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Compensating & Retaining Community Health Workers_Christianson_5.11.11

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Compensating & Retaining Community Health Workers_Christianson_5.11.11

  1. 1. Uganda Ministry of Health<br />An Entrepreneurial Solution for Improving Community Health Combining the best practices in franchising, microfinance, and public healthCollaborating with BRAC under the BRAC-Living Goods Partnership<br />Key Partners<br />CORE Group Spring Meeting <br />May 2011<br />Molly Christiansen<br />415-632-1697 | mchristiansen@livinggoods.org | www.livinggoods.org<br />
  2. 2. Living Goods Model<br /><ul><li>LG recruits, trains and supports community health promoters (CHPs) who educate mothers about health, sell health products door-to-door and make referrals to clinics.
  3. 3. CHPs sell low-cost high-impact health products priced 10-40% below market</li></ul>Leverages the combined buying power of many agents to obtain quality medicines at the lowest possible cost <br />Bypasses most wholesalers, distributors and other middlemen<br /><ul><li>LG aligns incentives of CHPs with key health goals, driving BOTH sustainable incomes for health workers and health outcomes</li></ul>Retail margins from product sales makes CHPs economically viable; <br />Wholesale margins contribute to program operating cost, creating financially sustainable model at scale <br />LG’s diverse product mix drives sales and enables cross-subsidization<br />CHPs sell key health prevention and treatment products, consumer staples and household goods<br />Fast moving items increase frequent home visits and opportunities for client interaction <br />Branch distribution network within 7km of CHPs where CHPs resupply weekly<br />Low-cost inventory loan for initial products; free “business in a bag” with everything needed to run business. <br /><ul><li>LG targets reducing child mortality by 15% and morbidity from key child diseases by 20%. RCT in process with results in 2012. </li></li></ul><li>LG’s Diverse Product Mix Drives Sales…<br />… And Enables Cross-Subsidization<br />Prevention<br />Insecticide Treated Bed Nets<br />Water Treatment<br />Condoms<br />Vitamin A, Iron, Zinc<br />Hand Soap<br />Iodized Salt & Fortified Foods<br />Treatment<br />Anti Malarials<br />Oral Rehydration Salts<br />De-worming<br />OTC Pain & Cold<br />Consumer Staples<br />Feminine Hygiene<br />Diapers<br />Laundry Soap<br />Toothpaste<br />Lotions & Creams<br />Money Saving or Making<br />Solar Lanterns / Chargers<br />Efficient Cook Stoves <br />Water Filters<br />Reading Glasses<br />Human-Powered Irrigation Pumps High-Yield Seeds<br />>> Fast moving items increase frequent home visits<br />
  4. 4. Advantages of Entrepreneurial Approach <br />Income generation for CHW  Retention and motivation of CHWs <br />Door-to-door sales approach  Frequent household interaction, good customer service, convenience, “on call” trained provider<br />Products, health ed. & referrals  Meets health needs of community <br />Sustainable distribution channel/supply chain  >90% in stock rates, flexible, other pro-poor products<br />Community-based care  Reduces workload for public facilities<br />Franchised network Highly scalable<br />Highly cost-effective  Financially sustainable at scale  NO-COST CHW network<br />
  5. 5. Harder in very low pop density areas (but as model evolves, will reach further and further)<br />A “cure-most”, not “cure-all” approach - will address many, but not all health problems or populations <br />Management talent with strong business and operational skills can be hard to find<br />Need right organizational “DNA” – “enterprise mindset” focused on impact and profit<br />Limitations of Entrepreneurial Approach<br />
  6. 6. Myth: The poor can’t afford to pay for essential health items<br />Fact: 45% of lowest quintile in 11 SSA countries use private sector (WB Africa Development Indicators 2006)<br />Fact: High OOP health spending even for lowest earners, with high% on pharmaceuticals. <br />Fact: w/ $$ saved on low prices, transport, & lost income, can be “cheaper than free”<br />Myth: Profit motive and health impact are inherently at odds<br />Fact: strict monitoring and controls can prevent overtreatment. <br />Fact: Strong CHP health impact metrics correlate with strong sales<br />Fact: Increasing number of private sector, entrepreneurial approaches to poverty alleviation and global health<br /> Myths<br />
  7. 7. DO hire management with appropriate business, sales, and supply chain skills & pay well, including using performance incentives <br />DO incorporate a diverse product mix to allow for cross subsidization and regular interaction between CHW and households <br />DO incorporate a rigorous recruitment and selection process for CHWs - find most connected, charismatic, and dedicated women <br />DO replace low performing CHWs - more bang for buck for org and community<br />DO incorporate incentives to motivate CHWs and for specific health outcomes– “top seller of the month; “most improved”; “Monthly Champions”, cash incentives for pregnancy outcomes, etc. <br />Entrepreneurial “Do’s” <br />
  8. 8. Community Health Promoter: Zamin Nsibambi Location: Bwaise slum <br />
  9. 9. Living Goods — The Avon of Village Health<br /><ul><li>Avon was founded in the U.S. in 1886
  10. 10. The population was mostly rural and agricultural
  11. 11. The standard of living was substantially lower
  12. 12. Access to quality products in rural areas was poor
  13. 13. There were strong village social connections
  14. 14. Targeted to rural women needing extra income</li></ul>Today Avon sells over $10 billion and thrives in <br />140 diverse cultures – from Peru to the Philippines.<br />>> There is a compelling analogy between the conditions that provided the fertile ground for Avon over 100 years ago and the developing world today.<br />>> If Avon can build a $10 B direct selling business with products that are purely discretionary, imagine this models’ potential impact if harnessed to promote products that people desperately needed.<br />
  15. 15. Thank you <br />Phone: 415-632-1697Email: mchristiansen@livinggoods.orgWeb: www.livinggoods.org<br />
  16. 16. Health Promoter Supports<br />Free Training<br />Free Health Promoter Toolkit:- Backpack - Locking Storage Chest- Uniform- Signage- Record Books- Health Tools<br />Access to Low Cost Products<br />Subsidized Promotions<br />Low Cost Inventory Loan<br />Ongoing Coaching and Training<br />Branch distribution system within ~7km of CHPs where CHPs re-supply weekly<br />
  17. 17. The Living Goods Health Business in a Bag<br />Locking Storage and Display<br />Cell phone <br />Measuring Tape<br />Thermometer<br />Breath Timer for ARI Diagnosis<br />Visual Referral Guide<br />Visual Dosage Guide<br />Visual Training Tools on 17 Key Health Behaviors<br />Shoulder Bag<br /> Branded Signage<br />Whistle<br />Training Certificate<br />Branded Apron<br />Branded Tee Shirt<br />Price List<br />Sales Register<br />2 Pocket Money Pouch<br />Umbrella<br />Medication Instructions Form<br />Referral Form<br />
  18. 18. Living Goods Products<br />Oral Contraceptive<br />Condoms<br />Clean Birth Kit<br />De-worming<br />Pain/Cold/Cough<br />Antacid<br />Anti Fungal<br />Soaps<br />Feminine Pads<br />Tooth care<br />Diapers<br />Water Filter <br />Solar Lanterns<br />Water Treatments<br />ORS / Diarrhea Treatments<br />Malaria Treatment<br />Treated Bed Nets<br />Fortified Foods + Vitamins<br />

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