Project Lead(s): Kevin McKague
South Sudan has some of the poorest health indicators in the world: a life expectancy at birth of 54 years; under-five mortality of 135 per 1,000; and the world’s highest maternal mortality rate of 2,054 per 100,000 live births.
These poor outcomes are due to the extremely limited number of health facilities and health providers, including doctors and nurses. Access to healthcare is further compromised by poverty, limited infrastructure, lack of health information and lack of familiarity with the practices of modern healthcare.
The use of community health workers (CHWs) is a common strategy to reach people from low-income, rural and marginalized communities in many countries, including South Sudan.
Because these workers are often unpaid, it is a challenge to keep them motivated to deliver the necessary health services.
The innovation tested was a novel, micro-franchised social enterprise business model to allow 200 CHWs to generate income, with incentives for their work to reduce maternal and child mortality.
The objective was to establish a public-private enterprise of micro-franchised mobile health workers that would extend healthcare throughout South Sudan to those who need it most.
Activities included development of:
1) A standardized training module for mobile health workers
2) A standardized kit and inventory of health supplies and products
3) A standardized, SMS-based inventory and patient contact management system.
Initial health worker training can be undertaken by hospital or clinic staff. The workers and their home-based clinics then earn a viable income, based on clients served and products sold. Additional revenues can be generated from contracts with NGOs or donors for implementing public health campaigns.
Working with BRAC South Sudan, the Ministry of Health and the South Sudan Physicians Organization, the project team successfully developed a financially sustainable social enterprise model to support CHWs.
· Successfully piloted a social enterprise model, with 200 BRAC CHWs who sold medicines and health products door-to-door to generate income
· Piloted a social enterprise model where six CHWs were trained and based at a public-private partnership clinic run by the South Sudan Physician’s organization
· Piloted a mobile clinic where two CHWs and one nurse accessed unserved villages in a small, three-wheeled motor vehicle on regularly scheduled days
· Laid the groundwork for a pilot project where subsistence farmers could pay for the services and medicines provided by BRAC CHWs with agricultural commodities.
With 200 BRAC CHWs operating as micro-franchised social entrepreneurs, an estimated 100,000 individuals have benefitted (each CHW serves 500 individuals).
The Stars in Global Health grant enabled the project team to lay the foundation for attracting $1 million in additional funding from the International Development Research Centre (IDRC), Global Affairs Canada and the Canadian Institutes of Health Research, as part of their Innovating for Maternal and Child Health initiative.
These resources will facilitate research into the best way to optimize the mix of financial and non-financial incentives for CHWs, including conducting a randomized controlled trial.