Report Making
Experiences from “Center for Health Market Innovations (CHMI)”
Working to improve the performance of health markets for the poor
January 20, 2014
Session Goals
• Narrate the process we followed in creating
www.healthmarketinnovations.org so as to
inform participants about–
–
–
–
–
Picking an agenda for documentation
Defining the purpose
Target audience
Developing tools
Working through the process to create the outputs
• Familiarize the participants to the tool used by us
for documenting health innovations for CHMI
Structure
• Why document health innovations?
• Selecting Innovations
• Process of
– Planning (Team, Time, Tools)
– Tool Development, Customization and Testing
– Data collection
– Synthesis and writing
• Benefits to intended target
Health Markets
•
•
•
Health markets: Where decisions about health care are made by
consumers and providers
Transactions with private providers occur within diverse, chaotic
health marketplace
Different from food or clothing markets
– Health consumers often not well-informed about health care needs
– Struggle distinguishing between high-quality and low-quality care
Most developing country health systems
include many types of private providers
Private clinicians
Private hospitals
Pharmacies
Village health workers
Informal providers
Social marketing NGOs

Out-of-Pocket Spending makes up more than
half of health spending in many countries
Source: WHO National Health Accounts data for 2006
Public/private mix of child fever/cough care varies
by country
Health Market
Innovations
have potential
to improve
health and
financial
protection for
the poor
Current Situation  Stakeholders
not well linked
Funder
Researcher
Disconnected actors
• Innovations not diffused, not replicated
• Funders unable to find, evaluate programs
for support
Implem
enter
• Policymakers lack information about scale,
scope, and effectiveness of programs
• Implementers do not learn from each
other’s failures and successes
Policy
maker
• Disconnection between vital collaborators
Center for Health Market Innovations
Overview
Accelerate the
diffusion of Health Market
Innovations that lead to better
health and financial
protection for the poor
Vision:
•Improved health status
•Adequate risk protection
•Better consumer satisfaction
CHMI’s Core Functions
FIND AND
DISSEMINATE
INFORMATION ON
INNOVATIVE
PROGRAMS
ANALYZE
HIGH-POTENTIAL
INNOVATIONS
MAKE CONNECTIONS
TO ENCOURAGE
DIFFUSION
Dynamic, Interactive Web platform
Landscaping Approach
1. Exhaustive in-country landscaping by
partner organizations in 20 countries.
2. In-country partners
3. Open database entry via
HealthMarketInnovations.org
Current Countries
1.
2.
3.
4.
5.
6.
India (Access Health)
Nigeria
Pakistan
Philippines
Kenya
East and South African countries
Where does the model belong in the continuum of care?
Care Delivery Value Chain
Monitoring/
preventing
Diagnosing
Preparing
intervening
Recovering/
rehabilitating
Monitoring /
managing
Staying healthy
Maternity & Newborn
care
Care for children
Categ
ories
of
Care
Acute care
Planned care
Mental health
Long-term conditions
Palliative care
|
Is it an Innovative Solution?
Models
Levers
Increase Access
Physical Capacity
Increase number of resources (train more or utilize task shifting)
Optimize use of scarce resources (including use of new channels e.g. telemedicine)
Deploy resources more equitably
Information
Increase awareness of services
Increase awareness of symptoms and importance of early diagnosis
Improve Quality
Financial
Improve ability to pay (subsidies/ risk pooling)
Improved
effectiveness
Prevention
Treatment
Increased safety
Reduce medical errors
Reduce treatment-acquired infections
Reduce prescribing errors
Better patient
experience
More patient -focused /responsive care
More integrative care
More continuous care
Strengthen
financial
sustainability
Reduce unit cost
Increase efficiency of resources
|
Team, Time and Tools
Structure
Accountability
Ongoing
support
Capacity
Plans
Framework
1 Sustained demand
2 Viable operating model
Self-sustaining
business model
▪ Ability/ willingness to pay for proposed
solution (viable revenue model), e.g.
– Small out-of-pocket payment by user
– Private insurance coverage
– Long-term commitment by govt. to
subsidize
▪ Significant market size (to ensure
viability of business model)
of service
– Optimal deployment of medical
talent across configuration
– Standardized clinical protocols
and other patient facing processes
▪ Unmet needs, of individuals or other
users
▪ Efficient delivery architecture
– Optimized configuration of points
Innovative
solutions
• Improved
access
• Low cost
• Quality
care
▪ Good governance and leadership
▪ Viable funding model
▪ Effective talent management –
recruiting, training and development,
incentives/compensation
▪ Cost-efficient sourcing of equipment
and consumables
▪ Ability to generate additional sources
of revenue where possible (e.g.
training, consulting, product sales)
3
Supportive
eco-system
▪ Favorable regulation/policy
▪ Availability of partners and enablers with aligned interests
(suppliers, collaborators, sponsors, insurance companies)
▪ Availability of capital for startup and scaling
|
Sustained Demand
▪ Provide a brief overview of the solution, including the background information on how
0
Overview
1
Demand
the founders got together, what was the catalyst for starting the initiative, key
milestones in the progress etc.
▪ Does the need for the proposed solution exist in the target market?
– If the need exists, how well is it understood?
– What would it take (time and resources) to educate the population of the latent
need?
– Is there a existing solution that meets the need today?
▫ Would users be willing to switch?
▫ Are the switching costs viable?
▪ Is there sufficient willingness to pay for the proposed solution (to ensure viability of
the model)?
▪ Is the solution affordable for the target population? How will they pay for the solution?
e.g.
– Personally (out-of-pocket)
– Employer support
– Through private insurance coverage (individual or employment based)
– Through committed government granted support
▪ What is the size of the target market?
– Geographically
– Demographically
|
Operating Model
2
Operating
model
▪ Delivery architecture
– Where is the solution delivered? How close to the users home can it be delivered?
– Who delivers the solution?
▫ Is it possible to disaggregate tasks and employ and “right-skill” lower-cost staff to
reduce operating costs?
▫ What are typical staff ratios? Are you leveraging any pro-bono work?
▫ Are there contract arrangements for service delivery?
– How is the solution currently delivered?
▫ Are there standardized protocols and processes – clinical and non-clinical?
▫ Can existing infrastructure be used to reduce unit costs? If not, can new
delivery channels/models be created in a time and cost effective way? (ex.
franchising)
▫ Can new/emerging technologies (e.g., mobile phones) be leveraged to increase
delivery efficiency?
▪ Marketing
– What is the product/solution that is being marketed?
– How is the placed in the market vis-à-vis competing products/solutions? Do you
have a branding strategy?
– What are the pricing mechanisms implemented for selling the product/solution?
– What promotion mechanisms have been deployed e.g., advertising, discounts?
▪ Operational excellence
– What are the mechanisms in place to improve quality in operations (e.g., analyzing
operational data, quality improvement projects)?
– What are the processes to monitor and evaluate impact and incorporate learning |
into the solution?
2
Operating
model
(contd.)
▪ Can you provide the overall organization structure (e.g., org chart)? Are there any
specific management innovations contributing to your success?
▪ How established are corporate governance practices?
How experienced and
recognized is the leadership?
▪ What are the innovations in management and supervision, if any?
▪ How is/was the business funded?
– Does the business generate sufficient profits to fund operations?
– If not, what are the sources of capital?
– What is the strategy for non-paying customers?
▪ How is talent managed?
- What is the recruitment process?
- How is the staff trained? By whom? At what frequency?
- How is the staff incentivized/compensated?
▪ How is sourcing of equipment and consumables managed?
– Are high-value assets leased or bought?
– Is there centralized procurement of equipment and consumables to leverage
economies of scale?
|
2
Operating
model
(contd.)
▪ What were the major issues in scaling your solutions to the current levels? What are
your plans for scaling in the future?
▪ What are your plans to scale across regions (e.g., to other countries)?
– Are you interested/willing to partner with other groups in different regions?
– How do you see you role e.g., knowledge transfer, training, consulting, remote
support?
– Have these opportunities been leveraged (e.g., have you helped another company
in replicating your solution)?
|
▪ Are there any regulations/policy affecting the implementation of the idea in the target
3
Ecosystem
market? Is the effect positive? Can they be influenced?
▪ Are there potential partners (local or external) with aligned interests? e.g.
– Private sector companies
– Academic institutes
– NGOs
– Government agencies
▪ Are there skilled healthcare/community workers in the target market that can help
deliver the solution? If not, what would it take to train/up-skill the potential pool of
service providers?
▪ Is there sufficient capital available for startup and scaling?
What are the typical
sources of capital?
– Donor agencies
– Government grants
– Corporate, bank, and/or government loans
– Angel investors
– Venture capital
|
Currently, CHMI contains comparable data
about more than 1200 organizations that
operate in over 100 countries
…or by Program Type
(Organizing delivery,
Financing care..etc.)
Programs can be viewed
by Health Focus:
HIV/AIDS, TB, malaria,
MCH, FP, etc
CHMI Database – by Mechanism
# Programs in CHMI Database
800
700
600
500
400
300
200
100
0
Enhancing
Process
Changing
Behaviour
Financing
Care
Organizing
Delivery
Regulating
Performance
Example of a Program Profile
Other Analytical products
Type of Analysis
Description of Analysis
1. In-depth case studies
In-depth quantitative, qualitative program
descriptions outlining challenges, lessons learned,
enabling replication
2. Disease Specific Briefs
Synthesize findings from database analysis. Ex: TB,
malaria, HIV/AIDS.
3. Comparative Analyses
of Models
Collect comparable information across multiple
programs to compare models and approaches such as
call centers, vouchers for maternal health, and
telemedicine
4. Program Evaluation
Third-party evaluations of impact on health
outcomes, sustainability, etc.
5. Thematic studies
Thematic analysis of mechanisms improving
functioning of health markets. Ex: Informal provider
study underway
6. Development of
metrics to assess
programs
Develop indicators to serve as a guide to assess the
impact of programs and gauge if they are truly
innovative
Key benefits of CHMI -Implementers
• Connect
Needs assessment
feedback to date
– To funders / donors / investment organizations
• Corporate / foundation / philanthropists
– Other experienced implementers to learn or
receive support (eg training)
– Disseminating lessons learned replicate your
model
• Assess
– Where you are in comparison with other
programs
– With CHMI metrics to better position for
funding
– How to replicate successful programs and
measure performance
Shelly Batra,
Operation ASHA
• Raise profile
– Visibility on site, reports, newsletters, blog
Key benefits of CHMI - Funders
“I am looking to identify a
project that is near scale up
has 2-3 successful centers,
and can expand regionally. If
CHMI could shortlist
opportunities for me – I’d be
very interested in that.”
Parag Poonawala
Impact Investment Partners
•
Comparable, easily filterable data on programs of
interest
•
Reduce resources for due diligence work
•
Incentivizing programs to disclose information
publically aids vetting process
•
Display program stage pilot, early and later
stages, or finished
•
Funding opportunities for successful programs
ready for scale up identified
•
Connect donors to implementers running
promising program
Key benefits of CHMI – Researchers
•
Role in helping CHMI increase validity of
data presented
•
Knowledge translation of research to
implementers
•
Reduce distance between research output
and policy implementation
•
Shortlist programs ready for impact
evaluation /other analysis
•
Locate + design studies with implementers
and CHMI partners
•
Connect with other researchers to get
feedback on relevant working papers
“With CHMI we can pull
existing knowledge
together, determine what
reliable information can be
collected, and determine
what are truly best
practices in these areas.”
-Onil Bhattacharyya,
University of Toronto
Implementer-to-Implementer
Connections
•
Communities of practice
–
–
–
–
•
Joint Learning Network
Social franchising
RH Vouchers
Other based on interest
Marketplace for technology
– Telemedicine equip
•
Marketplace for mature programs
– Offer trainings and support for
replication of their model
•
Direct contact through CHMI site
Training of EMTs at EMRI, Andhra
Pradesh
Implementer-to-Funder
Connections
• CHMI badge
Profiled at
• Funder endorsements
• Program alerts tied to funder
interest
• Funder-implementer conferences
For program sites, linked to CHMI
program profile
• Requests for funding from
programs that funders can
respond to/Kiva-like function
• Funder RFP promotion
Implementer-to-Researcher
Connections
• Knowledge translation –
briefs summarizing key
research findings
• Researcher evaluation
marketplace
• Program evaluation fund
• Map widget
Thank you!
www.HealthMarketInnovations.org