1. The Bangladesh Smiling Sun Franchise Program Sustainability as Program Objective

2. Definition of Sustainability Sustainability is understood as the systemic capacity of an organization to consistently respond to societal demands while generating resources that cover structural needs and planned development. Sustainability is understood as the managerial capacity of an entity to consistently deliver needed and demanded quality healthcare services while directly or indirectly generating sufficient revenues to cover overall operating and management expenses.

3. The Sustainability Cycle Understanding evolving needs Distinctive Competencies Competitive advantage Entrepreneurial invention Resources Results BUSINESS MODEL Adapted from Van Der Heijden, Kees; Scenarios: The Art of Strategic Conversations, John Wiley and Sons, 2005, West Sussex, England

4. Smiling Sun - the challenge: Double bottom line – Expand access to quality affordable health services – Increase the number and proportion of poor people served – Attain high levels of cost recovery

5. Enabling Exogenous Factors Large populations. High numbers, high density. Custom of paying for health services. Majority of health services in Bangladesh are paid OOP Sophisticated market –GOB contracting out –Third party payers (Companies, Insurance Schemes) Societal changes –Growing middle class –Urbanization –IT use on the rise Donor’s interest

6. Enabling Endogenous Factors Sunk investment. USAID had invested for years in establishing a clinic network Diversified service structure. SSFP provides FP, child and maternal health services, diagnostic and LCC. Installed capacity available Brand equity

7. Sustainability: Areas of Attention – Invest in relevant market differentiation – Develop ecosystem – Redefine relationships with clients More service options for existing clients Expand client base (regular, corporate, government) Develop new products – Address financials Cost management Pricing

8. Client Centered Quality of Care Methodologies & Tools Management Systems Improvement & Development Brand Equity Enhancement & Services Promotion Continuous Capacity Building Clinic Physical Enhancement Higher value perception Client loyalty developed Increased client traffic Increased clinic income Conversion Elements Sustainability Determinants Conversion Process: Preparing for Sustainability

9. Lessons Learned Challenges – Culture matters – Business as usual, – “Donor dependence” – Clients in the center – Mind the timeframe – Align agendas of different stakeholders – Effort to promote new models

10. Lessons Learned What works – It is important to have a common (well understood) objective – Clients and providers like good quality – People pay… really – If you offer, they will come (integration works, new services and more) – Partnership with government