In the Democratic Republic of Congo, where nearly one in 10 children dies before the age of five and half the population lacks access to clean drinking water, the traditional approach to aid–donations–hasn’t worked very well. Despite tens of billions in international aid delivered to the country since the turn of the millennium, it’s still hard to find clean water. Health clinics regularly run out of medicine. After more than two decades of conflict, it keeps getting harder to get new donations to keep everything running.
A startup is piloting a new model of aid: a community-run business that sustains itself. Called Asili (the name means both “tradition” and “what holds us together” in a local language), it includes three interconnected parts. A farming cooperative gives loans of seeds and fertilizer and gives access to a guaranteed market for crops. With income from the farms, families can afford the Asili’s other two services–kiosks that sell clean water, and modern healthcare at clean, well-stocked clinics.
In January 2017, three years after launching, Asili saw its first profitable month. Now 25,000 people have access to water for the first time; to date, the business has sold more than 1.3 million gallons, piped in from a clean local water source. The clinics, which have served thousands of patients, open each day at 7:30 a.m., in a region where 40% of clinics are closed, unpredictably, on any given day. The pharmacies inside the clinics have never run out of the medicine they provide.
“We’re doing this in the hardest place in the world, and it’s working,” says Daniel Wordsworth, CEO of the American Refugee Committee, the aid organization that co-created the startup with USAID, Congolese community members, and the design firm Ideo.org.
The business is an early experiment as the American Refugee Committee thinks about how to evolve for the future. “We’re trying to grapple with this idea of what a 21st–century humanitarian organization looks like, and what a 21st-century humanitarian response looks like,” he says. “Our view is that everything you’re seeing around are kind of like perfected 20th-century institutions. They’re like big, dumb, scaled machines that deliver ‘results,’ but it’s all a little bit Comcast-y. There are some great things about Comcast–like they go everywhere and they do everything at scale, and it kind of works–but it also kind of sucks at the same time.”
Rather than focus on scale, Asili is focused on customer service, and providing a quality product that people are willing to pay for. “I think in our world, everyone thinks that our moonshot when it comes to humanitarian work is around scale,” Wordsworth says. “Whereas I think our moonshot is actually around intimacy. How do you have an organization or an approach or a service that is absolutely oriented to the customer?”
To create the new business, the team worked with Ideo.org and the community itself. “It included co-design sessions where we were putting together role plays and asking [community members] to play out different scenarios,” says Jocelyn Wyatt, executive director of Ideo.org. “Like, ‘You’re the woman who is pregnant, but you don’t have enough money to cover your visit, and you’re the nurse, and you’re the doctor. Show us what happens.’ Through these role plays, they showed us what would happen in these moments of service delivery.”
The community was involved in every aspect of the business creation, including the logo. Red–the color the ARC initially proposed–was rejected because it is used by local rebels. Green was associated with the military, and other colors were associated with political parties. Instead of choosing a single color, the logo uses red, yellow, blue, and green, to emphasize that the services are for everyone.
Before the first clinic was built, the community gave feedback on the layout. The community also helped shape the choice to have clear, transparent prices for services at the clinic. At other clinics, fluctuating prices meant that many patients stopped using services. A woman might go for a free prenatal screening somewhere else, and then return and find that the price was now an unaffordable $5.
“Human-centered design is allowing us to be able to build with the community in mind, with the community at the center,” says Abraham Leno, the DRC country representative for the ARC, who manages Asili. “They are not just the way we used to position them as the beneficiary . . . Here your opinion matters. When that opinion feeds into their goals for themselves, their goals for future, their goals for community, then they know that we are serious about building something that would stay longer.”
Leno, who lived in a refugee camp himself as a teenager, believes that traditional humanitarian aid–while helpful for short-term crises–is both hard to sustain and disempowering. In a recent poll of Congolese citizens, a third of respondents said that the country would be better off without international NGOs.
“I speak with knowledge of growing up being an African, and coming from this community,” he says. “The global society has not always been able to see things through our eyes. Most times when someone is categorized as vulnerable, as helpless, it takes away a lot of power from you. You start to feel vulnerable and you feel I have nothing to offer. That needs to change. Asili is not a handout.”
Service at the clinics, designed with the goal that the American-based ARC staff would feel comfortable taking their own children there, is so respected locally that people from the nearby city of Bukavu have started coming to the villages to use them. “That’s really unprecedented–you would never leave the city to go to the country for that sort of thing,” Wyatt says.
Asili plans to continue expanding locally. There are currently three clinics, each surrounded by water kiosks, and a fourth clinic will come soon.
By putting three businesses together in each village–the clinics, the water kiosks, and the agriculture business–it helps reduce overall costs. “If you’re in Congo and you have to import stuff in, you have to hire your own customs person to sit on the border for two days a week, that’s going to kill you,” says Wordsworth. “But instead we could share the costs of one person to manage customs and the supply chain. Each business pays for it, but they only have to pay for a portion.”
The business model still has challenges to overcome. The water infrastructure, with 60 kilometers of pipeline, was expensive to build. Before recreating the system in other locations, the team hopes to find ways to lower the capital expense. But the business has proven that it can be operationally sustainable. And if it can work in the DRC, one of the poorest countries in the world, it’s likely it could work elsewhere.