Health costs represent an invisible yet massive barrier for smallholder farmers worldwide on the path to achieving a Living Income. Annually, health expenditures push over 100 million people globally into extreme poverty. The Living Income Community of Practice (LICOP) webinar in October 2025, co-hosted together with Elucid, highlighted the impact of poor health access on farmer productivity. This blog summarizes the key takeaways from the discussion and shows how innovative, cross-sector partnerships can overcome this critical challenge.

The Invisible Barrier: Health Costs and Productivity Loss

Unexpected health shocks force farming families into a vicious cycle of debt, prompting them to sell assets early or take out unfavourable loans, ultimately preventing them from reaching a Living Income. The core reason for this burden is the frequent lack of functioning national health insurance systems, which forces smallholder farmers to pay for treatment out-of-pocket, transforming a necessary medical visit into a financial crisis. But the issue goes beyond immediate costs; poor health creates deep structural barriers that undermine the very foundation of farm viability in rural supply chains globally.

Across many regions where corporate partners source cotton and cocoa, critical infrastructure gaps are the norm. For instance, in areas like Tchologo, Côte d’Ivoire, where the poverty rate exceeds 60%, the challenge is stark:

• Geographical Distance makes timely treatment almost impossible, with the nearest health centre often 10–15 km away.
• This leads to a severe healthcare deficit, sometimes recording as few as 0.74 doctors per 10,000 people.

The financial consequence is devastating. The cost for a single medical treatment can easily exceed a week’s income, forcing families into high-interest debt and financial instability. Critically, frequent illness translates directly into economic loss, leading to an estimated 3 to 7 days of absenteeism per month, which reduces yields and output. This lack of productivity and the resulting debt strains supply chain relationships, delaying the achievement of resilience.

 

From Risk to Resilience: Elucid’s Solution

Elucid implements targeted, community-level health programs in partnership with supply chain stakeholders such as Tony’s Chocolonely and Olam Agri to break this cycle. The programs are context-specific, always matching the needs of the community and the country they serve.

Elucid’s solution encompasses a simple, digital health model that integrates health into sustainability strategies:

• Household Registration: The process begins with context assessment and registration.
• Seamless Reimbursement: Patients seek care; the healthcare provider files the claim digitally; the claim is then reimbursed by Elucid. This simplifies the financial process for the farmer and provider.
• Data-Driven Decisions: Socio-economic and health data is collected to measure impact and guide future strategies, providing clear documentation of the work.

The investment in health demonstrates a high return on investment, underscoring that health is a vital economic catalyst: An analysis showed that for every $1 invested by partners, a Social Return on Investment (SROI) of $5.28 was generated for the farmers.

 

Cross-Sector Action: A Model for Collaboration in Cotton and Cocoa

The webinar highlighted that the solution's power lies in its cross-sector adaptability. This model is proven across different supply chains:

The ReACT Project (Cotton)

The ReACT (Resilience through Collective Action and Access to Healthcare) project serves as a robust example of collaboration in the cotton value chain, uniting Olam Agri/SECO, Elucid, and Better Cotton. This initiative provides access to affordable healthcare via the Elucid digital platform for 8,000 people in the cotton-farming sector in Northern Côte d’Ivoire. It strategically builds upon the existing Universal Health Coverage (CMU) system, ensuring the model’s long-term scalability across vast regions.

The CHASI Program (Cocoa)

In the cocoa value chain, the CHASI Program (in partnership with Tony’s Chocolonely) demonstrates the direct human impact. The program reached 3,188 families (12,471 people) in Ghana, facilitating 9,437 paid doctor visits. Cooperative leaders, including those from the Asetenapa Cooperative, confirmed the necessity of prioritizing maternal and child health and addressing farm-related injuries (occupational health issues). Notably, 65% of care seekers were women, highlighting the program's crucial role in empowering female farmers and their families. Read more on the program's impact here.

Ultimately, investing in farmer health creates a virtuous cycle that strengthens the entire supply chain. This means that better health leads to higher productivity, which builds greater resilience to shocks, and finally results in long-term sustainability. This cycle is one the most effective mechanisms to directly contribute to closing the Living Income gap.

 

Conclusion: 

The webinar discussion confirmed the key strategic takeaway: investing in smallholder health is not a cost factor, but the decisive catalyst for building resilient, sustainable supply chains. Only through innovative Public-Private Partnerships and cross-sector models that bring together corporate partners, public funders, and implementation specialists can the goal of a Living Income be effectively achieved.

Do you want to be part of this learning and action?

• Get in touch with Elucid: If you’re eager to cooperate with us, feel free to contact: louisa.truss@elucid.de
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