For World Health Day, we caught up with entrepreneur and adviser on community health policy, Liz Jarman, who is currently driving change and saving lives in Africa.

Liz is the Chief Strategy Officer for a not-for-profit organisation called Living Goods. Living Goods works to strengthen community health care in developing countries by supporting governments in the delivery of high impact health services to mothers and children in their communities at a low cost. She has been working for Living Goods for more than 4 years and has been living in Kenya for 6 years. However, before that she lived in London, working for Sainsbury’s as Head of Product Technology, overseeing a team of 60 that ensured the quality of 10,000 private label products, from more than 1,000 suppliers.Liz is the Chief Strategy Officer for a not-for-profit organisation called Living Goods. Living Goods works to strengthen community health care in developing countries by supporting governments in the delivery of high impact health services to mothers and children in their communities at a low cost. She has been working for Living Goods for more than 4 years and has been living in Kenya for 6 years. However, before that she lived in London, working for Sainsbury’s as Head of Product Technology, overseeing a team of 60 that ensured the quality of 10,000 private label products, from more than 1,000 suppliers.

How did she go from a successful career in food retailing at one of the leading supermarkets in the UK to a not-for-profit role in Africa?How did she go from a successful career in food retailing at one of the leading supermarkets in the UK to a not-for-profit role in Africa?

Liz’s parents were adventurous; straight after university they took their first trip abroad to support the Zambian government by teaching in a very rural part of the country in the early days after independence. This is when Liz was born. After 4 years in Zambia they went back to the UK and seven years later, moved again to live in Papua New Guinea where Liz spent her early teens. This may have helped wet her appetite in later years for moving abroad, even if it took a few decades to get there! “I was never keen to go to a developing country straight after university when I had no experience to offer” says Liz.

After gaining an Agriculture and Food Science degree from the University of Nottingham, Liz started working for Nestlé on their quality management graduate scheme, based in a number of different factories across the UK. In 1994, she joined Sainsbury’s and worked there for 17 years ultimately progressing to a senior leadership role. In 2006, whilst at Sainsbury’s she convinced the now CEO, Mike Coupe that spending 4 months in Kenya, to get an in-depth understanding of their African supply chains, would be beneficial in driving the supermarket’s strategy of ‘sourcing with integrity’. In early 2007 she moved to Kenya, spending time with suppliers of flowers, tea, coffee, fruits and vegetables. She soon realised that Sainsbury’s could make an even bigger difference by moving a number of product ranges to become 100% Fairtrade. She gained board approval to implement this strategy and took Sainsbury’s to become the largest retailer in the world of Fairtrade products. Over the next 5 years, she introduced a number of initiatives including working closely with Comic Relief and DFID to support several development projects, hosting trips for store colleagues to visit Fairtrade farms in African countries and introducing the first ever supplier conferences in the continent, now a trend across most of the major retailers. In 2008, this earned her a finalist position by the Observer Newspaper’s “Future 500 People to Watch” with a special intrapeneur commendation.After gaining an Agriculture and Food Science degree from the University of Nottingham, Liz started working for Nestlé on their quality management graduate scheme, based in a number of different factories across the UK. In 1994, she joined Sainsbury’s and worked there for 17 years ultimately progressing to a senior leadership role. In 2006, whilst at Sainsbury’s she convinced the now CEO, Mike Coupe that spending 4 months in Kenya, to get an in-depth understanding of their African supply chains, would be beneficial in driving the supermarket’s strategy of ‘sourcing with integrity’. In early 2007 she moved to Kenya, spending time with suppliers of flowers, tea, coffee, fruits and vegetables. She soon realised that Sainsbury’s could make an even bigger difference by moving a number of product ranges to become 100% Fairtrade. She gained board approval to implement this strategy and took Sainsbury’s to become the largest retailer in the world of Fairtrade products. Over the next 5 years, she introduced a number of initiatives including working closely with Comic Relief and DFID to support several development projects, hosting trips for store colleagues to visit Fairtrade farms in African countries and introducing the first ever supplier conferences in the continent, now a trend across most of the major retailers. In 2008, this earned her a finalist position by the Observer Newspaper’s “Future 500 People to Watch” with a special entrepreneurial commendation.

In 2011, she was loving her job, enjoying living in London, but she was also feeling restless. Hitting her 40s, she felt maybe there was something else she could be doing. “Sainsbury’s offered a year career break for long-service employees, so I decided this was a low-risk way of testing the water elsewhere, but I did not really know what I wanted to do and was pretty exhausted working long hours over the last few years, so I decided first to go travelling on my own for 6 months”. After 6 months, Liz, who was now on the board of Fairtrade International, offered her services for free to Fairtrade Africa based in Nairobi, Kenya. She moved there for six months helping with a number of marketing initiatives and soon realised that this was the change she wanted, working in a new country and bringing her many years of experience to really make a difference. “After the year career break, the decision was much easier to not to return to my previous world, and Fairtrade Africa asked me to stay on for a year as they recruited a new Executive Director. After that year, I found a new role at Living Goods”.In 2011, she was loving her job, enjoying living in London, but she was also feeling restless. Hitting her 40s, she felt maybe there was something else she could be doing. “Sainsbury’s offered a year career break for long-service employees, so I decided this was a low-risk way of testing the water elsewhere, but I did not really know what I wanted to do and was pretty exhausted working long hours over the last few years, so I decided first to go travelling on my own for 6 months”. After 6 months, Liz, who was now on the board of Fairtrade International, offered her services for free to Fairtrade Africa based in Nairobi, Kenya. She moved there for six months helping with a number of marketing initiatives and soon realised that this was the change she wanted, working in a new country and bringing her many years of experience to really make a difference. “After the year career break, the decision was much easier to not to return to my previous world, and Fairtrade Africa asked me to stay on for a year as they recruited a new Executive Director. After that year, I found a new role at Living Goods”.

“Living Goods is perfect for me. It is an organisation that uses private sector approaches to strengthen public health. We have a diverse, talented team from different countries with unique skill sets who all work incredibly hard to deliver our ambitious vision we all believe in. It aims for scale, just like when I was at Sainsbury’s, driving transformative change in countries where focusing on health in the community makes a huge difference to lives of mothers and children”. In Kenya, there are just two doctors for every 10,000 people. This means that families who need treatments for childhood diseases like malaria and diarrhoea, pregnancy support, and nutrient-rich foods, often do not get it. As a result, less than 70% of births are attended by a skilled health worker, and every 1,000 children will die before their fifth birthday. These are terrible statistics and a reality that no family should have to face.“Living Goods is perfect for me. It is an organisation that uses private sector approaches to strengthen public health. We have a diverse, talented team from different countries with unique skill sets who all work incredibly hard to deliver the ambitious vision we all believe in. It aims for scale, just like when I was at Sainsbury’s, driving transformative change in countries where focusing on health in the community makes a huge difference to lives of mothers and children”. In Kenya, there are just two doctors for every 10,000 people. This means that families who need treatments for childhood diseases like malaria and diarrhoea, pregnancy support, and nutrient-rich foods, often do not get it. As a result, less than 70% of births are attended by a skilled health worker, and every one in every 1,000 children will die before their fifth birthday. These are terrible statistics and a reality that no family should have to face.

In a podcast for the Chronicle of Philanthropy on 30 March 2018 Chuck Slaughter, founder of Living Goods, said Living Goods “supports networks of community health workers throughout Africa. These are women who are digitally empowered with a smart phone. What’s really transformed this model in the last several years is technology. When we started, we described what we do as the Avon of community health, bringing the power of a simple business model to the imperative to improve healthcare in the developing world. In the last three to four years, it’s really become more like the Uber of healthcare, putting the power really in the hands of the consumers and enabling them to call for the healthcare they need any time of day… and have a local, independent healthcare provider come to them, provide them an accurate diagnoses using an algorithm on their phone, and provide them the medicine they need right there on the spot.” This is very much aligned to private sector thinking but applied to a not-for-profit sector, and is where Liz’s experience comes into its own.founder of Living Goods, said the organisation “supports networks of community health workers throughout Africa. These are men and women who are digitally empowered with a smart phone. What’s really transformed this model in the last several years is technology. When we started, we described what we do as the Avon of community health, bringing the power of a simple business model to the imperative to improve healthcare in the developing world. In the last three to four years, it’s really become more like the Uber of healthcare, putting the power really in the hands of the consumers and enabling them to call for the healthcare they need any time of day… and have a local, independent healthcare provider come to them, provide them an accurate diagnoses using an algorithm on their phone, and provide them the medicine they need right there on the spot.” This is very much aligned with private sector thinking but applied to a not-for-profit sector, and is where Liz’s experience comes into its own.

“The importance of and the use of data has been pivotal in shaping our strategy, as well as helping secure greater funding and government engagement. Being able to tangibly demonstrate that the community health work supported by Living Goods is responsible for a 27% reduction in the mortality figures for children under 5 was a key moment. Not only did it lend credibility, but it was also empowering for the workers on the ground”.“The importance of and the use of data has been pivotal in shaping our strategy, as well as helping secure greater funding and government engagement. Being able to tangibly demonstrate that the community health work supported by Living Goods is responsible for a 27% reduction in the mortality figures for children under 5 was a key moment. Not only did it lend credibility, but it was also empowering for the workers on the ground”.

Liz explained “By giving Living Goods supported Community Health Workers (CHWs) a smart phone with the Living Goods SmartHealth App, it gives the CHWs a standing in their communities, it helps them to accurately diagnose and treat sick children, register pregnant women, so they get the support they need and most importantly provides real-time data. What this means is that the CHWs who are not performing, are struggling or who have not been out in the field can be immediately identified and quickly given extra support. Those doing a fantastic job can also be recognised and rewarded. This led to the introduction of the Fast Start Programme. We discovered that if we can motivate the CHWs to perform at a high level in their first month, they gain a much greater level of commitment, leading to fewer CHWs dropping out of the programme. Peer-to-peer mentoring has also been successful in not only improving the performance of those CHWs that are struggling, but also the performance of the mentors improved as they have a real sense of pride in seeing others succeed. We pay small financial incentives that are performance based. But we also know, although important, money is rarely the primary motivating factor to the CHWs. Linking financial incentives does drive performance and health outcomes, but we also know non-financial incentives are equally important and simple ideas like the receiving a certificate, helping their peers or just feeling they are equipped and trained to help their neighbours is also key.”Liz explained “By giving Living Goods-supported Community Health Workers (CHWs) a smart phone with the Living Goods SmartHealth App, it gives the CHWs a standing in their communities, it helps them to accurately diagnose and treat sick children, register pregnant women, so they get the support they need and most importantly provides real-time data. What this means is that the CHWs who are not performing, are struggling or who have not been out in the field can be immediately identified and quickly given extra support. Those doing a fantastic job can also be recognised and rewarded. This led to the introduction of the Fast Start Programme. We discovered that if we can motivate the CHWs to perform at a high level in their first month, they gain a much greater level of commitment, leading to fewer CHWs dropping out of the programme. Peer-to-peer mentoring has also been successful in not only improving the performance of those CHWs that are struggling, but also the performance of the mentors improved as they have a real sense of pride in seeing others succeed. We pay small financial incentives that are performance-based. But we also know, although important, money is rarely the primary motivating factor for the CHWs. Linking financial incentives does drive performance and health outcomes, but we also know non-financial incentives are equally important and simple ideas like the receiving a certificate, helping their peers or just feeling they are equipped and trained to help their neighbours is also key.”

The work by Living Goods supporting the Government  of Kenya to provide high quality community heath care started in 2016, bringing lessons learnt from their experiences in Uganda. Starting with 150 CHWs in 2016 and working in one sub-county (area), this rose to 750 in 2017 across 8 sub-counties and it will more than 2000 by the end of 2018 reaching more than 1.2 million  people.The work by Living Goods supporting the Government of Kenya to provide high quality community health care started in 2016, bringing lessons learnt from their experiences in Uganda. Starting with 150 CHWs in 2016 and working in one sub-county (area), this rose to 750 in 2017 across 8 sub-counties and it will more than 2000 by the end of 2018 reaching more than 1.2 million people.

Liz is now working to shape how Living Goods can take the learnings from its direct implementation of community health services in Kenya and Uganda, and to help other governments shape their community health policies and implementation plans. Smart phones are at the centre of this strategy. Living Goods feels the use of technology and digitally equipping community health workers is a game changer in ensuring high levels of care is delivered right in the communities where it is needed for the common diseases that kills children, that real time data helps drives performance and keep supervisors informed, and provides valuable information for government to inform policy change.Liz is now working to shape how Living Goods can take the learnings from its direct implementation of community health services in Kenya and Uganda, to help other governments shape their community health policies and implementation plans. Smart phones are at the centre of this strategy. Living Goods feels the use of technology and digitally equipping community health workers is a game changer in ensuring high levels of care are delivered right in the communities where it is needed for the common diseases that kills children, that real time data helps drives performance and keep supervisors informed, and provides valuable information for government to inform policy change.

If you are interested in finding out how Living Goods is Motivating Community Health Workers listen to this podcast with Liz by Finding Impact

For more information on Living Goods – livinggoods.org