Liz Jarman reflects on where Living Goods is halfway through the Audacious Project on the plans we made, our learnings and future goals for strengthening community health at this extraordinary moment.

What We Planned To Do

The Living Goods vision is a world in which every family has access to quality community-based primary care. The goal of our partnership with The Audacious Project was to catalyze the global health community towards achieving this vision. We aimed to radically increase the number of CHWs we support, to improve the services they provide, and to share our learnings broadly. In doing so we planned to work across three different approaches:

Direct Management

Where we would be responsible for the hands-on management of networks of government CHWs

Operational Assistance

Where we would assist governments and other implementing partners to apply some of the best practices we have developed to how they themselves manage CHW networks

Policy Assistance

Where we would contribute to government efforts to put in place best-in-class community health policies and systems – including tech and financing solutions.

What We Learned

Rather than be comprehensive here—we learned A LOT—I’d like to highlight three areas where we were really surprised over the past two years: First, governments wanted to move faster on community health, and to be more creative and diverse in their approaches, than we had expected. Two years ago, even as we expected government interest in partnering with Living Goods, we underestimated how proactive and creative governments would want to be in strengthening their community health programs. This level of interest is fantastic, but it also poses challenges. While we’ve had lots of opportunities to partner, those opportunities have been diverse—different partners with different needs facing different obstacles. We have to work hard to meet that diversity: To create an approach where we are working hand in hand with potential government partners to understand their needs, and to offer the appropriate type and level of support to add value for them.

Second, partnering in general was a more complex and slower-moving process than we anticipated. Getting to a place where we have enough flexibility and capacity to work successfully with a variety of partners has been, as they say, a journey. The first thing we had to do was get out of the mindset that we would only take on opportunities where our complete model would fit in perfectly: That wasn’t realistic.

The second thing we needed to do was accept that “doing” and “supporting” are two different skillsets, and that we would need a big internal shift to get really good at supporting others. Over the past year especially we have been laser-focused on building our capacity as a helping organization, that can take the lessons we’ve learned from years of execution, and help our partners to put them into practice.

Third, there were more opportunities to have an impact than we had expected outside of our core health focus on MNCH, and the payoffs from some of these opportunities were very big. In some cases, things have in fact been easier to do, or gone even better than we had planned. To give one example, we’ve found extremely strong synergies between our original focus on MNCH and our two new areas of family planning and immunization counseling and referrals. In the past two years we began expanding into both new areas with pilot programs, and found that not only were we getting strong results – we were also seeing CHWs improve on their MNCH performance when they added family planning and immunization to their portfolio.

How We Will Improve

Informed by these learnings and by our overall experience of the past two years, below are four key areas that we will focus on as we move forward.

Government engagement

We need to build strong foundations with multiple governments, both where we currently work and in new countries. Not all of these relationships will move forward to a full-fledged partnership, and that’s ok. We will accept a measure of risk in order to move fast, and recognize that there will be failures. We will also be flexible, recognizing that we can help in a lot of different ways; and that sometimes the most needed help could be an advisory or advocacy role.

Controlled experimentation

What we mean by an “experiment” is a data-driven test of a practice in community health. This could range from testing levels of CHW compensation, to testing a new health services, to testing a new management technique. Our goal will be to implement experiments that are impactful, that are fast, and that yield results that can be applied by lots of other organizations.

Internal tech capacity

Living Goods is one of the most experienced organizations at integrating mobile tech and CHW networks. We were lucky to have had a great partner early on in Medic Mobile, who helped us develop our Smart Health platform. More recently, we have brought all of our app development and other tech functions in-house. We have also worked to become platform agnostic and open-source – recognizing that each partner will have their own needs and preferences for the tech they work with. Thus this is already an area that we are very active in; but we will need to keep pushing ourselves because we have a lot to offer and want to make sure our expertise is of maximum benefit to the field.

Thought leadership

This is another area where we have already seen a lot of progress, but need to make sure that progress doesn’t slow. Aside from tech, we have expertise from our years of experience in CHW compensation, supervision, and performance management. These are hard issues that we have spent years working on, and we will remain focused on translating that experience into support for our partners and the broader field.