New country expansion: a year of learning and adaptation

Given the tremendous global need for effective community health services and increasing government interest across the continent, Living Goods is actively exploring new countries where we can drive significant impact through DESC approaches.

We planned to engage in four opportunities in 2020 that would enable us to explore how to strengthen the digitization and performance management of community health programs in additional countries. However, we made the tough decision to pause operationalizing in the first two when the COVID-19 crisis hit.

  1. Ethiopia: We were in the final stages of solidifying a partnership with the Federal Ministry of Health and PSI Ethiopia to support government to design and test digitally-enabled performance management for their Health Extension Program.
  2. Rwanda: We were in final negotiations with the MOH to sign an MOU to support the digitization of their community health program over the next five years.

We ultimately felt we could make the biggest impact by doubling down on our support to two West African countries where we already had staff on-the-ground:

  1. Sierra Leone: Before the pandemic, we planned to finalize a partnership with multiple partners to demonstrate the impact of digitally-enabling community health efforts in an exemplar district in Sierra Leone. Our goal was to generate evidence that would inform scaling up these approaches beyond the exemplar through government and other partners. Once COVID-19 hit, our team shifted to support the Ministry of Health and Sanitation; Directorate of Science, Technology and Innovation; and Dimagi to develop COVID-19 and CHW dashboards and set up a dynamic, WhatsApp-based two-way communication channel to provide accurate information about disease spread and prevention. We also supported the government’s CHW Hub to adopt and set targets for its national CHW program and made recommendations that led to the adoption of an enhanced policy on performance management best practices. While we believe we helped deliver significant impact in Sierra Leone at a critical time, we are pausing future investments and will not have any permanent staff based there in 2021.
  2. Burkina Faso: With U5 and neonatal mortality rates that are markedly higher than those in Kenya and Uganda—and a government committed to strengthening and digitally-enabling its 18,000 CHWS—Living Goods already had a team in Burkina Faso supporting the MOH in assessing digital tools for community health and CHW performance management effectiveness. When the pandemic hit, we initially focused on supporting the development of the country’s CHW Response Plan for COVID-19; developing and maintaining DHIS2-based digital health tools that support contact tracing, border entry tracking and disease call centers alerts; and linking DHIS2 and UNICEF’s mHealth tools.

Beyond these COVID-19 response initiatives, at the request of the MOH, our team was also able to conduct its initial assessment and develop recommendations for 1) a digital tool to be used by CHWs and their supervisors, and 2) improved performance management approaches and processes that will leverage this digital tool for improved community health service delivery to all. We also supported the MOH to develop a budget for the design, implementation and testing of this digital tool and improved performance management approaches/processes, which will be funded in part through the MOH 2021-23 Global Fund/Rockefeller matching fund.

Being inventive and adaptive is one of Living Goods’ core values and pivoting to support the urgent COVID response in both Burkina Faso and Sierra Leone enabled our teams to deliver meaningful impact in a time of crisis while using the opportunity to better understand government needs and priorities for longer-term partnerships.

In 2021, we will be focusing on partnership opportunities with the Burkina Faso and Ethiopia MOHs to  design effective CHW digitalization tools that integrate best practices in performance management—with the goal that governments will operationalize demonstration sites by the end of 2021. We will also be taking a fresh look at opportunities to partner with other governments that are committed to digitally enabled community health systems and have made strong operational commitments, with the goal of recommending a third country for new country expansion by year-end.  For each engagement, we will develop a detailed theory of change and clear performance metrics that will define what “success” looks like and determine whether we see the potential for long-term impact and investment.


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