Jan 2015 – Dec 2018

Reducing under-5 mortality in Uganda

Country

Uganda – Africa

To change the way community health worker programmes are designed and implemented in Uganda.

$16,198,929 Multi-Year Grant Value

Partners

Community health workers are widely recognised as one of the most effective ways of preventing deaths among children younger than five years. However, many of these programmes are failing to reach their full potential. They are predominately managed by the public sector, where oversight is often weak and a lack of incentive threatens performance. 

Living Goods is based on the idea that community health workers - when trained, motivated, and equipped with the necessary tools and products - can be the key to saving the lives of children. The programme is based on 'Avon-like' networks of independent entrepreneurs who go door-to-door selling low-cost, subsidised health and health-related products, as well as motivating households to adopt healthy behaviours.


Impact

Uganda has made good progress in reducing child mortality over the past 15 years, yet more than 100,000 children each year still fail to reach their fifth birthday. 

Approximately 33,000 of these deaths occur in the first month of life. 

Progress in reducing deaths within the neonatal period has been far slower than among older children.

If successful, the model has the potential to fundamentally change how community health worker programmes are designed in Uganda. This can then offer governments and donors an alternative to the existing, poorly-performing model.

In the first phase of our work with Living Goods and BRAC, the programme achieved a 26 per cent reduction in child deaths.

The following impacts in household practices and service access were also seen:

  • Households in Living Goods villages were 3.3 times more likely to have interacted with a community health worker compared to control villages
  • Children in villages with a Living Goods community health worker were 12% more likely to sleep under an insecticide-treated bed net
  • Children in Living Goods villages were 33% more likely to receive a follow-up visit after falling sick with diarrhoea, malaria or pneumonia
  • Mothers in Living Goods villages were 39% more likely to receive a home visit from a community health worker within the first week after giving birth.

Following our initial grant to test the model, this second investment will seek to bring the programme to scale across Uganda and ensure its sustainability. We are aiming to reach one million households which represents 15 per cent of the population during the programme.