chmi highlights 2012 final

7/30/2019 Chmi Highlights 2012 Final

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1HIGHLIGHTS 2012

HIGHLIGHTS 2012


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HIGHLIGHTS 2012 1

Table o ContentsIsie Health Marets ............................................................................. 6

Diusion o Health Market Innovations ...................................................8

Database at a Glance .............................................................................10

Emergig Practices i Maret-Base Health Mels ............................. 12

Primary Care Franchises and Chains .......................................................14

Spotlight: Urban Primary Care Chains in India ..........................................16

Healthcare on the Move .........................................................................17

Spotlight: Public-Private Partnerships .........................................................18

Innovating to Save the Lives o Women and Children .............................. 19

Spotlight: Four New Approaches in Maternal and Child Health ..................22

Brie: New Research on eHealth ..............................................................24

Tracig a Reprtig Prgram Perrmace ...................................... 26

Cectig Peple t Scale Iatis ................................................ 30

Creating Partnerships ............................................................................. 32

Networking in Countries ..........................................................................32

Making Online Connections ...................................................................33

Working with Global Collaborators ..........................................................33

CHMI Success Stories Across the Globe ...................................................34

Hw CHMI Ca Help With Yr Wr ...................................................... 36

Resources ................. ................. ................. .................. ................. ......... 38

GEnERouSLY undEd BY:

ABouT THE CEnTER oR HEALTHMARkET InnovATIonS

The Center or Health Market Innovations (CHMI)promotes programs, policies and practices that makequality healthcare delivered by private organizationsaordable and accessible to the worlds poor. Operatedthrough a global network o partners since 2010, CHMIis managed by the Results or Development Institute withsupport rom the Bill & Melinda Gates Foundation, theRockeeller Foundation, and UKaid.

Details on more than 1200 innovative health enterprises,nonprots, policies, and public-private partnerships inlow- and middle-income countries can be ound online

at HealthMarketInnovations.org.

ABouT THIS REPoRT

This report was compiled by the CHMI team at Resultsor Development: Maria Belenky, Donika Dimovska,Molly Jamieson Eberhardt, Rosa Kang, GinaLagomarsino, Trevor Lewis, Dexter Ndengabaganizi,Rose Reis, and Alex Robinson. CHMIs global partners,listed below, contributed insights on new programsand practices.

RECoMMEndEd CITATIon

Center or Health Market Innovations. (October 2012).Highlights: 2012. Results or Development Institute,Washington, D.C. Available atwww.HealthMarketInnovations.org.

CHMIS GLoBAL PARTnERS

ACCESS Health International / Indian School

o Business, Bangladesh, Brazil, India MercyCorps, Indonesia Consultation of Investment in Health Promotion,Vietnam and Cambodia

Institute of Health Policy, Management & Research,Kenya, Rwanda, Uganda, Tanzania

Freedom From Hunger, Bolivia, Ecuador, Peru The Asia Foundation, Pakistan Philippine Institute for Development Studies, Philippines

ConTACT CHMI AT R4d

Reslts r deelpmet1100 15th Street, NW, Suite 400Washington, D.C. [email protected]

Cover Photo: Hadiza, a young womanin the north o Nigeria, lost her baby

and nearly lost her lie in childbirth.

This report provides a summary o

promising healthcare innovations that

could save the lives o women and theiramilies in poor communities.


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HealthMarketInnovations.org2 HIGHLIGHTS 2012 3

Were excited to bring you this secondannual edition o Highlights, with new

observations about health market

innovations around the world.

Since we launched the Center or Health MarketInnovations in 2010, weve been providingcomprehensive, up-to-date inormation about programs

working to make quality healthcare delivered by privateorganizations aordable and accessible to the worldspoor. We seek to identiy practices that, i scaled-up oradapted to new settings, would improve healthcare ormore poor people. And with renewed support rom theBill & Melinda Gates Foundation, continued support romthe Rockeeller Foundation, and new unding rom UKaid,we are setting our sights even higher.

WHATS nEW In HIGHLIGHTS: 2012

Highlights of 80 newly launched programs in the pastyear, including a Somaliland pharmacy ranchise anda Kenyan call center, on page 8.

Insight into cutting-edge approaches to increaseaccess to quality healthcare or the poor, includingbusiness models adopted by ast-growing primaryhealthcare ranchises and chains, mobile healthcare,and programs striving to improve maternal healthcare, starting on page 13.

A framework for reporting on program performancein key dimensions like quality, cost, and eciency;selected results rom a sample o close to 150 healthprograms, on page 28.

Findings about how eHealth practices are diffusingglobally rom our recent publication in the Bulletino the World Health Organizationthe #1 mostclicked-on article rom a dedicated issue oninormation technologyon page 24.

oTHER MILESTonES RoMCHMIS PAST YEAR

CHMI now proles more than 1200 nonprots, socialenterprises, public-private partnerships, and policiesin 105 countries. More than 200 proles have beenadded since our last report. See a visualization o ourdatabase on page 10.

In the past year, more than 100,000 unique visitorsused CHMI to explore healthcare innovations.The majority o web visitors arrived rom low- andmiddle-income countries, with India, the Philippines,Kenya, Indonesia, Bangladesh, and Uganda in thetop 10 countries or visitor origin.

Our partners in the Philippines, Indonesia, Kenya, andelsewhere in CHMIs global network have led the wayin convening people who are implementing, studying,and unding market-based health programs. Highlightsrom these events start on page 32.

To understand how CHMI is used and how it canbe improved, the Gates Foundation commissioneda midterm survey o program managers, donors,investors, researchers, and policy makers. Turn topage 38 to view a summary o the ndings.

WHAT You CAn ExPECT RoM CHMIIn ouR nExT PHASE

Going orward, CHMI will ocus increasingly on osteringpartnerships among program managers, donors,investors, researchers, and policy makers that lead tomeasurable scale-up, adaptation, or improvement opromising healthcare programs. Learn more abouthow CHMI can support your work on page 36.

Were also happy to share that the success o CHMI hasled R4D to explore this model as an approach to identiynew solutions in other sectors. As a result, the Centeror Education Innovations (CEI), managed by R4D andunded by UKaid, will launch in mid-2013.

We hope you nd this report useul. Please dont hesitateto contact me with your eedback.

Gia [email protected]

Reslts r deelpmet (R4d)On behal o the global CHMI network

CHMI enableshealth systems aroundthe world to better utilize

private organizations todeliver quality, aordable,and accessible care,especially or the poorestand most vulnerable.

Dear Colleagues,


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Secti Title

6 Ceter r Health Maret Iatis 5HIGHLIGHTS 2012

Health markets are the part o the health system wherehealthcare decisions are made both by consumers, whoseek care rom a variety o dierent types o private andpublic healthcare providers, and by providers, who makedecisions about what care to deliver based on knowledgeand incentives. Health markets are signicant and widelyutilized by the poor in most developing countries; yet

patients do not always seek the kind o care that willmake them healthier, and providers do not always actin patients best interests.

THE PoTEnTIAL o HEALTHMARkET InnovATIonS

Health market innovations are programs andpoliciesimplemented by governments,non-governmental organizations (NGOs), socialentrepreneurs, or private companiesthat havethe potential to improve the way health marketsoperate. They are new approaches that can allowprivate providers to improve quality, achievegreater eciencies, and increase access to careor under-served populations.

A TooL To IMPRovE HEALTH MARkETS

The Center or Health Market Innovations (CHMI)promotes programs, policies, and practices that makequality healthcare delivered by private organizationsaordable and accessible to the worlds poor.Operated through a global network o partners since2010 (see page 30), CHMI is managed by the Results

or Development Institute.

Details on innovative health enterprises, nonprots,policies, and public-private partnerships inlow- and middle-income countries can be oundonline in the ree, interactive programs database atHealthMarketInnovations.org. Through the database,blog posts, in-person events, and research publications,CHMI collects and disseminates inormation, conductsanalysis, and orms and maintains relationships andnetworks o researchers, policy makers, unders,and program managers.

A oCuS on THE HEALTH MARkETPLACE

Health market innovations are programs

and policies that have the potential to

improve the way health markets operate.

Photo Right: A doctor listens to a patient in

a new community health clinic in Aghanistan.


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Section Title

HIGHLIGHTS 2012 7

Isie Health Marets

duRInG THE PAST YEAR, the CHMI database grew to include

a total o over 1200 programs and policies, operating in morethan 100 countries. CHMI program proles are categorized into

ve kinds o Health Market Innovations: Organizing Delivery,

Financing Care, Regulating Perormance, Changing Behaviors, and

Enhancing Processes. Each prole provides inormation about the

programs operational design, including health ocus areas, targeted

populations, unding sources, and where available, results to date.

In the aggregate, CHMI program proles yield macro-level

inormation about a wide range o potential solutions.1 This

section synthesizes inormation rom the CHMI database to reveal

developments in health markets across the globe.

CHMI identifed 80 new programs

that launched in 2011-2012.

Photo Let: A nurse preps her station at Jacaranda Health,a nonproft organization providing maternal healthcare

in Nairobi, Kenya.


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HealthMaretIatis.rg

Isie Health Marets

ExAMPLES o nEWLY LAunCHEd PRoGRAMS InCLudE:

BulshoKaab Pharmacies Network: Operating in Somaliland since 2011, BulshoKaab isa pharmaceutical ranchise aiming to expand the availability o quality clinical health servicesin private pharmacies. Launched in the city o Hargeisa, BulshoKaab has expanded to

68 pharmacies over the last year, aiming soon to reach 150 pharmacies in our regions.PSI Somaliland supports the ranchise with training and quality monitoring.

Daktari 1525: Launched in 2012, Daktari 1525 is a Kenyan hotline service providingphone-based health consultations. Staed by 50 registered medical doctors, the service oersinormation and advice, as well as acility reerrals or appropriate diagnoses or prescriptions.Individuals can access the service at KES 20 (US $0.23) per minute by dialing 1525 roma Saaricom line.

Ross Clinics: Started in India in 2011, Ross is a chain o low-cost, low-overhead clinics,providing all components o primary care under a single roo. Clinics are located in under-servedurban areas, and open seven days a week, twelve hours a day. Ross Clinics has served morethan 5,000 patients through its six clinics.

Health israce: Four insurance programsenrolled signicant numbers o new members.MicroEnsures client rolls in Tanzania increased byabout 20%, rom 499,000 health insurance clients to600,000, Hygeiasenrolled subscribers in Nigeria grewby about one-third, while Sampoorna Suraksha andeQuality Health Bwindi expanded in India and Ugandaby about 460,000 and 4,000 members respectively.

Health serice eliery: At least nine networkso clinics added new acilities. The nonprot ranchiseWorld Health Partners now covers more than 4,300rural points o care in Bihar alone, plus 40 aliatedclinics and diagnostic centers. Through a public-private

partnership, IGE Medical Systems now operates350 radiology units in government acilities in Bihar,an increase o 200 since 2011. The amily planningranchise ProFam Cameroon now includes 80 acilities,up rom 24. And the Indian pharmacy chain MedPluscontinued its expansion, opening 200 more outlets.

PRovIdInG nEW SERvICES

VillageReachs new health advice hotline launched inAugust 2011 with 6,000 registered users. JacarandaHealthopened its rst static maternity hospital, allowingthe nonprot organization to provide delivery servicesto women who had accessed prenatal care rom itsmobile clinic.

CRoSSInG BoRdERS

To date, we have identied just a handful of programsthat have crossed borders to adapt their modelto a new country. In 2012, the nonprot programOperation ASHAwas successul in taking its TB DOTStreatments model, originally developed in the slumso Delhi, to Cambodia. In addition, Singapore-basedViva Healthcare adapted its network o primary healthclinics in India serving middle-income amilies to newchains in Indonesia, Kenya, Pakistan, Egypt, Philippines,and Vietnam, as well as a chain o generic pharmaciesin Indonesia.

ExAMPLES o PRoGRAMS ExPAndInG THEIR REACH InCLudE:

In the past year, several programs reported adding new services, opening acilities, or adapting their

model in new countries to reach more people. Below, a ew examples o programs that have expanded

their operations in the past year.

Photo Above: Nigerian amilies enrolling in a community

insurance plan oered by Hygeia.

Photo Above: Shelly Batra is the coounder o Operation ASHA, a nonproft program that adapted its TB DOTS treatment modelto Cambodia.

8

CHMI identied 80 new programs that launched

in 2011-2012. The top three countries o operation

or new programs were Kenya, the Philippines, and

India.2 One-hal o all new programs use technology

in some way, with one-quarter o these ocusing

on improving data collection. Twenty-three new

programs are or-prot, and nearly one out o our

programs are public-private partnerships, a larger

percentage than among all proled programs.

This may refect an increasing ocus on the part

o CHMIs in-country partners on identiying and

documenting public-private partnerships rather

than the overall growth o these models; either

way, the 224 documented examples on CHMI o

public-private partnerships provide a host o ideas

or governments and private partners collaborating

to construct health programs.

dIuSIon o HEALTH MARkET InnovATIonS

Photo Above: Bike4Care provides health workers with bicycles, and isolated communities with bicycles plus bicycle

ambulance trailers.

HIGHLIGHTS 2012 9

SCALInG oPERATIonS
http://healthmarketinnovations.org/program/bulshokaab-pharmacies-networkhttp://healthmarketinnovations.org/program/daktari-1525-programhttp://healthmarketinnovations.org/program/ross-clinicshttp://healthmarketinnovations.org/program/microensure-0http://healthmarketinnovations.org/program/hygeia-community-health-plan-hchphttp://healthmarketinnovations.org/program/sampoorna-suraksha-micro-health-insurancehttp://healthmarketinnovations.org/program/equality-health-bwindihttp://healthmarketinnovations.org/program/world-health-partners-whphttp://healthmarketinnovations.org/program/contracting-of-radiology-services-in-biharhttp://healthmarketinnovations.org/program/profam-cameroonhttp://healthmarketinnovations.org/program/medplushttp://healthmarketinnovations.org/program/villagereachhttp://healthmarketinnovations.org/program/villagereachhttp://healthmarketinnovations.org/program/jacaranda-healthhttp://healthmarketinnovations.org/program/jacaranda-healthhttp://healthmarketinnovations.org/program/operation-ashahttp://healthmarketinnovations.org/program/operation-ashahttp://healthmarketinnovations.org/program/jacaranda-healthhttp://healthmarketinnovations.org/program/jacaranda-healthhttp://healthmarketinnovations.org/program/villagereachhttp://healthmarketinnovations.org/program/medplushttp://healthmarketinnovations.org/program/profam-cameroonhttp://healthmarketinnovations.org/program/contracting-of-radiology-services-in-biharhttp://healthmarketinnovations.org/program/world-health-partners-whphttp://healthmarketinnovations.org/program/equality-health-bwindihttp://healthmarketinnovations.org/program/sampoorna-suraksha-micro-health-insurancehttp://healthmarketinnovations.org/program/hygeia-community-health-plan-hchphttp://healthmarketinnovations.org/program/microensure-0http://healthmarketinnovations.org/program/ross-clinicshttp://healthmarketinnovations.org/program/daktari-1525-programhttp://healthmarketinnovations.org/program/bulshokaab-pharmacies-network


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LEGAL STATUS HEALTH FOCUS

DATABASE AT A GLANCE

PRIMARY SOURCE OF FUNDING

Nonprofit

For-profit

Private Unspecified

Public PrivatePartnership

Government

Corporate Program

Unknown

General Primary Care

HIV/AIDS

Maternal & Child Health

Reproductive Health

Malaria

TB

Chronic Disease

Number of programs

500

Donor

Government

Out of pocketpayments

Membership/subscription fees

Other

Unknown

CHMI programs byLegal

Status, Health Focus, and

Primary Source of Funding

As of September 2012, CHMI has identified over1200 programs in 105 countries.Here, we've highlighted some of the interesting characteristics of the database. To learn more,explore the database at HealthMarketInnovations.org/programs.

INDIA PHILIPPINESINDONESIAKENYA

CHMI has identified185 programs in Kenya,with 75% of themfocusing on HIV/AIDS,maternal & childhealthor, generalprimary care.

243 programs wereidentified in India,with a particular preva-lence ofpublic privatepartnerships (47 programs)and for-profit enterprises(45 programs).

A full 34% of theprograms identified inthe Philippines aregovernment-funded ,compared to only 27%that are donor-funded.

Over 50% of programsidentified in Indonesiause informationtechnology, mostlyphones and computers.

In the past year, CHMI has added 200+ PROGRAMS to the database

of these were launched during this same period:80

32%

LAUNCHED IN KENYA

45%

USE TECHNOLOGYLEGAL STATUS

23For-profit

18Public-PrivatePartnership24

Nonprofit

15Other

Including 68 chains, 67 franchises,and 120 networks that reduce thefragmentation and informality ofhealth care delivery.

ORGANIZE DELIVERY

Including 122 microinsuranceprograms that give purchasingpower to the poor.

FINANCE CARE

Including 22 programs that licenseand accredit private programs to setstandards and promote quality care.

REGULATE PERFORMANCE

Including 317 programs that useinformation technology and 98programs that use mobile clinicsto improve quality and access, andlower the cost of care.

See p. 27 to learn more about Reported Results

ENHANCE PROCESSES

Including 189 programs that trainand incentivize providers to deliverbetter care.

CHANGE BEHAVIORS

PROGRAMS REPORTINGRESULTS IN THEIR WORK: 147

CHMI identifies programs that:

HealthMaretIatis.rg10 HIGHLIGHTS 2012 11


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14 HIGHLIGHTS 2012HealthMarketInnovations.org 13

Isie Health Marets

Emergig Practices iMaret-Base Health Mels

AS CHMIS dATA SET HAS GRoWn, new patterns o innovative

practices are emerging. To provide inormation on topics relevant to

program managers, unders, researchers, policy makers, and others,

weve provided deep dives on three themes. First, we look at chains

and ranchises providing primary health services in low income

communities. Next, we prole dierent mobile healthcare models

extending services to populations outside the reach o static acilities.

Finally, we summarize several common new approaches to provide

quality health services to women and children around the world.

New practices in

primary healthcare,

mobile healthcare, and

maternal and child health

are emerging.

Photo Let: A nurse at the NICE Foundation, a hospitalor newborns in Hyderabad, India.


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HIGHLIGHTS 2012HealthMarketInnovations.org 1514

Emergig Practices i Maret-Base Health Mels

PRIMARY CARE RAnCHISES And CHAInS

*Note that this category represents less than 3 years, compared to 5 years or the others

A growing number o private organizations operate ranchises or chains o clinics providing accessible,

aordable, and quality primary care in low-income communities. Many o these companies are

experimenting with new business models and operational strategies. CHMI has identied and proled

42 such programs, with nearly one-third o these launching in the past three years.

nmber Primary Care Chais a rachises Prfle i the CHMI database, By date Lach

Both ranchises and chains consist o outlets operatingunder the same brand where services are standardizedby a central organizer. Franchises, however, areoperator-owned, whereas operators o clinics in chainsare paid employees o a central organization.

Both o these models provide the advantage o allowingparticipating outlets to spread overhead costs, sharemanagerial resources, standardize processes that improvethe quality o care, and use common branding.

Characteristics Primary Care Chais a rachises i CHMIs database

CoMMon APPRoACHES AMonG RAnCHISES And CHAInS InCLudE:

oe Stp Shps. A number o chains and ranchisesaim to oer a ull range o health services in onelocation. In Peru, Por Ti, Familia gives patients accessto doctors, pharmacies, and laboratory services in eachlocation. Similarly, patients visiting Primedic clinics,in Mexico, can see a range o specialists.

Mlti-Serice Mels. Realizing time constraintsorce many people to orgo healthcare,Sehat First inPakistan includes a general store in all o its clinicsso that patients can pick up groceries and soap whenvisiting the doctor. Similarly, E Health Point in India sellsclean water at its clinics. This allows these programs toincrease patient volume, and use revenue rom addedproducts and services to reduce the costs o neededhealthcare, while simultaneously providing an additionalvaluable service to the community.

Hb-a-Spe Mels. Tiered systems oclinics help chains and ranchises reach urther intocommunities without stocking each location with allservices. Five satellite Mi Doctorcito clinics reer upto a Por Ti, Familia anchor clinic. Similarly, each

o Pathnder Health Indias Family Medical HealthCentres will support ve to 10 smaller outlets inpoorer communities.

Telemeicie.Facilities used by World HealthPartners, operating in rural India, allow rural providersto share patient data such as blood pressure or heartrate with a qualied physician in Delhi through anInternet-connected computer. The physician can also beconsulted via webcam on the diagnosis and treatmento a patient. Other increasingly more commontechnology solutions used by chains and ranchisesinclude electronic medical records and tracking systemsto monitor stock levels o drugs and supplies.

Membership Schemes. Membership schemeshelp programs promote preventive careand avoidmajor month-to-month revenue fuctuations. InMexico, Primedicpatients pay a membership ee oapproximately US$10 and receive access to unlimitedprimary care consultations with doctors in internalmedicine, pediatrics, obstetrics and gynecology,and amily medicine.

About hal o the primary healthcare ranchises and chains that CHMI proles are located in urban or peri-urban areas;16 operate in India, and most are or-prot (see graphs above). While the majority o the programs ocus on providingclinical services, nine operate primarily as pharmacies, which oten act as primary care providers when patients seekhealth advice and services rom pharmacists. Realizing this, several pharmacy chains are training their pharmaciststo provide customers with a limited menu o basic health services.

Providing primary care services to low-income populations at an aordable cost is a challenging undertaking.To respond, organizations oten experiment with new business models and strategies to reduce costs, increasecustomer volume, and more eciently use resourceswhile also striving to improve quality.

Photo Above: A clinical coordinator welcomes clients at Penda Health, a chain o primary care clinics in Kenya.
http://healthmarketinnovations.org/program/por-ti-familiahttp://healthmarketinnovations.org/program/primedichttp://healthmarketinnovations.org/program/sehat-firsthttp://healthmarketinnovations.org/program/e-health-point-0http://healthmarketinnovations.org/program/pathfinder-family-medical-health-centreshttp://healthmarketinnovations.org/program/pathfinder-family-medical-health-centreshttp://healthmarketinnovations.org/program/world-health-partners-whphttp://healthmarketinnovations.org/program/world-health-partners-whphttp://healthmarketinnovations.org/program/primedichttp://healthmarketinnovations.org/program/primedichttp://healthmarketinnovations.org/program/world-health-partners-whphttp://healthmarketinnovations.org/program/world-health-partners-whphttp://healthmarketinnovations.org/program/pathfinder-family-medical-health-centreshttp://healthmarketinnovations.org/program/pathfinder-family-medical-health-centreshttp://healthmarketinnovations.org/program/e-health-point-0http://healthmarketinnovations.org/program/sehat-firsthttp://healthmarketinnovations.org/program/primedichttp://healthmarketinnovations.org/program/por-ti-familia


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Millions o low-income amilies in urban Indian communities

seek out healthcare in an ecosystem dominated by

under-regulated clinics. CHMI network partnerACCESS

Health International studied three chains that are striving

to provide quality services in this market. All launched in

the past fve years, Kriti Clinics in Hyderabad, Swasth India

in Mumbai, andViva Sehat in Bangalore and Andhra Pradesh

provide outpatient services in uniormly branded clinics or

easy recognition. They dispense generic drugs and have

computerized health management inormation systems. Both

Swasth and Kriti work with government authorities to acilitate

national health programs such as immunization. Aiming

or high patient volume, their clinics are sited near dense

neighborhoods o potential patients. In addition, to help

keep costs o operation low, the employees o all three chains

multitask. For example, the nurse doubles up as phlebotomist

and a receptionist in Viva Sehat and Swasth. Swasth doctors

also dispense medicines.

These chains have ambitious plans or growth. Swasth

has seven clinics in Mumbai that have served more than

11,000 people and the company aims to serve 100,000 by

2014. Kriti aims to grow rom two to our clinics serving the

Hyderabad slums. Viva Sehat currently operates three clinics

in India, targeting southern states or growth to match

the Singapore-based companys burgeoning chains in

Indonesia, Kenya, Pakistan, and Vietnam, and soon,

Egypt and the Philippines.

uRBAn PRIMARY CARE CHAInS In IndIASPoTLIGHT

The size o primary care ranchises and chains ranges greatly, rom thosethat are on the cusp o launching, like Indias Family Medical HealthCentres, to others that have hundreds o clinics, like the Smiling Sunand World Health Partners ranchises in Bangladesh and India, respectively.A number o ranchises have numerous outlets across both urban and ruralsettingsparticularly retail pharmacies like Farmacias Similares in Mexicoand The Generics Pharmacyin the Philippineswhile chains tend to haveewer outlets concentrated in urban and peri-urban areas. Clinical chainsare oten characterized by the provision o more extensive services such asmaternal care and basic surgical procedures, which require larger acilitiesto accommodate more sta and equipment. Franchises, on the other hand,tend to ocus on oering a limited set o basic services at a larger scale, otenprovided by low-skilled sta who are trained and monitored by the ranchisor.The ranchise business model is oten contemplated by some clinical chainswhen they are looking to scale up some or all or o their services to newareas, especially rural settings.

As primary care chains and ranchises continue to test out new approaches,

the sharing o promising practices and experimentation with alternativebusiness models will be crucial to ensure the diusion o eective programsand the success o these business models as a whole. It is yet to be seenwhether primary care ranchises and chains have staying power and thepotential to scale and deliver quality health services to large numbers opeople in low- and middle-income countries.

Mobile care extends healthcare to populations beyond the reach o static acilities. The mobile care model

takes a range o orms, rom a basic bicycle carrying health workers and medicine into rural villages to a ully

mobile cardiac catheterization lab. It can serve many more people with the same equipment, help to recover

operating costs, and more eciently utilize sta time.

CHMI proles close to 100 mobile care programs, with most operating in rural areas and delivering primary

care service. Interventions with standardized procedures that are relatively easy to deliver, such as eye care,

amily planning services, and HIV/AIDS outreach and counseling, are oten delivered through mobile services

and thereore constitute a substantial number o proled programs (see graph below).

Mbile Prgrams by Health csMbile Health Prgramsby Target Gegraphy

HEALTHCARE on THE MovEPhoto Top: Outside a Smiling Sun clinicin Dhaka.

Photo Bottom: A Generics Pharmacy

storeront in Manila.

Photo Above: Swasth India runs sel-sustaining primary care

centers in slum communities.

Rural

All

Peri-urban

Urban

Photo Above: Camels are used by Community Health Arica Trust (CHAT) to carry clinic supplies, enabling them to provide amily

planning and integrated health services to remote, nomadic communities in northern Kenya.

http://healthmarketinnovations.org/partner/access-health-internationalhttp://healthmarketinnovations.org/partner/access-health-internationalhttp://healthmarketinnovations.org/program/kriti-arogyam-kendramhttp://healthmarketinnovations.org/program/swasth-health-centrehttp://healthmarketinnovations.org/program/viva-sehat-formerly-razi-clinicshttp://healthmarketinnovations.org/program/pathfinder-family-medical-health-centreshttp://healthmarketinnovations.org/program/pathfinder-family-medical-health-centreshttp://healthmarketinnovations.org/program/smiling-sun-franchise-program-ssfphttp://healthmarketinnovations.org/program/world-health-partners-whphttp://healthmarketinnovations.org/program/farmacias-similareshttp://healthmarketinnovations.org/program/the-generics-pharmacyhttp://healthmarketinnovations.org/program/the-generics-pharmacyhttp://healthmarketinnovations.org/program/farmacias-similareshttp://healthmarketinnovations.org/program/world-health-partners-whphttp://healthmarketinnovations.org/program/smiling-sun-franchise-program-ssfphttp://healthmarketinnovations.org/program/pathfinder-family-medical-health-centreshttp://healthmarketinnovations.org/program/pathfinder-family-medical-health-centreshttp://healthmarketinnovations.org/program/viva-sehat-formerly-razi-clinicshttp://healthmarketinnovations.org/program/swasth-health-centrehttp://healthmarketinnovations.org/program/kriti-arogyam-kendramhttp://healthmarketinnovations.org/partner/access-health-internationalhttp://healthmarketinnovations.org/partner/access-health-international


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MoBILE CARE PRoGRAMS PRoILEd BY CHMI CoME In THREE CoMMon oRMS:

Health Camps. Health campswhen clinics set up temporary locations to diagnose and reer patients to otheracilitiesare traditionally large-scale opportunities or hard-to-reach populations to access basic health educationand preventive care. Health camps organized by the Islamia Eye Hospital in Bangladesh provide treatment or minoreye diseases and reer others to acilities.

Mbile Cliics. Oering the same basic services as a primary health acility, mobile clinics return to each locationon a periodic basis, enabling them to provide longer-term care or chronic conditions, maternity, and other specialtyservices. Kenyas Jacaranda Health runs regular mobile clinics that oer antenatal care and birth preparednessor women in urban slums, while Kolping Bolivia uses ambulances to transport doctors and counselors toperi-urban and rural neighborhoods around the city o El Alto, oering low-cost or ree medical attention.

Mbile acilities. Mobile acilities are, in essence, traveling hospitals. Staed with doctors and nurses, they areequipped with medical equipment on par with static primary care centers or hospitals, including laboratories andoperating theaters. In Bihar, India,Arogya Rath is operating mobile medical units that oer the same acilities asa basic hospital, as well as more than 30 medications that are issued to patients ree o cost. In Peru, Pro Mujerspecialists provide dental and sonogram services out o vehicles converted into two consultation units, one or

dentistry with an exam seat and accompanying dental instruments, and the other or gynecological exams.

In India, an ACCESS Health International case study describes

contracting agreements between state governments and

private providers delivering healthcare through mobile

acilities.3 Under Arogya Rath, 38 mobile medical units

provide primary healthcare services in remote areas o Bihar.

Private partners provide inrastructure, sta, and services; the

units aim to serve at least 50 patients each day, 26 days in

a month. Similarly, under Deen Dayal Chalit Aspatal Yojana,

92 mobile units provide services in Madhya Pradesh. Each

unit is equipped with GPS and carries a doctor, nurse, lab

attendant, pharmacist, and driver. Operating the units has

required intensive management and maintenance. Among

a series o recommendations, ACCESS suggests that these

schemes budget separately or monitoring and evaluation,

and defne perormance parameters in the contract, such

as service quality.

PuBLIC-PRIvATE PARTnERSHIPSSPoTLIGHT

Mobile care programs leverage a variety o dierent transportation methods,depending on the local topography, to deliver services. For example, oroad trucks are used to traverse rough terrain (Mailaya), boats navigate

isolated rivers (Navio Abar, Sailing Doctors), motorcycles pass through ruraland unpaved roads (Health by Motorbike), and camels serve remote desertcommunities (Community Health Arica Trust, orCHAT).

As this model continues to evolve, a key question will be whether it willcome to represent a long-term solution to reaching those in remote areas,or simply a useul tactic to ll the gap until static clinics adequately expandtheir reach.

Sustainable nancing will be a key criterion. A majority (69%) o mobile careprograms proled by CHMI operate primarily through donor unding. Whilestill rare, mobile services operated through public-private partnershipssuchas those described in the box aboverepresent a novel approach that mayhelp channel public resources to improve the availability o care in areas notreached by traditional government acilities.

Providing quality maternal and child health services is an ongoing challenge, refected in the stubbornly

high rate o maternal mortality seen in many low- and middle-income countrieseven those that have

successully met other Millennium Development Goal targets. As a response, many private organizations

are experimenting with new approaches to provide quality health services to women and children

around the world.

InnovATInG To SAvE THE LIvESo WoMEn And CHILdREn

Photo Above: Sailing Doctors travels

up the Kenyan coast in a dhow

providing basic medical care to

people on remote islands.Photo Above: A mother and her inant in ront o Jacaranda Health, a nonproft maternity care organization in Kenya.

The CHMI database proles 224 maternal and childhealth programs working across 48 countries. They arepioneering the implementation o new practices, rangingrom vouchers improving access to basic health services,to chains o clinics that provide low-income motherswith aordably-priced services such as pre-natal care,

deliveries, and newborn care. Observations romCHMIs data ollow.

The CHMI database profles 224maternal and childhealth programs working across 48 countries.

Photo Let: mothers2mothers is an NGO that helps prevent

mother-to-child transmission o HIV.

http://healthmarketinnovations.org/program/islamia-eye-hospitalhttp://healthmarketinnovations.org/program/jacaranda-healthhttp://healthmarketinnovations.org/program/fundacion-adolfo-kolpinghttp://healthmarketinnovations.org/program/arogya-rath-mobile-medical-units-mmu-in-biharhttp://healthmarketinnovations.org/program/pro-mujer-peruhttp://healthmarketinnovations.org/program/nomadic-and-e-health-programhttp://healthmarketinnovations.org/program/navio-abar%C3%A9http://healthmarketinnovations.org/program/sailing-doctorshttp://healthmarketinnovations.org/program/health-by-motorbikehttp://healthmarketinnovations.org/program/community-health-africa-trust-chathttp://healthmarketinnovations.org/program/community-health-africa-trust-chathttp://healthmarketinnovations.org/program/health-by-motorbikehttp://healthmarketinnovations.org/program/sailing-doctorshttp://healthmarketinnovations.org/program/navio-abar%C3%A9http://healthmarketinnovations.org/program/nomadic-and-e-health-programhttp://healthmarketinnovations.org/program/pro-mujer-peruhttp://healthmarketinnovations.org/program/arogya-rath-mobile-medical-units-mmu-in-biharhttp://healthmarketinnovations.org/program/fundacion-adolfo-kolpinghttp://healthmarketinnovations.org/program/jacaranda-healthhttp://healthmarketinnovations.org/program/islamia-eye-hospital


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The majority of maternal and child health programs CHMI has documented are private, not-for-prot models(58%). Many o these provide education to mothers or train healthcare providers, and nearly one-third are nowusing inormation and communication technology as a way o collecting and delivering inormation to mothers andhealth workers. A small number o organizations have recently launched or-prot businesses that rely on technologyinnovations. Mobile phone-based savings plans or deliveries and pay-per-text subscription schemes are some o thenewly developed or-prot models.

A number of nancing tools are used to mobilize funds for maternal and child health coverage for the poor.Micro-health insurance schemes, voucher programs, and contracting arrangements with private providers are themost common o the documented nancing approaches used to pay or maternal and child health services. Largerhospitals and clinics with high patient volumeslike the NICE Foundationin India, CEGIN in Argentina, and Charisin Ugandaalso cross-subsidize between the poor and wealthier patients.

One-third of documented maternal and child health programs organize the delivery of healthcare, with mostoperating as ranchises, chains, or networks o clinics. Many o these programs are adding technology on topo existing approaches, or example, by linking networks o midwives to medical specialists through mobileapplications enabling live consultations, or by launching paperless clinics where all patient inormation is storedand tracked electronically.

CHMI dATA SET AT A GLAnCE: MATERnAL, nEonATAL, And CHILd HEALTH

Photo Above: NICE Foundation provides specialized newborn care in Hyderabad.

http://healthmarketinnovations.org/program/nice-foundationhttp://healthmarketinnovations.org/program/centro-ginecologico-integral-ceginhttp://healthmarketinnovations.org/program/charis-international-medical-centrehttp://healthmarketinnovations.org/program/charis-international-medical-centrehttp://healthmarketinnovations.org/program/centro-ginecologico-integral-ceginhttp://healthmarketinnovations.org/program/nice-foundation


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1. GIvInG PATIEnTS PuRCHASInGPoWER To ACCESS MATERnALAnd CHILd HEALTH SERvICES

vchers t icrease tilizati care:vchers r Reprctie Health SericesPrject, Cambia.Poor and vulnerable women

are given voucher cards covering dened benetpackages such as delivery and antenatal care, aswell as money or transportation and other allowances.The KW-unded program contracts with publicacilities and not-or-prot organizations to deliverthese services, aiming to spur competition and qualityimprovement. Quality assurance is also providedthrough a continuum o training, accreditation,sel-assessment, and supervision. CHMI proles13 Maternal, Neonatal, and Child Health (MNCH)programs that use vouchers to nance care.

Saig schemes that se techlgy:Chagama Micrhealth, keya.This socialenterprise uses mobile money systems to help womensteadily save money used to pay or quality antenatal,maternity, and postnatal services at participatingacilities. Changamka also provides an electronicadministration platorm or voucher programs in theregion. CHMI proles 3 MNCH programs thatencourage savings through technology.

2. PRovIdInG LoW-CoSTdELIvERY ModELS

High qality a lw-cst serice elierychais: The amily Cliic, Iesia. The FamilyClinic is a nonprot chain o ve low-cost clinics inpoor urban communities. To keep costs low, midwivesprovide most services, including maternal and childhealthcare as well as amily planning services. Tokeep patient volume high, The Family Clinics acceptJampersal, the government health insurance thatcovers deliveries or all Indonesian women. Whilemost patients pay or services out-o-pocket, acceptinggovernment insurance or deliveries increases patientvolume or all services. CHMI proles 11 servicedelivery chains providing MNCH services.

Mbile cliics:PrSmilig Terpa, Iesia.ProSmiling Terpadu serves women and their amiliesin rural areas by hosting mobile health clinics incommunity locations like primary schools. In addition toproviding primary care services and nutritional screeningor children, ProSmiling clinics oer maternity care,including ultrasounds. CHMI proles 16 programsthat deliver MNCH services through mobile clinics.See page 17 or more on mobile care.

3. uSInG TECHnoLoGY ToEduCATE MoTHERS

Mbile phe-base spprt alg thectim care: keya Itegrate MbileMnCH Irmati Platrm (kimMnCHip).KimMNCHip sends SMS and voice messages topregnant women who register and provide theirdue date. In the uture, the project will also providepregnant women with donor-nanced, electronicvouchers to redeem in a collaborating clinic o theirchoice, and it will link primary healthcare workersto electronic medical records, checklists, and otherjob aids.

Mbile phe-base aice r mthers:Apj (MAMA Baglaesh). Aponjon givespregnant women, new mothers, and their amiliesaccess to reliable and culturally relevant inormationabout how to care or themselves and their babies.The USAID-supported mobile service delivers messagesbased on the subscribers due date or the inants age.It also gives advice on when to seek medical care,linking subscribers to health services. CHMI proles8 programs that use mobile phones to educate

women about MNCH care.

4. uSInG TECHnoLoGY ToIMPRovE THE PERoRMAnCEo RonTLInE WoRkERS

Cliical ecisi spprt stware:d-tree Iteratial, Glbal. D-trees mobilephone-based clinical decision support sotwarehelps clinic sta and community health workersaccurately diagnose and treat patients. In addition

to protocols that monitor the health o the mother andchild during the antenatal period, D-tree is developingprotocols to guide health workers through postnataland neonatal care. Protocols help health workers identiycomplications and encourage women to deliver saelyin acilities.

Mbile phe-base irmati system:

Materal Health Reprter, Iia.Global HealthBridge developed this mobile phone-based healthinormation system that enables community healthcareworkers (CHWs) to provide uninterrupted care andollow up, even in rural areas, through SMS andrecorded inormation. CHWs collect health inormationon their phones, receive reminders about patients,and store and retrieve clinical data instantaneously.CHMI proles 48 programs that utilize mobilephones to deliver MNCH services.

FOUR NEW APPROACHES IN

MATERNAL AND CHILD HEALTH

SPoTLIGHT

Photo Let: A woman and her child at a ProSmiling Terpadu mobile health clinic.

Photo Above: Global Health Bridge empowers health workers to deliver better healthcare at the community level.

http://healthmarketinnovations.org/program/vouchers-for-reproductive-health-serviceshttp://healthmarketinnovations.org/program/vouchers-for-reproductive-health-serviceshttp://healthmarketinnovations.org/program/changamka-microhealth-limitedhttp://healthmarketinnovations.org/program/the-family-clinic-with-the-concept-of-low-cost-and-quality-servicehttp://healthmarketinnovations.org/program/prosmiling-terpaduhttp://healthmarketinnovations.org/program/kenya-integrated-mobile-mnch-information-platform-kimmnchiphttp://healthmarketinnovations.org/program/kenya-integrated-mobile-mnch-information-platform-kimmnchiphttp://healthmarketinnovations.org/program/aponjonhttp://healthmarketinnovations.org/program/d-tree-international-0http://healthmarketinnovations.org/program/maternal-health-reporterhttp://healthmarketinnovations.org/program/maternal-health-reporterhttp://healthmarketinnovations.org/program/maternal-health-reporterhttp://healthmarketinnovations.org/program/d-tree-international-0http://healthmarketinnovations.org/program/aponjonhttp://healthmarketinnovations.org/program/kenya-integrated-mobile-mnch-information-platform-kimmnchiphttp://healthmarketinnovations.org/program/kenya-integrated-mobile-mnch-information-platform-kimmnchiphttp://healthmarketinnovations.org/program/prosmiling-terpaduhttp://healthmarketinnovations.org/program/the-family-clinic-with-the-concept-of-low-cost-and-quality-servicehttp://healthmarketinnovations.org/program/changamka-microhealth-limitedhttp://healthmarketinnovations.org/program/vouchers-for-reproductive-health-serviceshttp://healthmarketinnovations.org/program/vouchers-for-reproductive-health-services


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CHMI currently proles more than 300 programs utilizing inormation

communication technology to improve their operations in 58 low- and

middle-income countries (LMICs). A study analyzing approximately

hal o these programsothers have since been added to CHMIs

databasewas published in the May 2012 issue o the Bulletin of the

World Health Organization.4

Not surprisingly, the study ound thatthe use o such technology in health(eHealth) is becoming increasinglycommon, with a growing proportiono programs incorporatingtechnologies into their models romthe start. O the programs CHMIproles that launched between 1991and 1995, only 8% are currentlyusing inormation communicationtechnologies in their work. O theprograms that launched between

2006 and 2011, 43% are utilizingeHealth to urther their goals (seegraph at right).

The study also ound that the mostcommon reason programs employtechnology is to extend geographicaccess to healthcare, or examplethrough telemedicine or health helplines. This is particularly promisinggiven the shortage o health workersand the poor distribution o serviceproviders in many countries. Thestudy ound that technology is usedless requently to enable nancialtransactions related to healthcare.Nevertheless, the growth in mobile

New Research on eHealth

Percetage Prgrams Crretly usig Techlgy,By Year Lach

While the sty shwe that eHealth has a ariety ses, a mber barriers remai t eectiely sigtechlgy t impre healthcare:

Program managers interviewed for the study cited problems with end useracceptance o technology; many health workers were not amiliar with thenew technology or lacked an incentive to adopt new tools. This barrier canbe overcome with education about the benets o eHealth, and trainingopportunities that help workers learn practical applications or technology.

To ensure the continued growth of eHealth, programs should seek morediversied sources o revenue, such as rom contracts with national andlocal governments, contributions rom consumers at aordable rates,and support rom investors to scale-up operations to new areas or ornew services.

In many low-and middle-income countries there is a lack of infrastructure,such as reliable electricity and internet access, to support eHealth. Thisbarrier may be overcome over the next ew years with the advent o new andcheaper technologies and investment rom companies and governments.

While the growing use o technology in health programs promises to alleviatemany common challenges in healthcare delivery, these remaining barrierswill need to be addressed or technology solutions to be adopted by moreprograms, where appropriate.

payment technologies, such as M-PESA in East Arica,indicates that this may be a major area o opportunityor eHealth in the uture.

For programs delivering services focused on HIV/AIDS,tuberculosis, and amily planning and reproductivehealth, the main reason to utilize technology is to betterreach patients in their daily lives, outside o traditionaldoctor visits. This may be because these types o servicesoten require patients to interact requently with lowerlevel providers, who must ensure compliance withtreatment protocols and provide education.

Meanwhile, or general primary and secondary care,which require health workers with strong diagnosticskills and specialized knowledge, technology is usedto improve the quality o the doctor-patient interaction,either by enhancing the abilities o health workers or

by connecting patients with doctors or specialists inother locations.

Techlgy-EablePrgrams by PrimarySrce ig

Photo Above: Health workers use mobile phones to registerpatients at Jacaranda Health.

BRIE



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28 HIGHLIGHTS 2012HealthMarketInnovations.org

Section Title

27

Tracig a ReprtigPrgram Perrmace

CHMIS REPoRTEd RESuLTS InITIATIvE IS A IRST STEP

in identiying what worksthe programs and practices that

improve access, quality, and aordability o healthcare or the

poor. Launched in June 2011, Reported Results is an eort to

collect and publicize inormation about the perormance o

programs documented in the CHMI data set.

Reported results are clear, quantiable, and sel-reported

measures o program perormance catalogued across several

key dimensions. CHMI collects results through regular program

surveys. One year ater the initial call or results, reprte

reslts are aailable r clse t 150 prgrams.

Reported results

are clear, quantifable,

and sel-reported measures

o program perormance.

Photo Let: Riders or Health provides reliable transportation

solutions so that health workers can reach rural communities on

a regular basis, delivering commodities and providing services.

Riders has reported promising results to CHMI.


16/23


Tracig a Reprtig Prgram Perrmace

ExPAnSIon ACTIvITIES: PRoMISInG PRACTICES In PERoRMAnCE REPoRTInG

In addition to collecting and reporting results, CHMIis exploring promising practices in perormancereportingand identiying what practices enablepositive results. In partnership with the University oToronto, CHMI is aiming to standardize perormancereporting, starting by reviewing common indicatorsused by programs to measure their perormance ineach category. This analysis will inorm the designo the CHMI database and eorts to systematicallycollect results, particularly around measures o eciency,quality, and scale.

To understand what kind o practices yield positive results,CHMI also seeks to strengthen links between researchersand program managers. Eventually, these activitiesshould lead to more systematic third-party evaluations,as well as the development o a comprehensive set ostandardized health metrics.

For a list o all the programs with reported results,visit the Reported Results page onHealthMarketInnovations.org.

CoLLECTInG And REPoRTInG RESuLTS

Programs reporting results to CHMI include a diverse set o organizations and initiatives that deliver and nance a broadrange o health services. Results are reported in ten categories such as aordability o care, user satisaction, eciency,quality, and pro-poor targeting (see chart at right or results by category). What kind o results do programs typicallyreport? Below are our examples o programs reporting quantitative results in several categories. Relying on internaldata tracking mechanisms, these programs have submitted detailed inormation.

World Health Partners, India, a clinical ranchise thatprovides a range o primary care services in the Indianstates o Bihar and Uttar Pradesh, states that they arelowering the cost o TB care. TB patient servicesrange between Rs. 1,250 and Rs. 2,360 (US $22.50-$42.50), prices that they say are nearly one-third o therate oered in other private acilities.

In Bangladesh, Kollyani Primary Health Care Centres,

a nonprot clinic chain providing a range o primarycare services, reports a doubling in the percentageo pregnant women receiving our antenatal care

visits in the target area. During the same time period,the maternal mortality ratio ell rom 8.2 to 6 per1000 live births in the project area.

MedicallHome oers hotline-based health servicesto over ve million subscribers in Mexico. Staedby qualied doctors around the clock, the hotlineimproves the eciency o the healthcare system byresolving basic complaints over the phone and reerring

others to the appropriate level o care. The companyestimates that 86% o patients perceive an emergencywhen they require only basic care, and only 14% otheir callers typically require emergency attention.MedicallHome calculates that by reerring patientsto the appropriate level o care the company savespatients US $19.7 million each year (7,878 caseswith an estimated savings o US $2,500 each).

Karuna Trust, a public charitable trust managing48 Primary Health Centres and seven mobile healthclinics in India, reports improved child health outcomesor the target population. From 1996 to 2007, primaryhealth centers saw a decrease in perinatal mortality by40%, neonatal mortality by 60%, and under-5 mortalityby 9%; overall inant mortality rates ell rom 75.7%to 23.8%.

Reprte Reslts Categries a defitis

utilizatiVolume o clients served as a percentageo a dened target population.

Health otptQuantitative inormation about thenumber of health services/products

provided and/or clients served/trained

in a given time period.

Health otcmeQuantitative evidence o intermediateor long-term health outcome as

demonstrated by changes in learning,

actions, or health status o the target

population. This includes modeled

estimates o impact such as Couple YearsProtection (CYPs) and Disability Adjusted

Lie Years (DALYs).

ArabilityQuantitative evidence o the price o

services and/or products in comparison

to the average cost o accessing similarservices in the local context, or as

a proportion o income.

AailabilityQuantitative evidence o the ability

of patients to access services and/or

products. Measures can include: thenumber o acilities, providers, or hospital

beds per segment o population; distance

to nearest acility; sta absenteeism

rates; and stock-out rates o medicinesand/or medical supplies.

Pr-Pr TargetigThe proportion o a programs clients

who are poor or disadvantaged,

including the criteria used to determinewho is poor.

Cliical QalityQuantitative evidence o providing sae and eective care to the

patient. Quality measures may include: adherence to established

protocols, rates of appropriate diagnosis, and/or issuance of

incorrect prescriptions, among others.

user SatisactiQualitative or quantitative evidence o service quality asperceived by the patient, including the methodology used

to collect this inormation.

EfciecyEvidence o a change in operational processes leading to

higher/lower cost-effectiveness, the operational cost or time

to provide a product or service compared to its quality.

iacial SstaiabilityQuantitative evidence o ability to cover costs in thelong-term, including a diversity o donor base or other

secure revenue streams.

Reprte Reslts by Categry*

*Programs may report results in more than one category.
http://healthmarketinnovations.org/program/world-health-partners-whphttp://healthmarketinnovations.org/program/kollyani-clinicshttp://healthmarketinnovations.org/program/medicallhomehttp://healthmarketinnovations.org/program/karuna-trusthttp://healthmarketinnovations.org/program/karuna-trusthttp://healthmarketinnovations.org/program/medicallhomehttp://healthmarketinnovations.org/program/kollyani-clinicshttp://healthmarketinnovations.org/program/world-health-partners-whp


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32 HIGHLIGHTS 2012HealthMarketInnovations.org

Section Title

31

CHMI works to transer

promising practices and

encourage innovative

programs to scale.

Cectig Peple t

Scale Iatis

CHMI MAkES ConnECTIonS BETWEEn PEoPLE WoRkInG

To IMPRovE HEALTH MARkETS. Over the past year,

CHMI acilitated unding and operational partnerships that will

enable organizations to deliver better services to more people.

Photo Let: In Jakarta, the team behind Dengue Fever Insurance

cards discuss a budding partnership with Bidan Delima,

a network o accredited private midwives.


18/23


nETWoRkInG In CounTRIES

Working across sixteen countries, CHMIs partner organizations regularly host targeted learningand networking events to oster connections among health innovators, donors, investors,researchers, and policy makers in their country and region. The events are designed to acilitatejoint learning and create new partnerships that help promising programs grow and improveon their model. During the past year, CHMI partners hosted events ranging rom competitions,to workshops, to high-level roundtables.

Cmpetitis t ietiy prmisig mels.At a series o roundtables organized by the PhilippineInstitute or Development Studies (PIDS), leaders romgovernment, industry, and academia ranked morethan 30 innovative nonprots, social enterprises,and public-private partnerships on criteria such as theirability to serve the poor and sustain their operations.Four winners o the rst competition were invited toa high-prole national maternal health summit,where they pitched their programs to governorsand business leaders. The Institute o Health Policy,Management & Research (IHPMR) hosted a similarcompetition in East Arica, recognizing outstandinghealth programs in that region and providinga platorm or interactions.

Rtables t share prmisig appraches.In the past year, CHMI partners have hostedroundtables convening health innovators in Kenya,Indonesia, Peru, Rwanda, and Tanzania. In Peru,Freedom From Hungerconvened representativeso Micronance Institutions (MFIs) rom the regionto discuss promising approaches in oering healthproducts and services to their communities. At themeetings, participants exchanged inormation aboutpromising practices and discussed opportunitiesto address their common challenges.

MAkInG onLInE ConnECTIonS

More than 100,000 unique visitors accessed CHMIs website during the past year. The majorityo web visitors arrived rom low- and middle-income countries, with India, the Philippines, Kenya,Indonesia, Bangladesh, and Uganda in the top 10 countries or visitor origin.

Many o CHMIs 800 registered visitors used the website to identiy programs o interest andcontact them directly through the site. During the past year, over 300 messages were sent throughthe CHMI site. This includes at least 100 messages rom program managers to peer innovatorslooking to identiy potential partners, more than 50 messages rom researchers contactingprograms to learn more, and approximately 35 messages rom unders looking to identiyprograms or support.

WoRkInG WITH GLoBAL CoLLABoRAToRS

CHMI works with a number o global collaborators with the common mission o acilitating learning

and scale-up o promising market-based health programs. CHMI works with a wide range ocollaborators, ranging rom organizations that help programs identiy partners and share lessonslearned, to academic institutions that study and evaluate promising approaches, to organizationsthat help programs get unding through grants, investments, or micro-donations rom globaldonation platorms.

Oten these global collaborators will search or and contact programs through the CHMI database.In other cases, CHMI will highlight promising programs rom the database to unders and otherprospective partners.

CREATInG PARTnERSHIPS

Cectig Peple t Scale Iatis

More than 800 people have registeredon CHMI and they have sent over300 messages to programs throughthe database in the past year.

1

2

3

Photo Top: CHMIs partner in East Arica convened a group o health innovators, donors, researchers, and other stakeholders

in Nairobi, Kenya.

Photo Above: Discussion at a

roundtable in Manila.

Photo Above: Discussing MFIs

delivering health services in the

Andean region.

CHMI works to connect people implementing, unding, and studying innovativeprograms to transer good practices and encourage innovative programs to

scale. CHMI uses three main approaches to acilitate partnerships between thosestriving to make health markets work better or the poor.


19/23


Cectig Peple t Scale Iatis

At a roundtable in Jakarta hosted by MercyCorps, a midwives accreditation network called Bidan Delimabegan a partnership with ACA Insurance, a company selling Dengue Fever Insurance. Midwives are nowselling the insurance to amilies they serve, belieig the prct gies them a aatageer cmpetitrsand a reason or private midwives to become accredited to deliver quality services.

INDONESIA

Four o seven programs CHMI reerred to the GlobalGiving Open Challenge won a permanent placeon the undraising site. Participants had to raise at least $4000 through at least 50 individual donors

to earn their places. Since CHMI reerred Global Health Bridgea program that equips communityhealth workers with mobile technology tools to improve quality and eciencyGlobal Health Bridgehas raise thsas llars rm mre tha 280 rs.

INDIA, INDONESIA & TANZANIA

Investors based in emerging economiessuch as Aureos Capitals Arica Health Fund and Impact

Investment Partnershave used CHMI to iscer a iitiate tals with ew prgrams iterest. In addition, investment intermediaries such as Total Impact Advisors use CHMIto highlight prspects t glbal iestrs.

EAST AFRICA & SOUTH ASIA

Nineteen innovators were selected or the International Partnership or Innovative Healthcare Delivery(IPIHD), conceived by the World Economic Forum, Duke, and McKinsey, and housed at Duke Medicine.Four o the innovators selected to join the Network were discovered through CHMI: Operation ASHA(India, Cambodia), APROFE (Ecuador), LV Prasad (India), and Changamka (Kenya). Participants get accessto know-how through private orums, including annual events with investors, metrship rm glbalistry eecties, and insight into working within regulatory structures.

GLOBAL

Ater winning a competition hosted by the Philippine Institute or Development Studies (PIDS),Wireless Access or Healtha system that organizes electronic medical records, reduces patientwait time, and provides real-time data that can aid decision-making at the local levelwas invitedto attend a high-prole national maternal health summit. At the summit, Wireless Access or Healthwas bi by tw gerrs t wr i their prices.

PHILIPPINES

1

Networking in Countries

Working with Global Collaborators

Networking in Countries

Making Online Connections

Working with Global Collaborators

l


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HIGHLIGHTS 2012HealthMarketInnovations.org

Section Title

36 37

1. LEARn ABouT HEALTH MARkET InnovATIonS.

Find programs and policies that harness private providers

and improve the quality, aordability, and accessibility

o healthcare or the poor.

2. Ind ouT WHAT WoRkS. Browse CHMI program proles,

case studies, and reported resultsstatements o impactin areas such as quality, cost, and sustainability.

3. ConnECT WITH InnovAToRS. Explore the CHMI database

to learn about innovative health programs. Then register with

CHMI to send them a message and create new partnerships.

4. PRoMoTE A HEALTH MARkET InnovATIon. Programs that

serve the poor and improve the health market are eligible to

be proled by CHMI. Proled programs can get global visibility,

inormation about promising practices, and connections

to potential partners.

Use CHMI to fnd out

what works and

connect with innovators.

Photo Let: Midwives and sta members at the Family Clinic,a chain o low-cost clinics run by the Kusuma Buana Foundation

in Indonesia.

Hw CHMI Ca Helpwith Yr Wr:


21/23


Hw CHMI Ca Help with Yr Wr

Resources

Prgram Case Sties

CHMI in-country partners have produced more than60 case studies rom 11 countries. Case studies rangerom a look into the Pro Mujer model in Bolivia, whichprovides primary health services alongside microloansto women, to a comparison o two dierent Indonesianprograms that use modern technology-based teachingtools to enhance the education o health workers.

sterig Healthy Bsiesses: delierigIatis i Materal a Chil Health

Launched at the 2012 United Nations General Assembly,this report was issued by the Every Woman, Every ChildInnovation Working Group (IWG). The report, whichrequently cites CHMI program proles, was preparedby the IWGs Task Force on Sustainable Business Models.

Imprig the Health Mther a Chil:Sltis rm Iia

ACCESS Health International identied 16 providerso maternal and child healthcare services in India anddocumented their approach, impact, and challengesin a comprehensive compendium.

Aes Micrface a HealthLascape Sty

To increase knowledge o the eld o health andmicronance in the Andean region, Freedom romHunger conducted a survey and landscape analysiso micronance institutions that are providing theirmembers with health services.

Over the past year, collaborators have used data rom CHMI to shed light on innovative programs and

global trends. Below is a selection o the resources they have created. To view these and other materials,

visit HealthMarketInnovations.org/partnerresources.

CHMI EvALuATIon

In March 2012, the Bill & Melinda Gates Foundation commissioned a quasi-baseline survey o CHMI with programmanagers, donors, investors, researchers, policy makers, and other key actors in health systems. Conducted byInterMedia, the evaluation aimed to set baseline perormance data or CHMI. InterMedia conducted an online surveyo nearly 600 people and in-depth interviews with 30 people to assess CHMIs use, useulness, impact, and areas oruture growth. The results provide insight into ways CHMI is working, and how it can expand its oerings to provideinormation and connections or people who create change in health markets.

The evaluation showed that awareness o CHMI is high. Seventy-our percent o those who took the survey said theyhad heard about CHMI. Hal o those aware o CHMI had used its inormation products, like the website, or hadparticipated in CHMI activities. A majority o users (95%) had a positive experience participating in CHMI activitiesor using CHMI products. More than hal o those who had used CHMI products agreed that CHMI contributed toimproved health status among the poorspeaking mostly to the potential o CHMI to achieve this impact in the uture.

The eedback rom the survey is being used to improve the way CHMI identies and works to scale up healthmarket innovations.

Photo Right: Children near a BRAC Manoshi satellite clinicin Dhaka. With ClickDiagnostics, BRAC is implementing

a mobile phone-based solution or data collection

and screening or maternal, neonatal and child health.
http://healthmarketinnovations.org/program-case-studieshttp://healthmarketinnovations.org/partnerresourceshttp://healthmarketinnovations.org/partnerresourceshttp://healthmarketinnovations.org/program-case-studies


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HIGHLIGHTS 2012HealthMarketInnovations.org

Ie

4140

End noTES & PHoTo CREdITS

1. Results or Development Institute makesevery eort to ensure that the contento the CHMI Website is accurate andup-to-date, but does not oer anywarranties as to the reliability, accuracyor completeness o the inormation.For more inormation please seehttp://healthmarketinnovations.org/about/frequently-asked-questions/terms-use

2. This may be due to the presence oCHMI partners actively proling healthmarkets in these country. CHMI partnershave operated in Bangladesh, Bolivia,Brazil, Cambodia, Ecuador, India,Indonesia, Kenya, Pakistan, Peru, thePhilippines Rwanda, South Arica,Tanzania, Uganda and Vietnam.

3. ACCESS Health Internationalscomparative case study o mobile medicalunits operated through public-privatepartnerships in Bihar and Madhya Pradeshwas developed through interviews withpublic and private partners, eld visits,

and secondary research. Read thestudy at HealthMarketInnovations.org/

partnerresources.

4. Lewis T., Synowiec C., LagomarsinoG., Schweitzer J., E-Health in low- andmiddle-income countries: ndings romthe Center or Health Market Innovations.Bull. W.H.O. 2012 May; 90 (5): 332-40.

Cover photo: Lindsay Mgbor/DFID

Page 4: Sam French / Development Pictures,courtesy o DFID

Page 6: Allan Gichigi or CHMI

Page 8: Photo courtesy o CooP-AricaBike4Care

Page 9: Top, Photo courtesy o HygeiaCommunity Health Plan; Bottom,Andr J.P. Fanthome

Page 12: Andr J.P. Fanthome or CHMI

Page 14: Photo by Jonathan Kalan

Page 16: Top let, Nahiyan Kabir or CHMI;Let, Ida Pantig or CHMI; Bottom othe page, courtesy o Swasth India.

Page 17: Photo courtesy o Community HealthArica Trust (CHAT)

Page 18: Photo courtesy o Sailing Doctors

Page 19: Top, Allan Gichigi or CHMI; Bottom,Photo by Andrew Topham, courtesyo mothers2mothers.


Page 22: Alex Robinson or CHMI

Page 23: Courtesy o Global Health Bridge

Page 25: Allan Gichigi or CHMI

Page 26: Photo courtesy of Riders for Health/Tom Oldham

Page 30: Oscar Siagian or CHMI

Page 32: Top, Alex Kamweru or CHMI;Bottom, courtesy o PIDS

Page 33: Maria Belenky or CHMI

Page 36: Alex Robinson or CHMI

Page 39: Nahiyan Kabir or CHMI


Photo Above: Technicians train at GVK Emergency Management and Resource Institute (EMRI) in Hyderabad, India.

Anne Spoerry Sailing Doctors, 18Aponjon, 23APROFE, 33Arogya Rath, 18Bidan Delima, 31, 35Bike4Care, 8BRAC Manoshi, 38BulshoKaab Pharmacies Network, 8Centro Ginecologico Integral

(CEGIN), 20Changamka Microhealth Ltd.,

22, 35Charis International Medical

Centre, 20Community Health Arica Trust

(CHAT), 17-18D-tree International, 23Daktari, 15, 25, 8Deen Dayal Chalit Aspatal

Yojana, 18Dengue Fever Insurance, 31, 35

E Health Point, 15eQuality Health Bwindi, 9Farmacias Similares, 16Family Medical Health

Centres, 15Global Health Bridge, 23, 35GVK Emergency Management and

Research Institute (EMRI), 39Health by Motorbike, 18Hygeia Community Health Plan, 9IGE Medical Systems, 9Islamia Eye Hospital, 18Jacaranda Health, 7, 9, 19, 25Karuna Trust, 28Kenya Integrated Mobile MNCH

Inormation Platorm(KimMNCHip), 22

Kollyani Primary Health CareCentres, 28

Kolping Bolivia, 18Kriti Arogyam Kendram, 16LV Prasad Eye Institute, 35Mailaya, 18MedicallHome, 28MedPlus, 9MicroEnsure, 9mothers2mothers, 19Navio Abar, 18NICE Foundation, 13, 20Operation ASHA, 9, 35Penda Health, 14Por Ti, Familia, 15Primedic, 15ProFam Cameroon, 9Pro Mujer, 18, 36Prosmiling Terpadu, 22Riders or Health, 27Ross Clinics, 8

Sampoorna Suraksha, 9Sehat First, 15Smiling Sun Franchise Program, 16Swasth India, 16The Family Clinics, Kusuma Buana

Foundation, 22, 37The Generics Pharmacy, 16VillageReach, 9Viva Sehat, 16Voucher or Reproductive Health

Services Project, 22Wireless Access or Health, 35World Health Partners,

9, 15-16, 28

PRoGRAMS MEnTIonEd In THIS REPoRT

Programs providing comprehensive, up-to-date inormation and reportingresults are more likely to be eatured in CHMIs Highlights reports.

CHMI GLoBALCoLLABoRAToRS

Abt Associates Ashoka Changemakers Boston University DKT International Future Health Systems

Consortium GlobalGiving Global Impact Investing

Network (GIIN) Information Society

Innovation Fund International Partnership

or Innovative HealthcareDelivery (IPIHD)

Johns Hopkins Bloomberg

School o Public Health Marie Stopes International Microinsurance Network (MiN) Nossal Institute for Global Health RH Vouchers/ Population

Council - Nairobi PharmAccess Foundation Population Services

International (PSI) Private Sector Healthcare

Initiative, UCSF Skoll Foundation USAID/SHOPS Project University of Toronto World Bank/IFC


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Section Title

HealthMarketInnovations.org

chmi highlights 2012 final

Documents