Delivering (and Sustaining) Services on Scale. Anywhere.

November 20, 2008 Gopi Gopalakrishnan

Time to Go Rural

• Challenge: How to deliver services on scale in any part of the world, however rural or remote

• Primarily in areas where the public sector is ineffective or unavailable

• Private sector is the only other option for large-scale service delivery

Using private sector to target the poor needs ability to reconcile two naturally divergent forces

Using Private Sector -- A Quick Review

• 20 years ago, focus was primarily urban. Demand creation was difficult, supply was relatively easy

• For products—we just used supply infrastructure created by private companies

• For services—the challenge was day to day management but personnel, premises and communication vehicles were more easily available

Delivery in Rural Areas—Need is for New Set of Paradigms

• Demand is a given—even for family planning, unmet need is estimated at 20%. Health care is even more

• Adequate finances available

• Binding constraint is providers—for subsidised products, volumes are too small; for services, the appropriate providers are unavailable or unwilling

• Clients will some services only if available closeby

• Vertical provisioning is unviable and unsustainable

• Preventive care (and low level curative care) has not much attraction

• Public sector is willing to support provision through private providers

• Skilled providers not willing to stay in rural areas—will work only for short periods

Programmatic Structure

• Create a viable package which will leverage and sustain interest

• Curative part of package will anchor it financially

• Preventive part is a non-negotiable part

• Develop technology to fit service delivery and not vice versa

• Flexibility to adapt to uncertainties that come with the territory

Overview

• Create a basket of services that combines preventive with curative services

• Identify and induct a range of providers on the basis of competency and inter-link them financially

• Three broad functions for providers: Provide services directly Facilitate services through other networks (and

earn) Manage provision by WHP (and earn)

• Use financial instruments to leverage public sector support

Determine services that are of primary interest, quantify and work toward achieving them

SKY CAREV i l l a g e

P r o v i d e r s

SKY HEALTH

T e l e m e d i c i n e C e n t e r s

F r a n c h i s e e D o c t o r s

C e n t r a l M e d i c a l F a c i l i t y

S h o p s

T h i n kT a n k

V i l l a g e s

S p e c i a l i s t s

S u p p l i e s

9 0 0

9

1 0 0

1 , 0 0 0

WHP Service Delivery Structure

D I a g n o s t I c C e n t e r s

W H PO f f i c e

Impact

• Project aims to address over 20% of unmet need in year 1

• 33% increase in contraceptive prevalence rate in 4 years