased approach to the entire country with a goal of reaching 80 percent of the rural communities within ten years.

MicroBusiness for Health is an initiative of Freedom from Hunger, a recognized expert in microfinance; adult education for improved health, nutrition and personal finance; and for partnerships with organizations that build local capacity for sustainable implementation of quality programs. In addition to creating and distributing programs and services that are proven effective, Freedom from Hunger is also known for innovation, finding new ways to bring effective self-help programs to families living on the margin of survival. Freedom from Hunger has worked in Ghana since 1985.

There are two levels of sustainable operations to consider:
1) A livable wage for the distributors (Mamasantes) who will make their profit from the margins charged on the products and services they sell; and
2) Sustainability of the franchise itself. Products and costs related to the distribution network will be completely covered by the small profit margin charged to the distributors for the goods they purchase from the franchise.  The core operating costs will use ‘smart-subsidy’ to get the franchise up and running, but it is envisioned to be at 50% operational self-sufficiency within three years and, over time, self-supporting.

The direct-selling system has two other powerful benefits for potential entrepreneurs:
1) Low start-up costs. Unlike store-based franchise systems that can require significant capital, a Mamasante can get started with very little investment. Various start-up strategies are being considered to eliminate barriers to becoming a Mamasante entrepreneur and to assist in the business start-up, including special loans and savings plans provided by rural banks, subsidized sponsorship from donors and other financing strategies.
2) Flexible hours and lifestyle. Mamasante can work on her own schedule and in her own or nearby communities. This is particularly valuable because women must juggle the competing demands of family and household.

Upon successful completion of design and implementation on a limited basis, the initiative will roll out to the country nationwide, in order to capitalize on economies of scale and impact.

Rigorous evaluation of our Malaria Initiative demonstrated that the main barrier to use of interventions such as insecticide-treated bednets or home treatment medicines was not people’s unwillingness to buy or use them, but lack of access and affordability. In difficult-to-reach rural areas, such products have not been readily available and the affordability of items challenges household cash flow. The MicroBusiness for Health initiative began as an attempt to close the critical gaps in access to insecticide-treated bednets but has grown into a more comprehensive microenterprise strategy to bring not only bednets, but many other health protection products, right to the doorstep of poor rural families.

The operating budget of this initiative for FY08, which carries the initiative through its first phase, is $500,000. In order to reach operational scale, however, a budget at twice that amount would be needed for at least the first five years.