LifeNet International

Dave Evans has spent his life dedicated to alleviating the multi-faceted burden of poverty around the world. Dave is a leader who likes to get his hands dirty. Over the course of his career, he has worked in and led food security, water, and health-strengthening programs around the world—he has lived in Burkina Faso, Chad, Bolivia, Mali, and Zimbabwe. This on-the-ground field work uniquely positions him to effectively lead international development organizations. He has previously served as President and Global Executive Officer of Food for the Hungry US and as Senior Director for Innovation & Strategic Initiatives at World Vision International. Dave’s vast experience is augmented by an MSc degree in agricultural economics from Penn State University. Today, Dave draws on his education and 36 years of experience in international relief and development to lead LifeNet International, where he is passionate about bringing quality healthcare to communities in sub-Saharan Africa. 

Millions of Africans, young and old, are dying of preventable diseases and conditions because their health clinics lack access to cost-effective medical knowledge and resources that could save lives. To help solve this problem, I am proposing to scale a proven model of high-impact training delivered directly to existing health facilities in 10 countries in Africa, which will lead to improved quality of care in more than 10 million annual patient visits. This project will elevate humanity by embracing the inherent dignity and worth of every person’s life—no matter where they are born. Every person should have the opportunity to access high-quality healthcare and live a full life.

People in sub-Saharan Africa (SSA) face some of the worst healthcare realities in the world. According to the World Health Organization (WHO), life expectancy is lower in Africa than anywhere else in the world. The region leads the world in child death, HIV infections, and Malaria. Two-thirds of worldwide maternal deaths occur in SSA. The region is also the most dangerous place for a baby to be born—according to UNICEF, 8 of the 10 countries with the highest newborn mortality rates are in SSA.

Rural populations depend upon community health centers for all healthcare needs. Unfortunately, centers often lack the knowledge and resources necessary to provide quality care for patients. This has deadly consequences. Research indicates that significant barriers to obstetric care include long wait times and “poor staff knowledge and skills, poor referral practices and poor staff interpersonal relationships.” Further research confirms this on a macro level. The Lancet recently published research indicating that 900,000+ lives are lost in SSA every year as a direct result of patients accessing poor-quality healthcare. 

Millions of Africans are dying of preventable conditions because their health clinics lack access to cost-effective and up-to-date medical knowledge and resources that could save their lives.

We can help stop preventable deaths in SSA. LifeNet’s cost-effective and high-impact model provides essential training and tools directly to local faith-based health centers, serving the poorest-of-the-poor in African communities.

Here’s how it works: once a health center joins our network, they receive
> Rigorous quality evaluations;
> Personalized training in five modules of medical care, addressing leading causes of death;
> Personalized training in four modules of management best practices, ensuring facilities can remain open and sustainable;
> Supportive supervision and mentoring;
> Regular quality evaluations to assess impact and provide feedback; and
> Access to essential tools and equipment, including Ambu bags for infant CPR.

LifeNet currently works with 240 health centers in four countries. Rigorous internal and external studies (Duke University) have confirmed LifeNet’s dramatic effect on healthcare quality. Since 2012, we have improved more than 9 million patient visits. 

But 9 million is not enough. Every day, people are dying because they need access to quality care. So, our current project is an aggressive 10-10-10 growth strategy that will take our proven model and scale it to 10 countries by 2023, improving care for 10 million patient visits every year, at a cost of $10 million annually—just $1 per patient visit!

This project serves vulnerable people seeking care from ill-equipped SSA health facilities. These patients are in the 20% of the population that earns the lowest income in the world and who live in countries with some of the lowest UN human development ratings. These patients often lack access to doctors and rely on their local community health center for all healthcare needs.

Local voices are at the center of our project. We believe that people closest to the problem understand needs and opportunities best. Three of our four country directors are African, and 79 of our 80 program team members are African. Our local teams speak into this project as members of the communities they serve.  

The project effectively addresses leading causes of death in the region. In 2019, health workers in our partner facilities saved 241 newborns by implementing the infant CPR they learned from LifeNet. A third-party validation study conducted by Duke University concluded that LifeNet “significantly improve[s] maternal and neonatal healthcare quality” (Evidence Lab at Duke Global Health Institute). These improvements included a 545% increase in provider adherence to proper handwashing protocols thanks to LifeNet training. Handwashing alone saves lives by preventing the spread of disease.

In the United States, life expectancy is 78 years. If you happen to be born in Africa, that drops to 61 years. I believe that every person should have the opportunity to live a healthy and whole life, no matter where they are born. Cost-effective solutions exist that can address preventable deaths in Africa. Unfortunately, African communities are continually left behind, while countries like mine enjoy the benefits of good health. I am committed to addressing African healthcare quality through our project to transform health centers. No one should die from a preventable cause. No one should be left behind.

When I joined the LifeNet team in January 2019, the organization was fairly small, had flat revenue year-over-year, and was growing, but at a slow pace. At the same time, the results of the program were phenomenal. It had successfully expanded into four country contexts, health centers were improving, health workers’ skills were developing, and lives were being saved.

This was clearly an organization with immense potential to impact millions more lives in Africa. That’s when I came up with the idea for our project: an aggressive 10-10-10 growth strategy. If we have a program that we know works well and that we know saves lives, then we need to scale that program, and we need to start today!

Together with our field staff, I committed to taking our proven model of healthcare training and leading its scale to 10 countries by 2023, improving care for 10 million patient visits every year, at a cost of $10 million annually—just $1 per patient visit!

I knew we’d need a plan to get there, so I drew on my extensive experience at other INGOs to develop a strategy to sustainably scale into 10 countries by 2023.

In 1985, I was living in Chad, working on an agriculture and water program. I lived in a village where there was a small, faith-based health center—the only health facility for 40 miles. This center was a magnet for surrounding communities. It was the only place to go if you got sick or injured or were having a baby. I remember, even as a young man, being so inspired by nurses at this health center. They served their patients with a spirit of love and sacrifice. I’ll never forget when the head nurse, Samuel, was moving away. He had worked in the center for 15 years and when he moved, people traveled long distances to share stories of how much he had impacted them. I will never forget the power that one small health center can have in a community.

When I think about why I am passionate about our project to bring life-saving training to health centers in 10 countries in Africa, I don’t just think in terms of high-level forecasting, fundraising, and strategy. I think about Samuel. I want to see Samuels around Africa given the tools and training they need to save lives in their communities.

I’ve had the privilege of working in international development for 36 years now and have worked at each level of development, as a staff member on the field, in field leadership, regional leadership, and at the director and executive levels. This multi-layered experience uniquely positions me to deliver this project. 

During my on-the-ground field-level experience at Food for the Hungry, I lived in multiple countries in Africa, where I became even more passionate about alleviating the burden of poverty—including the burden of poor-quality health. Through that field work, I led the design, implementation, and evaluation of multiple programs, oversaw field staff, and expanded programmatic work in multiple countries.

Through my experience in senior leadership at both Food for the Hungry and World Vision, I oversaw multiple projects, massive budgets, and large staffs and multiple field offices. In each leadership role, I provided strategic vision, led global initiatives, and led resource development strategies and policy agendas. As president of Food for the Hungry, that resource development work resulted in a 190% growth in US government cash income for the organization.

This combination of field-level experience and proven strategic leadership have led me to LifeNet, where I am eager to harness all I have learned to lead the organization to transform healthcare in 10 African countries so that local health workers are empowered to save lives in their communities.

The biggest challenge we have faced has been COVID-19—something none of us could have expected. As soon as the pandemic hit, I remember thinking that our entire growth plan was blown out of the water. At that moment, I sat down with my team and asked: how can we transform ourselves and pivot so that this can be a time where we become more resilient so that we can mentor and train health centers to address COVID-19 and, in the process, become more resilient themselves? 

We worked quickly, securing financial partnerships from foundations so that we could provide personal protective equipment and emergency COVID training to all of our partners. We also developed a digital-enablement strategy to ensure that training could continue even during lockdowns. Through all of this, we remained committed to improving the quality of primary healthcare. 

When the pandemic hit, I was concerned that we would need to contract our goals and postpone our growth plans. But today, because we worked together as a team, we are a more resilient and stronger organization. In fact, we are now expecting to end the year 2020 with 20% growth in our program.

When I joined LifeNet as President, I was excited about the organization’s potential, but immediately recognized the need for a shared vision for growth.

I spent the first year casting a vision for all that we could accomplish by scaling into other country contexts. I knew that this vision for LifeNet would not work if it was “my” vision—it needed to be “our” vision as a team. 

I spent time with LifeNet’s board of directors, sharing a strategy for significant growth that included some risk. They were excited! I traveled to our four countries in Africa, building relationships with country directors and field staff, gathering input and buy-in from each of them. I worked closely with our two fundraising staff members to develop and improve donor strategies. 

This work of cultivating a shared vision for growth and expansion has paid off in ways I couldn’t have expected. The organization’s income had been flat over two years. In my first year as President, that income doubled. At the same time, our number of facility partners increased by 37%. A leader cannot succeed alone. I measure my success as a leader based on the results we accomplish as a unified team.

LifeNet’s project uniquely engages an often-overlooked segment of the healthcare community in Africa: faith-based health centers. Our two-pronged strategy to achieve our 10-10-10 project includes: 1) becoming the go-to organization for strengthening faith-based health facilities in Africa, and 2) designing and executing a diverse resource development strategy. That first prong of our strategy is the core of our project’s innovation.

An estimated 40-70% of all health coverage in the continent is provided through faith-based health centers, making the sector a pivotal part of the health landscape. Unfortunately, this massive segment of the health sector is often neglected by the international development community. LifeNet’s unique contribution to the work of health-systems strengthening in Africa is its ability to successfully penetrate the faith-based healthcare market, improving care for the millions of people served in faith-based health centers around the continent. 

Our innovative work with faith-based health centers has been successful so far in Uganda, Burundi, Malawi, and the DRC, where we have successfully built relationships with faith-based health oversight organizations, church diocese leaders, and religious oversight bodies. These partnerships are also pivotal for building community trust and educating communities on essential health best practices. We are eager to bring this new dimension of health-systems strengthening into more countries in Africa.

LifeNet strengthens healthcare and saves lives in sub-Saharan Africa by working from the ground up: our theory of change begins in the walls of local health facilities that serve hard-to-reach, vulnerable patients.

Activities: We lead 5 modules of high-impact, capacity-building medical training directly to health workers serving in rural health centers in Africa. We also lead 4 modules of proven management best practices to health center staff members, equipping them to sustainably operate their health center for years to come. We conduct comprehensive quality assessments before, during, and after our work with a health center to provide them with valuable information about their quality of care and to assess our own activities. Finally, we provide access to essential equipment needed to provide high-quality healthcare to patients.

Outputs: We carefully track the number of training visits and sessions with health workers, the number of quality evaluations conducted, the number of pieces of equipment distributed, and the number of health workers engaged through training. We also track the number of patients receiving care from trained health workers, the number of mothers giving birth, the number of children vaccinated, and the number of patients screened for various diseases.

Outcomes: Our short term outcomes are measured by our quality evaluations and demonstrate that health workers are successfully implementing the best practices they’ve learned through LifeNet training, leading to improved quality of care for patients and a more sustainably-run health center. These outcomes include higher rates of proper handwashing, proper management of postpartum hemorrhage, implementation of infant CPR, higher patient volumes, increased budgets, and more. Our long-term outcome goal is to see more lives saved and improved through this high-quality healthcare. In 2019 alone, our partners saved 241 babies’ lives by using the infant CPR they learned in their LifeNet training.

This theory of change is based on years of research, implementation, and on-the-ground experience working with local governments, low-level health facilities, and ministries of health.

Today, our project improves the quality of healthcare for more than 3 million patient visits every year. Next year, we expect to improve more than 4 million patient visits. In 5 years, we expect to improve more than 10 million patient visits every year.

Over the next five years, our goal is to bring LifeNet’s proven model of training into at least 10 African countries, improving care for an annual 10 million patient visits. We will work toward this aggressive goal by pursuing the following plans:

1. In-Country Expansion: Existing LifeNet field teams in Burundi, Uganda, the DRC, and Malawi are working toward a 60% or more saturation coverage among faith-based health centers. 

2. New Country Expansion: LifeNet will expand into 10 countries over the next five years. This expansion will position the organization for continued and accelerated growth. The selection process for new countries of operation includes a matrix of health statistics, willing health partners, areas lacking NGO investment, and more. 

3. Refining LifeNet Curricula: LifeNet will continue to work to refine its curricula, ensuring that facilities can rapidly progress through the program while maintaining high levels of retention. Continual updates ensure that all trainings stay up-to-date, medically-sound, and evidence-based.

4. Improved Impact Measurement: LifeNet’s high-capacity monitoring and evaluation team will move further into measuring and demonstrating impact on health outcomes through the use of the Lives Saved Tool (LiST) and Proxy Indicators. LiST was developed at Johns Hopkins University and is recognized by some of the world’s key players in global health, including UNICEF, WHO, USAID, and the Bill & Melinda Gates Foundation. 

Looking to the future, we expect to encounter two primary barriers over the next five years that may limit our ability to meet our aggressive goals: limited administrative capacity and financial investment in the organization.

Limited administrative capacity: we have always operated as a lean organization, particularly administratively. We are now reaching a tipping point, where the organization is still too small to hire a large administrative staff, but is getting too large for our small administrative team to manage. With a headquarters staff of just four people helping to support, fund, and manage a program staff of 80, we believe we will encounter growing pains and challenges as we seek to rapidly grow from a $3 million organization to a $10 million organization.

Financial investment: We expect to encounter some financial challenges due to some economic impacts of the COVID-19 pandemic. Although our donors have been even more generous in the face of the pandemic, we are preparing to encounter challenges as foundations may choose to hold off on accepting new grantees for a time. 

Limited administrative capacity: We have worked with a consultant to identify the key staff roles we are going to need on the administrative side of the organization if we are to continue growing at a rapid rate. We’ve triaged these roles based on timing and importance for our strategy and to care for our staff well. We will plan to follow this strategy, while maintaining flexibility as we grow.

Financial investment: We are maintaining close contact with all of our donors, continuing to cultivate new relationships as we are able, and also spending time focusing on potential government sub-granting opportunities with other organizations. We have also hired a contract grant writing consultant to help us increase our number of application submissions.

We have the privilege of working with a number of other organizations working in healthcare in Africa. We have partnered with donors like the Gould Family Foundation and Segal Family Foundation, who have contracted with LifeNet to improve other health initiatives they are investing in, including Lwala in Kenya and other health clinics in Uganda, Burundi, and DRC. LifeNet recently received a grant from the Government of Canada, through Grand Challenges Canada, to grow its programs in the DRC and Burundi. We are working with Bergstrom Foundation and their Ministry of Health and Clinton Health Access Initiative partners in Africa to provide family planning access for underserved women. 

We provide essential training directly to local health workers working in private health clinics in Africa. Because we serve low-income clients, our revenue is derived primarily from grant funds and individual donations. Our key beneficiaries are lowest-quintile patients in SSA who rely on these facilities for all healthcare services. Through LifeNet’s training, local health workers become proficient in providing life-saving care to their patients, improving the quality of life for people in their communities. Ultimately, LifeNet’s services in SSA dramatically strengthen health facility sustainability, increase health worker knowledge and skills, improve healthcare quality, and save lives.

Because we serve low-income clients (under-resourced health clinics in Africa), our path to financial sustainability includes a diverse donor base of individual donors, government funding, and private foundation grants. This diversity in donor base is essential to the organization’s sustainability, ensuring that we do not rely on one single stream of funding to operate. 

LifeNet has always operated without debt and continues to operate debt free due to good financial management and leaders who are passionate about sustainability. The nature of the LifeNet model is incredibly cost effective and precludes redundancies, preventing waste for both LifeNet and the partner health facility. This efficiency results in an average cost per improved patient visit of $1 (USD) and keeps the organization in excellent financial health. 

LifeNet is funded by a combination of grants, corporate donations, and generous individual donors. Just a few of our donors include:

The Conrad N. Hilton Foundation

The Planet Wheeler Foundation

Grand Challenges Canada

The Pfizer Foundation

David Weekley Family Foundation

Our project to expand into 10 countries and improve 10 million patient visits by 2023 will come at an annual cost of $10,000,000—just $1 per patient visit! 

We are seeking to raise funds from foundation grants, government grants, and personal donations from individuals who are passionate about providing high-quality healthcare for underserved people in Africa.

Estimated expenses for 2020 are: $3,477,230.

We are at a tipping point in our organization. We are getting too big to operate as a mom-and-pop nonprofit organization. And yet, we are not big enough to hire a large administrative staff. That means that each of our team members is operating at a high level and is serving in multiple roles. We have a huge need for coaching and mentoring in how to make that transition from a $3,000,000 organization to a $10,000,000 organization. I believe the Elevate Prize, in addition to contributing financially to our project vision, can be a valuable asset in helping me lead that transition through professional development and mentoring opportunities.

As mentioned above, I would love support in helping me lead our organization’s growth transition. We also would greatly benefit from help in learning how to best share our story with others through marketing and media exposure.

We are eager to partner with faith-based healthcare oversight organizations, particularly the Christian Health Association of Zambia and the Chrisitan Health Association of Kenya. As we continue our expansion plans over the next three years, we are also interested in partnering with other christian health associations and Ministries of Health.