sometimes there are things that you say about work-related topics that you think you should only say with friends at the bar and then it turns out other people are thinking about it. like, ‘why can’t haiti be part of africa?’ and then this happens. my growing feeling is that there shouldn’t be such a divide between what you talk about at the bar or in hushed tones at a conference because there a lot of lessons to be learned, even if some connections are wacky/wrong and some process information is sensitive.
anyway, another such of my comments that i feared was un-PC or not fully substantiated was about the similarities between BRAC’s shastya shibikas in bangladesh’s health system and Mary Kay or Tupperware women (I don’t know about many Mary Kay or Tupperware men but am happy to learn!) in the US.
i have a fairly limited understanding of Mary Kay and Tupperware: along with Discovery Toys and Pampered Chef, I went to some parties with my mom growing up and remember examining the catalogues. i also remember the woman with the pink car at the Mary Kay party and I recall the Pampered Chef party being somewhat an excuse for mimosas and chatter – but also getting a cool (and much-used) slap-chop precursor out of it and a neat-o cooking demonstration. my understanding of the 1950s, 60s, and 70s Mary Kay and Tupperware scene is almost certainly Norman Rockwell-ized but I have a vague sense of the role they might of played in burgeoning post-war female employment and empowerment in the US. i am sure there is an official study (or episode of mad men?) i should read and would be happy to be pointed to it. [the only tupperware-related TV show i remember was the short-lived eerie, indiana.]
anyway, when teaching about the BRAC model of health care delivery in Bangladesh for ‘SW 25 Case Studies in Global Health: Biosocial Perspectives,’ it always struck me to have unexplored parallels with Mary Kay (we used mostly gated GHD case studies but some similar info here). but, this never quite seemed like something to state widely and we didn’t really read about the empowering aspect of giving women this earning opportunity. so, then, imagine my surprise when the article ‘the avon ladies of africa‘ made an appearance last week, also linked to BRAC. yay!
in bangladesh, this system includes ‘shastya shibikas,’ or ‘health volunteers,’ who have played an important – but perhaps somewhat controversial – role in treatment completion for TB (e.g. see here). more generally, these women receive a brief, basic health training and then work part-time to sell medicines, etc, door-to-door. basic criteria for these positions include being between 25-35, married but having no children under the age of 2, and preferably being able to write (in order to limit turnover and improve availablity and effectiveness). not only was this mechanism seen as a way to overcome spread-out rural populations – as is also mentioned in the nytimes article about uganda and the US at the inception of avon - but also strictures such as purdah on females’ out-of-home movement.
i think there is scope for this franchise model to do a lot of good in not only delivering appropriate health-related products but following up on their appropriate use and customer satisfaction (bonus points if the sellers have a way of tracking satisfaction info and sending it back up the supply chain). but, i have a few questions.
five key things.
1. door to door v parties. why avon and not tupperware? of course, there is some reason why an avon (door-to-door model) might make sense in rural areas. but what about tupperware parties: bringing women together, learning about and discussing health issues, encouraging each other to obtain the necessary products. certainly there is evidence about the benefits (though not the necessity, here or here) of peer groups in changing behavior. has it been tried? what happened?
2. follow-up. i just want to re-highlight the important role of these workers not just in completing the supply chain of getting commodities to bodies but being able to help the right commodities to the right people and to follow-up on them being used correctly. it would be great to hear more about the incentive mechanisms for these services and how they are received by customers (repeat sales, appropriate use, etc).
3. empowerment and within-company upward mobility. i‘d like to hear more discussion of whether/what are career advancement opportunities within these models (and, slightly more peripherally, whether these employment opportunities are changing views of the importance of schooling and skills-acquisition for females.) about five years ago, i did some work with the then-newish Health Extension Workers in Ethiopia, a new cadre of workers (e.g. here) with high-school + 1 or 2 years of training that focused almost exclusively on health education and preventative services, also relying on a door-to-door rotation (in their place of residence or nearby, generally). an awful lot of the young women with whom we spoke saw this as a temporary role, which they hoped to use as a back-door stepping-stone to becoming a nurse (a position for which they were not otherwise qualified). i think this mindset needs to be accounted for when considering investments in training and also the importance of trying to offer continuing incentives and opportunities to increase pay and status. the nytimes piece mentions that the ladies get a snazzy blue t-shirt and I fully understand the power of branded t-shirts, tote bags, etc. not exactly that pink cadillac but similar concept. still, how long does this keep workers interested? ashraf has certainly done work on incentive theory, related to health workers such as this, but it’d be good to hear more about it in action. is being an ‘avon lady’ for an effort like Living Goods seen as a a long-term career? could it be seen as such? i hope there are some balanced qualitative studies occurring about the experiences of these women (i.e. not just the testimony for one enthusiastic woman, as happy as i am for her).
4. local goods. it’s great that companies like unilever and others that have been focusing on the near-BOP consumer are looking on getting in on the action, providing a range of products that help ensure the income for the “avon lady” and the overall model of something like Living Goods, which still requires a lot of donor funding. but, it’d be awful nice to hear a bit about links to local industry in this – say, shea butter lotion – in some of these efforts as a means of further stimulating income and female labor-force participation.
5. supply chain lessons. i hope the lessons learned about the scope for text messaging to be used for supply chain tracking and stocking will be widely shared.
finally, will blue t-shirts ever get memorialized as songs as have pink Cadillacs (though i don’t think any of the songs have Mary Kay ties at all)? are there any incentive lessons to be learned here?