1. Uganda Ministry of Health An Entrepreneurial Solution for Improving Community Health Combining the best practices in franchising, microfinance, and public healthCollaborating with BRAC under the BRAC-Living Goods Partnership Key Partners CORE Group Spring Meeting May 2011 Molly Christiansen 415-632-1697 | mchristiansen@livinggoods.org | www.livinggoods.org

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

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

6. Myth: The poor can’t afford to pay for essential health items Fact: 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 odds Fact: 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

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”

8. Community Health Promoter: Zamin Nsibambi Location: Bwaise slum

10. The population was mostly rural and agricultural

11. The standard of living was substantially lower

12. Access to quality products in rural areas was poor

13. There were strong village social connections

14. Targeted to rural women needing extra incomeToday Avon sells over $10 billion and thrives in 140 diverse cultures – from Peru to the Philippines. >> 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.

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

16. 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

17. The Living Goods Health Business in a Bag 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 Branded Signage Whistle Training Certificate Branded Apron Branded Tee Shirt Price List Sales Register 2 Pocket Money Pouch Umbrella Medication Instructions Form Referral Form

18. 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