Women at a Communal Bank Association meeting. Photo courtesy of Pro Mujer

Today, like every day, Adela Reyes, 56, gets up at five in the morning. She serves her family breakfast, prepares lunch, organizes the household, sends the kids off to school, and takes care of her 11-month old motherless grandson, her daughter having died in childbirth in home birth in an isolated rural community. Adela leaves the house at 8:30, carrying the baby on her back as she makes her way to the small business she runs: selling school utensils in a local market. As she walks, she does mental arithmetic: today, she is due to pay back a third of the loan she owes for her business.

For many, Adela is just one more of the thousands of poor women who live in Bolivia. Although the country has made some progress in poverty reduction, it is still the poorest country in South America, and recently surpassed Brazil as the continent’s most unequal country (as measured by the widely used Gini coefficient).

For others, Adela is an indigenous woman who received a fourth-grade education with a lot of difficulty. Of all countries in Latin America, Bolivia has the largest indigenous population (about 60%), a group of people with various mixed identities who rely on a private enterprise-based western economy, combined with indigenous spiritual values, bilingualism, and traditional customs including the use of traditional clothing.

For those who understand the world of microfinance, Adela is one out of the approximately 918,000 clients served by the microfinance system in Bolivia (as of December 2010), of which women participants constitute 58.57%. For many years now, Bolivia has been a world leader in microfinance.

In the health arena, on the other hand, Bolivia has consistently underperformed, coming in second worst only to Haiti on the American continent. Adela and her family are represented in these statistics, since for every 1,000 live births, fifty Bolivian children die before their first birthday (2008, ENDSA); for every 100,000 births, 310 women die in childbirth or shortly thereafter (2008, ENDSA); and average life expectancy for Bolivians is 65.4 years (2007, UNDP). The statistics have shown a tendency to improve, but Bolivia still lags far behind other Latin American countries.

Bolivia’s health system is fragmented, split between public health, with staterun hospitals and health centers; private medicine; and the social security system. The latter only covers one out of every four Bolivians, which means the rest need to use money out of pocket to pay for health care. Unfortunately, Adela is part of the group with no coverage.

In a sense, Adela represents each of these statistics. But to Pro Mujer, a social development organization, she is a strong, respected woman and president of her Communal Bank, a group of 20 to 30 women who have organized as an association to access credit. Adela began her business six years ago with a US$100 microcredit granted by Pro Mujer; in addition to Pro Mujer’s financial services, Adela also attends medical checkups with her children and grandson at the Pro Mujer agency, and she receives training in health, personal care and basic business skills. She is very proud of being the head of her household and counting on a business that has grown considerably in the past few years because of her effort.

Pro Mujer began its health services in 1998, with full coverage in all its offices. In the last two years, it is starting to bring these services to rural communities, where health care is precarious or nonexistent, and where cultural practices often rely heavily on herbal or animal-based remedies, as well as the use of rituals.

Women like Adela—whose struggles may be the same, a little bit better, or a little bit worse—are members (or clients) of Pro Mujer. Pro Mujer aggregates approximately 93,000 women in Bolivia and close to 212,000 women in the five countries where Pro Mujer operates—Argentina, Bolivia, Nicaragua, Mexico, and Peru. These women all share a common denominator: they are entrepreneurial women who live or have previously lived in precarious conditions; who suffer from social exclusion, limited access to health services, and limited sources of financing, because while they need capital to launch a business, very few financial institutions take the risk to lend under these circumstances. They are all brave women who fight for better days, who take care of their health, and who have started their own businesses to support their families.

For the last five years, Bolivia has had a populist government under the indigenous leadership of President Evo Morales, who has made considerable strides in public health, especially by giving economic incentives to make sure women use prenatal and postnatal services and take their children for regular checkups. But it is precisely because of this policy of incentives that the public health clinics are overloaded. The consequent long waits at public health clinics represent a costly loss of productive work time for women like Adela and other Pro Mujer clients, so they prefer not to use the public system. Since they are not wage workers, they do not have access to the social security system. Thus, they often become victims of an unregulated private health system that charges too much in relationship to their unstable income. The health services provided by Pro Mujer fill a niche with easy access to free, high-quality primary care.

It is far from easy to combine financial services with human development services, such as health care and business training. But this is the formula that Pro Mujer has applied succesfully for more than 20 years, working to empower women and in the process, benefit their families and communities.