Stealing from Avon to Serve the Poor Collaborating with BRAC under the BRAC-Living Goods Partnership

CORE Spring Conference May 2016

Panel: CHW Models, A Focus on Sustainability

Molly Christiansen, Director Impact & Advocacy

mchristiansen@livinggoods.org

Living Goods supports networks of Community Health

Promoters who go door-to-door teaching families how to

improve their health and delivering life-saving products and

services.

Living Goods community health program reduces child

mortality by 25% for an annual cost of under $2 per person.

1. Sustainable funding for

CHW compensation, and

some of operating costs.

CHPs are neither volunteers nor salaried workers, they’re paid for results CHPs earn a modest margin on what they sell, solving the great challenge of how to motivate and pay community health workers LG recovers 100% of product costs LG earns a modest wholesale margin that covers some of operating costs making net cost to funders under $2 per capita annually

“Living Goods solves two of our biggest

challenges in the health care sector:

How to keep vital medicines in stock, and

how to compensate and retain community

health workers.”

DR. RUHAKANA RUGUNDA Prime Minister Uganda

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2. Integrated Health Delivery to the Last Mile

Our integrated platform avoids the inefficiency of single-issue health strategies.

Malaria Diarrhea Pneumonia Worms

Childhood Diseases

Prenatal checks SMS reminders

Nutrition Delivery in facility

Family Planning

Healthy Pregnancy

Postnatal Checks Kangaroo Care Preventing Infection

Newborn Survival

Pregnancy supplements Breastfeeding

6-24 month nutrients

Nutrition

3. Broad Product Mix Drives

Impact and Sustainability

• Oral contraceptive, condoms

• Clean delivery kit • Prenatal vitamins

• ACTs • ORS/Zinc • Amoxicillin • RDTs for Malaria • Deworming

• Fortified porridges • Iodized salt • Sprinkles • Nutributter

• Solar lights • Clean burning cook stoves • Water filters

Maternal & Newborn

Health

Childhood

Diseases Health Tools

The more CHPs have to sell, the more income they earn,

the more time they invest... and the greater impact they deliver.

Nutrition

4. Always-in-Stock Distribution System

Branches are always in stock,

tracking inventory electronically

and restocking monthly

CHPs restock weekly Branches can deliver to

CHPs via motor bike saving

CHPs time and money.

5. Best in Class Performance Management

LG selects and actively manages the performance of its CHPs

CHPs earn a performance-based income while serving the needs of their community.

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Select! Train! Equip! Manage! Incent!

Community Referrals

Literacy and Numeracy

Interviews

Replace Low Performers

3 Weeks Initial

Monthly in Services

Hands-on Learning

Mobile Tools

Business in a Bag

Uniform

Smart Phone

Inventory Loan

Targets

Real-time Data & Dashboards

Field Supervision Checklists

Random Quality Checks

Retail Margin On Sales

CHW Performance Incentives

Performance based Compensation for all Staff

6. Living Goods Smart Mobile Tools

Every CHW uses a smart phone with best in class health apps New LG Android application does ICCM assessment, flags acute cases, and spots high- risk pregnancies.

Smart Apps Increase Treatment Accuracy & Improve Quality  LG “Smart Health” application automates ICCM assessment, flags acute cases, and spots high- risk pregnancies.

Delivers Health Education by SMS Tailored text messages educate clients on vital health behaviors and provide timely reminders for pregnant moms.  ‘CHPs on Call’ Drive Prompt Treatment Living Goods CHPs encourage their clients to call or text their CHP at the first sign of disease illness symptoms. This ‘on-call’ health worker system speeds treatment and improves outcomes.  Analytics Dashboards Improve Performance and Monitoring Automated dashboards show field staff how CHPs are performing in real time. Staff call or text customer to check service quality. Managers see real time performance data on every CHW on any devise.

Real time data drives impact, quality and efficiency

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Analytics Dashboards & Performance

Management

Real Time District/Region/Branch Comparison

Analytics Dashboards & Performance Management

Prioritized support to agents

A J-PAL randomized control trial

revealed Living Goods is achieving a

25% REDUCTION IN UNDER-FIVE

MORTALITY

The study was independently sponsored by the Children’s

Investment Fund Foundation. IPA surveyed 8,000

households over 3 years across 214 villages. Mortality rates

improved across income groups at similar rates. The study

also found a 7% reduction in under 5 stunting.

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Vision: Improve health of over 50 million people in the next 10

years through highly effective, well-managed CHWs.

Where we currently work:

Uganda – 3500 CHWs; 6500 CHWs by 2018

Kenya - 250 CHWs; 1800 CHWs by 2018

Partnership w/CARE in Zambia and PSI in Myanmar

Future:

•  Grow networks of CHWs in close partnership w/government

including PPP arrangements.

•  Technical Assistance to other NGOs and governments to build

and manage CHW networks

•  Advocate with bi/multilateral funders and governments to

effectively finance and plan community health

•  Leverage bi/multilateral aid and performance based financing

deals to drive more domestic financing of community health

“A lot of programs

give lip service to

‘sustainability’ —

this is the real deal.

Living Goods is one of

few models with the

potential for game-

changing scale.”

HOLLY WISE Former Secretariat Director, USAID Global Development Alliance Thank you!

mchristiansen@livinggoods.org !

Made Possible by Extraordinary Partners

“Living Goods is a pioneering initiative—effectively reducing childhood mortality while

structured from the outset to endure fiscally. Their approach of training community members

to be ‘Avon-like’ entrepreneurs creates a level of sustainability that is hard to match.”

JAMIE COOPER-HOHN, Co-founder of The Children’s Investment Fund Foundation

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