Living Goods: Data-smart community healthcare

Despite considerable gains in recent decades, the health of Kenyan citizens continues to be marked by geographical and socioeconomic inequalities. When faced with health problems and illnesses, people from poorer households are less likely than others to seek care in health facilities, and the quality of healthcare providers is lower in lower-income areas.

While some private providers offer quality services, they cater to people who are wealthier and/or health-insured through formal employment – most of them urban dwellers. People with fewer financial resources generally rely on public or lower-quality private providers.

All this makes universal health coverage a particularly urgent goal for Kenya’s government, which aims to achieve it by 2030. Doing so requires having a solid base of data to inform decision-making, planning and progress monitoring. Community health workers who offer services directly door-to-door are the backbone of healthcare provision, particularly in rural areas, so detailed community-level data is crucial. Currently, however, medical record-keeping is largely paper based, which is not only inefficient, but also prone to transcription errors and other data quality issues.

Digitising the records of Kenya’s community health system is expected to improve the quality of health data, the timeliness of reporting and ultimately the inclusiveness of healthcare.

In an earlier project (2018-2021) funded by the Swiss Re Foundation, Living Goods focused on supporting networks of trained community health workers who deliver basic health services and products to low-income families in rural communities of Kenya. Building on its proprietary Smart Health App, in 2020 the organisation began helping the Kenyan government roll out an end-to-end national digital health platform covering all 95 000 community health workers in the country. Known as an Electronic Community Health Information System (eCHIS), this platform is designed to address the current issues with data availability, quality, acceptability, utilisation, cost and accountability and to enable the monitoring and improvement of health outcomes on a national scale.

In this follow-up project (2021-2024) with the Foundation, Living Goods provided technical assistance to local governments in the counties of Busia, Isiolo, Kisumu and Vihiga during their roll-out of the eCHIS while continuing to support community health workers’ delivery of vital primary care services.

Together, the two projects had the following impacts:

• Digitisation of the work of 3 760 community health workers in the counties of Kisumu and Isiolo, who reached a total of more than 1.85 million Kenyan people with high-quality, low-cost home-based healthcare from July 2018 through end of 2021.
• Successful pilot of the eCHIS tool in Kisumu County in 2022, paving the way for the national rollout. As of February 2024, the eCHIS had been deployed in 23 of Kenya’s 47 counties, and over 25 000 community health workers were actively using the tool.
• By the end of 2023, 99% of community health workers supported by Living Goods had functional mobile phones, 96% had functional apps and many were fully stocked with essential medicines, receiving monthly supervision and earning a monthly income.

In a third phase of this collaboration (2024-2027), the Swiss Re Foundation is supporting Living Goods to roll out eCHIS in Vihiga, Busia, and a potential third county. Living Goods will also introduce features such as dashboards and supervisor tools to boost eCHIS utilisation and will cultivate the enabling environment (including policies, practices and financing) to ensure that digitally enabled community health is sustainably institutionalised in the three counties.

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