What’s the first thing you buy?

What’s the first thing you buy?

Publication info


Imagine you’re HIV positive in Malawi. Life isn’t easy to begin with in a place where most rural people are living on less than $60 a year, and 53% of people can’t afford to cover their basic needs.  Add in a chronic disease, a weakened state to accomplish your daily tasks, even higher nutritional needs, and a social stigma that makes it hard to get paid work or run a business, and you’re your opportunities get pretty limited pretty fast.  Even if you’re able to get the ARTs from the health clinic for free, you have to make sure you can buy enough food so the drugs work and don’t make you feel sick.  And you can’t figure out where you’ll get the money for that. You’re afraid to tell friends and family, or to ask for help, because you think the disease means they won’t accept you anymore.  If you go to a loan shark, you have to pay back 100% interest, and the loan is only good for a week.

Now imagine that someone gives you a chance to make some money.  The counsellor at your health clinic refers you to a Village Savings and Loan Association, where people save money every month, and are able to take out loans, earn interest, and access emergency cash in times of crisis.  You’re able to start a business, and earn some money.  The VLSA has lowered the interest rate for you, to make sure that you can benefit from their services, and they are helping you figure out how to manage your money.  Despite you challenges and your disease, they are welcoming you into the group just like everyone else. Life is looking a little better.

On the first day that you have earned some money, what’s the first thing you buy?

I just got back from Malawi and spoke with some of the people who have had this experience with support from the LIFT II project. Every single person I spoke to said the first thing they buy is soap.  Soap lets them take care of themselves, and feel clean and dignified, and able to start new opportunities. It lets them join groups and activities without feeling embarrassed about their appearance.  It’s a mark of just how precarious the situation is for people with no resources and no social support.  They can’t buy soap. In a million years (and after 10 years working in international development), I would never have predicted soap was the first investment.  

After soap, people buy food, school fees and clothes for their children. They grow vegetables, invest in businesses, improved agricultural practices, and helping other people.  They tell others in their community that if they can send their kids to school, so can anyone else.  They spread the word at HIV testing centers and counselling groups that HIV is not the end. In fact, the people I spoke to even offered to come to America and help people here learn how to save money and start businesses.  After soap, the sky’s the limit.

How do we do it?  We work with village referral volunteers and counsellors in 17 health clinics in Malawi to connect HIV positive patients to VLSAs that CARE has started at some time in the last ten years.  For some communities, CARE stopped working their five years ago, and they continue to run the VLSAs. Those groups made changes to allow the poorest and most vulnerable people in their communities have access to opportunities. So far, we have referred over 4,000 people to services, and we’re just getting started.

About the Program: In 2013, with funding from the President’s Emergency Plan for AIDS Relief (PEPFAR), the United States Agency for International Development (USAID) awarded LIFT II to a consortium headed by FHI 360. LIFT II’s primary goal is to provide evidence-based, gender-sensitive programming to improve household economic strengthening and food and nutrition security support as a component of a continuum of nutrition and health care and support for vulnerable individuals and families. An essential component of the LIFT II approach is supporting community referral networks that systematically and appropriately link Nutrition Assessment, Counseling and Support (NACS) clients with community-based economic strengthening and food security support.


© 2012 Brendan Bannon/CARE