BY ROSE REIS, CENTER FOR HEALTH MARKET INNOVATIONS
New approaches to improve health access and quality being pioneered by Future Health Systems
6000 Ugandan women die every year from preventable pregnancy and childbirth related complications. If women could only deliver under skilled care, about 80 percent of these deaths could be prevented. Enter Future Health System’s Safe Deliveries initiative: The program offers vouchers for transport and maternal services as well as training for health workers and provision of essential equipment, drugs and supplies. Its impact? The number of facility deliveries more than tripled during the pilot phase.
Vouchers are an example of a ‘health market innovation,’ a program that harnesses the private sector in low- and middle-income countries to deliver better health and financial protection for the poor. While many governments promise well-functioning, state-run public health systems, what often happens is much more chaotic and less centrally managed, with patients seeking care from a plethora of providers, including drug shops, village doctors, non-governmental organization (NGO) clinics, private hospitals, as well as government clinics.
Health market innovations help health systems improve quality, access, affordability and efficiency in transactions between patients and providers, promoting better health with less financial risk, especially for the poorest and most vulnerable. In 2010, the Center for Health Market Innovations (CHMI) was launched to serve as a global information source on these programs and policies—implemented by governments, NGOs, social entrepreneurs or private companies—that have the potential to improve the way health markets operate.
With eight partners based in 16 countries, CHMI has identified more than 1000 programs in 108 countries—including several programs FHS studies. These programs work to:
- Better organize fragmented providers
- Mobilize funds and create financing mechanisms to provide purchasing power to the poor
- Set quality standards and monitor provider performance
- Educate consumers and providers to ensure that appropriate care is both demanded and provided
- Enhance quality and efficiency through standardized operational processes and innovative information technologies
In its 2011 Annual Highlights Report, CHMI identified five innovative emerging models that show promise, and may ultimately improve the performance of health markets in low- and middle-income countries.
1. Low-cost, high-quality retail pharmacies
Small family-owned drug shops line the streets of cities and villages across low- and middle-income countries. Unfortunately the quality of their offerings is equally all over the map, with many shops offering counterfeit drugs that don’t work and can be toxic. Professionalized pharmacy chains and franchise networks proliferating in Asia may improve drug quality and operational efficiency to keep prices low. In the Philippines, Botika ng Bayan and Generics Pharmacy are two popular franchise networks that have seen success. Similarly, in India, the pharmacy chain MedPlus originated in tech-hub Hyderabad and has since spread nationally.
2. Affordable Primary Care Clinic Chains
These chains—often for-profit—are set up to standardize quality and give low-income people more care options. Many chains operate in urban areas where large volumes can help them keep prices down. Inspired by the U.S. drug store chain CVS and its Minute Clinics, Saúde 10 opened in 2011 in Rio de Janeiro, Brazil. In Nairobi, LiveWell's main clinic provides consultation, diagnosis, and treatment for a wide range of illnesses, while qualified clinical officers and registered nurses run satellite clinics.
Vouchers—distributed for free as with FHS’s Safe Deliveries project in Uganda, or sold for a small fee, as with Kenya’s Output Based Aid Voucher Program—increase access to key health services by allowing low-income people to “purchase” (through demand-side donor or government subsidies) a specific package of services from approved clinics which often include both public and private facilities. Private maternity clinics have been able to expand their services and extend their customer base to poorer clients as a result.
In many countries doctors and specialists cluster in urban areas leaving rural areas underserved. Telemedicine shows promise in bridging the rural-urban health divide. In one example of how this model works, World Health Partners is a promising not-for-profit chain using technology that allows doctors in urban areas to monitor vital signs, diagnose illnesses, and recommend treatment for patients in India’s rural north.
5. Health Hotlines
Health hotlines provide basic health information and connections to available health services. HealthLine — run by Dhaka’s Telemedicine Reference Center, an FHS partner — connects providers and patients in Bangladesh through a mobile phone based hotline number (789) to a call center manned by licensed physicians that provide medical consultations 24/7. MeraDoctor is a for-profit health line just launched in Mumbai. Popular throughout South Asia, these well-utilized businesses may soon be replicated in East Africa.
These models offer promising solutions to key health system challenges, but the question remains: do they really work in the long term? What programs are actually improving quality, affordability, and access? We look forward to working with Future Health Systems and other partners to collect and share better evidence, and then promote the scale-up and replication of high-impact programs.