Healthy Village

My name is Joke Le Poole, and I am the Co-Founder and Director of Max Foundation. My background is in the corporate sector, which has influenced how I approach decision-making and organisational development at Max Foundation. I have an engineering background from the Technical University of Delft and Imperial College London, and worked at Heineken Company for 14 years. At Heineken I held a broad range of responsibilities, including supply chain, marketing, and logistics, before settling into the role of Innovation and Development Manager for 5 years. In our search for an effective way to fight child mortality, this business background helped me in thinking: how will we get most value for the donated money we spend? Where and how will our impact be largest, and most sustainable? 

We are committed to solving the problem of childhood mortality and stunting (being too small for ones age) by driving down rates of preventable diseases such as diarrhea and dysentery. 

Within the Healthy Village programme, we work with an integrated approach of safe Water, Sanitation and Hygiene (WASH), awareness on nutrition, and safe and healthy motherhood (including sexual and reproductive health services). This has proven to be effective in driving down rates of preventable diseases. 

Our methods to drive long-term behaviour change in these fields include community- and government engagement, support of entrepreneurship, and access to finance. We aim for institutional change to ensure the communities in our project areas become healthier as a whole, with a positive impact on child stunting and mortality rates.

This elevates humanity by giving children in low-access areas the opportunity to grow up in a safe and healthy environment, greatly enhancing their future prospects

Around 4% of all children in South Asia, and up to 8% of children in Sub-Saharan Africa,  will not reach their fifth birthday. Additionally, approximately 144 million children under five are stunted (too short for their age) worldwide, and 80% of them live in South Asia or sub-Saharan Africa. Being stunted has grave effects on the further cognitive and physical development of a child.

In Bangladesh and Nepal, 36% of the children under five are stunted, in Ethiopia it is 38%. 

Undernutrition and water-and sanitation-related diseases are amongst the main causes of poor health, stunted growth and death for children under five. However, this is preventable. One of the ways to prevent these diseases is by increasing access to safe water, sanitation and hygiene, sexual and reproductive services, and good nutrition.

Our mission is to provide children under five with a healthy start in life and a better future, by reducing levels of stunting and fighting childhood mortality.

Our ‘Healthy Village’ programme has an integrated approach of safe Water, Sanitation, and Hygiene (WASH), nutrition, and health components, including sexual reproductive health.       

To create a long-lasting behaviour change, we work closely with the stakeholders in our project-areas: the communities themselves, national and regional government, local entrepreneurs, and the financial sector.       

Project field-staff create a sense of urgency through education in community settings, such as court-yard meetups in the villages. This creates demand for good WASH, nutrition, and health-related services, and prompts willingness on behalf of the community to invest time, money, and effort into receiving these.

We believe the supply to match this demand should be locally carried, and work as a catalyser to grow income and expertise. We train local sanitation entrepreneurs and “Health Promotion Agents” in the communities, who become experts in providing and maintaining high quality products and services. 

By engaging local stakeholders from the start, we catalyse lasting change in sanitation and hygiene behaviour in the entire community – guaranteeing better futures for children and their parents.

Our project areas are in rural, hard-to-reach and low-access regions.

Behaviour change, which is key in creating sustainable change, starts with community mobilization. Therefore, we make sure to work closely with the communities in our project areas. 

In Bangladesh for instance, we currently work with five partner organisations who are not based in the capital Dhaka, but in the Southern Coastal areas of Bangladesh. Our partner organisations and the field officers we work with (of which there are currently around 360) are highly integrated in these communities, and sometimes reside within them. 

In Ethiopia, we will be active in the Sekota districts, which are recognised as amongst the most deprived and impoverished, with high levels of stunting and a high population denstity.

As we work with local implementing partners, who are generally based in the communities we work in, local entrepreneurs, as well as the regional and national authorities, the needs of our beneficiaries' are highly embedded in our programme design. By driving systemic change that addresses access to goods and services, we can create a long-lasting impact and improvement for the communities we work with.

By working with hard-to-reach, low-access rural communities in Bangladesh and Ethiopia, we are elevating the opportunities for a healthy start in life for children who normally would not have access to tools and services in the fields of Water, sanitation, hygiene and nutrition. Our training and support of entrepreneurs also contributes to the economic well-being of rural communities with little access to economic means. 

We also elevate issues by increasing awareness on the level of regional and national governments, by working together on solving the problem of stunting, and co-creating roadmaps for future implementation.

When founding Max Foundation, we wanted to create the most impact for every euro spent on the project: maximum value for money. We were driven by the movement of effective altruism within the development sector, which focuses on using reason and evidence to do the most good possible.

This research led us to Bangladesh – which is where Max Foundation started. We started working on safe WASH (water sanitation and hygiene), as this is one of the biggest influencers on water-and faecal borne diseases that cause mortality and stunting. 

Over the years, research and experience, as well as the cooperation with regional stakeholders in our project areas, made us realise that integrating nutrition in our interventions, as well as safe motherhood and sexual and reproductive health elements, was needed to get to the comprehensive, long-lasting change that we wanted to achieve. 

Together with the team in Bangladesh, and in cooperation with our partner organisations in the communities and the governmental institutions we were working with, I designed the Healthy Village approach. 

My passion for this project is rooted in a personal story. In 2005, my 8 months-old son Max sadly passed away from a viral disease. The virus attacked his organs and became fatal. Fortunately, it is extremely rare in the Netherlands that a healthy child dies so suddenly. 

I felt that no parent in the world should have to go through this, and it made me want to help avoid children’s deaths wherever, and however possible. Through research, we soon found out that in many countries children die from easily preventable diseases. So, we decided to maximise our impact in those areas – to safeguard a future for as many children as possible.

This brought us to Bangladesh, and we have been able to create a strong team of 38 people there that enable us to reach this goal. We now want to scale our concept of Healthy Villages to as many regions as possible – to be able to prevent as many easily preventable children’s deaths as possible. Knowing the pain of losing my son drives me to work for Max Foundation every day. 

I have overseen the transition Max Foundation made from being a voluntarily run group to a having a highly skilled team, with high quality standards, in the role of its director. As a co-founder, the vision of our Healthy Village approach “providing a healthy start of children” is close to my heart. My entrepreneurial spirit, which are rooted in my family (my father started his own business) and my 10-year managerial experience at the Heineken Company, are of much use. 

That being said, I am not the only one delivering this project. I believe strong regional teams are essential. From the start our country director Riad Mahmud has been very involved in our programme’s growth. When we first drafted the ideas of what would become the Healthy Village approach, it was just me and him brainstorming at his kitchen table. I think you cannot have an international programme without having partners in the country you work in: Riad Mahmud built up a strong team in Bangladesh in the 9 years he’s worked for Max Foundation, and we intend to do the same in Ethiopia. I think my eagerness to redistribute part of the direction to local directors, and seeing the importance of a great, invested team, as well as my passion for impact we want to create, make me very suitable to deliver this project internationally.

While there have been many examples of overcoming adversities over the last 15 years of Max Foundation, the biggest example of my ability to overcome adversity is the founding story of the Foundation: turning around the tragic event of my son Max passing away.

As described above, my husband Steven and I founded Max Foundation after our son Max passed away just before turning 1 year old. This immense loss was stifling, but at the same time we wanted to prevent what happened to Max from happening to other children: we wanted to prevent other parents from going through this pain. 

We decided to research the causes of childhood mortality globally, and the most effective ways to fight it. In doing so, we were inspired by the principles of effective altruism: using evidence and reasoning to determine the most effective ways to benefit others.

We managed to transform our great grief and loss into something positive, with a long-term impact on other children and parents' lives.

In 2011, 6 years after founding Max Foundation, we were at a point in the organization where I could see it had a lot of potential. However, with an entire team doing this work voluntarily and beside their main job, it was hard to reach that potential on a larger scale. That’s when I decided to quit my full-time job, and give myself 1 year to get to a place where we could pay staff in the Netherlands and Bangladesh – while remaining as efficient as we wanted to be. 

Together with two voluntary board-members I took on this challenge. We secured the writing of a project-plan together with the Dutch Embassy in Bangladesh, and received our first institutional funding to implement this shortly after. This is when I officially became director of our professionalized organization, and hired a team in the Netherlands and a country-director in Bangladesh. From there on we started to grow.

I believe that this leap of faith; distancing myself from a managerial position at a corporate to dedicate all my time to Max Foundation, turning a voluntary organization into a professional one, and overseeing the development of teams in two countries, highlights my leadership ability.

Innovation is one of the core values of Max Foundation. 

For the Healthy Village Programme, we spearheaded the integrated approach of not solely working in one sector and with one ministry/department (such as the water department), but integrating the departments and offices of other sectors (such as nutrition and sexual and reproductive health). In Ethiopia, this is shown through the letters of intent signed by three different ministries (Health, Agriculture, and Water, Irrigation and Energy) for the implementation and cooperation on our Healthy Village programme.

Our business-driven approach keeps us on our toes. In Bangladesh, we have installed a call-centre that cross-references and follows up on our partner’s data collection in the field. We aim to constantly adapt and change based on the research and data collected.

On top of that, we also constantly innovate in our own financial management: we have introduced a payment-by-result financial model, which shifts our work from the traditional input-based development payments to an achievement-based model of incentivisation.

Our Theory of Change has been developed to guide and inspire our work towards our overall goal of contributing to a reduction of stunting and water- and faecal-borne diseases in children under 5, through creating sustainable social businesses and influencing change within the sector via engagement and advocacy.

IMPROVING CHILD HEALTH:

We believe that an integrated approach can tackle the roots of child mortality, morbidity, and impaired child growth, and this is best done through collectively addressing practices in the areas of WASH, Nutrition, and Sexual and Reproductive Health:

• Safe WASH (Water Sanitation Hygiene) - effective WASH interventions include food hygiene, handwashing with soap, use of hygienic latrines, and Baby WASH.
• Good Nutrition –facilitating access and availability to nutritious food and use of a diverse diet.
• Sexual and Reproductive Health Services - to ensure safe motherhood and a healthy environment for women and girls.

These three fields feed into each-other, and our experience has shown that the best outcomes happen when they are tackled integrated and cross-sectoral (with multiple ministries, stakeholders, and agencies).

BUILDING BUSINESS:

We believe that accelerating development should be done through market-based solutions, and that local entrepreneurs are the key to economic development. Therefore, we always significantly emphasise the business models within our programmes. Through our programmes we have developed different business models on WASH and nutrition products and services for entrepreneurs, with a priority on supporting female entrepreneurs.

(As a spin-off of these activities we have set up a separate social enterprise in Bangladesh, named Max TapWater. With it we aim to bring affordable, safe water to households in Bangladesh through mini-grid piped water supply systems, locally operated and provided as paid services. The aspiration is for Max TapWater to be financially independent on the long term.) 

Our projects that have taken the Healthy Village approach currently serve 1.2 million people in Bangladesh. In one year, this number will be the same, as we are not expanding our project-areas in Bangladesh currently (the Healthy Village projects are based in the same region for several years, so that the healthy habits and ecosystem of supply and demand become sustainable). 

However, next year we will also have started in Ethiopia. It is estimated that half-way through 2021, we will be working in a region with around 50,000 beneficiaries in Ethiopia. 

In five years we are estimating to work with 400,000 beneficiaries in Ethiopia, as well as aiming to scale up our work in Bangladesh and potential other countries to be serving a projected 3 million people world-wide.  

In the coming year we are working mainly on our COVID-19 response in Bangladesh. Our project-areas have very low-access to hospitals and medical equipment, and it is highly important that we prevent COVID-19 from spreading in these regions. Our COVID-19 approach fits perfectly within our Healthy Village approach; improved hygiene measures and investment in health are the key features of both our Healthy Village programme ánd a COVID-19 response. 

At the end of last year, we hired our first team-member in Ethiopia. In the coming year we will start the implementation of Healthy Village Ethiopia with this team, and in cooperation with the ministries of Water, Health, and Agriculture. In 5 years, we aim to have reached 400,000 beneficiaries, of which 300,000 with improved sanitation, and 200,000 with increased safe water access and food intake. 

As we have been invited by the three ministries mentioned above to feed into their national policies and programming addressing stunting, we are assured that within the next 5 years institutional change will have been brought about. 

In the next five years, we aim for focused growth in the three countries we currently operate in, to create further proof for scale-up to at least one additional country. On top of that, we aim to enhance our capacity in data collection on stunting, so that we may improve our M&E and impact assessments.

We see three main barriers or challenges in the upcoming years: 

COVID-19 
COVID-19 has affected everyone everywhere. It has posed a challenge on our operations in two ways. Firstly, if community meetings are put on hold because of distancing, this changes our programmes that are partly based around village congregations. Secondly, it has caused a hold on some of the financing we were supposed to receive from some of our donors. This financing has now been confirmed, but naturally this caused some delay in our programming. 

Concept adaptibility
We place a lot of importance on regional demand and knowledge in our programmes. Our programme has proven to be very succesful in Bangladesh: now, how do we create a similar programme in another country or region, without simply copy-pasting? In other words, to what extent can we standardise a successful programme, however still make it regionally adaptable? We have worked on this in Ethiopia throughout the last year, and would continue with this in the upcoming years as the concept scales.

Organisational growth
Throughout the last years, we have grown significantly – in terms of finance but also teammembers and scale. How do we manage the growth to a team spread over several countries? How do we manage to stay efficient and sustain our impact? How do we remain regionally and culturally embedded, while entering new project-areas?

COVID-19
The barrier faced concerning financing delays have been partly overcome – since our work is crucial in aiding the prevention of the spreading of COVID-19, the paused funds will be reignited in the near future. We have found ways to continue our programmes with distancing measures in place, examples being our mobile-phone campaign.

Concept adaptability
Last year, we started the process of building up a team in Ethiopia, who will navigate this adaptation. We are also approaching this through an extensive process of South to South learning: what are the lessons learned in Bangladesh? Why did/ didn’t they work? Conversations between the country-director in Bangladesh and the country director in Ethiopia are crucial. On top of that, we are engaging with regional NGOs for implementation, as well as with the ministries of Health, Water, and Agriculture for our programme adaptation. This experience could help us in drafting a scalable framework or concept, which is locally and nationally adaptable to connect with regional demand and needs.

Organisational growth

Managing the organisational growth, and the restructuring of this, is where our main barrier lies. We are redistributing resources to this internally - creating new processes, dedicating board-meetings, and planning international strategy sessions to the topic. The connection between the team in Bangladesh and the team in Ethiopia is crucial in this process. However, as we want most of our resources to flow straight to our programmes and project areas, finding a balance in managing this growth is critical.

We always partner with the regional authorities in our project-areas to ensure sustained growth and regional policy change. Besides this, we work with international NGOs, emmbassies and ministries, and, crucially, regional implementing partner organisations. Below you can find a break-down of our current and upcoming programmes with the Healthy Village approach, and the organisations and institutions we are partnering with.

Healthy  Village Ethiopia:

• Plan International Nederland
• Wageningen Environmental Research
• Ministry of Water, Irrigation and Energy, the Ministry of Health, and the Ministry of Agriculture.
• Regional Implementing Partnes: ORDA, iDE
• Potential knowledge partners such as KIT (the Royal Tropical Institute) and IRC (the Water and Sanitation center) 

Healthy Village Bangladesh:

• Ministry of Water DHPA, 
• Embassy of the Kingdom of the Netherlands
• Regional Implementing Partners: Jagrata Juba Shangha (JJS), SKS Foundation (SKS), DAM, SLOPB, Shushilan

Right2grow alliance:

• The Hunger Project Netherlands 
• World Vision Netherlands
• Acción contra el Hambre España
• Save the Children Netherlands
• CEGAA South Africa.

Our programmes are primarily funded through grantors/donors, but within the Healthy Village programmes we have business models concerning the local entrepreneurs and governments through market mobilisation, investment, and leverage. 

Our business model combines public and private funding. End users (communities/ households) purchase their own sanitation, hygiene products and food, but they don't pay for everything Healthy Village delivers. Likewise, government can’t meet its commitments without market-based solutions (blended financing). Ongoing training and support for the community, local government, private- and financial sectors will be sometimes self-sustaining, but sometimes covered by national government programmes.

Loans from third party Micro Finance Institutions ensure access to credit for ultra-poor households for purchasing sanitation products.

The entrepreneurs’ revenues come from sales of WASH products & services, both for manufacturers and sales agents who receive commissions, e.g. for latrine sales. Revenue increases as more customers invest in their family’s sanitation, also facilitated by access to micro-credit. 

We divide the total cost of delivering the Healthy Village market mobilisation package on water, sanitation, hygiene, food and nutrition security, per beneficiary.

The revenue model of the entrepreneurs will change due to improved income of the consumers. We will explore product diversification, such as handwashing devices (successful in Bangladesh), and entrepreneur groups to jointly negotiate with suppliers.

We reach financial sustainability for our own programmes through sustained donations and grants. Usually these are multi-year commitments from governmental institutions.

We reach financial sustainability within our programmes through our collaboration with local authorities/governments and entrepreneurs.

Local authorities / governments: 

Our goal is to feed into national policies, based on joint best-practice and evidence and learning. This is why we cooperate with government bodies from the get-go. Through government engagement, sustainability and national scaling of the Healthy Village concept can be assured.

Local entrepreneurs: 

By supporting entrepreneurship in the regions we work, we assure that demand and supply is carried locally - and that the communities do not become dependent on products or sevices that need to be brought in externally.

Our programme in Ethiopia, which we are implementing with the Ethiopian ministries of Water, Agriculture, and Health, Plan International Netherlands, and Wageningen Environmental Research Network, has received 15.8 million dollars from the Royal Embassy of the Netherlands in Ethiopia. However, we will need to make an own contribution of 847.350 dollar as a leverage for this amount. Thus, the funds we are looking to raise have a leverage of 1:14.

Our estimated expenses for 2020 were originally higher, however as COVID-19 had an impact on some of our grants (that were delayed or altered), we have had to adjust these. In 2019, our expenses were close to 3.4 million USD, which is what are current estimation for 2020 is as well.

In scaling our Healthy Village concept, and starting its implementation in Ethiopia, the Elevate Prize could help us in several important ways. 

The mentorship and support that would be offered in terms of professional management and development services would be crucial in managing our organisational structure as a growing Foundation. With a team in several countries and a growing number of beneficiaries and partner organisations, we are in need of capacity building and resource management support. A connection to experts that can support us with our concept adaptability would be of incredible added value to the Healthy Village projects.

The global platform that the Elevate Prize provides, in terms of connections as well as support in media and marketing, would be critical in spreading the message of our Healthy Village approach, and scaling our concept to other regions. 

Lastly, we are looking for an additional 850.000 USD for our Ethiopia programme, and the potential financial compensation offered by the Elevate Prize would help us in providing this leverage for the 15.8 million USD from the Embassy of the Netherlands in Ethiopia.

Since effectiveness and impact is one of our core aims, we would love to cooperate with parties or organisations that can help us prove the impact we make, and help us prove (and improve) the effectiveness of our programmes. A great example of one of these organisations would be 'Givewell'.

Besides this, we are open to all organisations and people that are interested to help us develop Healthy Village into a scalable, adaptable concept that can provide children with a healthy start in life globally.