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 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

 Pharmacies Social marketing NGOs Private clinicians Private hospitals Village health workersInformal providers Most developing country health systems include many types of private providers

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 Implem enter Policy maker Researcher Disconnected actors Innovations not diffused, not replicated Funders unable to find, evaluate programs for support Policymakers lack information about scale, scope, and effectiveness of programs Implementers do not learn from each other’s failures and successes 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 F IND AND D ISSEMINATE I NFORMATION ON I NNOVATIVE P ROGRAMS A NALYZE H IGH -P OTENTIAL I NNOVATIONS A NALYZE H IGH -P OTENTIAL I NNOVATIONS M AKE C ONNECTIONS T O E NCOURAGE D IFFUSION Dynamic, Interactive Web platform

Current Countries 1.India (Access Health) 2.Nigeria 3.Pakistan 4.Philippines 5.Kenya 6.East and South African countries Landscaping Approach 1.Exhaustive in-country landscaping by partner organizations in 20 countries. 2.In-country partners 3.Open database entry via HealthMarketInnovations.org 1.Exhaustive in-country landscaping by partner organizations in 20 countries. 2.In-country partners 3.Open database entry via HealthMarketInnovations.org

| Where does the model belong in the continuum of care? Care Delivery Value Chain Monitoring/ preventingDiagnosing Preparing intervening Recovering/ rehabilitating Monitoring / managing Categ ories of Care Staying healthy Maternity & Newborn care Care for children Acute care Planned care Mental health Long-term conditions Palliative care

| Is it an Innovative Solution? Models Levers Increase AccessPhysical CapacityIncrease 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 InformationIncrease awareness of services Increase awareness of symptoms and importance of early diagnosis FinancialImprove ability to pay (subsidies/ risk pooling) Improve Quality Improved effectivenessPrevention Treatment Increased safetyReduce medical errors Reduce treatment-acquired infections Reduce prescribing errors Better patient experienceMore patient -focused /responsive care More integrative care More continuous care Strengthen financial sustainability Reduce unit cost Increase efficiency of resources

Team, Time and Tools

| Framework Sustained demand ▪ Unmet needs, of individuals or other users ▪ 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) ▪ Efficient delivery architecture – Optimized configuration of points of service – Optimal deployment of medical talent across configuration – Standardized clinical protocols and other patient facing processes ▪ 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) Supportive eco-system Viable operating model 3 ▪ Favorable regulation/policy ▪ Availability of partners and enablers with aligned interests (suppliers, collaborators, sponsors, insurance companies) ▪ Availability of capital for startup and scaling 12 Innovative solutions Improved access Low cost Quality care Self-sustaining business model

| Sustained Demand Demand ▪ 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 1 Overview 0 ▪ Provide a brief overview of the solution, including the background information on how the founders got together, what was the catalyst for starting the initiative, key milestones in the progress etc.

| Operating Model 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)? 2

| Ecosystem ▪ Are there any regulations/policy affecting the implementation of the idea in the target 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 3

…or by Program Type (Organizing delivery, Financing care..etc.) Programs can be viewed by Health Focus: HIV/AIDS, TB, malaria, MCH, FP, etc Currently, CHMI contains comparable data about more than 1200 organizations that operate in over 100 countries

CHMI Database – by Mechanism

Example of a Program Profile

Other Analytical products Type of AnalysisDescription 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 – 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 Raise profile – Visibility on site, reports, newsletters, blog Needs assessment feedback to date Shelly Batra, Operation ASHA

Key benefits of CHMI - Funders 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 “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

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 Funder endorsements Program alerts tied to funder interest Funder-implementer conferences Requests for funding from programs that funders can respond to/Kiva-like function Funder RFP promotion For program sites, linked to CHMI program profile

Implementer-to-Researcher Connections Knowledge translation – briefs summarizing key research findings Researcher evaluation marketplace Program evaluation fund Map widget

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