An idea for scaling up healthcare for underserved populations that just might work

Many promising health social enterprises are successfully reaching the poor in a local context, but struggle to achieve scale and grow their impact. Governments are interested in expanding service provision to the poor, but remain skeptical about the transaction costs of working with small-scale social enterprises. A key question is how the two can work together to deliver services at scale and to under-served populations?

Reducing fragmentation with chains and network models

At Results for Development’s Center for Health Market Innovations (CHMI), we have documented hundreds of social enterprises in our global database. Many of these are embracing business models that organise delivery, linking providers together to deliver services to specific population groups. These business models—including chains, networks, and social franchises—provide a set of benefits to providers in the network including branding, mechanisms to improve clinical quality, and business training. They reduce transaction costs for governments looking to purchase healthcare services, and are conducive to the formation of public-private partnerships.

CHMI documents many social enterprises[1] that are working to organise existing, private healthcare providers in order to solve different health systems challenges. Here are three examples:

1. Linking village-level providers to the broader health system in India

In India, rural households often rely extensively on informal healthcare providers. These providers lack the necessary medical qualifications to practice, but are often trusted members of the community, making them a preferred source of primary healthcare. Recognising their potential, World Health Partners links existing village level service providers in a social franchise network called Sky. Informal providers at the community level are linked to formally qualified doctors through telemedicine, and patients are linked to in-network providers when more comprehensive care is needed. In only eight years of operation, World Health Partners has grown to 14,100 India-based clinics with over 2 million client visits; in 2015, the model was replicated to Kenya, where there are 22 Sky clinics[2].

2. Harnessing the potential of faith-based healthcare providers in Burundi

Similarly, Lifenet International recognised that existing church-run medical centres already provide healthcare to Burundi’s rural poor. The organisation uses a franchise conversation model to bring these existing providers into Lifenet’s network, which now includes 56 health centres. Lifenet provides each facility with comprehensive training in quality management, financial management, pharmacy, and human resources in order to improve its services. A recent report by Lifenet found that, after the training programme, facilities in Burundi improved from meeting an average of 50 per cent of Lifenet’s quality assurance indicators to an average of 85 per cent[3]. Lifenet International has recently expanded its model to the Democratic Republic of the Congo and Uganda. 

Lifenet International Clinic in Burundi © Chad Bartlett, courtesy of LifeNet International.

3. Lowering the cost of quality care in Lagos, Nigeria

In Nigeria, over 50 per cent of citizens across income levels rely on the private sector for healthcare[4], with many relying on low quality drug shops, or bypassing primary care clinics for more expensive but perceived higher quality secondary and tertiary providers. Purplesource Healthcare, a new healthcare management company in Lagos, wants to reverse this trend by building up a network of high quality, lower cost primary care facilities targeted at patients across income levels. Purplesource organises strategic purchasing for facilities in its network and develops preferred relationships with vendors, from pharmaceutical companies to cleaning, laundry, and medical waste management; these savings are passed directly to patients. Purplesource is now working to implement SafeCare quality assurance standards at all of its seven networked facilities, and organises management training and knowledge sharing across its facilities.

Looking forward—how can we increase impact on the health system?

These three organisations are all working to reduce fragmentation in their health systems and achieve solutions at greater scale. But organising delivery is just the beginning. Increasingly, these organisations are evolving to take on even more of the critical functions of improving healthcare, including quality improvement, management capacity, integration into payment systems, and population health. Recent research completed by Results for Development Institute explores these functions and the role of intermediary organisations[5] in mixed health systems, arguing that intermediaries are the missing link between the public and private health markets in many countries.

Looking forward, CHMI is excited to see many health social enterprises evolving to take on these critical functions in improving the overall health system. As global health stakeholders think about how to engage the private sector in achieving universal health coverage, governments and funders may encourage the development of stronger social enterprises that organise delivery for patients.

This blog is part of the October 2016 series on Exploring the social enterprise landscape, in partnership with the World Bank Group and endeva. Read the whole series for insight and opinion on policy, business models and definitions from social entrepreneurs, policy makers and facilitators around the world.

Notes

[1] The author has used the World Bank’s definition of social enterprises as, “social-mission-led organisation that provides sustainable services to Bottom of the Pyramid (BoP) populations”. The organisations listed in this blog are both for-profit and not-for-profit organisations, but all seek to provide services to the poor with the goal of working towards a sustainable business model.

[2] Viswanathan, R., Behl, R., and Seefeld, C.A. (2016). Clinical Social Franchising Compendium: An Annual Survey of Programs: findings from 2015. San Francisco: The Global Health Group, Global Health Sciences, University of California, San Francisco.

[3] Lifenet International. (2016). Lifenet Quarterly Report: Quarter 1 2016. Retrieved from http://www.lninternational.org/wp-content/uploads/2016/05/Q1-2016-KPI-r…

[4] SHOPS Project. 2012. Nigeria Private Health Sector Assessment. Brief. Bethesda, MD: Strengthening Health Outcomes through the Private Sector Project, Abt Associates.

[5] The report defines an intermediary organisation as, “organisations that form networks between small-scale private providers in order to interact with governments, patients, and vendors while performing key health systems functions that are challenging for individual private providers to do on their own” The social enterprises listed in this article perform some, but not all, of these recommended functions.