Video - Panel Two: Literacy for Health

Randall Tobias, Director of U.S. Foreign Assistance and Administrator, United States Agency for International Development
Hasina Mojadidi, Instructional Development Coordinator, Learning for Life, Afghanistan
Salah Sabri Sebeh, Head of Education Sector, Caritas Egypt
Gonzalo Fiorilo, Director, Alfalit Bolivia

MR. TOBIAS: Good morning. I too want to thank Mrs. Bush for her extraordinary leadership and dedication to international development in education and in health. And I too welcome the opportunity to be here with you today. I am especially pleased to be a part of this important and timely panel on Literacy and Health.

Prior to assuming my current position, I served for three years as the United States Global AIDS coordinator for PEPFAR, the President's Emergency Plan for AIDS Relief. The work we continue to support under PEPFAR is often described as an effort to turn the despair of suffering and death to hope and good health for a good life.

This same message can be offered in the campaign for literacy because we know the ability to read and write not only improves the lives of individuals but can also help save lives. And the HIV/AIDS pandemic is showing us just how important education is in the face of such a crisis.

In fact, we know that women who can read and write are far more likely to know how to avoid HIV/AIDS than women who don't have basic literacy skills. We also know, through studies, that women who participate in literacy programs gain critical and essential knowledge of good health and family care practices, and they are better able to use that information. When there are medical emergencies, they also are more likely to seek treatment for themselves and for their children.

Literacy enables individuals, families, and communities to gain access to basic health services. Adults who have learned to read and write can follow important medical instructions. They know to avoid hazardous chemicals and other dangerous situations posted on warning signs. They also are capable of learning about basic sanitation practices that help prevent the spread of diseases. Literacy provides the foundation for every facet of our lives. It makes continued learning possible and enables individuals to contribute to their own social and economic well being and to that of their communities.

The presenters you are about to meet are involved in literacy programs that are providing individuals and communities with ability to save lives, and I mean that quite literally. Each of their programs combines basic literacy training with health related information.

Our first speaker will tell us about Afghanistan's Learning for Life program. Miss Hasina Mojadidi has a degree in literature from the University of Education in Kabul, Afghanistan. She was a literacy teacher, and secondary school principal, and has also taught high school subjects. Miss Mojadidi helped to design the Learning for Life curriculum.

The second presenter you will meet is Mr. Sala Sabri Sebeh who is director of the Basic Education Program for Adults at Caritas Egypt. Mr. Sebeh received a degree in linguistics from the Faculty of Arts at Cairo University. He was a librarian at the Egyptian National Library and has been an active literacy volunteer in Egypt since 1967.

Our final presenter on this panel will be Mr. Gonzalo Fiorilo. Mr. Fiorilo, the director of the Alfalit Bolivia graduated from San Simon University in Cochabamba, with a degree in agro economics. He was the director and professor of agricultural economy in Cochabamba, and has served as director of several social projects, and written a number of handbooks on literacy programs.

So now to begin, ladies and gentlemen, please welcome Miss Hasina Mojadidi representing the Learning for Life Program in Afghanistan.

(Applause.)

MISS MOJADIDI: Good morning, Mrs. Bush, First Lady of the United States, your excellencies, ladies, and gentlemen. My name is Hasina Mojadidi, and I want to tell you a troubled truth.

As we sit here in this beautiful place, in my home country of Afghanistan a woman will die every 30 minutes needlessly from causes related to pregnancy and childbirth. Two of the main reasons for these are, one, a lack of health education, and two, a critical shortage of female healthcare workers.

Today I want to tell you about a project which is helping to change this situation. But first, do you know that 80 percent, I mean 8 0 percent of Afghan women and older girls cannot read and write? In rural areas, over 19 percent of women are illiterate, and there are many villages where there is not one literate female.

Second, do you know that in many areas when a woman needs medical care, a male doctor cannot treat her? This is the culture, but the problem is that there are very few female healthcare workers in Afghanistan particularly midwives, and least of all in the rural areas. Yet, my country has one of the highest infant and maternal mortality rates in the world. In fact, one remote area in the north has the highest maternal mortality rate ever recorded globally.

Now why are there so few female healthcare workers in Afghanistan? Well, historically there was very little education for girls in the rural areas. Then, as you know, Afghanistan was the central of war and destruction for over twenty three years, including six years of the Taliban when the women and girls were not allowed to study at all.

So now very few rural girls and women are literate enough to be trained as community health workers. This is the basic reason why we created learning for life.

USAID funded the first phase from mid 2004 to April 2006 to do the following: First, learning for life increases the literacy rate among rural women and girls and improves family health and hygiene practices; and second, it increases the pool of women eligible for training as community healthcare workers and midwives.

Our approach is this: In order to promote literacy for village women and to qualify many to be trained as healthcare workers, we created a health focused literacy foundation schools in language, health, math, and social studies. It covers three grade levels in nine months so women can achieve sixth grade literacy in 18 months.

For more literate women to enter midwifery training, we designed a six month (inaudible) program curriculum to achieve ninth grade literacy. We use milestones that enable learners and facilitators to assess key competencies on progress cards.

The first milestone is counting to 20. Later milestones are on using fractions and percentages. Classes are multi level. A learner works each day in a small group depending on which milestone she is at. Faster learners can move to new groups.

To begin work in a village, our community mobilizers, who are mostly men, meet with local elders and Mullahs to explain our project and get their approval. The village contributes a learning space such as a mosque or someone's house.

We recruit and train village women and older girls as facilitators or teachers and they, in turn, recruit learners. We conduct multiple training workshops for the facilitators and visit frequently to monitor classes and help improve their skills even when the snow is deep and travel is dangerous.

Classes begin with women telling the students in their own words about what it means to be healthy and unhealthy. An illiterate woman learns that simple symbols can represent key concepts of health and illness. Each woman tells her life story such as when she was ill as a child and when her children were born.

Her classmates chart her story along a line using the symbols. She then reads back her own story from the symbols. Then her words from her story are written and read aloud with attention given to their different sounds. Gradually words are put together in short phrases, then short sentences.

Later she has access to very simple texts about such things as raising children or hygiene. There is no textbook. Learning is active. The students do health surveys in their villages, for instance, counting the families who use iodized salt. They do role plays about issues such as early marriage.

In this way, a woman builds literacy around concepts, words, and activities that she will use every day. Her literacy skills then become more sustainable.

Now I'd like to tell you how literacy linked with health can empower village women. One of our learners said that she had lost two of her children from diarrhea. The village people had told her not to give them liquids, and she felt so helpless as they were dying.

From studying Learning for Life, she learned that she should give her children liquids, and learned how to make a simple, effective, oral re hydration treatment. She said she will never feel so helpless again.

Another group of learners said that their village council they asked their village council to move (inaudible) from their village, and they did. They also asked the council to organize digging of a deep well because the water supply was not so clean, and they did.

So many women wanted to attend classes that we had a hard time keeping the class sizes to only 25. Almost all attended regularly, and very few dropped out.

Since December 2004, 8,000 rural women have become literate in our foundation classes, and over 500 women have raised their literacy level through our program. Ninety percent of our foundation's class participants pass the final test and receive certificates of completion. Five hundred thirty six of our learners were prepared for training as midwives. Two hundred twenty seven were later trained as community healthcare workers, and an additional 169 were trained as traditional birth attendants.

Our projects are succeeding because of our strategic approach. One, we based the program on the needs of the communities. Two, by focusing on health, men in more conservative villages allowed women to participate. Three, because we were respectful of Islam, community leaders were willing to support us and allow women to attend classes. And, four, we used interactive teaching methods that held the attention of learners and made learning fun.

The lessons of Learning for Life are that the demand for women's literacy and health education in Afghanistan is extremely high, even in very conservative areas; that women and older girls with less than a 9th grade education can become excellent facilitators of literacy if they receive good training and support; and that health focused literacy courses can increase the number of women who can be trained as health workers.

Learning for Life is a partnership of our Ministry of Education, Ministry of Public Health, USAID, and Management Sciences for Health. The implementing partners for phase one were the University of Massachusetts, International Rescue Committee, and aid Afghan NGOs. To our Ministers and our partners, we are very grateful.

We are pleased that phase two of learning for life will begin this fall with funding by USAID. More than that, we are very happy that our new Minister of Education has announced a new national literacy program that will expand literacy throughout the country.

This program's contribution to literacy and to the health and welfare of my people will be life saving and life giving. Thank you.

(Applause.)

MR. TOBIAS: Thank you very much, Ms. Mojadidi for your courage and your creativity, and for all that you are doing.

Our next presenter is Mr. Sallah Sabri Sebeh, who manages the Basic Education Program for Adults, administered by Caritas in Egypt. Mr. Sebeh.

MR. SEBEH: Thank you.

Madam Laura Bush, First Lady of the United States, Excellencies, The Minister of Education of Egypt, ladies, and gentlemen, thank you for giving me this opportunity to present in a few words the experience that we have had in the area of basic education since 1972 through Caritas Egypt.

My name is Salah Sabri. I am responsible I am in charge of this program from Caritas Egypt. Caritas Egypt is an Egyptian NGO whose task is to be at the service of the most poor of our population. Having understood that the illiteracy rate makes it impossible to obtain sustainable and true human development, Caritas immediately emphasized a literacy campaign, especially for adults.

In fact, 11 million and a half Egyptians are still illiterate despite the efforts by the state and by NGOs. Given the situation, Caritas Egypt focused on a global literacy program suited to the local context, especially for the villages of upper Egypt, which are considered its most dispossessed.

I would like to talk to you about the evolution of this program. This is a three tier program: literacy, health education, and civic education. The methodology used is based on dialogue with words pertaining directly to various aspects of daily life.

These are simple and everyday words. For example, the word fool, which means bean, allows us to talk about nutrition, given that fewle is a very popular dish in Egypt. In order to learn how to read, the word is broken down phonetically. The sounds thus obtained will allow you to use them and to create other words. In this way, all the necessary symbols for learning to read and write in Arabic, all these symbols are therefore learned.

In this example, after the breakdown of the word fewle and the learning of the consonants and the vowels, faa, waw and lam, another vowel is introduced, the yeh, the letter i, which produces another word, fiil, and that's somewhat funny because fiil also means elephant. So fool and fiil but why not? Why to have fun with the students? It shouldn't be hard work. It should be fun.

In rural areas, unfortunately, girls have more difficulties to have access to formal education. Sixty five percent of the illiterate population are women. It is therefore mostly girls and women who attend our classes because for them, to learn is a validation of a way of becoming self confident.

One of the consequences of the very low level of education of women is their vulnerability towards health problems especially during pregnancy and delivery. The ignorance of mothers also has very devastating effects on their children: malnutrition, accidents , oftentimes using traditional and often negative traditional methods, which is why, during these discussions, these problems oftentimes occur.

This has pushed us to develop a healthcare program that will be able allow us to respond scientifically and more systematically to the needs of their participants and their families. This health program has four areas of concentration: general hygiene, nutrition, reproductive health, and the environment.

In the classes, we deal with each theme with concrete examples, diseases, health problems, and we explain the symptoms of various illnesses, how you can prevent them and what types of healthcare you can provide. These are very lively classes, and they are supplemented by posters and small pamphlets that we're able to publish thanks to UNICEF and other organizations. These books also help them learn how to read.

But the true strength of the program comes from the role of the trainees. They are not just receivers of information, but they commit themselves to play a role in order to raise the awareness of their families towards healthcare issues. So it goes beyond the classroom, and the concept, the principle is learn how to act.

This slogan can be translated into concrete actions. For example, to deal with anemia or malnutrition in general, groups of ten mothers who have underweight children get together in order to learn how to feed them in a more suitable manner. Twice a week, the child is weighed, and on his health card, the mother herself will tell about the evolution of the condition of her child. Therefore, approximately every year, 1000 children under five years of age are saved from malnutrition.

These classes are offered by the local communities, and the facilitators are chosen among the young people of the village. They receive a short training program and they are supported by supervisors who visit them and help them every week. The training programs for health are provided by volunteer doctors.

To carry out the follow through of the literacy program, Caritas Egypt started a project of village libraries. We created approximately 70 libraries in the villages in order to avoid relapse into illiteracy but especially to continue to allow the trainees to expand their knowledge and hopefully to provide greater options.

Every year, more than 18,000 people go through this program, which pertains to more than 200 villages in the most remote areas of the countries. Over 90 percent of the students become literate at the end of the program, and more than 2,000 trainees succeed the final literacy test administered by the state. And they, in turn, sign up in the formal education.

The length of the classes is between 18 to 20 months. The total cost of the program is $1.5 million per year, despite our very limited means. The number of 1000 classes currently could double if we had the necessary budget.

The impact of the program can also be seen by the raising of the awareness of the trainees and through the changing of their behavior in their environment. Many diseases now can become prevented, and mothers follow more and more monitor more and more the healthcare of their children.

We succeeded because we were receptive. We listened to the needs of the trainees. Thanks to us, they were more able to solve their problems, and they were able to become true actors in their own development.

In order to illustrate this, let me tell you the story of Mariam. Mariam was a young girl who was working in the fields in a village in order to help her family. And, at the age of 15, she was already responsible of her nine brothers and her mother, and that's how she started this literacy.class. Thanks to the class, she learned how you can learn prescriptions, how you can learn signs, how you can use medication, but she also gained knowledge, basic knowledge about the diseases that were in her area.

Her younger brother who was always sick, he was always tired the family thought that he was lazy, but Mariam was able to recognize that this fatigue was actually the symptom of a disease.

With great courage, Mariam took it upon herself to have her brother examined against the will of her family because the family feared that it would be long trip outside of the village, feared the meeting with the doctor, reading the signs, the medical prescriptions. But the medical examination demonstrate that the brother had heart rheumatism, but thanks to ability to read, Mariam was able to help her brother follow a treatment for one year, and now her brother is cured.

"I learned how to read, and I became self confident," says she, "Therefore I was able to save my brother." Mariam is currently in charge she works in the library of her village. She is happy because thanks to this library, she is providing all this medical knowledge to others.

Before concluding, I would like to express my thanks to all of those contributed to the success, the donors, especially Miziryar in Germany, which supervised this program for 13 years, the Ford Foundation, the Swiss Egyptian Development Fund, the European Union, the Canadian Agency for Development, the World Bank, UNICEF, UNESCO, as well as the Drosos Foundation in Switzerland. We also would like to thank our partners, the Egyptian governmental and non governmental organizations who are with us in order to reach the UNESCO goal, which is education for all.

Thank you very much for your attention, but thank you most of all for all the future cooperations hat we expect from you all. Thank you very much.

(Applause.)

MR. TOBIAS: Thank you very much, Mr. Sebeh Our final presenter on this panel is Mr. Gonzolo Fiorilo of Alfalit Bolivia. So please welcome Mr. Fiorilo.

(Applause.)

MR. FIORILO: Esteemed First Lady Mrs. Laura Bush, Mrs. Barbara Bush, Excellencies, ladies, and gentlemen, my name is Gonzalo Fiorilo and I am the director of a project called USAID Alfalit Bolivia. I am very honored to speak to you about the experience we've had in my country with this project.

Alfalit Bolivia is one of the largest literacy organizations in the country. Since 2002, the project has taught approximately 75,000 people to read, to write, and to count. And this year, we have over 20,000 people registered. The annual cost of each student or participant is approximately $40.

Undoubtedly, we are very proud of our achievements, but we're also aware that it's necessary to have an even greater effort to be able to deal with this enormous challenge of dealing with almost 700,000 illiterate people according to the data in our country.

Most of the illiterate people are concentrated in western Bolivia where 70 percent of the inhabitants speak the Quechua language and their knowledge of Spanish is very basic. The average monthly income of men is 216 bolivianos or $28, and 56 bolivianos or $7 in the case of women.

The towns where we work are very distant from urban centers, and people lack basic services such as education, health, electric energy, and any access roads. Consequently, our literacy classes are developed in various places such as homes, churches, community rooms, schools, prisons, and even out in the open air.

The problem of illiteracy in Bolivia is a direct consequence of the general poverty of the country, the social policies that have fostered social injustice in the past, people leaving rural areas, and the discrimination of the poorest, especially women.

Health the health and the wellbeing of those we serve are seriously threatened by their incapacity to read and write. The high rates of absenteeism and dropouts are frequently due to illnesses that cannot be attended to because insufficient or inexistent (sic) health services.

Illnesses that are easy to treat or prevent like cholera, malaria, TB, often lead to unnecessary deaths in a poor and ignorant population. Our literacy program contains issues like reading, writing, and basic arithmetic calculations using a methodology appropriate to the reality of our country.

Alfalit provides its participants with the necessary skills for full participation in society and encourages them to continue their study in school. They are encouraged to write their testimonials and to write letters to local authorities, as well as to friends and family. Additionally, we establish community libraries with books that are collected with the help of cooperating institutions like the rotary clubs.

One of the goals of Bolivia's Alfalit is to achieve the interest of our participants from the first lesson. If they understand that they can do it, then there will be hope.

The initial educational material is made up of reading and writing cards, syllable cards, arithmetic text, and other reading material related to issues like the home, work, and farming. Later we touch on issues related to health, hygiene, nutrition, home remedies, and guides for future mothers, as well as home economics, and other issues that are useful for improving the daily life of families and the community.

Alfalit Bolivia offers bilingual education in the early years through the so called facilitator teachers. Alfalit makes sure that these facilitators will at least have a high school degree, but many of them have college degrees or they have technical training in agriculture, theology, medicine, et cetera.

After being selected, they are taught how to handle the Alfalit methodology, adult education, and how to prepare reports. The trained facilitators begin by teaching in the maternal language of the participants and then they gradually introduce Spanish. To improve the reading skills of the participants, they are encouraged to constantly read, both in public and out loud.

We have designed complementary material as part of the Early Reader Program. For example, one of them contains valuable advice on the care and nutrition necessary for pregnant mothers and their babies. Others refer to the terrible experiences due to alcoholism or they highlight the importance of hygiene in the home.

But most of the people who learn to read and write describe their experience as if a bandage had been taken off their eyes, especially because now they are capable of seeing and doing things that in the past were forbidden for them, such as, for example, reading the names of streets, the destination of public transportation, cooking recipes, etc.

When consulted, they state that they use their new knowledge to teach their spouses, children, parents, brothers, sisters, friends to read and write. They have acquired better habits as far as nourishment, hygiene, and nutrition are concerned. They have become leaders in their communities, and they want to become local authorities, and so they present their respective candidacies.

They now recognize the importance of education, and they are making sure that their children will go to school, and they want to continue their education to a professional level, especially among the young.

The methodology of our program and its impact can be best illustrated through the personal experience of Emiliana, a lady living in a small town called Ticamblaya. In her literacy classes she learned to associate pictures and the names of common things with the initial sound of words, for example, the mah in 'mama'. And from her first lesson, she started putting together new words with the syllable cards and reading basic sentences. Very shortly, she was reading different kinds of texts, and when she graduated, she also knew something about mathematics, and she was able to solve simple problems.

The main lesson we've learned in Alfalit Bolivia is that in order to achieve truly effective work, it is necessary it is basic to understand the needs, the limitations, and the biases in the illiterates. We have also learned that when we are able to involve the community and its leaders, and they can see the benefits of the program, they will immediately take on the process, and even communities with very scarce resources will seek out all the means necessary to support the project.

Finally, we have understood the importance of women in Bolivian homes. We have become convinced that when a woman, a mother, in a family is poor, her family will also be poor. Fortunately, 76 percent of our participants are women, and fortunately also, we have 50 Bolivian institutions which have identified themselves with the project and have provided different kinds of resources.

Emiliana now recalls how her reading skills saved the life of her young, two year old son. One day at 3 a.m., her son began to suffer violent convulsions, and he became unconscious. She immediately took him to the hospital, and since she had no one to help her, she just followed the various signs she saw in the hospital until she got to the emergency room and she found the doctor who was on shift.

Emiliana was also able to follow the instructions written down by the doctor until her son recovered completely. She now states proudly, "I never imagined that knowing how to read would save my son's life."

I want to very specially thank USAID and Alfalit International. Without the support of these organizations, we would be unable to carry out this important work, nor would we be able to be here taking part in this distinguished panel. Thank you so much.

(Applause.)

MR. TOBIAS: Thank you very much, Mr. Fiorilo (Interruption to tape) away from your presentation is the person seeing learning to read being the same as removing a bandage off of one's eyes and being able to see the world in a very different way.

Each of these programs that you've heard about from three very different parts of the world recognizes the unique needs of girls and women and how important they are to the health and welfare of their families and their communities. When you teach women and their daughters to read, you are increasing the likelihood that their children will be healthy and that they too learn to read, and write, and become productive members of society.

Today's literacy and health panel participants have presented innovative approaches to investing in people that are improving the quality of life for tens of thousands of people. We've heard the testimony offered by our presenters of knowledge that is saving lives and providing people with pride in their accomplishments, improved self esteem and a new understanding of their responsibilities as members of their communities.

I want to thank all of the panel members for all that they have accomplished and for sharing their stories with us this morning, and I, for one, look forward to following your progress closely and hearing more about your continued success. Thank you very much.

(Applause.)