Field Update from Living Goods

Although I do not have direct contact with Living Goods I have always been interested in their work as the concept is nearly identical to the HealthKeepers of Freedom from Hunger, the market research for that business being the topic of my graduate thesis. I am anxious to see how the models mold as they are refined on the ground. This is a recent update from Chuck Slaughter, the founder and president:

Friends of Living Goods,

Living Goods, known as the “Avon of Rural Health”, is delighted to share the following milestones from this last fast-paced year on our journey to becoming the first fully sustainable system for defeating the diseases of poverty:

• Last May Living Goods and BRAC signed a joint venture agreement to collaborate on building a Living Goods network serving 20+ districts in Uganda.

• The Rockefeller Foundation, Mulago Foundation, Causal Fund and the Horace W. Goldsmith Foundation each awarded core funding to Living Goods.

• Extensive research, field study and customer focus groups helped LG identify its first 28 health products which are now in stock across the LG network.

• In a sizable launch, Community Health Promoters were carefully selected, trained equipped and deployed to serve 200 communities.

• Poverty Action Lab began helping Living Goods design a best-of-class randomized evaluation system to measure LG’s key objectives of dramatically reducing mortality and fertility rates.

• Harvard Business School and the Harvard School of Public Health selected Living Goods to participate in their Project Antares field study.

• Living Goods was awarded an exclusive Draper Richards Fellowship.

• Most recently Living Goods began developing plans to market low cost solar lanterns and high efficiency cook stoves to help poor households dramatically reduce fuel expenses and indoor pollution.

• Chris Elias- President of PATH, Paul Polak - Founder of IDE, and Erastus Kibugu of Technoserve Uganda joined the Living Goods Advisory Board.

We extend our sincere thanks to all who helped LG reach this important juncture. In particular we want to acknowledge the BRAC Uganda team and their exceptional director Mr. Khondokar Ariful Islam. Their commitment, experience and professionalism are unmatched and indispensable.

Of course this is just the beginning. We will add 300-500 more Health Promoters before the end of the year, and scale to 3,000+ in four years serving four million people in Uganda alone. In the coming years LG plans to replicate this model across the developing world with other world class partners and test expanded product offerings in clean water, power and small holder agriculture. In fact a half dozen multinational NGOs are already expressing keen interest in collaborating with LG to implement its innovative system in other countries.

Naturally, along with these opportunities abundant challenges lie ahead. Living Goods represents a disruptive innovation in rural health care that will require considerable trial and error. Building a truly sustainable, replicable business model will be one measure of Living Goods success; the far greater success will be counted in the many diseases prevented, the many children saved, and the many healthy productive years families will enjoy by virtue of having affordable essential medicines within reach.

Please feel free to contact me directly (cslaughter@livinggoods.org) if you have any questions, or are interested in partnering with or supporting Living Goods.

To Your Health,
Chuck

Freedom from Hunger pilots HealthKeepers: Preventative Healthcare in a Basket

I'll start with Freedom from Hunger and their MicroBusiness for Health Initiative. I, of course, am biased towards this project as I was involved in the needs assessment which turned out to be my main graduate work. Ellen Vor der Bruegge was the presenter.

Quick summary: Preventative health products in a basket sold by an microcredit borrower in rural Ghana patterned after the Avon or Tupperware models that were successful in rural America beginning in the late 1800's.

FFH could be considered the new kid on campus, they are just launching their program. They have put together a team of ladies to pilot the business and provide feedback. The name of the business is HealthKeepers and I like the fact that the women sellers chose the name for the business. As expected, they sell insecticide treated nets, condoms, and ORS packets with zinc but they also sell a handful of products, which Ellen called their “door-openers”. What would you guess is their biggest seller? Now, this is a region where malaria is hyperendemic, polio still exists in pockets, and children die everyday from ailments such as diarrhea. The answer, drum roll.... athlete's foot powder. That in and of itself is amazing--no traditional public health intervention would focus on athlete's foot, yet, market feedback identified a quick and simple product that is viewed to have high value in terms of quality of life. I think the key is that they experimented, they put something out there and let the market respond. If athlete's foot cream gets the customers attention which allows the HealthKeeper to explain the cost-benefits of investing in an insecticide treated net then I hope they become the largest distributor of athlete's foot powder in the world. I also liked that they gave free products to their entrepreneurs to try out, creating converts of the products, and subsequently creating a very convincing sales force. They also allow the seller to give away some products in the village to stimulate demand. I also liked that they try to source products locally.

Some of their challenges: Pricing--so that all parties in the value chain are sustainable. They are constantly trying to balance their three goals: increased health protection, providing a living wage for the entrepreneur, as well as create a sustainable business themselves as the franchisor. Another main challenge, and it was echoed by other presenters, is free handouts by other programs. There must be dialogue between the various NGOs and government entities working to fight malaria. I personally feel that it is better to sell the nets, that it will be perceived with greater value, that it is more likely to be used and maintained, that it will lead to consistent supply and greatest penetration.

They are aiming high looking to have 4-5,000 HealthKeepers covering all of Ghana. I'm excited to watch their business grow over the next couple years. As they say at FFH, Onward!

Concept Paper
Blog Discussion among HealthKeeper staff
Chat with field director

A worm store

It's not everyday one can take inspiration from the movie Dumb and Dumber, but Llyod's “I've Got Worms” store could be a wonderfully simple and low-cost microfranchise in rural areas in the developing world. Vermicompost, an excellent organic fertilizer, uses earthworms to convert organic waste such as kitchen waste, animal waste, and agricultural residues into compost. A vermicomposting franchise would train franchisees to properly 'feed' the worms and how to construct proper holding containers. Franchisees could then sell worms and holding containers to their neighbors. It would not be an all-consuming business but it could be an additional revenue stream, much like Honey Care Africa beehives can be an additional revenue for farmers in Kenya. I also think it is a microfranchise that could be particularly suited for rural women.

Source: Where the are No Jobs Vol. 4

Avon meets Rural Healthcare Worker

This organization caught my eye because it is attempting to implement the same model as an organization I am working with, namely Freedom from Hunger. It is a testament to the strength of the idea that two organizations independently saw the same need and solution. Could this be for microfranchising what Accion and Grameen were for microfinance?

It is not clear from their website where they are in the implementation process. It also does not mention where they are working but I understand it is in Uganda.

Some of LivingGoods strengths as I see it, which are also in the FFH model:

Living Goods focuses on a short list of diseases that account for over two thirds of mortality and can be prevented and/or treated at very low cost.

Living Goods employs all the key characteristics of successful franchises: methodically screened agents, strict quality monitoring and follow-up training, uniform branding and product mix, effective promotions, low cost of goods achieved through scale, and stiff penalties for violating the rules (including expulsion).

Depending on local circumstances it may operate as a highly efficient non-profit social enterprise, as a contractor to government health ministries, or even as a for-profit business.

Living Goods will partner with local community groups, NGOs, FMCG distributors, and Microfinance organizations to source, screen and possibly finance Mobile Health Promoters.

Women's Health Store

During my research in Ghana I felt one of the most exciting possibilities of a microfranchise would be a women's health store. In focus groups and interviews with women the idea was always met with enthusiasm. Many women we talked to, and I would suspect similar feelings in many traditional societies, did not feel comfortable going to the local male-run chemical shop to describe womanly problems they are having and asking for proper treatment. Most woman simply live with various rashes, infections, and uncomfortableness.
The idea of a women’s health store was always received warmly and I would anticipate it being successful financially. More importantly, I think it can be empowering to women in that it can be a channel of information about their own bodies and also a simple solution to small little problems that can have a dramatic effect on their day-to-day quality of life. It also has great potential for growth as far as expanding product lines and partnering with education and as a potential resource in the future to get access to an audience of women of childbearing years.
Products might have to focus on non-drug items due to government regulations. Possible products could include:
ABSORBENTS: Based on the difficulty I had getting women to talk about any sort of woman’s problem I really didn’t delve into the specific products that women are currently using. There are alternatives to disposable pads or tampons that should be considered, such as different cups or sponges. There are a number of solutions that are reusable and environmentally friendly such as Sea Pearls sponge. It might also be a business for a woman to sew reusable cloth pads (designs and instructions can be found online).
MENSTRUAL CRAMPS: There must be some medicines or herbal treatments that are more specific to menstrual cramps than a generic pain killer. Cost would have to be very low to compete with the generic drugs.
WAIST PAIN PRODUCTS: Perhaps the most common problem and most cause for complaining among women was the day-to-day ‘waist-pains’ (lower-back pains) and body pains. The most likely culprit of their waist pains is the method of bending at the waist to work and to lift heavy things on their head. The products I would push would be LONG-HANDLED BROOMS AND HOES, and WOOD MASSAGE TOOLS. All would be very easy to make in-country. The long-handled tools would require extensive salesmanship, demonstration and education in order to be adopted but they would help prevent some of their problems. The massage tools are recommended over any sort of massage service. Additional products would be heating pads, or something like a homemade heating pad (rice in a cloth pillow that is heated and retains heat). You could locally make some sitting pillows that mimic cushion pillows designed to minimize lower back pain. You could also sell back supports or knee braces in they secured cheaply enough.
There are a whole number of other products that could quickly be adopted including clean-birth kits, ORS packets for their small children and so forth.
On a side note I thought a business entitled “Stop that Itch” would also be quite successful based on the things I was hearing in focus groups. This could be part of the women's store or it could be its own little package business. The simplicity of the model and product line make it appealing as a separate business, it would be so easy to market as well. I would predict the best seller to be EYE DROPS for itching eyes. Other than that, the rest of the products could treat any of the various itchy problems (skin rashes, insect bites, genital or underside of breast itching, etc.)