Living Goods

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

Their annual demonstrated impact includes:

  • Supporting over 12,000 community health workers with training, digital literacy, and digital tools, bringing basic healthcare to the most in need in Kenya, Uganda, and Burkina Faso with the use of advanced digital tools to transform health systems.
  • Measuring a 46% reduction in child mortality in areas impacted by droughts where Living Goods-supported community healthcare workers operate, suggesting an effective healthcare workforce reduces the number of children who might have died due to drought, and that investing in improved community healthcare helps build climate resilience in low-income areas. 

Key Strengths: Scale, Respect for dignity

Multidimensional Poverty Index Indicators: Child mortality

Other Key Outcomes: Healthcare utilization, Vaccination rates, Child development 

Recent Expense Budget: US$26,000,000

Year Founded: 2007


12k+
active community health workers
8M+
people served with essential health services, products and information
33%
reduced infant mortality
27%
reduced under-5 mortality

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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

Supporting community health workers (CHWs) to provide reliable and affordable health 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 sub-Saharan Africa: 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.

Living Goods-supported CHWs are equipped 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.

“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 ORGANISATION

CHWs take clients through the app’s diagnosis workflow free of charge. During the COVID-19 pandemic, CHWs provide clients with essential medicines and health items for free, including birth control pills, Sayana Press injectable contraceptive and malaria medications. Living Goods manages the supply chain to help ensure medicines are always in stock, whether through government or Living Goods-managed supply chains.

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 and supervisors are digitally enabled to collect data, improve quality of care, and monitor performance with digital tools
  • CHWs are equipped with the skills, tools and supplies they need to their job well
  • CHWs are supervised by dedicated personnel whom they meet with regularly
  • CHWs are compensated through performance-based incentives

Living Goods community health worker speaking to mother and child

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.

Living Goods’ solution also builds government capacity to better manage, strengthen, and own these health systems themselves, laying the groundwork for longer-term impact and sustainability. They provide implementation support that enables government to sustainably lead community health programs.

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

They also work in partnership with well-respected organizations such as BRAC, Last Mile Health, Malaria Consortium, and Terre des hommes. Previously, they have partnered with CARE and Population Services International (PSI).

Frequently Asked Questions

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.

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.

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. [7] 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.

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.

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.”

We recommend Living Goods because they were recognized as a GiveWell standout charity before GiveWell retired that designation.