Adapting the Door-to-Door Model to Improve Health in Africa



Health outcomes 1A child in the developing world dies every three seconds because of a lack of basic access to health care and medicines. Public health systems in many developing countries are critically underfunded, understocked, and understaffed. Poor consumers seeking health care frequent private outlets, which are often no better than the public health care system.

Many of the poorest end up paying high prices for improperly stored or counterfeit medicines, or services from poorly trained health clinics and health workers. However, one organization, called Living Goods, is taking an idea from the Avon Lady to help solve this problem.

Living Goods was started in Uganda in 2007 by entrepreneur Chuck Slaughter, and has since expanded to Kenya, Myanmar, and Zambia. Living Goods uses a network of direct salespeople, similar to Avon, to sell essential drugs and supplies door-to-door, even in remote areas. Salespeople are called Community Health Promoters (CHPs) and teach families how to improve their health, as well as sell treatments for malaria and diarrhea, safe delivery kits, fortified foods, clean cook stoves, water filters, and solar lights.


Community Health


CHPs are community members who are familiar and trusted advisors to their neighbours. They receive basic medical training and a phone with a custom app to help them diagnose common diseases. Customers know they can call their local Living Goods CHP at any time, and the CHP will come to their door, provide an accurate diagnosis, and deliver trusted, high-quality medicine.

The medicine sold is cheaper than local shops, but there is a large enough margin to cover the cost and help the CHPs to supplement their incomes through a small commission. In addition to earning more money, CHPs also earn the loyalty and trust of their neighbours and help to improve significant health outcomes.

This model generates enough revenues to pay for the cost of the products and help CHPs to earn a supplementary income. As a result, Living Goods helps to keep products in stock and pay badly needed health workers. In total, it costs approximately $1 to $2 per year per person to run the program. Results from a study led by MIT researchers has also shown that the model works well. MIT found that the network of CHPs was able to reduce deaths in young children by as much as 27%.


Learn and Adapt


Health outcomes 2The study also found that Living Goods has created competition that is changing the local health care system. Drugstores near communities with CHPs began to sell less expensive malaria drugs, and they also sold 50% less counterfeit medicine than stores that were further away. Living Goods is quickly expanding, and they’re also working to share their method with others. Working with organizations like the Uganda Ministry of Health, BRAC, CARE, and Population Services International (PSI), Living Goods hopes to support over 10,000 CHPs across four countries in the next four years.

Overall, Living Goods aims to improve health conditions of 50 million people in need within ten years. To reach that scale, Living Goods will continue to grow and improve its own operations, but they also hope to partner with and influence others as well. Slaughter knows that Living Goods can’t solve the immense health problems of developing countries on its own, and they hope to learn from others and adapt their model to local contexts. Most importantly, Slaughter hopes other organizations will want to adopt the model and adapt it themselves. Essentially, he wants others to steal his idea. “If you want to make a difference, that’s the only way to go about it,” he says.


Valerie Busch

Valerie Busch

Valerie is a development professional based in Toronto, Ontario.

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