Bringing quality healthcare to more than 1.5 million Kenyan people’s doorsteps

To test the effectiveness of the Living Good's community health programme, independent researchers affiliated with Innovations for Poverty Action ran a randomised controlled trial in Uganda in 2014 and found that it reduced under-5 child mortality by 27% at an estimated average cost of USD 68 per life-year saved.

Living Goods has become an important partner for health care delivery in Kenya, having learned a lot from implementing multiple iterations of its programme. It currently supports roughly 2500 Community Health Workers (CHWs) in three Kenyan counties.

Living Goods started with a direct operations approach in community health, investing and directly implementing high-quality, cost-effective digitised community healthcare under government supervision. It then moved on to providing implementation support to governments and partners by helping them develop the policies and financial frameworks needed to deliver best-in-class care, co-financing costs and responsibilities with government, and improving its own capacities to jointly deliver best practices in community healthcare that have been tested and proven effective through its operations. Step by step, it is also evolving into a co-financing and innovation partner in community health, with the government in the role of owner as well as investor.

Learnings

Living Goods has found that institutionalising government financing is a challenge because frameworks to support financing via legislation and policy have been lagging. Another key learning has been how to provide technical assistance well. Although Living Goods co-created its programme with government, it realised in hindsight that building government capacity requires different skillsets than managing networks of CHWs directly. Further learnings were the need for behavioural change within government, building the capacity of government teams and being deliberately flexible as plans change.

Living Goods would like the cost-effectiveness of its programme in Kenya to be higher, especially compared to its operations in Uganda. The difference is fundamentally driven by Kenya’s lower disease burden and slightly more developed economy, which raises higher costs.

The organisation also found that remote supervision increased CHW engagement. While it previously assumed that field supervisors could support CHWs effectively only in person, supervisors have found that they can achieve the same level of support and engagement remotely and thus supervise many more CHWs in a day. Instead of stopping in-person supervision altogether, Living Goods will look at incorporating remote supervision into its protocols, a model likely to be more replicable for government as well.

The final learning from this project is that success depends on political will. Living Goods is therefore sharing its learnings with counterparts in Uganda and other countries to inform future scaling, especially with co-financing becoming an attractive approach to building government capacity sustainably over time.

Way forward

In recent years, Living Goods has built credibility with the Kenyan government and is excited that through its work and other partners’ advocacy, the national government will include an electronic community health information system (eCHIS) serving all 95,000 CHWs in Kenya in its overall health system infrastructure so that there is continuum of care from community data integrated at facility level.

Swiss Re Foundation's takeaways from the project

To achieve universal health coverage (UHC), governments must improve health systems at the national level by prioritising health in policymaking, mobilising resources through taxation, increasing efficiency and driving implementation. The private sector and civil society can support them by fostering innovation to meet the healthcare needs of the most vulnerable and to boost the efficiency of health system management. Our collaborations with partners like Living Goods represent small steps toward mastering these big challenges. Through this partnership, we learnt that the delivery of community healthcare in Kenya continues to suffer from weak data collection and reporting tools.

Living Goods is building on earlier work funded by Swiss Re Foundation in Kenya to support the government’s commitment to achieving UHC by 2030. In a new project with Living Goods, the Swiss Re Foundation is now providing funding to ensure that the momentum for CHW support in Kenya continues and that the Kenyan government shifts its health outcomes and achieves national-scale impact through an eCHIS (read more about the new project here).