Transitioning Towards Sustainability in Kenya: Open Letter from Living Goods CEO Liz Jarman

Dear friends,

We began our journey in Kenya in 2014 from very humble beginnings. We were operating out of a small office in Kariobangi, Nairobi with about 13 staff working with 30 entrepreneurial sales agents to promote door-to-door sales of health products. We never imagined that in less than six years, we would have evolved well beyond this initial focus. We are now a lead partner supporting health systems strengthening nationally and sub-nationally and worked with 7 county governments to support more than 3,000 CHWs—locally known as community health volunteers—and more than 2 million families across Kenya.

Early on, we knew that to create lasting impact, we needed to invest in the most cost-effective, replicable, and sustainable approaches for delivering essential community health care. This meant that our efforts needed to focus on investing in country-led models that aligned with and strengthened existing government health structures rather than creating parallel ones. As the first country director for Living Goods in Kenya, I oversaw our first major transition from a social enterprise model to one where we started working with county governments to support cohorts of CHWs within government systems.  We started off directly implementing community health programs for small networks of CHWs across five counties—Busia, Kakamega, Kisii, Kiambu and Nakuru—to learn about operating in different environments within Kenya’s devolved system of governance. We then pioneered co-financed partnerships with the Isiolo county government in 2018 and Kisumu County government in 2019 to jointly support 100% of CHWs. These efforts were a step-change in how we initially operated, as they entrenched government’s capacity to fully own, implement and finance highly effective, digitized community health programs.

As we’ve scaled our support to more CHWs and focused our approaches on ensuring that government CHWs are Digitally empowered, Equipped (with training, medications, and other equipment), Supervised and Compensated—what we call the DESC approach—we saw a massive positive evolution in Kenya’s enabling environment. The Kenyan government has progressively invested in resources to advance universal health coverage (UHC), we have partnered with them to develop meaningful health policies and frameworks that speak to DESC and digitizing community health nationally, and they want support that enables them to lead their health system long-term.

Consequently, now that Kenya has robust facilitative policies in place, Living Goods has made the strategic decision to support government’s sustainable leadership of the health sector more intentionally, and work ourselves out of the job. While this is incredibly exciting and will drive the lasting impact we seek, it was imperative that we make some tough strategic choices about how we operate in Kenya, so that we can make the most meaningful contributions with finite resources.

Operationally this meant that at the end of July 2021, Living Goods transitioned back to government the direct support we had been providing to more than 1,300 CHWs in Kisii, Kiambu, Nakuru and Kakamega counties—as they’ll ultimately receive similar support directly from the Kenyan government once the new supportive policies are operationalized.  We are providing some resources through the end of 2021 so that upskilled CHWs in these counties can keep using their digital tools to aid their work and collect data with their phones, and government supervisors can keep accessing it in the interim.

Going forward, we will focus on enabling government-led scale by continuing to strengthen our partnerships in counties like Kisumu and Isiolo—and more to come—where government has made the commitment to co-finance the DESC approach. Specifically, we’ll support government to roll out its new national community health digitization program, which contains all components of the DESC approach, to all 95,000 CHWs in the country and drive the use of health data for decision making. We are already supporting the digitization pilot in Kisumu, which will inform a phased rollout enabling national scale by 2025.

Second, we are more overtly focusing on building evidence on best practices in community health by strengthening Learning Sites in certain areas where we previously led direct operations, which will serve as centers of excellence and innovation.  Busia County will be the hub for this work in Kenya, given our length of operations there, and the strong impact we’ve driven despite its high disease burden.  Busia is the only county in Kenya where we’ll continue to directly fund DESC support for approximately 850 CHWs (nearly half of the county’s CHWs), and we’ll work to ensure it serves as a learning hub for innovation that showcases the best of what’s possible in community health.

Finally, we will support and advocate for continued improvement of the community health enabling environment to ensure the right policies and financing are in place within Kenya’s devolved health system and advance the community health movement regionally and globally.

Our new approaches in Kenya necessitated a redesign of our organizational structure. This regrettably meant that 37% of our Kenyan staff were impacted—as their roles significantly changed or ceased to exist in the new structure. While Kenya was the epicenter of our pivot and the most affected, we simultaneously reviewed our staffing structures across the organization. This included Uganda, our global support functions, and the C-suite, to ensure they were fit for the future, and resulted in 10 percent of roles changing globally. We endeavored to synchronize the change management process across the entire organization, to create equal opportunities for impacted staff to participate in a competitive process to fill the vacancies and  demonstrated our duty of care through separation support services to the exiting staff. We developed and implemented plans to address both the external and internal changes, and to support county governments, CHWs and our staff through the transition, while ensuring business continuity. While we have already communicated directly to those affected, I want to reiterate publicly:

  • To the government health teams we have partnered with in Kisii, Kakamega, Nakuru and Kiambu counties, we sincerely appreciate our collaboration and proudly celebrate what we have accomplished together. We laud your leadership and commitment in progressively capacitating CHWs, developing transformative policies and legislation, and broadening the health services offered by CHWs to fundamentally transform health service delivery. We are excited about what lies ahead, building on the foundation of our work together. We will continue to share best practices; help shape the broader enabling environment and advocate for greater financing for the primary health ecosystem to support you in strengthening your community health system and delivering UHC to your constituents.
  • To the CHWs we support in Kenya, we salute you for your extraordinary devotion and recognize your courage and sacrifices, especially during the current pandemic. You are at the heart of what we do. Even though we may no longer have boots on the ground in areas we’ve exited, we will continue to advocate at all levels for the development and operationalization of policies and practices that promote your empowerment, integration, and recognition. We are excited that soon you will all be digitally enabled, equipped, supervised, and compensated and that this will become institutionalized for generations of CHWs to come.
  • To the families we’ve served in counties we’ve transitioned back to government, thank you for the pleasure of being a part of your lives. Thank you for letting us walk your health journey with you. We promise to continue working to ensure that you and all Kenyans have access to quality health care at your doorsteps through work we’re doing at county, national and global levels.
  • To our directly impacted staff, I will be honest: this has been a difficult time. I am glad that many of you secured new roles, with some getting promotions after successfully applying for newly advertised roles. Unfortunately, we still had to let many of our colleagues go, which was not in any way a reflection on their performance or abilities. It is never easy to make decisions that impact the lives of our colleagues—people we know well and who have done remarkable work—especially during the COVID pandemic. However, I and the rest of the leadership team worked hard to ensure a fair, equitable and transparent process to manage this transition and to minimize job losses.  Thank you for your hard work, your devotion, and the role each of you has played in supporting Living Good’s mission-driven work. I wish none of our colleagues had to leave the LG Family and we have done our best to provide you with a soft landing outside of Living Goods through decent severance packages, and a range of support services including counseling, wellness advisory, job outplacement and more. To those who have had to leave us, you have been a big and important part of our family, and you will remain dear to the Living Goods fraternity and Alumni.
  • To our remaining LG staff, I know we have all been affected by the recent organization restructure and I am thankful for your patience, your professionalism, and your resilience during this important transition. I know that the work ahead is as important as ever, and it will both challenge and inspire us. It will be my life’s honor to lead you on this reignited adventure as we embark on executing our new strategy over the next five years, and I hope each one of you is as excited as I am about the journey ahead.

We truly look forward to the next frontier of impact as we follow government’s lead in scaling holistic and data-driven community health. We will continue to evolve, to adapt and to grow as we work to create a world where every family can easily access the healthcare they need to survive and thrive.  We remain committed to this cause and continue to stand with families, CHWs and governments to make universal healthcare and health equity a reality for all here in Kenya and everywhere we have the privilege of working.

Sincerely,

 

Liz Jarman

Chief Executive Officer

Living Goods

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