Living Goods: Improving Health, Improving Incomes
Mary is a typical mother living in a rural Ugandan village. She has two options when one of her four children falls sick.
Her first and allegedly cheapest option is walking long distances to a public facility, where she will spend hours waiting in the heat and in many cases find that free treatments are out of stock. Desperate, her other option is traveling to a closer private clinic or pharmacy that charges high out of pocket fees for well-stocked but potentially counterfeit drugs.
In both scenarios, access to services is tragically compromised, and Mary’s child’s illness becomes fatal or life-threatening.
Community Health Challenges at Large
Mary is not alone in facing limited options. Finding and obtaining quality health products and services at an affordable price is a challenge across Uganda and many other developing countries.
Public systems may achieve scale, but they struggle on sustainability due to limited government funding and subsequent dependence on donors. Meanwhile, the private sector suffers from a high degree of fragmentation, resulting in retail prices that reach 350% of factory cost, counterfeit products, and poorly trained and monitored outlets. This leaves individuals unsure of where to turn for help when lives are on the line.
For Mary’s family, her neighbors, and other communities, there is a clear need for hybrid solutions that bring to bear public sector scale and government support, with the business acumen and sustainability focus of private sector counterparts.
Micro-Entrepreneurs Improving Community Health
Living Goods, a social enterprise that has operated in Uganda since 2008, is tackling community health challenges with a much-needed hybrid approach that leverages the best of the public and private sectors.
Harnessing individual entrepreneurialism, we recruit, train, equip, and deploy Community Health Promoters (CHPs) who go door-to-door dispensing health advice, diagnosing and treating sick patients, and referring severe cases to nearby facilities. To date, Living Goods in partnership with BRAC manages a network of 1,000+ CHPs who serve individuals like Mary and her children and make their communities healthier places to live.
What differentiates Living Goods CHPs from government-led community health worker counterparts is the 15-20% margin our agents earn on their door-to-door sales of treatments, preventions, and pro-poor household products like highly efficient clean cook-stoves and solar lights. This small product margin provides supplemental income and an essential staying incentive that keeps our agents active in their communities year after year.
Because Living Goods also earns a wholesale margin on products sold, our operations are highly cost-effective with potential to be fully self-funded at scale. This type of model can thus support the public sector in a more sustainable way, as it offers an alternative to weak volunteer-based schemes or expensive salaried networks that are too expensive to take to scale.
Living Goods has seen huge success to date. CHPs have delivered over 563,000 treatments and supported over 153,000 pregnancies in their communities, contributing significantly to improved health outcomes in urban, peri-urban and rural communities. Additionally, Living Goods is actively partnering in other countries with organizations like PSI to adapt the model and scale its impact.
Focus on Learning
The Living Goods model is inspired by a long history of successful direct selling and franchising organizations across the globe, such as Avon, Amway, and current partners BRAC and PSI.
We are not only building on the foundations created by others, but also helping to shape what the future of effective development looks like by rapidly piloting new initiatives to learn, improve, and avoid costly longer term mistakes. Our focus on fast, cheap learning has been the genesis of very exciting initiatives like the recent decision to equip agents with Android smartphones, as well as important learning moments on topics ranging from agent consignment lending, to hub-and-spoke distribution.
Sharing Our Model on the Road Ahead
Our focus on learning is important for sustaining current operations, but even more critical for taking our model across the globe in pursuit of game-changing disruption to and scale of community health systems.
Recognizing that global scale cannot be achieved through direct operations alone, our dedicated Partnerships Team is proactively seeking opportunities to give away our model and provide consulting services to like-minded organizations looking to establish their own version of a scaled entrepreneurial, income-generating, community health worker network.
Together with partners, we hope to create a universal third option for a poor mother like Mary whose child falls ill: a home visit from an always in-stock community health entrepreneur who can assess, diagnose and treat the child with quality drugs offered at an affordable price. As this third option is made available to more mothers and families worldwide, we can be proud of improvements in health outcomes that translate into millions of lives saved.