Proof of Concept RCT
A Randomized Controlled Trial (RCT) is considered the gold standard for research design, and the best way of accurately determining the causal effects of a given intervention to learn what works and what does not. In an RCT, we use a comparison group to understand what would have happened without the program. Villages, households, or individuals are randomly assigned to either receive a program (or intervention) or not such that we have confidence the impact we see is due to the program and not to other factors.
RCTs can be expensive and time-consuming, and we do not plan on conducting large-scale RCTs of our overall program routinely. However, having an RCT embedded in our roll-out was crucial in giving us evidence and confidence early on that our community health program was having an impact. Learn more about RCTs here.
A large-scale, randomized evaluation of Living Goods’ and our partner BRAC’s community health program in Uganda showed substantial impact in reducing unnecessary deaths. After three years, results demonstrated a 27 percent reduction in under-five mortality at an estimated average cost of $68 per life-year saved. Infant and neonatal—under 1 month—mortality were also significantly reduced by 33 and 27 percent, respectively. The Children’s Investment Fund Foundation funded the independent evaluation led by a team affiliated with IPA and J-PAL.
The RCT found that the community health program improved other intermediate outcomes as well, including improved health access, health knowledge, and behaviors. For example, households with a newborn baby were 71 percent more likely to have received a visit in the first week after birth.
Publication in American Economic Journal: Applied Economics
Our Research Partners
RCT of Large-Scale Community Health Program
We are conducting a second RCT of Living Goods and BRAC’s operation in Uganda to evaluate the impact of our community health program on child mortality when operating at a much larger scale. This study uses a stratified cluster RCT design in a sample of 13 districts of Uganda, 500 villages, and over 12,500 treatment and control households with data gathered from both caregivers and CHWs.
Evaluation of Living Goods’ CHW Program in Kenya (In Progress)
In 2015, Living Goods expanded our community health program into Kenya. Living Goods partnered with the Kenyan Ministry of Health and the Kenya Medical Research Institute to conduct a quasi-experimental evaluation in Busia County, Kenya. The baseline was conducted in May 2017, and the endline will be conducted in Q4 2019.
Evaluation of Community-Level Intervention to Improve Immunization Coverage in Uganda and Kenya (In Progress)
Living Goods is partnering with Gavi and the Ministries of Health in Uganda and Kenya to improve immunization coverage by empowering community health workers to deliver a package of immunization services at the community level.
Evaluation of Community-Based Family Planning Scale-Up in Uganda (In progress)
Uganda has one of the highest fertility rates in the world. Living Goods tested comprehensive FP services including offering Sayana Press at the community level through CHWs with strong results. In 2019, Living Goods is rolling out FP services across its network of CHWs. The goal of this research project is to evaluate the impact of the FP program on uptake and utilization of FP methods, mCPR, and unmet needs, as well as obtaining a better understanding client and community attitudes, acceptance, self-efficacy, and behaviors over time.
Socio-Economic Data Center (SEDC)
Relevant External Research
New WHO Community Health Guidelines
Released in October 2018, these guidelines present a systematic review of the evidence on community health policies and practices. The aim of the guidelines is to assist national governments and national/international partners in improving the design, implementation, performance, and evaluation of CHW programs, contributing to the realization of UHC. These guidelines put community health at the center of PHC and UHC and are the go-to-resource for governments, policymakers, and NGOs on community health programs.
What do we know about Community-Based Health Worker Programs? A systematic review of existing reviews on community health workers.
Scott, et al. Human Resources for Health. August 2018.
This publication synthesizes the findings of reviews that have been published regarding community health workers. This was commissioned by the World Health Organization to develop guidelines for countries to develop and strengthen their CHW programs.
Comprehensive Review of the Evidence Regarding the Effectiveness of Community-Based Primary Health Care in Improving Maternal, Neonatal and Child Health.
Black et al. Journal of Global Health. 2017.
This 8-article series published in the Journal of Global Health offers recommendations from an Expert Panel for strengthening community-based primary health care (CBPHC) and prioritizing CBPHC for strengthening health systems.
Expanding the Population Coverage of Evidence-Based Interventions with Community Health Workers to Save the Lives of Mothers and Children: An Analysis of Potential Global Impact Using the Lives Saved Tool (LiST).
Chou et al. Journal of Global Health. 2017.
Estimates that a total of 3 million deaths would be prevented between 2016 and 2020 if evidence-based interventions that community health workers can provide are gradually scaled up in the 73 countries of the world with the majority of maternal and child deaths.
Setting the Global Research Agenda for Community Health Systems: Literature and Consultative Review.
Agarwal et al. Human Resources for Health. March 2019.
Literature review and expert consultations to develop and prioritize a global policy and practice-oriented research agenda for community health systems.
USAID / MCSP Landscape Analysis of National Community Health Worker Programs.
USAID’s flagship Maternal and Child Survival Program (MCSP) publication on an analysis of 22 USAID supported country CHW programs and highlighting promising practices and gaps in community health policy and strategy.
Practitioner Expertise to Operationalize Community Health Systems: Harnessing Operational Insights
Six organizations with high impact CHW programs including Living Goods have come together as a part of the Community Health Impact Coalition to identify insights from their implementation experience summarized in eight design principals to drive program quality.
Community Health Worker Assessment and Improvement Matrix: Updated Program Functionality Matrix for Optimizing Community Health Programs
The Program Functionality Matrix tool can be used to assess and improve CHW program quality through identifying and closing gaps in CHW program design and implementation.