p. 1

An Entrepreneurial Solution for Improving Community Health

Combining the best practices in franchising, microfinance, and public health

Collaborating with BRAC under the BRAC-Living Goods Partnership

415-632-1697 | mchristiansen@livinggoods.org | www.livinggoods.org

Uganda Ministry of Health

Key Partners

CORE Group Spring Meeting May 2011Molly Christiansen

p. 2

Living Goods Model• 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.

• CHPs sell low-cost high-impact health products priced 10-40% below market

– Leverages the combined buying power of many agents to obtain quality medicines at the lowest possible cost

– Bypasses most wholesalers, distributors and other middlemen

• LG aligns incentives of CHPs with key health goals, driving BOTH sustainable incomes for health workers and health outcomes

– Retail margins from product sales makes CHPs economically viable; – Wholesale margins contribute to program operating cost, creating financially sustainable model at scale

• LG’s diverse product mix drives sales and enables cross-subsidization– CHPs sell key health prevention and treatment products, consumer staples and household goods– Fast moving items increase frequent home visits and opportunities for client interaction

• Branch distribution network within 7km of CHPs where CHPs resupply weekly

• Low-cost inventory loan for initial products; free “business in a bag” with everything needed to run business.

• LG targets reducing child mortality by 15% and morbidity from key child diseases by 20%. RCT in process with results in 2012.

p. 3

LG’s Diverse Product Mix Drives Sales…

PreventionInsecticide Treated Bed Nets

Water Treatment

Condoms

Vitamin A, Iron, Zinc

Hand Soap

Iodized Salt & Fortified Foods

TreatmentAnti Malarials

Oral Rehydration Salts

De-worming

OTC Pain & Cold

Consumer StaplesFeminine Hygiene

Diapers

Laundry Soap

Toothpaste

Lotions & Creams

Money Saving or MakingSolar Lanterns / Chargers

Efficient Cook Stoves

Water Filters

Reading Glasses

Human-Powered Irrigation Pumps High-Yield Seeds

… And Enables Cross-Subsidization

>> Fast moving items increase frequent home visits

p. 4

Advantages of Entrepreneurial Approach • Income generation for CHW Retention and motivation of CHWs • Door-to-door sales approach Frequent household interaction, good

customer service, convenience, “on call” trained provider• Products, health ed. & referrals Meets health needs of community • Sustainable distribution channel/supply chain >90% in stock rates,

flexible, other pro-poor products• Community-based care Reduces workload for public facilities• Franchised network Highly scalable• Highly cost-effective Financially sustainable at scale

NO-COST CHW network

p. 5

• Harder in very low pop density areas (but as model evolves, will reach further and further)

• A “cure-most”, not “cure-all” approach - will address many, but not all health problems or populations

• Management talent with strong business and operational skills can be hard to find

• Need right organizational “DNA” – “enterprise mindset” focused on impact and profit

Limitations of Entrepreneurial Approach

p. 6

Myth: The poor can’t afford to pay for essential health itemsFact: 45% of lowest quintile in 11 SSA countries use private sector (WB Africa Development Indicators 2006)

Fact: High OOP health spending even for lowest earners, with high% on pharmaceuticals.

Fact: w/ $$ saved on low prices, transport, & lost income, can be “cheaper than free”

Myth: Profit motive and health impact are inherently at oddsFact: strict monitoring and controls can prevent overtreatment.

Fact: Strong CHP health impact metrics correlate with strong sales

Fact: Increasing number of private sector, entrepreneurial approaches to poverty alleviation and global health

Myths

p. 7

• DO hire management with appropriate business, sales, and supply chain skills & pay well, including using performance incentives

• DO incorporate a diverse product mix to allow for cross subsidization and regular interaction between CHW and households

• DO incorporate a rigorous recruitment and selection process for CHWs - find most connected, charismatic, and dedicated women

• DO replace low performing CHWs - more bang for buck for org and community

• 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.

Entrepreneurial “Do’s”

p. 8

Community Health Promoter: Zamin Nsibambi Location: Bwaise slum 

p. 9

Living Goods — The Avon of Village Health

>> There is a compelling analogy between the conditions that provided the fertile ground for Avon over 100 years ago and the developing world today.>> 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.

• Avon was founded in the U.S. in 1886• The population was mostly rural and agricultural• The standard of living was substantially lower• Access to quality products in rural areas was poor • There were strong village social connections• Targeted to rural women needing extra income

Today Avon sells over $10 billion and thrives in 140 diverse cultures – from Peru to the Philippines.

p. 10

Thank you

Phone: 415-632-1697Email: mchristiansen@livinggoods.orgWeb: www.livinggoods.org

p. 11

Health Promoter Supports• Free Training• Free Health Promoter Toolkit:

- Backpack - Locking Storage Chest- Uniform- Signage- Record Books- Health Tools

• Access to Low Cost Products• Subsidized Promotions• Low Cost Inventory Loan• Ongoing Coaching and Training• Branch distribution system within

~7km of CHPs where CHPs re-supply weekly

p. 12

The Living Goods Health Business in a Bag

Branded Signage

Whistle

Training Certificate

Branded Apron

Branded Tee Shirt

Price List

Sales Register

2 Pocket Money Pouch

Umbrella

Medication Instructions Form

Referral Form

Locking Storage and Display

Cell phone

Measuring Tape

Thermometer

Breath Timer for ARI Diagnosis

Visual Referral Guide

Visual Dosage Guide

Visual Training Tools on 17 Key Health Behaviors

Shoulder Bag

p. 13

Living Goods Products

Oral Contraceptive

Condoms

Clean Birth Kit

De-worming

Pain/Cold/Cough

Antacid

Anti Fungal

Soaps

Feminine Pads

Tooth care

Diapers

Water Filter

Solar Lanterns

Water Treatments

ORS / Diarrhea Treatments

Malaria Treatment

Treated Bed Nets

Fortified Foods + Vitamins