Despite decades of public health investments in Western Kenya, the region continues to suffer from a high burden of disease. The two provinces of greatest concern in the country, Western and Nyanza, are marked by the highest rates of infant and child mortality—12% and 15%, respectively, compared to the national average of 8%. HIV/AIDS prevalence in these areas is also a challenge; compared to the national average of 6.3%, 6.6% of adults in Western Province, and a staggering 14% of adults in Nyanza Province, are HIV positive (2008-09 Kenya Demographic and Health Survey).

Existing solutions to address these public health challenges rely heavily on external donations, in many cases with little sustainable economic incentives to support the supply chain, or motivate the individuals ultimately responsible for delivering products to end users.

The SWAP business model aims to address these challenges in a financially self-sustaining way. SWAP’s goal is to increase adoption and use of public health products in low-income, rural communities, while simultaneously creating local, income-generating opportunities.

In this model, SWAP recruits and trains Community Health Promoters (CHP), each assigned to a territory in Western Kenya to provide training and education about healthy habits and practices to families near the bottom of the pyramid. The key difference from other projects is that the Community Health Promoters’ financial success is tied directly to the number of families they serve, and the level to which they serve them.

The CHP’s also sell life-saving products not yet readily available to communities due to existing supply chain difficulties. CHPs will manage Jamii, or “community,” Centers, which serve as distribution, storage, and demonstration hubs for all health products. SWAP will expand existing Jamii Centers as well as establish additional ones, and will use revenue generated from sales to support operations and scaling up to become less dependent on donors in the future. The two main objectives of the Jamii centers are to:

  • Help improve the health and development of babies, children, and families in the community by increasing access to health products and information about health topics and healthy habits.
  • Become self-sustaining by generating enough income that local people can use to continue to operate the Center successfully far into the future without relying on ongoing donations.

Through support from USAID, SWAP and its collaborating partners – Procter and Gamble, George Washington University School of Public Health and Health Services, and the Centers for Disease Control will:

  • professionalize and scale up SWAP’s current distribution model to increase uptake and use of evidence-based public health products.
  • evaluate the impact of the model by measuring changes in health-related behaviors and business model factors hypothesized to influence scalability and financial sustainability.
  • determine how direct promotion and sale of public health products can affect people living in different economic strata, such as those living in the lowest quintile of poverty.
  • simultaneously increase economic opportunities for People Living With HIV/AIDS (PLWHA) while reducing stigma and discrimination.

This model is in line with the Ministry of Health’s strategy “the Kenyan Essential Package for Health”, specifically the Community Strategy, where community members play an active role in their own health and development.

The SWAP approach is a triple win scenario. First, the consumers win by having access to information and education about healthy habits and practices, as well as access to health products they would not otherwise have access to. Second, the Community Health Promoters win by generating income through the margins they are able to make on their sales, enabling their family to progress financially. Importantly, the harder the CHP works, and the more families she serves, the more money she will earn. The third and final win is that SWAP becomes less dependent on donors, with the goal of eventually being able to fund 100% of operations through revenue from their sub distributor role. It is this win that will potentially enable this to model to scale nationally and globally, as other regional NGOs can replicate this model to reduce their dependence on donor funding.

About SWAP

Safe Water and AIDS Project (SWAP) is a Kenyan registered NGO, with a mission to improve the quality of life of the vulnerable in the community by building their capacities and supporting them to develop profitable health oriented micro enterprises. SWAP has trained community health promoters to provide health information and sell health and hygiene products from door to door to vulnerable communities to improve their health while generating income. SWAP’s research department has undertaken various effectiveness studies evaluating the health and economic impact of its interventions and technologies.

About USAID’s Development Innovation Ventures

USAID’s Development Innovation Ventures (DIV) is an investment platform that finds, tests, and scales new solutions to development challenges around the world. Through a year-round open competition, DIV seeks ideas that demonstrate cost-effectiveness relative to traditional approaches, that gather rigorous evidence of their intervention’s impacts, and that have the potential to scale through the public or private sector without long-term DIV support.