East Africa's healthcare "Avon ladies" help to keep children alive

by Lee Mannion | @leemannion | Thomson Reuters Foundation
Wednesday, 13 December 2017 11:00 GMT

Nakakande Ritah logs a family’s health information in her smart phone app. Kampala, Uganda, January 24 2017. Living Goods/ Martina Bacigalupo

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"It's a real African thing, people looking after their own neighbours - that's the juice that makes so much of this work"

By Lee Mannion

LONDON, Dec 13 (Thomson Reuters Foundation) - Imagine living so far from a doctor that getting medication for your feverish child involved a day's travel and countless hours of waiting, only to be told the drugs aren't available.

A social enterprise in Africa is tackling this problem by getting an army of well stocked healthcare workers to go to the sick.

In doing so, Living Goods has reduced the number of deaths of children under five by more than a quarter in areas where it works in Uganda, according to a 2014 study.

The Living Goods model overcomes travel barriers that hinder healthcare delivery, ensures medication is available and its low costs make it an attractively affordable investment for African governments, said the enterprise's president, Shaun Church.

"It's a real African thing, people looking after their own neighbours - that's the juice that makes so much of this work," Church told the Thomson Reuters Foundation.

"And every dollar spent on community health gets a ten to one return for a country through increasing productivity."

Living Goods employs 7,200 people as community health promoters in Uganda and Kenya who offer health checks and sell medication for common ailments, such as malaria and diarrhoea.

They also offer products that improve living standards and cut household costs, such as solar lights and clean cook stoves, and supply contraceptives.

The workers register pregnant women and record details of consultations on smartphones which alert the healthcare worker by text of regular check up dates for the expectant mother.

No salaries are on offer; the promoters earn by buying medicines and products from Living Goods and keeping the profits. Because every visit is logged on a smartphone, random checks ensure no opportunistic profiteering takes place.


In 2014 a survey by three universities of 8,000 families in 200 villages in Uganda found that Living Goods had reduced child mortality by 27 percent.

Such an impact is much needed. Uganda's population is growing by more than a million a year, with 66,000 under fives dying each year, according to the United Nations.

The workers are chosen carefully. Only around 20 percent of applicants are accepted, often after consultation with local chiefs and church leaders about their reputation within the communities - which often number up to 800 people.

Nakakande Ritah, 48, has been working as a community health worker for three years in Kabanyoro village, a half hour drive from the capital Kampala. She advises 300 people.

Ritah says her major challenge is getting people to accept the idea of paying for medication, which they can get free from the government hospital - if it is in stock after a six km walk.

"If they don't pay me, I don't have the money to go and restock again. The challenge is that some clients cannot afford to pay," Ritah told the Thomson Reuters Foundation.

As well as serving her community, Ritah is also a farmer with two cows and 15 pigs. She works for Living Goods for two hours a day, which contributes about a fifth of her weekly wage and goes to educating her three children and growing her farm.

"We ask our workers to be 100 percent in stock all the time with essential medicines for malaria, diarrhoea and pneumonia – those three are major killers of children under five," said Gerald Alireki, Ritah's regional manager.

Ritah is popular with her customers.

"She does good work for us. The drugs are not too expensive compared to other clinics. Everyone is happy because of her and her work," Ritah's customer Susan Nabanja, who is about to have her fourth child, said by phone.

Nakakande Ritah treats a baby for diarrhoea in Kampala, Uganda, January 24 2017. Living Goods/Martina Bacigalupo


Living Goods was started in 2007 by American businessman Chuck Slaughter. After making his fortune selling easy-to-pack travel gear, Slaughter volunteered to try and turn around a struggling chain of drug stores in Kenya.

Noticing that shop owners were idle for much of the day, he encouraged them to get out and start knocking on doors and visiting schools.

Business improved as a result, which encouraged him to consider shutting the shops and selling directly on the doorstep. It made him think of Avon, the cosmetics company that uses "Avon ladies" to sell make up in people's homes.

Living Goods now has 6,000 health workers in Uganda, covering some 6 million people. There are another 1,200 in Kenya taking care of a million more.

With partnerships in place with charities operating healthcare in Myanmar and Zambia, there is potential for the model to expand to other countries in Africa and beyond.

Funds to source the goods come from donors such as Omidyar Network that funds social enterprises, and U.S. development agency USAID, said Church, Living Goods' president.

In Kabanyoro village, despite the challenge of finding paying customers, Ritah is happy with her work.

"I feel good when I work with children. When they are sick, I can treat them and teach their parents to look after them," she said.

"There are still some clients who can afford to pay so I can make a small profit. Best of all I have changed my community and I'm proud of that."

(Reporting by Lee Mannion @leemannion; Editing by Ros Russell; Please credit the Thomson Reuters Foundation, the charitable arm of Thomson Reuters, that covers humanitarian news, women's rights, trafficking, property rights, climate change and resilience. Visit http://news.trust.org)

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