Living Goods
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Living Goods

Living Goods supports and trains local community health workers in Kenya and Uganda — the majority of whom are women — to deliver lifesaving medicines, health education, diagnoses, and health products to millions of people who need them. They focus especially on preventing and treating the leading causes of child deaths.

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Active in
2
countries: Kenya & Uganda
8,934
community health workers
7.14M
people served
Work costs
US$3.09
per person per year
Reduced infant mortality
33%
Reduced under-5 mortality
27%

The problem: a shortage of frontline health workers and inadequate distribution of health products and knowledge

Half of the world lacks access to essential health care. [1] Many health care systems — particularly in developing countries — are chronically under-funded, under-stocked, and understaffed. Let’s look at some of the numbers.

On average, there are 2.3 health workers per 1,000 people in Africa, compared to 24:1,000 in the United States. [2] Further, more than 24% of the global burden of disease falls on people living in African countries, where only 3% of the world’s health workers operate with less than 1% of the world’s financial resources. Sub-Saharan Africa in particular makes up only about 13% of the world’s population, yet suffers an estimated 66% of global maternal deaths, 41% of global stillbirths, and 40% of global newborn deaths. [3]

More than 24% of the global burden of disease falls on people living in African countries, where only 3% of the world’s health workers operate with less than 1% of the world’s financial resources.
Living Goods community health worker looking in little boy's mouth

Stock-out rates (instances where an item or medicine is out of stock and unavailable) for critical medicines at public health facilities routinely exceed 50%, and poorly trained, poorly monitored health outlets are standard. [4] These issues increase in the hardest-to-reach rural communities where need is often greatest. In developing regions, more than 45 million women per year receive either inadequate antenatal care or none at all, and more than 30 million women deliver their babies outside of a healthcare facility.

The solution: community health workers

Empowering community health workers (CHW) to provide reliable and affordable care along with essential medicines and products to the doorsteps of millions saves and improves lives.

How Living Goods works

Living Goods aims to transform the way health care is delivered by addressing two fundamental barriers in the developing world: the significant shortage of frontline health workers and the inadequate distribution of health products and knowledge.

Living Goods helps governments strengthen and professionalize their community health systems. They recruit, train, equip, and manage government-recognized networks of local CHWs who go door to door within their neighborhoods, providing health education, diagnoses, medicines, and health products that save and improve lives. CHWs focus on high-impact areas where they make the biggest difference at a low cost, including pregnancy and newborn care, malaria, pneumonia, diarrhea, nutrition, immunization, and family planning.

“Community-level interventions are cost-effective even with delivery costs factored in, especially when several conditions are met (including strong supervision of community-level workers and integration of workers into teams supported by the larger health system).”  
— World Health Organization

Living Goods CHWs take clients through the diagnosis workflow free of charge. Clients pay for items they purchase (like sanitary napkins and powdered milk) as well as most medicines. Some medicines, like birth control pills, Sayana Press injectable contraceptive, and malaria medications are offered free of charge because they are provided by the governments of Kenya and Uganda and distributed by CHWs, though this varies by location.

Living Goods combines best practices from public health with business acumen and technology from the private sector to ensure effective operations. They believe in four essential components to strengthen community health programs:

  • CHWs are compensated for their work
  • Essential medicines and supplies are always in stock
  • CHWs receive supervision and data-driven performance management
  • CHWs are tech-enabled

Living Goods community health worker speaking to mother and child

CHWs are armed with a powerful, diagnostic mobile application — the SmartHealthTM app — that Living Goods co-developed with technology partner Medic Mobile. It allows CHWs to register, track, and follow up with patients, ensuring data-driven performance management, as well as real-time data collection. Clients can also receive messages on their mobile phones with care reminders.

Living Goods also advocates at the national level to strengthen primary health care (PHC) systems, striving to ensure all children and their families are able to access lifesaving care when and where they need it.

What makes Living Goods so effective


Cost-effectiveness

A randomized controlled trial showed that Living Goods reduced mortality in children under 5 by 27% and infant mortality by 33% at an average cost of $68 per life-year saved. [5] They estimate that their work costs an average of US$3.09 per person served per year.

Partnerships with local suppliers

All medicines and health-related products provided by CHWs are procured locally from manufacturers and importers within Kenya and Uganda. This allows Living Goods to buy in bulk and bypass middlemen in existing supply chains, keeping costs affordable. 

Holistic training

Living Goods provides CHWs three weeks of basic health care training from specialists, including technical modules on integrated community case management for malaria, pneumonia, and diarrhea. They also provide business modules where CHWs learn about the health-related products they can sell to generate additional income. 

Ongoing support and monitoring

CHWs attend monthly trainings to refresh and increase their knowledge and confidence. Branch managers visit regularly to monitor performance, review stock, oversee record-keeping, and ensure that CHWs are effective and supported.

Mobile technology

Living Goods uses its extensive mobile platform to monitor and improve productivity, quality control, and impact, while CHWs can collect data to better identify and target high-risk households with health services.

Sustainability

The money CHWs earn, the recognition they receive, and their community-oriented spirit keep them highly motivated to continue this essential work.

Living Goods’ accountability and sustainability

Living Goods taps into existing community health systems to reach households in dense urban slums, peri-urban, and rural areas — 70% of which reside more than five kilometers from the nearest health facility. They share documentation, tools, and methods to strengthen health systems, and partner with governments to provide technical assistance and capacity building.

A study completed by rigorous researcher Innovations for Poverty Action found that the Living Goods’ approach reduced under-5 mortality by 27% percent and infant mortality by 33%. [6] Living Goods has also worked with the highly-respected Abdul Latif Jameel Poverty Action Lab (J-PAL) to undertake a randomized controlled trial (RCT) to monitor its progress on reducing child mortality. Its second RCT with J-PAL is currently underway.

Living Goods’ recognition and partnerships

Living Goods is listed as a Standout Charity by GiveWell, which awarded them a US$250,000 GiveWell/Good Ventures grant. [7] They also work in partnership with well-respected organizations such as BRAC, CARE, and Population Services International (PSI).

Frequently Asked Questions

How much does it cost to support community health workers? What is the cost to provide care annually?

Living Goods’ approach to health care is incredibly cost-effective: it costs an average of US$3.09 per person served per year. The net cost (including in-country overheads) of supporting one active CHW averages approximately US$1,279 per year.

Why would the extreme poor pay for medicine that might be free in government hospitals, or that they could buy elsewhere?

Although some medicines are free of charge from Uganda’s healthcare system, the facilities that provide them have high stock-out rates, and travelling to a facility often involves unaffordable expense and hours of travel. Medicines sold privately at local drugstores are often counterfeit or cost-prohibitive for the populations Living Goods serves. Living Goods offers genuine, essential medicines and health-related products at below-market prices, delivered right to people’s doors – saving time, money, and lives.

What is the scale and reach of Living Goods community health workers?

At the end of 2018, Living Goods and its partners supported nearly 9,000 active CHWs who reached over 7 million people. They registered over 178,000 new pregnancies, as well as assessed 1.46+ million children under 5 and more than 306,00 children under 1 in Kenya and Uganda. [8] In the next few years, Living Goods will expand into two additional countries, and aims to reach 13.8 million people by supporting 18,350 CHWs by the end of 2020.

How are Living Goods community health workers compensated?

CHWs make a small profit from selling products and medicine; Living Goods also provides incentive-based pay for key health metrics, including sick child assessments, new pregnancy registrations, and on-time prenatal care visits. CHWs receive pay depending on the number of each of those types of visits they perform in a month. CHWs are asked to commit a minimum of 10 hours per week visiting clients door-to-door.

How do communities view Living Goods community health workers?

Sauda Baubidia, 28, says that her work with Living Goods “has moved me from zero to a hero…because I have saved them,” she said. “I saved lives for their kids.”

Pouline Nasuna, a CHW in Uganda, says, “I always wanted to be a nurse or health practitioner, but never had money for the studies, so when this opportunity came about, I jumped at it. Before, my income was never enough. So the extra income I get as a CHW of about US$60 per month is very important. I can now afford school fees, rent, and food. My job as a Living Goods CHW has helped me and my family so much… It gives me great respect in the community and it makes me so proud when I see the impact I have on my community.”

Why does The Life You Can Save recommend Living Goods?

We recommend Living Goods because they have been named a Standout Charity by GiveWell, one of our two charity evaluators.

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