Living Goods Model: Strengthening Community Health Systems Through Performance Management and Innovative Technology

Head of Community Strategy Dr. Salim Mohammed during a meeting with LIving Goods in Busia

Community health workers (CHWs) have been called the “world’s most promising health workforce resource” in terms of enabling health systems in resource-constrained settings. Most often, CHWs—also referred to as community health volunteers (CHVs)—are relied upon to deliver a range of health services directly to communities and link households with the formal health system. Recently, there has been resurgence in global attention to CHVs, recognizing them as an integral part of the health workforce needed to achieve country health commitments.

In Kenya, a not for profit organization Living Goods is partnering with Busia County to implement a low-cost community health model focusing on several key areas that precipitate the majority of child deaths: community case management of childhood diseases, pregnancy support and newborn follow ups, nutrition counseling and prompt referral of cases to health facilities. The Living Goods model offers promising potential: an independent randomized control trial conducted in Uganda—where the organization began—revealed that it is achieving a 25 percent reduction in deaths of children under five. Through its partnership with the county government, Living Goods is strengthening CHV networks, building capacity, and positioning them to play a significant role in health care delivery. Ruth Ngechu, Director of Health at Living Goods, explains that the organization, “help(s) mobilize resources and pass important health care skills into local hands through training—enabling communities to be better prepared to face adversity and be the first to respond effectively to an emergency.’’

Performance Management through Empowerment

The innovative Living Goods model provides performance-based income for CHVs. They don’t work as volunteers or salaried staff; rather, they are empowered entrepreneurs who earn a small income by distributing impactful products and services in their community. The Living Goods model generates revenue that pays for the products, a retail margin that provides motivating incomes for the community health workers, and wholesale margins that cover some of the field distribution costs. Dr. Morris Siminyu, Chief Executive Officer for Health in Busia County, said that the county struggles to compensate CHVs and has thus encouraged them to explore income-generating activities that can help sustain their work. Living Goods presents an innovative hybrid model that can both deliver health impact as well as generate revenue for some operating costs.

Living Goods supports Busia County in providing three weeks of training, plus monthly in-service education—resulting in a well-trained, fully-equipped, and motivated team of community volunteers. CHVs are viewed as valuable and respected resources in their communities, and families know exactly who to go to for products and services. Because inventory is tracked electronically and restocked regularly, Living Goods branches and CHVs are always in stock on essential health commodities. According to Living Goods Director of Health, Living Goods has so far trained over 300 CHVs in Kenya, registering over 30,400 households reaching over 152,000 people. In the next several years, the organization will continue to collaborate with the counties and national government to expand into additional regions and bring better health services to hundreds of thousands of Kenyans.

Dr. Siminyu acknowledges the role of Living Goods in the effective delivery of community health services in the county. He says that the Living Goods model has enhanced the effectiveness of the CHVs and reduced the workload in some link facilities such as Busibwabo Health Centre. They have been supportive as primary health givers in offering services such as making referrals,” he explains. “We have found that when CHVs are motivated and active in communities, there are less and less clients at the link facilities.’’ By directly visiting households, CHVs have increased access to care for groups who are particularly difficult to reach—such as secluded women, the extremely poor, or the lowest classes of society. “With their links to the health system, CHVs can also offer an entry point for and at times directly providing health services, such as contraceptive methods, home-based care for people living with AIDS, directly observed therapy of tuberculosis, and community-integrated management of childhood illnesses,’’ he stressed.

Leveraging Technology to Deliver Health Impact

The Living Goods model harnesses technology to keep CHVs motivated, organized, and effective. The organization’s innovative mobile tools allow CHVs to register and track pregnancies, accurately perform community case management through standard protocols, and follow up with clients in person and via phone. Monthly targets are set for the CHVs and performance is tracked real time using mobile data platform. The mobile phones help overcome geographical and other constraints, and provide innovative practice-based tools that help facilitate increased communication and support between CHVs, their supervisors, and the end clients. Ruth Ngechu, Director of Health Living Goods explains that the organization’s effective mobile tools provide higher-quality services and allows managers to actively track and enhance CHVs’ performance.

Buy cheap Viagra online

Moving Community Health Forward in Kenya

According to Dr. Salim Hussein, Head of Community Health and Development, Ministry of Health has approximately 4,700 established community health units, with 92,000 community health volunteers and 3,600 community health extension workers delivering health services to over 50 percent of the country’s population. He explains that since the implementation of community health services began in 2008, there has been an improvement in immunization, antenatal care, and reduction of childhood diseases. Cases of non-communicable diseases such as diabetes and hypertension have decreased as a result of intensive screenings and awareness creation.

The Ministry of Health implemented the community strategy after a 2004 evaluation of Kenya’s health status yielded unsatisfactory results. The importance of community health services has been restated in the Kenya Health Policy Framework of 2013-2030 as well as in the Kenya Health Strategic and Investment Plan of 2013-2017. Currently, the Ministry of Health is working with the county governments to develop a Community Health Policy to guide the implementation of the community health services.

The partnership between Busia County and Living Good demonstrates how collaborative and innovative approaches can help build, strengthen, and grow effective community health worker networks. It’s a step in the right direction toward a healthier Kenya.