One Family Health to improve access to healthcare products and services at the base of the pyramid in Zambia

--by Gunther Faber, Greg Starbird, and Andrew Kambobe.

According to the WHO, more than half of child deaths in Africa are from malaria, diarrheal diseases, and respiratory infections. UNICEF calls these diseases “easily preventable and curable,” but research indicates that even when Africans access healthcare, there is a 50% or higher chance the drugs they receive are substandard, counterfeit, or clinically inappropriate.

One Family Health is a nonprofit corporation dedicated to solving the access problem described above by improving access to essential drugs, basic healthcare, and prevention services in the developing world.

One Family Health operates a franchise network in Rwanda under a unique Public Private Partnership (PPP) with the Ministry of Health. In Rwanda, One Family Health’s private, franchised clinics function as the entry level into the formal public health system known as "Health Posts". One Family Health’s network of clinics in Rwanda is the first network of small-scale private providers ever accredited by Rwanda’s prevalent, subsidised community-based health insurance schemes. One Family Health’s goal is to open hundreds of Health Posts serving patients at the base of the socio-economic pyramid in Rwanda, fulfilling the Ministry of Health’s goals through a network of locally-owned, franchised providers.

One Family Health is now establishing two complementary initiatives in Zambia:

1. A network of franchised, micro-scale medical clinics owned by local nurses with the full blessing of the Ministry of Health, with whom we intend to work closely to ensure healthcare coverage across the country. These clinics will target a short list of diseases responsible for a disproportionate amount of illness and death. One Family Health uses the franchise business model because well-run business format franchise networks maintain quality standards, scale quickly, and achieve economies of scale. This approach is already operational in Rwanda, and has also been tested in Kenya, where the organisation of which One Family Health is an offshoot (The HealthStore Foundation®) has served over 3 million people since the year 2000 through its clinic network.
2. Alongside its network of franchised healthcare providers in Zambia, One Family Health plans to establish a subsidised micro health insurance scheme. The proposed activities are to take place with the full knowledge of the Ministry of Health and by working closely with the Economics Department at the University of Zambia in Lusaka where policy discussions as to the development of a National Health Insurance Fund in Zambia have already started. Note: by “subsidised micro health insurance” we mean a mechanism specifically tailored to provide low-cost cover for the most critical primary, outpatient healthcare requirements of particular underserved areas, e.g. malaria, diarrheal diseases, respiratory infections, etc.

At the base of the pyramid in Zambia, there is currently very poor access to healthcare. One Family Health’s plans represent an analytically robust, consumer-facing process during which we will be opening locally-owned medical clinics and feeding uniquely granular data from these clinics (and from clinics in other African countries where applicable) into specially-tailored financial models and virtual insurance products, to inform further developments of the clinics and to inform field tests of micro health insurance products from which more data will be collected and used to refine those products. This is an ambitious, multi-faceted goal; Zambia is a huge, sparsely populated country where we will face considerable challenges in logistics, human resources, and other areas. In response to this challenging environment, we have assembled organizations with expertise to successfully achieve the intended results.

Partners and Potential Partners:

• One Family Health is in discussions with the Ministry of Health in Zambia about this initiative, and intends to work in close cooperation with both the Ministry of Health and the Ministry of Finance.
• The Business Innovation Facility funded One Family Health’s 2012 explorations of the Zambian market, key parts of which were carried out in cooperation with the Economics Department at the University of Zambia.
• PharmAccess, a Dutch nonprofit which is the leading advocate and implementer of health insurance in Africa, with programs in Nigeria, Kenya, and Tanzania, will be advising on the development of the micro health insurance products.
• LifeSense, a South African healthcare company which has developed an innovative electronic clinic management system (“LifeQube”) which (among other benefits) will provide real-time data for use developing robust micro-health insurance around One Family Health’s network of quality entry-level clinics.
• One Family Health is in late-stage negotiations with two Fortune 100 companies who seriously considering funding the launch of its network of clinics in Zambia, funding that will include rudimentary provider-facing subsidies for our first three years in Zambia, a preliminary step towards micro health insurance.
• A major US foundation has signalled its intention to fund the first phase of One Family Health’s subsidised micro health insurance scheme in Zambia.
• One Family Health is also approaching a major mining company seeking support for the launch of its first clinics in NW Zambia.
• One Family Health is seeking to engage British companies active in Zambia, through the Commonwealth Business Council and the Zambia UK Health Workforce Alliance.
• One Family Health has signed up to the Global Health Policy Summit an international ‘think-tank’ made up of healthcare practitioners in the private and public sectors in both the developed and the developing world with the sole aim of throwing conventional wisdom out of the window and through disruptive out-of-the-box thinking change the paradigm of what is possible. This initiative is a joint venture between Imperial College and the Qatar Foundation which was launched in July in London during the Olympics.
• One Family Health will seek to introduce its concepts to forward-looking development ministries and development agencies
• One Family Health was delighted to accept an invitation to become a founding innovator of Duke University’s International Partnership for Innovative Healthcare Delivery.

One Family Health’s proposal is groundbreaking and will work at the base of the pyramid (“BOP”) through the following combination, unique to sub-Saharan Africa:

• One Family Health’s network of clinics will be a large, growing network that sets, maintains, and audits quality standards of its providers, who deliver low-cost care to BOP patients, targeting the short list of diseases/conditions cause ~70 per cent of illness and ~43 per cent of deaths.
• One Family Health’s health insurance will integrate appropriate, accountable subsidies as reimbursements to private providers. Without such subsidies, healthcare cannot be adequately extended to truly low-income people, and clinics cannot be sustainable enterprises in underserved areas. This leaves children and their families – real people who deserve healthcare just as much as anyone else —without access to high-quality care for basic diseases.
• One Family Health’s technology processes micro-scale claims efficiently so as to administer outpatient health insurance to broader populations than have ever benefitted from insurance. This technology—LifeQube—guarantees real-time and granular visibility into the exact amount of any subsidies routed through the micro health insurance plan: how and for whom this funding was spent, where, when, and why, along with financial insight into the clinics benefitting from begin accredited under the insurance scheme, morbidity statistics, etc.

Many other organizations, in prioritising financial sustainability, cannot target the most vulnerable populations and are accordingly migrating up the economic pyramid. Others prioritise vulnerable populations but in do doing relinquish all the quality controls and incentive-based benefits of locally-owned, private healthcare. One Family Health’s plans for Zambia represent an innovative solution to the financial challenge of serving these most vulnerable patients in a sustainable and scalable way.

A wide audience is eager to see the results of these efforts, including ministries of health and finance, funders seeking better uses of global health dollars, healthcare professionals and policymakers interested to see Africa’s disease burden fall, financial institutions interested to extend financing to private clinics which would have more reliable revenues in more remote areas if third party insurance payers existed, etc. We believe our proposal is revolutionary and could form the basic blueprint for many an LDC to follow.

We welcome inquiries at info@onefamilyhealth.org