Community health promoters are trained to provide basic health counseling on a variety of topics to their communities and make a modest living by selling health products such as mosquito nets, water purification tablets, oral rehydration salts, vitamin A, antimalarial drugs, dewormers, condoms, and the like at below-market prices. To boost sales and ensure long-term sustainability, community health promoters also sell personal care products such as soap, feminine pads, and toothpaste as well as products that support household income or savings, such as solar lanterns, efficient stoves, and high-yield seeds.
Key program components include:
- Local partnerships: LivingGoods has initiated a joint venture in Uganda with BRAC Uganda where BRAC recruits community health promoters from its base of 50,000 borrower group members (its very selective process chooses only 1 in 90 members). Existing BRAC microfinance branches double as depots and field offices. Community health providers live within 6 kilometers of a supply point.
- Public health training: All franchisees are trained to give basic public health counseling on the use of products and to facilitate referrals to acutely ill patients. Field agents monitor franchisees and clients monthly to ensure that appropriate public health counseling takes place, that providers have key health items in stock, and that medicines are prescribed accurately and sold at listed prices.
- Branding and communication: LivingGoods strongly emphasizes branding. Community health promoters wear a branded uniform, carry a pack with a clearly visible logo, display a sign on their home, and have signage to use at market stalls. When LivingGoods launches in a new community, field agents arrange community meetings in partnership with schools, village elders, churches, and local nongovernmental organizations to introduce the new health promoters and give them an official imprimatur.
- Financial sustainability: The sustainability plan relies on each franchisee generating $2,400 in annual sales with a 25% margin, yielding $500 in annual net income—quite comfortable by Ugandan standards for individuals with no professional training. The wholesaler retains a 15%–20% margin, which at scale should cover the overhead back office, training, transport costs, and an adequate supervisor to franchisee ratio.
- Below market pricing: LivingGoods’ buying power and ability to cut out intermediates allow it to set prices 10%–30% below market. This provides an incentive for community health providers and gives the product greater perceived value to the consumer. The program also distributes some items obtained through the government for free.
- Distribution and monitoring: Field agents meet community health promoters at least once a month to resupply, collect payments, communicate current promotions, and provide ongoing health education and business coaching. Agents are required to keep detailed and accurate records of all patient contacts and transactions. Field agents collect these data and enter them in a central database. Community health promoters must strictly adhere to the core rules of the program, particularly with respect to storage, prescription, and sale of regulated items, or they risk losing their franchise. LivingGoods is conducting an independent randomized trial to accurately measure the model’s impact on mortality and morbidity.
The model combines the latest and best practices from the worlds of microfinance, franchising, and public health to create a sustainable system for defeating diseases of poverty. Living Goods reduces illness and death by significantly improving access to and adoption of simple, proven health interventions in the many places these are scarce or non-existent.
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The New York Times: The 'Avon Ladies' of Africa