For many living in remote areas in countries like Uganda, accessing high quality healthcare has never been easy. But now, some in Uganda and Kenya are getting quality healthcare, health education and medication delivered to their doorsteps by community health workers using advanced algorithms to diagnose and treat health issues.
Living Goods, the organisation responsible, has a mission to prevent deaths by curable diseases. But it also sets out to ensure that the community health workers who would make this possible are adequately compensated.
The project has scaled rapidly in recent years — shifting its focus and working with different governments to roll out care. By maintaining a sharp focus on its mission even while working in environments with differing needs, this program has taken many people’s rural health experiences from virtually non-existent to on-demand in a matter of a few years.
The need for better healthcare
In countries like Uganda and Kenya, there’s often a huge gap between the public health service and the care that people in communities – especially rural ones – need on a daily basis. “Brain drain” means that many doctors choose not to live in their home country and those who do work as doctors often face limited funding and resources.
To accomplish its mission of preventing deaths from preventable diseases — with a focus on mothers and children under five years old— Living Goods provides continuous training to community health volunteers and equips them with a mobile phone and an app that enables them to standardise their health treatment.
If a mother calls in with a child experiencing diarrhoea, for example, the community health worker can ask a series of standard questions about the child’s other symptoms to rule out possibilities, such as pneumonia, or land on a probable diagnosis of say, malaria.
The data from the visit is collected in real-time and monitored by supervisors, who ensure that there are no significant gaps in care based on geography, socioeconomic status, or anything else and who can also detect outbreaks of certain illnesses early and get support.
When Living Goods first started its health impact programs in Kenya and Uganda, many of the community health workers delivering its services were not sufficiently compensated for their work. Many were volunteers who often worked several hours a day and made long, arduous journeys to deliver care to their neighbours, but went unpaid and unrecognised for much of their labour.
One solution that the program trialled was stocking the health workers with basic supplies – such as portable gas stoves, sanitary products and nutrient-rich porridge – which they could sell for a low price to community members who would benefit from them. This allowed them to earn a small margin while carrying out their duties.
But this led to the program sometimes being understood as a micro-franchising one. Ultimately, it sent the wrong message about the mission of these projects, which was above all to improve health impacts and to equip governments with the lasting tools and support to operationalise these practices and run them on their own.
As a result, Living Goods has shed the “Avon lady” message that used to describe the women going door to door selling supplies. It now focuses on the lives it saves by delivering high quality medical care using cutting edge technologies.
Further, while selling products helped supplement health workers’ income, it was never going to be a sustainable or foundational form of compensation.
Living Goods now also focuses on piloting new forms of compensation to see what works best in each area, working closely with governments as they also change and adapt the way they deliver care and medicine. In some places, they are testing out compensating health workers per assessment and experimenting with other kinds of results-based structures.
In Uganda, Living Goods is working with the Ministry of Health to pilot a results-based financing system, in which independent third parties pay health workers based on their impacts, which helps stimulate investment into community health.
Living Goods’ Jennifer Hyman explains that community health workers – 90% of whom are women in Uganda, while 70% are women in Kenya – also gain a new standing in their communities from the critical care they provide for their neighbours. Hyman says that “a significant number of women in Uganda who’ve been supported by us have run for local office and have won”.
Scaling new programs
As they continue to test these compensation structures at scale, Living Goods is rolling out some important new services, including a new family planning service which allows women to receive injectable birth control from a trusted health worker in the privacy of their home. For many women, privacy and autonomy about their sexual health choices – even privacy from their partner – can be hugely important.
In Kenya where this service is being piloted, the project is acting as an implementation researcher and advisor to the Kenyan government, who have yet to offer this same injectable in the formal healthcare system. As Hyman puts it, “At the end of the day, our north star is working ourselves out of business so that we become an advisor to governments as they scale community health”.
Hyman says that Living Goods plans to take its mobile technology and government enablement even further. It’s now rolling out an immunisation advice service, in which health workers will refer families to get their children vaccinated. GPS-enabled mobile phone technology will allow supervisors to make sure the family actually goes for the vaccination, and can “nudge” them if they are overdue.
From rarely seeing a healthcare professional to being nudged via text message for vaccinations – many of these community members have experienced the power of technology and nimble scaling.
— Megan Dent
[Picture credit: Jennifer Hyman]