Social Innovation for Health-Care Delivery in Africa: Incentivizing Health-Care Delivery Can Overcome Barriers to Health Care in Low-Income Countries

By Keeton, Claire | Bulletin of the World Health Organization, April 2017 | Go to article overview

Social Innovation for Health-Care Delivery in Africa: Incentivizing Health-Care Delivery Can Overcome Barriers to Health Care in Low-Income Countries


Keeton, Claire, Bulletin of the World Health Organization


Millie Balamu goes from door to door providing life-saving health care for about 200 households in the Wakiso district of Uganda.

Villagers call her masawu ("doctor" in the local Luganda language), but she is not a doctor, she is a community health worker.

Trained in 2011 and supported by a nongovernmental organization (NGO) called Living Goods, the mother-of-three always has tests and drugs with her to diagnose and treat malaria, diarrhoea and pneumonia--the major killers of children in Uganda. She uses her mobile phone to diagnose these diseases and register pregnant women for follow up.

"We've borrowed from the Avon lady model: our community health promoters are independent agents, not employees," says Shaun Church, president of Living Goods based in San Francisco, the United States of America (USA).

"Rather than selling make-up, they are selling affordable medicines and life-changing products and services."

The Living Goods' project was launched in Uganda in 2007 and in Kenya in 2015. It is one of 23 projects in 43 countries that were selected by the Social Innovation in Health Initiative, out of a total of 170 nominated in 2015, as promising new ways to improve health-care delivery.

The Social Innovation in Health Initiative is a collaboration between the Special Programme for Research and Training in Tropical Diseases at the World Health Organization (WHO), the Bertha Centre for Social Entrepreneurship and Innovation at the University of Cape Town, the Skoll Centre for Social Entrepreneurship at Oxford University and the London School of Hygiene & Tropical Medicine.

For Dr Francois Bonnici, co-founder and director of the Bertha Centre, these projects propose novel solutions that are sustainable and can be scaled up in other places.

"These projects need to go beyond health provision to empower people and create jobs or some other social value for communities," he says.

The concept of social innovation is taken from economics and business studies and refers to efforts to mobilize and incentivize communities.

In health, social innovation may refer to low-fee private delivery of health care, using mobile phone applications such as the one Balamu uses to diagnose common childhood diseases--and other novel ways to make health-care delivery more accessible and affordable in low-income communities, Bonnici says.

According to a working paper presenting the results of a randomized controlled trial in Uganda of more than 8000 households, published in 2016 by the Center for Economic and Policy Research, the Living Goods project helped to reduce child mortality across those households by 27% between 2011 and 2013.

Living Goods calculates that the approach costs less than US$ 2 per head of population served; costs that are covered by Living Goods.

"The project was designed to tackle three problems undermining community health: finding volunteers in impoverished communities, lack of supervision and a poorly-stocked supply chain," says Church.

"Each community worker carries what we call 'a toolkit in a bag'. These are preventative and curative health products, including vitamin-fortified porridge, antimalarials and treatment for diarrhoea. They also sell household products such as stoves that run on clean energy sources, solar lamps and water filters.

"The demand for these items is high and the cost of getting them into the field is largely covered by the savings from buying them wholesale," Church says.

Living Goods trains its community health workers, gives them an initial loan to buy the products at subsidized prices, and monitors and rewards their performance. The community health workers commit to working at least two hours a day, five days a week. Most of them work part time and make about US$ 10-15 per month from their sales mark up. The average monthly incomes in the villages where they work range from US$ 30-120. …

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