The nonprofit organization Living Goods garnered buzz soon after its 2007 founding. The group’s community health promoters, as the women are called, act as both businesswomen and frontline health workers. They sell medicine, educate people about health, and help diagnose and treat illnesses. To do so, they use the same door-to-door sales model popularized by Avon.
News stories celebrated the ‘Avon Ladies’ of Uganda who went door-to-door selling small goods and health products. They also told the story of founder Chuck Slaughter, an entrepreneur who sold his multimillion-dollar company and moved into the business of doing good. Living Goods won awards and recognition for the entrepreneurial model that empowered women to make a small profit by running their own businesses.
Praise and attention focused on the model. But what Living Goods cares about most is its impact.
“The entrepreneurial aspect for us is a means to an end for us,” said Shaun Church, president of Living Goods, in an interview with Humanosphere.
Donors wanted to know the impact the community health promoters where having on the health in their communities. They paid for a study that could measure the impact. Innovations for Poverty Action, a U.S.-based independent research organization, was brought on to run a large-scale randomized study of Living Goods in Uganda.
The results published in late November were better than expected. Community health promoters helped reduce child mortality by 27 percent and infant mortality by 33 percent. Neonatal mortality also was 27 percent lower, overall health knowledge improved and people were more likely to take preventive health measures compared to areas without community health promoters.
“The idea was, ‘we believe in this,'” said Church, “but if we can prove impact, then the potential is so much more huge than if it is people just saying we do a good job.”
The weight of the results led charity rater GiveWell to list Living Goods among its standout organizations for its 2016 giving guide. GiveWell makes recommendations based on impact and need. Only seven organizations made its ‘top charities’ list this year and six were in the second tier group with Living Goods. Church was proud of the inclusion given GiveWell’s reputation for setting a high bar for consideration.
“To have a randomized control trial that proves with statistical significance that you reduce child mortality is kind of a big deal,” he said.
The model tested in the study involves a collaboration between Living Goods and BRAC Uganda, an anti-poverty organization that provides a suite of services in communities including microfinance, farming support and youth empowerment services. Community health promoters are local women who competitively apply and must complete a training and skills test before they are deployed. They travel door-to-door providing health advice and selling goods that help prevent sickness and treat existing ailments. They also sell other goods like diapers, soap and water filters.
The program was tested in 214 villages across 10 districts in Uganda. Community health promoters were trained and deployed in 115 randomly selected villages. The remaining 99 villages did not get the program, acting as a comparison to measure the impact of the community health promoters. Villagers in both groups were surveyed throughout the study on various health-related questions.
Community health promoters operate as small-business owners, buying the goods from Living Goods or BRAC to sell for a small profit. Living Goods tracks sales and other data through mobile phones to capture impact and provide information to its community health promoters.
By comparing villages where the program to place against where it did not, the researchers showed the significant impact on child health and general health knowledge. But there is a small catch. Access to local hospitals and clinics allowed people to heed advice to seek medical attention. The advice is of little use if a facility-based professional health care system does not already exist, the researchers wrote.
The findings build on the evidence that frontline health workers going door to door can improve health. Combining that information with direct sales can save lives. It creates other positive impacts. A previous study on Living Goods found that its model helped reduce fake drugs sales by 20 percentage points. It also caused drug prices to fall by 18 percent and antimalarial usage to increase by 39 percent. Those early results were encouraging.
“Community health is this undertapped tool for improving health outcomes in Africa,” said Church. “You can reach people where they are and diagnose people who might go undiagnosed. You can get them to go seek care or treat them where they are. Community health has this enormous potential to cost-effectively deliver results.”
The focus for Living Goods is now about scale, Church said. It recently expanded to Kenya, but 90 percent of the 5 million people covered by its community health promoters are in Uganda. The hope is to reach more people in both countries and export the model to other parts of the world. Church does not define scaling up in terms of simply growing Living Goods, it is about spreading their model.
“We want to improve community health throughout the developing world, but there is no way that Living Good can be in every village in every country. So we are working with partners and policymakers,” he said. “As we evolve we will become a bit more externally facing and try to spread what we are doing indirectly as well as directly.”
Scale raises new questions about the Living Goods model. One of the criticisms of randomized control trials is that the results may only be applicable for the places study. What works in 100 villages in Uganda may fail in Malawi or Vietnam. That is why a second study is under way to see what happens as the program grows. Results will not come in until 2020, but it is important that Living Goods get feedback on how to work in differing communities, said Church.
“We are not about making money,” he said. “Our community health promoters need the money for what they are doing, but what really strikes anyone who takes to them is that they really want to help. That has an enormous potential for saving lives.”