We’ve Begun Supporting Community Health in Ethiopia!
In March 2021, Living Goods embarked on a partnership to support the Ethiopian government’s drive to massively scale the digitization of its community health workforce, known locally as Health Extension Workers (HEWs). Led by partner JSI Research & Training Institute (JSI), as well as Dimagi, Living Goods will help strengthen and accelerate performance management as the Ethiopian Federal Ministry of Health (FMOH) scales its electronic community health information system (eCHIS) beyond the 1,500 HEWS it currently supports.
We currently have two team members providing full-time support to the government of Burkina Faso’s COVID-19 response, including extensive support on development, maintenance, and training for Regional MOH staff on tools for contact tracing, call center alerts, and more.
Our team in Burkina Faso has been assisting with the development and maintenance of DHIS2-based digital health tools that are supporting COVID-19 contact tracing and tracking border entry and disease call centers alerts. They are also helping to develop COVID-19data management guidelines and training regional staff on appropriate data entry practices. They are currently in the process of building an interoperability layer between DHIS2 and UNICEF’s mHealth tools, which include case registrations and follow up, self-check tools for the population, and case identification and follow-up modules at the community level.
They are also supporting the development of Burkina Faso’s CHW response plan for COVID-19, including sharing guidelines Living Goods helped develop in Kenya and Uganda. Importantly, we have restarted work to support the MOH in reprogramming resources from the Global Fund to Fight AIDS, Tuberculosis and Malaria (Global Fund) to ensure CHWs have access to PPE and training to respond to COVID-19.
In Sierra Leone, we embedded two team members in Sierra Leone’s Ministry of Health and Sanitation and Directorate of Science, Technology, and Innovation to support interactive COVID-19 messaging systems for Sierra Leoneans and the integration and analysis of various COVID-19 data that will provide the government with timely and actionable information.
We also seconded three staff who are providing critical M&E assistance that has led to the development of harmonized community health indicators. We have supported the configuration of the country’s CHW and COVID-19 dashboards—built off DHIS2—to enable the use of integrated, real-time data to drive decision-making. Simultaneously, we’re conducting a situational analysis of the country’s COVID-19 response and developing detailed user requirements so that Sierra Leone’s Emergency Operations Center can better harness data visualization and analytics in its response.
In June 2020, Living Goods and our tech partner Dimagi inked a partnership with Sierra Leone’s Ministry of Health and Sanitation (MoHS) and Directorate of Science, Technology and Innovation (DSTI) to support the government in developing mHealth tools that assist with the prevention, early detection, tracking and case management of COVID-19, particularly at the community level. These focus on developing and rolling out digital surveillance and case management applications that collate data from multiple sources, including quarantine centers, health facilities and labs, and integrating that with DHIS2.
In August 2020, in partnership with Praekelt.org, we’re helping to launch Health Alert, a dynamic new WhatsApp-based tool that will enable people across Sierra Leone to immediately access accurate information about COVID-19 and arm the government with data-driven insights that will improve monitoring of community spread and contact tracing. The tool will provide users with the latest infection numbers, enable access to accurate information about disease spread and prevention, have myths dispelled, read relevant news, and more.
We intend to upgrade it to include modules for users to conduct symptom checks, seek referrals, and engage in case management. It will also serve as a two-way messaging system to facilitate health alerts and information sharing during and beyond the pandemic. All data collected will be integrated with DHIS2, and the account will also be integrated with Rapidpro—UNICEF’s common SMS platform for developing and sharing mobile data—as a fallback for areas with little or no internet connection.
In this context, PSI/Myanmar, in partnership with Living Goods, launched the Win-Win Network in April 2015 with our first site in Dedaye Township in the Ayeyarwady Region.
The Win-Win network has grown steadily and now includes 250 active CHWs spread across four hubs in four townships, in Seik Phyu (Magway Region), Shwe Pyi Thar (Yangon Region), Thabeikkyin (Mandalay Region), and Pekon (Shan State).
Win-Win is a network of community-based independent micro-entrepreneurs (88% women) who deliver health education and services and socially-impactful products in rural and peri-urban communities in five townships across Myanmar. Win-Win targets communities with high rates of informal settlements, and low infrastructure and access to health services, which often correlates to a lack of economic opportunities.
Win-Win equips CHWs with the knowledge and capacity to deliver health education and services covering a wide range of relevant topics including nutrition, family planning, maternal and child health, TB and malaria. Treatments for non-communicable diseases such as hypertension will be introduced soon. Monthly training and individual performance coaching visits reinforce and refresh knowledge and skills and enable the introduction of new topics over time. Win-Win CHWs work part-time, based on their own schedules and objectives.
In addition to delivering basic health services, CHWs sell a range of products addressing various health needs (such as nutrition, fever, diarrhea, deworming, water purification, pregnancy tests, supplements, and contraception), as well as hygiene products for the whole family. CHWs are supported with valuable business and marketing skills, and a “business-in-a-bag” approach to encourage door-to-door sales. The basket of goods is dynamic and carefully designed to meet the communities’ needs.
PSI/Myanmar acts as a wholesaler to the entrepreneurs, retaining a small margin to cover the costs of recruiting, marketing, training, and managing the network.
Living Goods provides technical support to PSI/Myanmar for the design and implementation of this network with a manager placed with PSI/Myanmar, and providing strategic direction to their senior leadership to maximize the scale and impact of the initiative.
Active CHWs generate more than $20 per month, most of which comes through sales. This is particularly valuable for women, who often juggle the competing demands of family, work, and household responsibilities. An informal qualitative survey of Win-Win’s CHWs suggests that the typical family revenue increases by 30% after joining, and CHWs report high levels of community recognition and enhanced social status.
Living Goods partnered with Care Zambia in 2015 to support the development of a new initiative called Live Well. In Zambia, CARE supports a large network of volunteer CHWs who are extending access to essential health services. With Living Goods’ support, CARE is supporting the long-term sustainability of the community health systems by layering an entrepreneur-led approach over their existing volunteer network. Living Goods support began as remote technical assistance and then shifted to full-time secondment of Living Goods Partnerships Manager embedded at CARE. Support included business planning, product mix and procurement, impact strategy, inventory management, monitoring and evaluation, and performance management to help them launch the health-focused social enterprise, Live Well, modeled after Living Goods and based on CARE’s aid-funded social marketing work in Zambia. Key results included:
- Helped CARE secure over $2 million from private investors to launch Live Well.
- Trained over 400 “Community Health Entrepreneurs” covering over 25,000 people across 5 districts in Eastern and Lusaka Province – peri-urban and deep rural.
- CHWs provided life-saving products to avert on average 250 disability-adjusted life years (DALYs) per month.
- Registered a local entity, and hired/onboarded a full leadership team and staff to support Live Well.
- Successfully handed over full ownership of the program to CARE at the end of 2017 after 3 years of support.