1. Uganda Ministry of Health Innovations for Scalability: Lessons from Living Goods’ Model in UgandaCombining the best practices in public health, franchising, and microfinance Key Partners CORE Group Fall Meeting Washington, D.C. Cailey Gibson, Living Goods 415-632-1909 | cgibson@livinggoods.org | www.livinggoods.org

2. Living Goods Mission and Key Goals Support Avon-like networks of mobile Health Entrepreneurs who make a good income providing health education and selling life-saving and life-changing health products at prices affordable to the poor - empowering them to make a living and make a difference at the same time. Key Goals Reduce mortality and morbidity rates by 15-30%, focusing on children under 5. Provide living incomes for thousands of health entrepreneurs, save poor families $ on healthcare prevention and treatment, and keep wage earners productive. Become financially self-sufficient at scale. Propagate the replication of the social micro-franchising model across developing world.

3. Key Elements of the Living Goods System Recruiting and Selection: Referral incentives, wide funnel, tight testing & standards Training and Coaching: Practical learn-by-doing, 2 weeks initial,1 day/month update, all free to agents; ongoing coaching by field agents Monitoring and Quality Control: Employs strict controls with monthly inspections; Replaces agents who do not meet standards Business in a Bag Toolkit: Uniforms, bag, locker, health tools, record books, health flip books, signage Branch Distribution System: Branches support 20-40 agents ~7km walking distance, target 90% in stock rate, agents re-supply weekly Diverse Product Mix:drive sales and enable cross subsidization Marketing, Promotions, Incentives:Door-to-door, mobile phones, community groups, home storefront, regular promotions and prizes

4. LG’s Diverse Product Mix Drives Sales… … And Enables Cross-Subsidization Prevention Insecticide Treated Bed Nets Water Treatment Condoms Vitamin A, Iron, Zinc Hand Soap Iodized Salt & Fortified Foods Treatment Anti Malarials Oral Rehydration Salts ZInc De-worming OTC Pain & Cold ARI Consumer Staples* Feminine Hygiene Diapers Laundry Soap Toothpaste Lotions & Creams Money Saving or Making Solar Lanterns / Chargers Efficient Cook Stoves Water Filters Reading Glasses >> Fast moving items increase frequent home visits

5. 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

6. Health Impact: LG Targets Increases in Key Health Behaviors Diarrhea Increase adoption of water treatment Increase consistent hand washing Increase prompt treatment of DD with ORS +Zinc Increase referral of acute DD cases to health center Malaria Increase % of kids <5 and mothers sleeping under LLINs Increase prompt treatment of malaria with ACT Malaria prophylaxis in pregnancy Increase referral of acute malaria cases to health centers Nutrition Increase Vitamin A supplementation for <5s Increase use of fortified foods, iodized salt Iron supplementation in pregnancy Maternal & Neonatal First pre natal visit in first 4 mos Nutritional supplements during pregnancy Delivery in health facility Post natal visit within 24 hrs Identify and refer high risk cases to health center Increase use of Family Planning ARI Diagnose and treat ARI infections in the home Increase referrals of acute cases

9. Lead times

11. Board and Advisors Board of Directors Randall Spratt: EVP of McKesson, the largest drug distributor in the US Andy Peterson: Procter & Gamble, Director of East and South Africa Charles Slaughter: Founder - TravelSmith, Former President – Healthstore Kenya Holly Wise: Consultant - Wise Solutions LLC, Former Mission Officer - USAID Uganda and Head of USAID’s Global Development Alliance Stephen Jarrett: Former, Deputy Director of Procurement, UNICEF Dr. John Cutler: Chief of Country Programmes, Health Metrics Network Secretariat, WHO Board of Advisors Sir Richard Feachem MD: Founding Executive Director of the Global Fund Bruce McNamer: President and CEO of TechnoServe Christopher Elias: President of PATH, Program for Appropriate Technology in Health Dr. Sam Okware, Uganda Minister for Community Health Kathryn Johnson, Former CEO of Health Forum Erastus Kibugu, Uganda Country Director for TechnoServe Dr. Allen Hammond: Former VP at World Resources Institute, now at Ashoka / E Healthpoint Dr. Paul Polak: Founder of IDE and D-Rev Kevin Starr: Director of Mulago Foundation and The Rainer Arnhold Fellows Dr Sam Okuonzi: Makarere University Uganda, Regional Center for Quality of Healthcare Dr Rebecca Weintraub: Harvard Global Health Delivery

12. Streamlined Supply Chain Lowers Costs Typical Supply Chain Manufacturer/Importer National Distributor Regional Distributor Local Distributor Rural Seller Living Goods Supply Chain Manufacturer/Importer Living Goods Rural Seller >> LG prices average 10-30% below market.

13. Competition – Value Proposition >> LG delivers lower prices, better quality, and more consistent availability than existing public health centers or private drug shops.

14. Keys to Financial Sustainability Significantly broaden number of products offered to achieve diverse, cross-subsidized product mix Add higher margin items Focus intensely on the profitability and livelihoods of CHPs Create buying power through scale & sourcing at lowest possible cost Cut out middlemen in existing distribution chain Maintain rigorous cost discipline Increase number of CHPs served per branch

16. Launched Q3 2009

17. CHP selection from community at large

18. 5 branches and growing

19. 40 CHPs per branch

20. 200 CHPs total

21. Retail sales of $125/CHP/Month

22. The BRAC partnership leverages their existing branch network and deep health expertise and provides scale

23. Launched Q1 2008

24. CHPs selected from existing BRAC lending groups

25. Using 24 branches out of 90

26. 20 CHPs per branch

27. 500CHPs total

29. Call Me for Help System Call Me for Help Button Stella Ikila 752 830 013 Stella Ikila 752 830 013 Home Stickers Placed in every home with <5 Child Has agent’s cell phone # Teaches family on danger signs

31. 1 week refresher training each year

32. Monthly coaching visits from a LG field staffMonthly Monitoring: Field agents meet with health promoters at least once a month to re-supply, review records, collect health and sales data, and create outreach plans. Staff also periodically interview community members to measure quality of service and accuracy of diagnoses.

34. Giving village health talks at primary schools, places of worship, women’s groups, etc.

35. Operating stalls at weekly markets

36. Maintaining daily “store hours” at home

37. Employing cell phones so ill patients can summon them