Healthy Entrepreneurs (HE) is a not-for-profit social enterprise improving community health services across Africa through a hybrid model that empowers Community Health Workers to become Community Health Entrepreneurs. To scale effectively, HE required a strong Monitoring, Evaluation, and Research framework to generate evidence on what works, why, and where.

With M&E and research expertise from Madiro, and in collaboration with a research group including experts from the University of Amsterdam and Makerere University, we support HE in developing a comprehensive M&E framework and evidence base, strengthened by targeted research, which are crucial foundations for refining its model and enabling sustainable, large-scale impact.

CHALLENGES

Key challenges to scaling effectively

Healthy Entrepreneurs (HE) operates in complex, resource-constrained environments across multiple African countries. To expand its Community Health Entrepreneur model sustainably, there is a need to strengthen Monitoring, Evaluation, and Research:

Establishing a Robust M&E Framework: A structured framework is needed to systematically capture and analyse data across departments, enabling continuous learning and model refinement.
Generating Targeted Evidence: Focused research can clarify what works, for whom, and under which contexts, supporting data-driven decision-making.
Harmonizing Data Systems: Consistent and integrated data collection across regions is essential to produce comparable insights and guide effective scale-up.

Addressing these areas will equip HE with the evidence and tools to become a data-driven, learning organization, refine its model, and deliver sustainable, large-scale impact.

SOLUTIONS

Comprehensive M&E and research support

Madiro guided HE in developing a Theory of Change and M&E framework to track CHE performance, community needs, and program impact. The research group (including Madiro) lead key research projects:

Performance Monitoring Tool: Linking CHE activity, product sales, and GPS data to assess performance and identify support needs.
Community Surveys: Mapping household care-seeking to align CHE services with local needs.

Scaling Guidance: Evaluates expansion processes and develops efficient scale-up strategies.

Do No Harm Analysis: Identifies and mitigates risks in the model.

Methodologies employed: Mixed-methods research combining quantitative and qualitative data, geospatial analysis, mystery shopping, qualitative evaluations, surveys, and risk assessments.

RESULTS

Tools & insights

While still ongoing, the M&E and research support is already producing practical tools and actionable insights.

Theory of Change & Indicators: Developed collaboratively with management teams across all countries, with the indicator matrix and data collection structure underway.
Performance Mapping: Integrates CHE activity, product sales, and contextual geospatial data to pinpoint high-performing areas and identify where support or refinement is needed.
Community Survey (2024): Confirms CHEs’ vital role in rural healthcare and highlights the need to better define roles of public and private providers to strengthen primary care.
CHE Performance Study: Mixed-methods research submitted for publication underscores the complexity of implementation and the importance of continuous monitoring, adaptive policies, and learning.
Ongoing Data Collection: Active in three districts in Uganda, covering approximately 1,000 households, 500 CHEs and 500 general CHWs, alongside mystery shopping and provider mapping.

These tools and insights equip HE with the evidence and strategic guidance to refine its model, improve outcomes, and drive sustainable, large-scale impact.

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Example Performance Mapping:

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