Supporting Digitally Enabled CHWs to Strengthen Health Systems

Living Goods supports resilient health systems by driving performance management of digitally empowered community health workers. 

Thomas Opiyo Onyango will serve as Living Goods’ Team Lead for our solution.

Globally, approximately 6 million children die each year due largely to preventable diseases such as pneumonia, diarrhea, and malaria, with approximately 3.1 million of these deaths occurring in Sub-Saharan Africa. The COVID-19 pandemic has shown that interruptions in access to essential services puts children at greater risk of dying from these causes due to the fractured health system in low and middle-income countries.  

Community health platforms are a proven channel to achieve universal access to primary health care, which strengthens the health system and ensures communities do not suffer from disproportionate health impacts during times of crisis. Community health workers (CHWs) save lives, increase access to care at the last mile, and keep healthcare affordable, all while delivering a positive economic return and reducing unemployment. Currently, most CHW systems are not achieving the scale and quality needed to move the needle on health outcomes. To address this, Living Goods uses smart mobile technology to save lives at scale. We digitally support CHWs to deliver care on call, making it easy for families in need to get the care they need, and work with governments to create a strong performance management system to drive impact—which is especially important during pandemics.  

Living Goods’ solution serves resource-constrained communities, CHWs, and national and local-level governments. Living Goods focuses on reaching women and children who lack access to reliable, quality health care. About 70% of our clients live more than five kilometers from the nearest health facility and highly benefit from high-quality, community-based care. This solution also impacts the lives of CHWs themselves. CHWs are mothers, farmers, and businesswomen who want to serve their communities and proactively address the essential health needs of their neighbors. CHWs improve the livelihood of their family while gaining valuable skills and respect—enabling them to get another job, start a small business, or run for political office. Feedback from CHWs and beneficiaries is regularly collected and used to make operational and programmatic refinements. Our quality assurance team gathers data from beneficiaries through home-based supervisory visits and phone calls, and CHWs continually receive feedback from clients during household visits and community events. Living Goods’ solution also serves the needs of governments. Living Goods works closely with governments to address their pressing health priorities and build their ownership of the CHW system. We share data via dashboards and reports to provide governments with actionable data to drive performance management.   

Living Goods is committed to ensuring that all of our digital solutions and innovations that are proven effective are open sourced and available for others to use and replicate. Living Goods’ approach  to working with government through co-financing and technical assistance partnerships ensures that governments have the digital capabilities and resources needed to strengthen their CHW networks and ultimately build more resilient primary health care which will in turn strengthen national health systems  Improvements in health services at the community level provide a public good, particularly for vulnerable communities, and ensure that these communities at the last mile are not susceptible to second-order impacts from pandemics. For example, the eCHIS, which Living Goods is supporting in Kenya, will integrate data from different sources, including service delivery, surveillance, and surveys to enable data-driven decision-making and will be key in ensuring an effective early warning system at the community level. The eCHIS will ensure that government resources are directed towards the community level and lead to a more resilient and strengthened health system in Kenya. Furthermore, the eCHIS will serve as an example for other countries transitioning to middle-income status. 

Our solution creates immediate, lifesaving impact for vulnerable populations by connecting them with high-quality health services—which has even greater urgency in the context of a pandemic. Our solution also builds government capacity to better manage, strengthen, and own these health systems themselves, laying the groundwork for longer-term impact and sustainability. For example, at the onset of COVID-19, Living Goods made programmatic adjustments to protect CHWs and enable them to maintain essential health services during the pandemic. This included procuring PPE, providing free essential medicines for clients, and simplifying CHWs’ compensation structure. As a result, Living Goods-supported CHWs reported record levels of motivation and performance, providing twice as many child treatments in 2020 as the previous year. Over the same time period, our review of government data revealed up to 35% declines in the number of people who sought facility-based care for those same diseases due to COVID-19. Moving forward, our solution will continue to create tangible impact by ensuring vulnerable communities have access to care and are resilient, both through direct service delivery supported by Living Goods and by shifts in local and national government to ensure these communities are prioritized

Living Goods believes the path to both scale and sustainability is through partnering with government and providing support to build resilient health systems from the bottom up, with an emphasis on digital tools to enable greater performance by ensuring CHWs are equipped, compensated, and well supervised. Our ultimate goal is to deliver improvements to health outcomes, in particular for children under-5 and women. We aim to unlock greater commitments from governments to scale high-performing community health programs.  

 To achieve government adoption, Living Goods has identified the following drivers: 

• Provide technical assistance: We must support the capacity building required to ensure governments are well-equipped to manage their community health systems, including providing technical assistance on performance management enabled through digital solutions. 
• Produce evidence and demonstrate CHW success: By generating evidence of impact and sharing findings and results, we will reach a tipping point at which the demonstration effect is sufficient to create pull from governments to adopt and fund best practices for creating and managing CHW networks. 
• Make community health attractive to government: We work with governments to integrate health data collected by CHWs into the national health database, demonstrating how community health contributes to government health goals.  

Living Goods uses key performance indicators (KPIs), which include number of assessments, treatments and referrals, pregnancies registered, and percentage of newborns visited in 48 hours, among others. We set monthly health impact and targets for each KPI and track performance against those targets using a mobile reporting system that provides data to drive decision-making at every level of operations. Living Goods measures indicators to monitor quality of program execution, including use of dashboards, appropriate functioning of CHW hardware and apps, timeliness of CHW compensation, in stock rates for medicines, and level of supervision among other indicators. 

CHWs log services they provide into the SmartHealth app, which is relayed to Living Goods’ cloud-based performance management dashboards. This enables supervisors to closely monitor, optimize, and verify CHW results. Supervisors can see the performance of CHWs in real-time and build work plans to improve performance based on these results. Mobile tools flag patients at highest risk, track supervisor movements, and use real-time data to push prioritized action lists to CHWs and their supervisors every day, allowing us to have deeper insights into drivers of impact. We will use KPIs, tools and learnings as we scale our partnerships to achieve our stated impact goals.  

One potential risk is that we are fielding more requests from governments than we are able to currently sustain. We want to be responsive and are careful about evaluating whether our unique value proposition is what is most needed in the places where we are fielding this demand. That said, we know we can do more if we have the resources required – this is largely with regard to personnel that will enable us to provide more technical assistance and continue to iterate and evolve our work. We know that we have a solution that is proven, but we need consistent and flexible financial support to be able to replicate and scale this solution where we know it can work and where there is government demand.

Living Goods is a founding member of the Community Health Impact Coalition and the Financing Alliance for Health. Living Goods has partnership agreements with the Ministries of Health in Kenya, Uganda, and Burkina Faso, as well as MoUs with sub-national level governments in Kenya and Uganda.