Living Goods
Impact score: 78
Location: Kenya, Uganda, and Burkina Faso
Focus: Preventable child and maternal deaths
Living Goods - Fierce Philanthropy Research Report
Date: March 21, 2026 Methodology: Todd Manwaring's Social Impact Evaluation Framework Organization: Living Goods (livinggoods.org)
PROMPT 1 -- Organization and Social Problem Summary
- Social Problem: Preventable child and maternal deaths
- Population: Women and children under 5 in underserved rural communities
- Location: Kenya, Uganda, and Burkina Faso
PROMPT 2 -- Top 20 Negative Consequences of Preventable Child and Maternal Deaths Among Women and Children Under 5 in Rural East/West Africa
| # | Negative Consequence |
|---|---|
| 1 | High under-5 child mortality from treatable diseases |
| 2 | Infant deaths from malaria due to delayed diagnosis and treatment |
| 3 | Child deaths from pneumonia due to lack of timely antibiotics |
| 4 | Child deaths from diarrhea due to lack of oral rehydration therapy |
| 5 | Maternal mortality from complications during pregnancy and delivery |
| 6 | Neonatal deaths from preventable causes in the first 28 days of life |
| 7 | Low immunization coverage leaves children vulnerable to outbreaks |
| 8 | Caregivers lack knowledge of danger signs in sick children |
| 9 | Families live more than 5km from nearest health facility |
| 10 | Delayed care-seeking behavior allows treatable illnesses to become fatal |
| 11 | Lack of antenatal care leads to undetected pregnancy complications |
| 12 | Home deliveries without skilled attendants increase maternal and neonatal risk |
| 13 | Malnutrition weakens children's ability to survive common illnesses |
| 14 | Low adoption of family planning leads to high-risk pregnancies |
| 15 | Weak health data systems prevent identification of at-risk populations |
| 16 | Overburdened health facilities cannot serve remote populations |
| 17 | Economic burden on families from catastrophic out-of-pocket health spending |
| 18 | Loss of household productivity when caregivers manage sick children |
| 19 | Emotional and psychological trauma from preventable child death |
| 20 | Community distrust of formal health system reduces engagement |
PROMPT 3 -- Negative Consequences Classified as Intermediary or Ultimate Outcomes
Sorted by Intermediary Outcomes first, then Ultimate Outcomes.
| # | Negative Consequence | Outcome Type |
|---|---|---|
| 8 | Caregivers lack knowledge of danger signs in sick children | Intermediary |
| 9 | Families live more than 5km from nearest health facility | Intermediary |
| 10 | Delayed care-seeking behavior allows treatable illnesses to become fatal | Intermediary |
| 7 | Low immunization coverage leaves children vulnerable to outbreaks | Intermediary |
| 11 | Lack of antenatal care leads to undetected pregnancy complications | Intermediary |
| 12 | Home deliveries without skilled attendants increase maternal and neonatal risk | Intermediary |
| 14 | Low adoption of family planning leads to high-risk pregnancies | Intermediary |
| 15 | Weak health data systems prevent identification of at-risk populations | Intermediary |
| 20 | Community distrust of formal health system reduces engagement | Intermediary |
| 1 | High under-5 child mortality from treatable diseases | Ultimate |
| 2 | Infant deaths from malaria due to delayed diagnosis and treatment | Ultimate |
| 3 | Child deaths from pneumonia due to lack of timely antibiotics | Ultimate |
| 4 | Child deaths from diarrhea due to lack of oral rehydration therapy | Ultimate |
| 5 | Maternal mortality from complications during pregnancy and delivery | Ultimate |
| 6 | Neonatal deaths from preventable causes in the first 28 days of life | Ultimate |
| 13 | Malnutrition weakens children's ability to survive common illnesses | Ultimate |
| 16 | Overburdened health facilities cannot serve remote populations | Ultimate |
| 17 | Economic burden on families from catastrophic out-of-pocket health spending | Ultimate |
| 18 | Loss of household productivity when caregivers manage sick children | Ultimate |
| 19 | Emotional and psychological trauma from preventable child death | Ultimate |
PROMPT 4 -- Positive Results Shared by Living Goods
| # | Negative Consequence | Outcome Type | Positive Results Shared by Organization |
|---|---|---|---|
| 8 | Caregivers lack knowledge of danger signs in sick children | Intermediary | Yes. CHWs conduct door-to-door visits providing health education. In both Kenya and Uganda, more than 80% of caregivers reported receiving health and immunization information from CHWs. CHWs were the primary information source, accounting for 56.3% of touchpoints in Kenya and 41.2% in Uganda. SmartHealth app guides CHWs through symptom assessment protocols. |
| 9 | Families live more than 5km from nearest health facility | Intermediary | Yes. 11,429 CHWs deployed across Kenya, Uganda, and Burkina Faso reaching 5.3 million people in 2024. CHWs deliver care directly at the household level, eliminating the need to travel to distant facilities. Program specifically targets populations more than 5km from nearest health facility. |
| 10 | Delayed care-seeking behavior allows treatable illnesses to become fatal | Intermediary | Yes. CHWs manage half of malaria cases at the household level. In Busia County, Kenya, a digital health project increased same-day diagnosis and treatment from 9% to 59%. Malaria testing coverage increased from 51% to 75%. |
| 7 | Low immunization coverage leaves children vulnerable to outbreaks | Intermediary | Yes. 82% of children aged 9-23 months in program areas were fully immunized. CHWs provide immunization education and referrals. |
| 11 | Lack of antenatal care leads to undetected pregnancy complications | Intermediary | Yes. CHWs conduct pregnancy follow-up visits and provide antenatal care support. SmartHealth app tracks pregnant women and generates follow-up reminders. |
| 12 | Home deliveries without skilled attendants increase maternal and neonatal risk | Intermediary | Yes. 95% of deliveries in program areas occurred at health facilities. CHWs counsel pregnant women on facility-based delivery and provide referrals. |
| 14 | Low adoption of family planning leads to high-risk pregnancies | Intermediary | Yes. CHWs provide family planning counseling and methods as part of their service package. |
| 15 | Weak health data systems prevent identification of at-risk populations | Intermediary | Yes. SmartHealth mobile app captures every patient touchpoint with names, mobile numbers, GPS locations, and timestamps. Real-time dashboards flag low- and high-performing CHWs and regions. Data used for performance management and targeting. |
| 20 | Community distrust of formal health system reduces engagement | Intermediary | Yes. CHWs are recruited from the communities they serve, building trust through familiar, accessible relationships. RCT found improved healthcare utilization in treatment areas. |
| 1 | High under-5 child mortality from treatable diseases | Ultimate | Yes. First RCT (IPA, 2011-2013): 27% reduction in under-5 child mortality. Second RCT (J-PAL): 28% reduction in under-5 child mortality at scale with 4,500 digitized CHWs serving 3.6 million people. |
| 2 | Infant deaths from malaria due to delayed diagnosis and treatment | Ultimate | Yes. CHWs manage half of malaria cases at household level. Same-day diagnosis and treatment improved from 9% to 59% in Busia County digital health project. Malaria testing coverage increased from 51% to 75%. |
| 3 | Child deaths from pneumonia due to lack of timely antibiotics | Ultimate | Yes. CHWs trained in integrated community case management (iCCM) to diagnose and treat pneumonia at community level. Treatment data collected via SmartHealth app. |
| 4 | Child deaths from diarrhea due to lack of oral rehydration therapy | Ultimate | Yes. CHWs trained in iCCM to diagnose and treat diarrhea at community level with ORS and zinc. Treatment data collected via SmartHealth app. |
| 5 | Maternal mortality from complications during pregnancy and delivery | Ultimate | Partial. 95% facility delivery rate suggests reduced maternal risk. No direct maternal mortality reduction data reported. |
| 6 | Neonatal deaths from preventable causes in the first 28 days of life | Ultimate | Yes. First RCT found 27% reduction in neonatal mortality on a base of 27.8 deaths per 1,000 live births. CHWs conduct follow-up household visits for newborns. |
| 13 | Malnutrition weakens children's ability to survive common illnesses | Ultimate | Partial. CHWs screen for malnutrition and refer. No direct malnutrition reduction data reported. |
| 16 | Overburdened health facilities cannot serve remote populations | Ultimate | Yes. CHWs handle community-level case management, reducing facility burden. Half of malaria cases managed at household level. |
| 17 | Economic burden on families from catastrophic out-of-pocket health spending | Ultimate | Partial. Care delivered at $3.09 per person per year, reducing cost barriers. No direct household spending impact data reported. |
| 18 | Loss of household productivity when caregivers manage sick children | Ultimate | No direct results shared. |
| 19 | Emotional and psychological trauma from preventable child death | Ultimate | No direct results shared. |
PROMPT 5 -- Counterfactual Results Shared by Living Goods
| # | Negative Consequence | Outcome Type | Positive Results Shared by Organization | Counterfactual Results Shared |
|---|---|---|---|---|
| 8 | Caregivers lack knowledge of danger signs in sick children | Intermediary | Yes. More than 80% of caregivers reported receiving health information from CHWs. CHWs were primary information source (56.3% in Kenya, 41.2% in Uganda). | No direct counterfactual on knowledge gains. The RCT found improved health knowledge in treatment vs. control villages but specific knowledge metrics not isolated. |
| 9 | Families live more than 5km from nearest health facility | Intermediary | Yes. 11,429 CHWs reaching 5.3 million people, targeting populations >5km from facilities. | No counterfactual results. Access is the intervention mechanism itself. |
| 10 | Delayed care-seeking behavior allows treatable illnesses to become fatal | Intermediary | Yes. Same-day diagnosis and treatment improved from 9% to 59%. Malaria testing from 51% to 75%. | Partial. The Busia County digital health project provides before/after comparison but not a randomized counterfactual for care-seeking behavior specifically. |
| 7 | Low immunization coverage leaves children vulnerable to outbreaks | Intermediary | Yes. 82% full immunization rate for children 9-23 months. | No direct counterfactual comparison of immunization rates between treatment and control areas reported. |
| 11 | Lack of antenatal care leads to undetected pregnancy complications | Intermediary | Yes. CHWs conduct pregnancy follow-up visits with SmartHealth tracking. | No counterfactual results on antenatal care uptake. |
| 12 | Home deliveries without skilled attendants increase maternal and neonatal risk | Intermediary | Yes. 95% facility delivery rate. | No direct counterfactual comparison of facility delivery rates between treatment and control areas reported. |
| 14 | Low adoption of family planning leads to high-risk pregnancies | Intermediary | Yes. CHWs provide family planning counseling and methods. | No counterfactual results on family planning adoption. |
| 15 | Weak health data systems prevent identification of at-risk populations | Intermediary | Yes. SmartHealth app provides real-time data capture and dashboards. | No counterfactual results. Data system is the intervention itself. |
| 20 | Community distrust of formal health system reduces engagement | Intermediary | Yes. RCT found improved healthcare utilization in treatment areas. | Partial. RCT compared healthcare utilization in treatment vs. control villages, showing increased engagement in treatment areas relative to control. |
| 1 | High under-5 child mortality from treatable diseases | Ultimate | Yes. First RCT: 27% reduction. Second RCT: 28% reduction at scale. | Yes. First RCT (IPA, 2011-2013, 3 years): 27% reduction in under-5 mortality measured against randomized control villages. Second RCT (J-PAL, 13 districts, 500 villages, 12,500+ households): 28% reduction measured against randomized control group at scale. Gold-standard counterfactual evidence. |
| 2 | Infant deaths from malaria due to delayed diagnosis and treatment | Ultimate | Yes. Half of malaria cases managed at household level. Same-day treatment improved from 9% to 59%. | Partial. Mortality RCTs capture malaria deaths within overall under-5 mortality reduction. No malaria-specific counterfactual isolated. |
| 3 | Child deaths from pneumonia due to lack of timely antibiotics | Ultimate | Yes. CHWs trained in iCCM to treat pneumonia at community level. | Partial. Captured within overall under-5 mortality reduction in RCTs. No pneumonia-specific counterfactual isolated. |
| 4 | Child deaths from diarrhea due to lack of oral rehydration therapy | Ultimate | Yes. CHWs trained in iCCM to treat diarrhea. | Partial. Captured within overall under-5 mortality reduction in RCTs. No diarrhea-specific counterfactual isolated. |
| 5 | Maternal mortality from complications during pregnancy and delivery | Ultimate | Partial. 95% facility delivery rate. No direct maternal mortality data. | No counterfactual results on maternal mortality. |
| 6 | Neonatal deaths from preventable causes in the first 28 days of life | Ultimate | Yes. First RCT: 27% reduction in neonatal mortality (base: 27.8/1,000 live births). | Yes. First RCT measured neonatal mortality against randomized control villages, finding 27% reduction. Significantly increased follow-up household visits for newborns compared to control villages. |
| 13 | Malnutrition weakens children's ability to survive common illnesses | Ultimate | Partial. CHWs screen and refer. No direct data. | No counterfactual results. |
| 16 | Overburdened health facilities cannot serve remote populations | Ultimate | Yes. Half of malaria cases managed at household level. | No direct counterfactual on facility burden. |
| 17 | Economic burden on families from catastrophic out-of-pocket health spending | Ultimate | Partial. $3.09 per person per year cost. | No counterfactual results. |
| 18 | Loss of household productivity when caregivers manage sick children | Ultimate | No direct results shared. | No counterfactual results. |
| 19 | Emotional and psychological trauma from preventable child death | Ultimate | No direct results shared. | No counterfactual results. |
SUMMARY REPORT
Section 1 -- Our Recommendation
We highly recommend Living Goods for donor support. This organization demonstrates exceptional evidence of impact, backed by two independent randomized controlled trials -- the gold standard in impact evaluation. The first RCT, conducted by Innovations for Poverty Action (IPA) over three years (2011-2013), found a 27% reduction in under-5 child mortality, a 33% reduction in infant mortality, and a 27% reduction in neonatal mortality. The second RCT, conducted with the Abdul Latif Jameel Poverty Action Lab (J-PAL) at much larger scale across 13 districts, 500 villages, and over 12,500 households, confirmed a 28% reduction in under-5 child mortality -- demonstrating that the program's impact holds at scale. Living Goods operates at remarkable cost-effectiveness, achieving these mortality reductions at an estimated $68 per life-year saved and $3.09 per person served annually. In 2024, 11,429 CHWs reached 5.3 million people across Kenya, Uganda, and Burkina Faso. The organization's model of equipping community health workers with digital tools (SmartHealth app) and embedding them within government health systems represents a sustainable, scalable approach to reducing preventable deaths. While intermediate outcome counterfactuals are less rigorously documented than ultimate mortality outcomes, the overall evidence base is among the strongest in global health philanthropy.
Seven-Point Evaluation:
- a. Understands the Social Issue
- b. Has Intermediate Outcome Goals
- c. Has Ultimate Outcome Goals
- d. Measures these Intermediate & Ultimate Outcomes
- e. Measures Intermediate Counterfactuals
- f. Measures Ultimate Counterfactuals
- g. Evidence of Continual Learning & Adaptation
Section 2 -- The Social Problem
In sub-Saharan Africa, preventable diseases -- malaria, pneumonia, and diarrhea -- remain the leading killers of children under five. Millions of women and children live more than 5 kilometers from the nearest health facility, making timely access to diagnosis and treatment impossible for many families. When a child falls ill with malaria, the window for effective treatment is narrow; delays of even a day can be fatal. Maternal mortality remains devastatingly high due to lack of antenatal care, home deliveries without skilled attendants, and undetected pregnancy complications. In the communities where Living Goods works in Kenya, Uganda, and Burkina Faso, these preventable deaths are driven by a combination of geographic isolation, weak health infrastructure, low health literacy among caregivers, and overburdened health facilities that cannot reach remote populations. The result is that millions of children die each year from diseases that are entirely treatable with basic, low-cost interventions -- if only care could reach them in time.
Section 3 -- The Solution
Living Goods recruits, trains, and equips community health workers (CHWs) -- predominantly women from the communities they serve -- to deliver essential primary healthcare door-to-door. The model has three integrated components:
- Digitally-Equipped Community Health Workers: CHWs are equipped with the SmartHealth mobile app (co-developed with Medic Mobile), which guides them through symptom assessment protocols, tracks patient registrations and follow-ups, and captures real-time data at every touchpoint. CHWs receive three weeks of basic healthcare training from specialists in integrated community case management (iCCM), covering diagnosis and treatment of malaria, pneumonia, and diarrhea, as well as maternal and newborn health, immunization education, family planning, and nutrition screening.
- Data-Driven Performance Management: The SmartHealth platform captures GPS-tagged, timestamped data on every patient interaction. Real-time dashboards flag high- and low-performing CHWs and regions, enabling supervisors and government officials to monitor coverage, identify gaps, and optimize resource allocation. Performance-based incentives align CHW effort with health outcomes.
- Government Partnership and System Strengthening: Living Goods embeds its CHW networks within existing government health systems rather than creating parallel structures. This approach leverages government co-financing, builds institutional capacity, and creates a pathway to full government ownership and sustainability at scale.
Section 4 -- Key Outputs
- 11,429 community health workers supported across Kenya, Uganda, and Burkina Faso (2024)
- 5.3 million people reached with essential health services (2024)
- $3.09 per person per year cost of delivering care
- $68 per life-year saved (cost-effectiveness from RCT)
- 95% of deliveries occurred at health facilities in program areas
- 82% full immunization rate for children aged 9-23 months
- 50% of malaria cases managed at the household level by CHWs
- Three weeks of specialist healthcare training per CHW
- Monthly refresher trainings to maintain and increase CHW knowledge and confidence
- CHWs provide health education, diagnoses, medicines, health products, family planning counseling, antenatal and postnatal care support, immunization referrals, and nutrition screening
- SmartHealth mobile app deployed across all CHWs for real-time data capture and clinical decision support
- Annual budget: approximately $26 million USD
- Founded: 2007
Section 5 -- Key Intermediate Outcomes
Living Goods measures several intermediate outcomes reflecting changes in caregiver knowledge, health-seeking behavior, and system capacity:
- Caregiver health knowledge: More than 80% of caregivers in program areas reported receiving health and immunization information, with CHWs serving as the primary information source (56.3% of touchpoints in Kenya, 41.2% in Uganda). The first RCT found improved health knowledge in treatment villages compared to control villages, though specific knowledge metrics were not isolated as a standalone counterfactual.
- Care-seeking behavior and treatment timeliness: In Busia County, Kenya, a digital health project demonstrated that equipping CHWs with digital tools increased same-day diagnosis and treatment from 9% to 59% and malaria testing coverage from 51% to 75%. CHWs now manage half of all malaria cases at the household level.
- Facility-based delivery: 95% of deliveries in program areas occurred at health facilities, indicating strong behavior change among pregnant women toward skilled birth attendance.
- Immunization coverage: 82% of children aged 9-23 months in program areas were fully immunized.
- Health data infrastructure: The SmartHealth platform provides real-time visibility into CHW performance, patient coverage, and health trends across all program areas, enabling data-driven decision-making at every level.
Counterfactual note: While the RCTs measured intermediate behavior changes (e.g., increased health knowledge, increased follow-up visits for newborns, increased healthcare utilization) in treatment vs. control villages, these intermediate counterfactuals are not reported as standalone, isolated metrics. The strongest counterfactual evidence is concentrated at the ultimate outcome level (mortality reduction).
Section 6 -- Key Ultimate Outcomes
Living Goods demonstrates exceptionally strong ultimate outcome measurement, with gold-standard counterfactual evidence from two independent RCTs:
- Under-5 child mortality: First RCT (IPA, 2011-2013, 3 years): 27% reduction in under-5 child mortality, measured against randomized control villages. Second RCT (J-PAL, 13 districts, 500 villages, 12,500+ households): 28% reduction in under-5 child mortality at scale with 4,500 digitized CHWs serving 3.6 million people. Counterfactual: Both RCTs used randomized control groups as the counterfactual, representing the gold standard in impact evaluation. The second RCT confirmed the effect holds at scale across heterogeneous populations.
- Infant mortality (under-1): First RCT found 33% reduction in infant mortality. Counterfactual: Measured against randomized control villages.
- Neonatal mortality: First RCT found 27% reduction in neonatal mortality on a base of 27.8 deaths per 1,000 live births. Counterfactual: Measured against randomized control villages. Significantly increased follow-up household visits for newborns in treatment vs. control areas.
- Child mortality in crisis contexts: Living Goods documented a 46% reduction in child mortality in drought-affected areas, demonstrating program resilience during emergencies.
- Disease-specific treatment: CHWs treat malaria, pneumonia, and diarrhea at the community level through integrated community case management. Half of malaria cases are managed at the household level. While disease-specific mortality reductions are not isolated, they are captured within the overall under-5 mortality reduction measured in the RCTs.
- Cost-effectiveness: $68 per life-year saved (from first RCT). $3.09 per person served annually. Among the most cost-effective health interventions globally.
Section 7 -- Continual Learning & Adaptation
Living Goods demonstrates strong evidence of being a learning organization that systematically uses data and evidence to refine its model:
Evidence-Driven Model Evolution: The organization invested in two independent RCTs -- the first a proof-of-concept study (IPA, 2011-2013) and the second a scale validation study (J-PAL, 13 districts). The decision to conduct a second RCT at much larger scale demonstrates a commitment to testing whether results hold under real-world conditions, not just controlled pilot settings.
Digital Health Innovation: The co-development of the SmartHealth app with Medic Mobile represents continuous investment in technology to improve CHW effectiveness. The platform has evolved from basic tracking to comprehensive clinical decision support, real-time performance dashboards, GPS monitoring, and automated follow-up reminders. In Burkina Faso, the organization chose CommCare over the CHT platform used in Kenya and Uganda, demonstrating willingness to adapt technology choices to local context.
Performance Management System: Real-time dashboards that automatically flag high- and low-performing CHWs and regions represent a systematic feedback loop between data collection and operational improvement. Performance-based incentives align CHW behavior with health outcomes.
Government Integration Strategy: The shift from operating as a parallel health delivery system to embedding within government health systems reflects strategic learning about sustainability and scale. Leveraging government co-financing creates a pathway to institutional ownership that independent NGO delivery cannot achieve.
Geographic and Contextual Adaptation: Expanding from Uganda to Kenya and then Burkina Faso required adapting the model to different health system contexts, languages, disease burdens, and government structures. The documented 46% mortality reduction in drought-affected areas demonstrates the program's resilience and adaptability in crisis contexts.
Monthly Training Cycles: CHWs attend monthly refresher trainings to update their knowledge and skills, creating a continuous learning cycle at the frontline level.
Scale Validation: The second RCT was specifically designed to test whether the program's impact diminishes at scale -- a critical question that most NGOs never rigorously investigate. The finding that mortality reduction actually increased slightly (from 27% to 28%) at scale provides powerful evidence of the model's robustness.
Report prepared using Todd Manwaring's Social Impact Evaluation Framework for Fierce Philanthropy. Sources: livinggoods.org, IPA RCT results, J-PAL RCT results, The Life You Can Save, Living Goods 2024 Year-End Report.
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