Solving Food Security in Healthcare

Isabelle Kamariza is Solid’Africa’s Founder and President. She is an Aspen New Voices Fellow and a One Young World Ambassador. In 2018, she became the 55th volunteer across the Commonwealth nations to receive the Commonwealth Point of Light Award, which is given by Her Majesty the Queen of England. The award celebrates young leaders making a difference in their communities by taking on apparent global issues. Prior to that, Isabelle received the Celebrating Young Rwandan Achievers (CYRWA) Award from Rwanda’s First Lady in 2013 through Imbuto Foundation. This award honors outstanding young Rwandan entrepreneurs and leaders who strive towards high levels of personal and professional accomplishments. In 2011, Isabelle was awarded the Young African Women Leaders Forum Award by Michelle Obama. Most recently, under her leadership, Solid’Africa received the Segal Family Foundation’s System Innovator Award.

Solid’Africa is a non-profit organization with a vertically integrated strategy for addressing the lack of food security in African healthcare systems. Health events happen every day and pose an imminent threat to patients since a single hospital stay can devastate a family’s income. Our vision is for sustainable systemic change in healthcare across Africa. We have a strategy that simultaneously meets immediate needs for nutritious food, secures the supply chain, and boosts the economy. This approach can be replicated in national healthcare systems with initial support from philanthropy dollars but is self-sustaining long-term. We have preliminary evidence demonstrating program efficacy but need to gather additional data showing how food security in healthcare reduces the demand on government resources, and alleviates poverty. These data will help us a make a compelling case to governments. KPIs will include successful development, pilot testing, and implementation of a permanent evaluation, monitoring and research infrastructure.

In many African countries, meals are not offered as part of a patient’s stay in public hospitals. By the time they come to the hospital, these families are in dire financial straits, with little to no money left to feed themselves during the hospital stay. Solid’Africa has developed a farm-to-fork program that wholistically addresses this critical gap. We feed people at their most vulnerable while advocating for systemic change that has implications for national economies, cultures’ survival, and the health of communities. Healthy people use fewer healthcare resources reducing the financial burden on national resources. Furthermore, teaching people how to feed themselves and how others should be fed to stay healthy is crucial to reaching that goal, and to ensuring societal survival and flourishing. Our staff and volunteers work to grow food on our own farmlands, and prepare and deliver nutritious meals to patients and their caregivers three times a day. Currently, we feed over 800 patients per day, as well as their caregivers, across four hospitals. We currently provide roughly 2400 meals per day, and plan to scale that up over time to reach more patients and hospitals in Rwanda and across Africa.

The lack of food security across many African nations is well-documented, and is being tackled by various subsistence agriculture initiatives. But these efforts miss a critical gap in the food equation – consistent access to nutritious food for people experiencing a health crisis and unable to feed themselves. Solid’Africa addresses this need using sustainable subsistence agriculture practices and local resources; by hiring local farmers to cultivate crops on local land; and by supporting the supply chain across the life of the food – growing crops, preparing meals and delivering them to patients and caregivers. The demand for our feeding program is significant. Currently, we meet the food and service needs of 80% of public hospital patients in Kigali and will be scaling up nationwide over the next five years. Globally, nutrition and healthcare professionals recognize that balanced meals are a crucial part of healthcare. Patients who eat healthy meals recover faster and have better health outcomes. Furthermore, teaching patients and their caregivers how to prepare nutrient-rich foods after they have left the hospital, increases patients’ chances of sustaining health into the future. Our work demonstrates that it is possible to eradicate hunger and malnutrition in healthcare systems across Africa cost-effectively.

We support populations living on the edge of poverty, and dealing with a range of health conditions. Many work menial, low-paying jobs that they risk losing because of their ill-health. These families are in dire financial straits. We have heard from thousands of patients that the meals we provide are the only food that they receive during their stay. Since founding, we have provided over 1.5 million meals to an estimated 79,560 patients as well as their caregivers and families in four of the largest public hospitals in Rwanda. By 2020, we intend to feed 1000 patients, three meals per day. This represents food security for 366,000 people (2.9 % of the total population).

Many patients who have benefitted from our program have expressed a desire to give back by volunteering with us. Through our efforts, families at risk of losing their livelihoods have gotten back on their feet quickly and returned to work. We estimate that we have helped save over 79,600 jobs. In addition, we have created 84 jobs including 37 permanent farmers - 28 are women and 9 are youth. We also hire 20 temporary farmers more than 70% of whom are poor women and youth.

The lack of food security for vulnerable populations across Africa is being tackled by various subsistence agriculture initiatives aimed at empowering and equipping poor people to support themselves. But these efforts miss a critical gap in the equation – consistent access to nutritious food for poor people experiencing a health crisis. Solid’Africa addresses this need using sustainable agriculture practices; and by providing full time wage positions for people formerly experiencing poverty to cultivate our farmlands, and prepare and deliver meals. We are committed advocates of the essential role of food security as part of health insurance policy for poor people.

Solid’Africa exists because of the transformative vision of its founder. While living in Belgium, Isabelle Kamariza was inspired by her faith to begin serving meals to homeless persons. She and a team of volunteers prepared and served 200 meals weekly to homeless persons. Back home in Rwanda, Isabelle learned of the feeding challenges for patients in large public hospitals in the capital city, Kigali. Armed with a detailed understanding of what patients’ needs are, Isabelle and her team came up with five programs under the Solid’Africa banner to meet the needs of the patients and their caregivers. These programs are part of a vertically-integrated strategy for addressing the immediate needs of people living on the edge of poverty who are undergoing a health crisis, while advocating for system change that alleviates the factors responsible for creating those needs. Our work is grounded in a clear, humanitarian understanding of the importance of healthy individuals and communities for culture and societies’ survival.

Food has always been my passion. As a university student, I would cook African food and invite people over to eat. As a person of faith, I believe that an individual’s life purpose is linked to their passion. For me, feeding those in need is not a job but a spiritual calling. Seeing people in hospitals unable to eat because they couldn’t afford it is something I could not accept.

I am passionate about the work that we do because I know it works, and I see the evidence of our impact in the faces and testimonies of the patients and caregivers that rely on our program.

My organization has deep roots in the local community. I work with a team of young Rwandans like me along with collaborators that share my passion for helping the poor and for systemic change across the African continent. I know that when people work together on a collective problem, they can solve it. I realized quickly that you don’t need significant upfront resources to solve problems. If put your heart and time into it, the resources come. I have found this to be true for us since founding.

As founder, I keep the mission and vision alive. In addition to the administrative work necessary to run the organization, I am constantly growing my skillset including taking courses to improve my business acumen and partnering with US-based NGOs to understand how to develop healthy and nutritious meals for patients. At least once a week, I go back to my first love – serving food to patients and seeing them move towards recovery. This renews my passion because it reminds me of the importance of our work. I use that passion to inspire people in my community to do good. Many former patients donate food and volunteer their time to feed patients.

As a local organization, we understand the challenges that our communities face, and the current policies that need to be changed. We have cultivated relationships with key stakeholders in the Rwandan government who recognize and support our efforts. In addition to receiving free farmland from government, I received the Celebrating Young Rwandan Achievers Award from Rwanda’s First Lady in 2013. Our work has a lot of visibility and has been recognized by national and international media organizations and foundations. This visibility puts us in strong position to advocate for policy change.

Solid’Africa has worked on food security in healthcare since 2011, and we have a solution that sustainably and cost-effectively addresses the need. This is a problem faced by many African countries. We have the requisite expertise to transform the way healthcare is done across the continent.

Global climate change is producing environmental instability. In Rwanda, we have seen larger seasonal flooding and that has impacted our farms’ productivity since 2017. Last year alone, we lost eight tons of rice to severe flooding. We addressed this by shifting to a permaculture design for our farms to better protect our crops. Our most recent challenge however was dealing with increased demand for our service during the COVID-19 pandemic. As Rwanda locked down, we were the only organization with a centralized kitchen able to continue feeding patients including those admitted during the crises. The number of patients and caregivers fed, as well as the number of hospitals served increased rapidly in a matter of weeks. We were required to serve three meals a day to over 800 patients as well as their caregivers in four public hospitals up from providing three meals a day to about 400 patients prior to the pandemic. We quickly organized a global fundraising campaign on social media to secure short-term funding. We received several one-time donations that allowed us to hire additional staff to scale-up to continue serving patients and their families during the emergency.

Food and feeding people, especially those in need, are my passions. When I learned of feeding challenges faced by patients in public hospitals in Rwanda, I launched Solid’Africa to provide access to nutritious, healthy meals for patients and caregivers during hospital stays. In addition to feeding people’s bodies and souls, we help them get back on their feet and become leaders in their communities. One former patient, Bosco, was in the hospital for seven years. We fed him daily and helped pay for his medicines. After he regained his health, we helped him start a phone charging business using solar panels in his community. He is now thriving and hires several employees. Another former patient, Damascene was in hospital for seven months recovering from burns. With our help, he has gone on to be successful and is committed to helping other patients as he was helped. For nine years, he has brought free bananas and bread to patients in the hospital. In his words, “because you have helped, me, and I have a job, I will deliver food to people I don’t know every day.” Other patients that we have helped also regularly send food donations for us to distribute.

Our key innovation is the creation of vertically-integrated strategy and a social-enterprise business model for providing food security in healthcare. Solid'Africa is the first and only organization in Rwanda with a scalable and sustainable approach for meeting the nutritional needs of vulnerable patients. We also provide other forms of needed support including paying for medical expenses not covered by insurance for over 18,000 patients, and provided specialized nutrition for over 7,400 newborns. Our work has helped thousands of patients heal quickly and return to their livelihoods, thus preventing devastating job losses. We rely on local land and natural resources and volunteer support to accomplish our mission. We also create jobs that help poor people – particularly women and youth – make a living that sustains their families. Lastly, we have a plan in place to ensure the long-term sustainability of our work and maximize how we invest the financial resources that we get from donors. Specifically, we will provide catering services to private businesses, schools, and other commercial enterprises to generate income that will be funneled back into providing free meals for patients and growing more food.

The government recognizes the vitality of our work and supports us by providing hectares of free land for our farms, and being willing to consider evidence-based policy change. We are collecting the data needed to make that case. Our approach is replicable, and once we have implemented it in hospitals across Rwanda, we will present the strategy to governments in other African countries.

Solid’Africa asserts that nutrient rich food:

·    Is Medicine;

·    Is the foundation of successful recovery from any medical procedure;

·    Prevents an economic and health crisis, when provided to patients and their primary caregivers;

·    Can be maximized through careful management of the food production and delivery process.

·    Starts at the source, through a farm-to-fork cycle that encompasses sustainable agriculture, efficient and hygienic culinary practices, and a system of delivery to the patient and caregiver.

·    Is the foundation of a healthy culture and part of a continuous system that starts in the ground.

African governments have recognized that health is a human right and several have taken steps to ensure access to healthcare for their citizenry. A critical oversight in their current efforts is the importance of good nutrition for patient outcomes. Solid’Africa believes that healthcare systems need to recognize that food security is an essential part of healthcare services and take steps to address the existing gap.

The innovation underlying Solid’Africa’s work is its ability to tap into African cultural values of strong families, connected communities, and faith which work in support of one another. Solid’Africa activates individuals from across all socio-economic levels in support of its mission. It draws in young men and women willing to invest their time, resources, and expertise in building and operating every initiative, from food delivery and feeding, accountancy and supervision, and political action.

Solid’Africa’s farm-to-fork approach boosts local economies and maximizes donor funding. Much of the food used in Solid’Africa’s feeding program is grown on its own farm, which reduces costs that would normally be associated with purchasing and transporting food from third-party suppliers and distributors. This also reduced the risk of breaks in the food supply caused by unpredictable suppliers and distributors. By managing the food supply, and the labor conditions of the supply chain, Solid’Africa is able to ensure both the quality of the food that is grown and quantity of meals it produces. Lastly, by buying products that can’t be farmed from local vendors, Solid’Africa ensures that more value goes to local producers and distributors.

We currently meet the food and service needs of 80% of public hospital patients in Kigali, Rwanda. We had to scale up the number of patients that we serve quickly because of the COVID-19 pandemic. As Rwanda locked down, we were the only organization with permission from the government to continue feeding patients including those admitted during the crises. Currently, we feed 800 patients and their caregivers, three times a day, across four hospitals – providing roughly 2400 meals per day. This is up from providing three meals a day to 400 patients and their caregivers prior to the pandemic. We plan to scale that up over time to reach more patients and hospitals in Rwanda and across Africa. In the next year, we expect to begin providing 3 meals for free to at least 1,000 patients in addition their caregivers per day. This represents food security for an estimated 366,000 people (2.9 % of the total population) per year who are living in extreme poverty. If our efforts to expand are successful, we estimate that we would be able to reach an additional 897,000 individuals and families in Rwanda annually.

Since founding, we have provided over 1.5 million meals to an estimated 79,560 patients, and their caregivers, in four public hospitals. We have also provided other forms of support including paying medical expenses not covered by insurance for over 18,000 patients, and providing specialized nutrition for over 7,400 newborns.

Solid’Africa completed construction on the Mike Stenbock Gemura Kitchen in partnership with Imbuto Foundation, which has the capacity to prepare 15,000 meals per day. We aim to run the kitchen as a social enterprise, allowing us raise the income needed to sustain our feeding and agricultural programs. We project that the Kitchen will be self-sustaining within 36-months and profitable within 48-months. We will use the profits to build several smaller kitchens that support regional referral hospitals outside of Kigali within five years, and also operate as social enterprises. We will mobilize the local communities around these hospitals to build and support these kitchens. Also, within the next five to ten years, we aim to introduce the model to healthcare systems in other African countries.

Solid’Africa grows 80% of our food on 9-hectares from the government, and harvests over 357 tons of crops annually. Recently, we received an additional 5-hectares of farmland that we will use to scale up food production. We have plans to green our kitchen further, reuse waste, and produce food more sustainably. We will use our kitchen’s leftovers in a composting unit – a 50m3 biodigester that produces 100m3 of compost. We are also installing 200 solar panels of 350 Wp each with an inverter of 80kVA. Lastly, we are installing infrastructure for harvesting and storing 200m3 of rainwater, as well as water reuse and waste water treatment systems. These efforts will reduce our electricity consumption, water use, carbon footprint, and increase overall crop quality.

Data deficit: Our work shows that it is possible to eradicate hunger and malnutrition in the healthcare system cost-effectively. We know that if replicated across Africa, our strategy will improve social conditions, trust, reciprocity, and provide sustainable food security. However, pushing for policy change is challenging and requires evidence of efficacy and cost-benefit. We need additional data before we can present a compelling case to the Rwanda national health service and other African nations’ health service agencies.

Financial barriers: We are under-resourced as an organization for the level of need that we see in hospitals and communities we serve. In 2004, Rwanda implemented the Mutuelle de Sante national healthcare system, which uses a four-tier approach to subsidize patients’ medical bills. The poorest patients make up the two lowest tiers and the population that we currently serve. Their numbers are growing because increasingly we see that even patients from higher categories of health insurance also need our services because of the financial burden caused by repeated and prolonged hospital visits and stays. Currently, we work in public hospitals in Rwanda’s capital, Kigali, and we plan to establish feeding programs and farms in cities and towns outside the capital by 2025. We estimate that we would need to quadruple our budgets to meet the national need at scale.

Environmental challenges: Global climate change has cause severe seasonal flooding in Rwanda and this has impacted farm productivity resulting in significant food losses including several tons of rice.

Data-informed Policy change: We are working on building an evidence-based business case that will support the implementation of our model across Rwanda, and internationally. We have some preliminary data showing efficacy and cost-benefit but we plan to conduct additional empirical measurements of how food security in healthcare reduces the demand on federal resources, and contributes to poverty alleviation. We aim to present the business case and replication strategy content to Rwanda health services and three other African nation’s health service agencies by 2022.

Infrastructure investment: We plan to establish patient feeding infrastructure in regional referral hospitals outside of Kigali by 2022. We will extend the service to District Hospitals by 2025. We have applied for the Zayed Sustainability Prize and other one-time grants in a bid to secure the funds needed to scale up our programs, and we continue to reach out to a network of individuals who are friends of Solid’Africa to raise some of the funds needed to support our work.

Environmental challenges: to deal with unpredictable weather patterns, we have had to rethink our farming strategy. The recent challenges with seasonal flooding made us shift into permaculture design to better protect our crops.

In 2018 we partnered with Imbuto Foundation and the King Mohammed VI Foundation for Sustainable Development to build the first industrial kitchen in Rwanda. We also partner with Barbara Stiefel Foundation and Imbuto Foundation to install water purification systems in hospitals. To date, we have installed these systems in the three biggest hospitals in Rwanda. These three systems together produce 18,000 liters a day, serving over 3000 patients daily and an average of 1000 hospital staff. Recently, Solid’Africa began piloting a new program that offers free yoga sessions for patients and caregivers in partnership with AZAHAR Foundation, an international non-profit that promotes peace-building and cross-cultural communication through yoga and the arts. We also have partnerships with Boston-based CRI Foundation, which provided general unrestricted funding for our core operations, the Segal Family Foundation, which supported our general operations and documentation of our efforts, and the Government of Rwanda which has provided no-cost land leases for our farms and kitchen construction. Last year we partnered with the University of Global Health Equity to conduct a multi-year study on the relevance and impact of our programs in public hospitals.

We now have an initial partnership with Knology, a US-based social science research organization, to develop, pilot, and implement evaluation, monitoring and research infrastructure by next year. This will be followed by staff training in performing evaluation and annual reporting commencing in 2022.

Solid’Africa has a novel strategy for addressing the pressing problem of food security in African healthcare systems. We understand that food security and healthcare services are inextricably tied, and have developed a vertically-integrated strategy for addressing the extraordinary need across Africa. In 2019, we completed construction on an industrial kitchen capable of preparing 15,000 meals daily. We currently provide three meals a day to 800 patients and their caregivers including specialized meals for patients with conditions that preclude them from eating certain foods. By 2020, we expect to provide three free meals to at least 1,000 patients, and their caregivers per day. This represents food security for an estimated 366,000 people (2.9 % of the total population) per year.

Solid’Africa uses donor dollars effectively. We manage all costs from bottom to top by drawing on community values and social support. We grow much of the food used in our feeding program on our own farmlands, which reduces food purchasing and transportation costs, and the risk of breaks in the food supply caused by unpredictable distributors. Furthermore, by controlling the food production process, we can ensure the quality of the food that patients eat. We plan to replicate our model in public hospitals across Rwanda in the next few years. Within a few years, we plan to operate our kitchen as a social enterprise that provides catering services to private businesses. This will allow us to raise the income needed to sustain our free patient feeding program.

Solid’Africa completed construction on the first industrial kitchen in Rwanda in 2019 that can prepare 15,000 meals per day. We intend to run this kitchen as a social enterprise. This infrastructure will support our efforts to develop a food services income stream to sustain our patient feeding and agricultural programs. We estimate that at current rates, we can feed 1000 patients for free, in the six major Rwandan hospitals, three times a day, for a cost of $913,905 per year. With seed funding for hiring new staff, we can scale up to produce 9,000 meals daily for sale, with an estimated income from food sales of $1.5 million per annum. We project that the Kitchen will be self-sustaining within 36-months and profitable within 48-months. Profit and fund-raising will then be used to help build smaller kitchens that support regional referral hospitals outside of Kigali. These kitchens will operate under a similar model where they feed vulnerable patients for free while producing enough extra meals for sale to commercial enterprises to raise income.

Once we are self-sustaining, we intend to use the Rwanda model as the basis for exporting our strategy to other African countries where food security in the hospital system is also a crisis. Our intention is to create a self-sustaining program in Rwanda that can be integrated as a support service in the national health system, and also support a mentoring and Africa-wide management program focused on helping other nations replicate the model.

To date, Solid’Africa has built its program on grant-funding, pro-bono professional assistance, and volunteer direct service. Major funders include Imbuto Foundation and King Mohammed Foundation for Sustainable Development: Award amount: $500,000. We received this grant in 2018. The funds were used to construct the first industrial kitchen in Rwanda. This kitchen has the capacity to prepare 15,000 meals per day and is a crucial component of our long-term financial sustainability plan. We completed construction in 2019.

Barbara Stiefel foundation. Award amount: $200,000. We received this grant in 2019. The funds were used as unrestricted funding for our operations as well as part of a program to install water purification systems in hospitals. To date, we have installed these systems in the three biggest hospitals in Rwanda.

CRI Foundation. Award amount: $100,000. We received this grant in 2020. It provided general unrestricted funding for our core operations.

Bonnie and Andre Weiss : Award amount : $100,000. We received this grant as an emergency fund due to Covid-19.

Segal Family Foundation. Award amount: $104,000. We received this grant in 2020. We used the funds to support our general operations and as emergency funds due to Covid-19.

VIF investments: discretionary Grant – 2020

Individuals: discretionary Grants - 2020.

Several one-time gifts of under $500 were received in response to our crisis appeal for funding to support the scale-up required to expand services due to the COVID-19 pandemic.

Based on our estimated expenses for the year 2020, we will need to raise $544, 000 in unrestricted grant funding to cover the costs of scaling up the number of patients and families fed daily, and the number of hospitals served. These funds will cover the costs of food production including farming, as well as meal preparation and transportation three times daily. It will also provide the seed money needed to develop our commercial catering services that will raise the income needed to support our free feeding and agricultural programs. This will set us on the path toward our goal of self-sustainability by the end of 2023.

We have assessed the market for patients who can afford to pay for food and their families around the hospitals – as well as big companies that want to feed their staff for lunch. We calculate that the market will support 9,000 meals-for-sale each day, generating an estimated income from food sales of $1.5 million per annum. These funds will be enough to cover our current operating costs.

If successful, we will also invest a portion of the grant funding we are trying to raise in research and evaluation infrastructure. The goal here is to gather needed data to allow us make the case for expanding our program across the Rwandan public health system, and also to present our model to governments in other African countries. In addition to this application, we are also seeking other funding opportunities.

We estimate that at current rates, to feed 1000 patients per day, in six hospitals, three square meals a day, our minimum annual budget is $913,905 for the year 2020 excluding pro-bono services, volunteer services, land donations and other in-kind support.

Solid’Africa is the first and only organization in Rwanda to create a scalable and sustainable approach for supporting vulnerable patients in public hospitals. We launched because the absence of food security in healthcare systems across Africa was creating needless suffering. We are committed advocates for the essential role of food security as part of a public health insurance policy for those living in poverty. Receiving this award will recognize our consistent effort since 2011 to prove that this is a solvable problem with implications for human flourishing, societal well-being, and economic development. We have demonstrated that our solution can be self-sustaining within a few more years, provide jobs, prevent lost livelihoods, and mobilize communities to actively participate in their health. Our government has already recognized the vitality of our work, provided free land for our farms and our kitchen construction, and showed willingness to consider evidence-based policy change. This prize will underwrite our scale up of income generating food services, support effectiveness measurement, and bring attention to our replicable strategy for other African nations facing the convergent crisis of food security and public healthcare. We will be able to collect the data needed to help us make a successful case to leaders in other countries.

We are a proudly African-created and African-directed non-profit charity. We seek technical support to build the business case and monitoring program needed to advance broader implementation of our strategy. We have preliminary evidence of program efficacy and cost-benefit but need additional data to really scale up our efforts across Rwanda and Africa. We will invest some prize money in empirical measurements of how food security in healthcare reduces the demand on government resources, and alleviates poverty. KPIs will include successful development, pilot testing, and implementation of a permanent evaluation, monitoring and research infrastructure, followed by staff and volunteer training and annual reporting. As a learning organization dedicated to continuous improvement in effectiveness and efficiency, we seek partnerships with organizations that can help us workshop ways to adapt international research to the needs of our country, our people, and our culture.

We have established an initial partnership with Knology, a US-based social science research organization that produces practical social science for a better world. Knology is helping us to develop the fully realized research, evaluation, and marketing program outlined in the prior question. As we raise funding, we will work with them as a technical support team to provide online mentoring, training, data analytics, and recommendations for continuous improvement of our work. With additional support, we intend to expand that work to build capacity for our staff and volunteers in data collection. We will also use emerging theory to help expand our volunteer support network (and their skills), and develop robust metrics on impact and outcome that can be used in our advocacy efforts to embed food service in public hospitals across Africa.