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Compensating & Retaining Community Health Workers_Christianson_5.11.11
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Compensating & Retaining Community Health Workers_Christianson_5.11.11


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  • 1. Uganda Ministry of Health
    An Entrepreneurial Solution for Improving Community Health Combining the best practices in franchising, microfinance, and public healthCollaborating with BRAC under the BRAC-Living Goods Partnership
    Key Partners
    CORE Group Spring Meeting
    May 2011
    Molly Christiansen
    415-632-1697 | |
  • 2. Living Goods Model
    • LG recruits, trains and supports community health promoters (CHPs) who educate mothers about health, sell health products door-to-door and make referrals to clinics.
    • 3. CHPs sell low-cost high-impact health products priced 10-40% below market
    Leverages the combined buying power of many agents to obtain quality medicines at the lowest possible cost
    Bypasses most wholesalers, distributors and other middlemen
    • LG aligns incentives of CHPs with key health goals, driving BOTH sustainable incomes for health workers and health outcomes
    Retail margins from product sales makes CHPs economically viable;
    Wholesale margins contribute to program operating cost, creating financially sustainable model at scale
    LG’s diverse product mix drives sales and enables cross-subsidization
    CHPs sell key health prevention and treatment products, consumer staples and household goods
    Fast moving items increase frequent home visits and opportunities for client interaction
    Branch distribution network within 7km of CHPs where CHPs resupply weekly
    Low-cost inventory loan for initial products; free “business in a bag” with everything needed to run business.
    • LG targets reducing child mortality by 15% and morbidity from key child diseases by 20%. RCT in process with results in 2012.
  • LG’s Diverse Product Mix Drives Sales…
    … And Enables Cross-Subsidization
    Insecticide Treated Bed Nets
    Water Treatment
    Vitamin A, Iron, Zinc
    Hand Soap
    Iodized Salt & Fortified Foods
    Anti Malarials
    Oral Rehydration Salts
    OTC Pain & Cold
    Consumer Staples
    Feminine Hygiene
    Laundry Soap
    Lotions & Creams
    Money Saving or Making
    Solar Lanterns / Chargers
    Efficient Cook Stoves
    Water Filters
    Reading Glasses
    Human-Powered Irrigation Pumps High-Yield Seeds
    >> Fast moving items increase frequent home visits
  • 4. Advantages of Entrepreneurial Approach
    Income generation for CHW  Retention and motivation of CHWs
    Door-to-door sales approach  Frequent household interaction, good customer service, convenience, “on call” trained provider
    Products, health ed. & referrals  Meets health needs of community
    Sustainable distribution channel/supply chain  >90% in stock rates, flexible, other pro-poor products
    Community-based care  Reduces workload for public facilities
    Franchised network Highly scalable
    Highly cost-effective  Financially sustainable at scale  NO-COST CHW network
  • 5. Harder in very low pop density areas (but as model evolves, will reach further and further)
    A “cure-most”, not “cure-all” approach - will address many, but not all health problems or populations
    Management talent with strong business and operational skills can be hard to find
    Need right organizational “DNA” – “enterprise mindset” focused on impact and profit
    Limitations of Entrepreneurial Approach
  • 6. Myth: The poor can’t afford to pay for essential health items
    Fact: 45% of lowest quintile in 11 SSA countries use private sector (WB Africa Development Indicators 2006)
    Fact: High OOP health spending even for lowest earners, with high% on pharmaceuticals.
    Fact: w/ $$ saved on low prices, transport, & lost income, can be “cheaper than free”
    Myth: Profit motive and health impact are inherently at odds
    Fact: strict monitoring and controls can prevent overtreatment.
    Fact: Strong CHP health impact metrics correlate with strong sales
    Fact: Increasing number of private sector, entrepreneurial approaches to poverty alleviation and global health
  • 7. DO hire management with appropriate business, sales, and supply chain skills & pay well, including using performance incentives
    DO incorporate a diverse product mix to allow for cross subsidization and regular interaction between CHW and households
    DO incorporate a rigorous recruitment and selection process for CHWs - find most connected, charismatic, and dedicated women
    DO replace low performing CHWs - more bang for buck for org and community
    DO incorporate incentives to motivate CHWs and for specific health outcomes– “top seller of the month; “most improved”; “Monthly Champions”, cash incentives for pregnancy outcomes, etc.
    Entrepreneurial “Do’s”
  • 8. Community Health Promoter: Zamin Nsibambi Location: Bwaise slum 
  • 9. Living Goods — The Avon of Village Health
    • Avon was founded in the U.S. in 1886
    • 10. The population was mostly rural and agricultural
    • 11. The standard of living was substantially lower
    • 12. Access to quality products in rural areas was poor
    • 13. There were strong village social connections
    • 14. Targeted to rural women needing extra income
    Today Avon sells over $10 billion and thrives in
    140 diverse cultures – from Peru to the Philippines.
    >> There is a compelling analogy between the conditions that provided the fertile ground for Avon over 100 years ago and the developing world today.
    >> If Avon can build a $10 B direct selling business with products that are purely discretionary, imagine this models’ potential impact if harnessed to promote products that people desperately needed.
  • 15. Thank you
    Phone: 415-632-1697Email: mchristiansen@livinggoods.orgWeb:
  • 16. Health Promoter Supports
    Free Training
    Free Health Promoter Toolkit:- Backpack - Locking Storage Chest- Uniform- Signage- Record Books- Health Tools
    Access to Low Cost Products
    Subsidized Promotions
    Low Cost Inventory Loan
    Ongoing Coaching and Training
    Branch distribution system within ~7km of CHPs where CHPs re-supply weekly
  • 17. The Living Goods Health Business in a Bag
    Locking Storage and Display
    Cell phone
    Measuring Tape
    Breath Timer for ARI Diagnosis
    Visual Referral Guide
    Visual Dosage Guide
    Visual Training Tools on 17 Key Health Behaviors
    Shoulder Bag
    Branded Signage
    Training Certificate
    Branded Apron
    Branded Tee Shirt
    Price List
    Sales Register
    2 Pocket Money Pouch
    Medication Instructions Form
    Referral Form
  • 18. Living Goods Products
    Oral Contraceptive
    Clean Birth Kit
    Anti Fungal
    Feminine Pads
    Tooth care
    Water Filter
    Solar Lanterns
    Water Treatments
    ORS / Diarrhea Treatments
    Malaria Treatment
    Treated Bed Nets
    Fortified Foods + Vitamins