Photo Credit: Better Cotton/Khaula Jamil. Location: Rahim Yar Khan, Punjab, Pakistan, 2019. Description: Farm-worker Shahida Parveen planting saplings in her tree nursery.

Driving Improvements in Health and Livelihoods for Smallholders

Louisa Marie Truß, Head of Partnerships at Elucid

The annual Better Cotton Conference brings together a diverse group of changemakers across the cotton value chain to build a sustainable future for cotton farming communities. 

This year’s conference is all about accelerating impact. The opening segment of the Conference, ‘Putting People First’, will explore how centring farmers and farm workers is a win-win-win for farming communities, the environment, and the cotton sector at large. We will challenge cotton stakeholders on what it means to ensure a living income and decent work. 

Our experts are action-oriented and will share ideas for social change that support people and strengthen livelihoods. One such expert is Louisa Marie Truß, Head of Partnerships at Elucid, who is joining us as a panellist in our session on Decent Work Gaps and Shared Responsibilities, taking place on the morning of 26 June. 

Elucid offers a digital solution that enables small-scale producers to access affordable healthcare, directly subsidised by sourcing companies and buyers. The organisation leverages existing health infrastructure and reduces both financial and geographical barriers to health for rural farming communities.  

Elucid’s learnings from other sectors like cocoa and tropical fruits resonate with many similar challenges faced in cotton production. Their model suggests a high potential for addressing some of the root causes of these challenges, driving positive impact among farming communities. Ahead of the conference, we spoke to Louisa about Elucid’s work, and the importance of improving healthcare access in solving decent work challenges.  

What challenges is Elucid working to address? 

Elucid is dedicated to addressing the pressing health challenges faced by rural farming communities. Despite national insurance systems, high out-of-pocket healthcare costs push over 100 million people into extreme poverty annually and deter individuals from accessing essential medical services.1 Rural areas face significant barriers such as long travel times to healthcare facilities, lack of financial resources, and service gaps in the national health system.  
These factors put disadvantaged groups like children and women at risk, endangering family livelihoods, and reducing production capacity and overall resilience. Poor health leads to increased absenteeism and decreased productivity, disrupting crop production and compromising the quality of produce. To cope with high healthcare expenses, families often resort to negative mechanisms such as child labour and unsustainable farming practices, contributing to deforestation and environmental degradation. 

Furthermore, the limited availability of data on health and social risks challenges companies working with these communities to manage social risks, jeopardising the long-term sustainability of agricultural production in the region. Elucid focuses on improving healthcare access for small-scale producers and providing companies with the tools to collect high-quality data to prove sustainability claims and manage social risks. 

How does improving healthcare access help farming communities? 

Health is a human right.  

Access to healthcare is a catalyst for increasing farmer health and resilience. Improved healthcare access enhances health outcomes and economic resilience by addressing barriers that boost agricultural productivity, reduce child labour, and support environmental conservation.  

Healthcare costs constitute a significant portion of non-food expenses for farming families, accounting for approximately one-third of monthly household spending. A single health crisis can push a household into poverty. Thus, preventing sudden, often impoverishing health expenditure at the household level has a positive impact on the available household income and investment in agricultural inputs and hired labour.2 This can be explained through the reduction of sick days and increased productivity.3 Research also shows increased investment in education, higher school attendance, reduction in child labour4, and lower malnutrition rates5.  

What work is Elucid doing to expand access to healthcare? 

Elucid provides quality healthcare for smallholder producers in Sub-Saharan Africa and Latin America. Our health programmes are designed to complement and support national policies and services, tailored to fit local contexts. Through our digital platform, producers can access subsidised care at partnering providers, addressing high healthcare costs and covering service gaps in national health systems. Healthcare providers are reimbursed for the treatments they provide.  

Healthcare data is automatically analysed and anonymised through the claims filed and shared with national governments to improve service quality. Socio-economic data on livelihoods is collected via surveys. The programme’s impact can be tracked and shared through our data portal, enabling credible impact claims. 

The Decent Work Gaps and Shared Responsibilities session at the Better Cotton Conference 2024 will showcase Elucid’s model, as well as other innovative partnerships and approaches to fostering decent work in cotton production, through multi-stakeholder action. 

  1. Eze, Paul et al. “Catastrophic health expenditure in sub-Saharan Africa: systematic review and meta-analysis.” Bulletin of the World
    Health Organization vol. 100,5 (2022): 337−351J. doi:10.2471/BLT.21.287673
  2. Adam et al. “Progress on catastrophic health spending in 133 countries: a retrospective observational study.” The Lancet. Global
    health vol. 6,2 (2018): e169−e179. doi:10.1016/S2214−109X(17)30429−1
  3. Osei-Akoto, Isaac et al. “The effect of health shocks on agricultural productivity: Evidence from Ghana.” International Journal of Agricultural Policy and Research 1 (2013): 67−79.
  4. Yao, Komlagan Mawuli Apélété et al. “Vulnerability of farming communities to malaria in the Bole district, Ghana.” Parasite epidemiology
    and control vol. 3,4 e00073. 2 Aug. 2018, doi:10.1016/j.parepi.2018.e00073
  5. Garcia-Mandicó, Sílvia et al. “The Social Value of Health Insurance: Results from Ghana.” Journal of Public Economics, vol. 194, 2021, article 104314. ISSN 0047−2727, doi:10.1016/j.jpubeco.2020.104314.
  6. Kofinti, Raymond Elikplim et al. “Reducing Children’s Malnutrition by Increasing Mothers’ Health Insurance Coverage: A Focus on Stunting and Underweight across 32 Sub-Saharan African Countries.” Economic Modelling, vol. 117, 2022, article 106049. ISSN 0264−9993, doi:10.1016/j.econmod.2022.106049.
  7. Nuñez, Pablo A et al. “Impact of Universal Health Coverage on Child Growth and Nutrition in Argentina.” American journal of public health vol. 106,4 (2016): 720−6. doi:10.2105/AJPH.2016.303056


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