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8/3/2019 CHMI Report 112711 High Links
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HIGHLIGHTS: 201
8/3/2019 CHMI Report 112711 High Links
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ABOUT THE CENTER FOR HEALTH MARKET INNOVATIONS:
The Center or Health Market Innovations (CHMI) accelerates innovative health initiatives by inorming and connecting
program managers, unders, researchers, and policy makers who strive to create better health markets or the poor. CHMI is
the worlds largest reely accessible web platorm on programs improving the access, quality, and aordability o privately
delivered health care or the poor. Funded by the Bill & Melinda Gates Foundation and the Rockeeller Foundation, CHMI is
a global network o partners coordinated by the Results or Development Institute.
ABOUT THIS REPORT:
This report was compiled by the Center or Health Market Innovations team at the Results or Development Institute with
contributions rom CHMI partners (below). Maria Belenky, Donika Dimovska, Gina Lagomarsino, Trevor Lewis, and Rose
Reis contributed content. The observations highlighted in this report are valid as o September 2011. For more up-to-date
gures, please visit www.HealthMarketInnovations.org.
UCSFs Global Health Group
Results for Development
Institute
BroadReachh e a l t h c a r e
I ns t i t u t e o f Heal t h Pol icy , Management & Research
http://healthmarketinnovations.org/content/chmi-partnershttp://healthmarketinnovations.org/http://healthmarketinnovations.org/http://healthmarketinnovations.org/content/chmi-partners8/3/2019 CHMI Report 112711 High Links
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Dear Colleagues,
In July 2010, we launched the Center or Health Market Innovations (CHMI; www.healthmarketinnovations.org). Today,
with more than 75,000 visitors rom 190 countries, CHMI is the worlds largest reely accessible web platorm on programs
improving the access, quality, and aordability o privately delivered health care or the poor.
This report highlights key observations about innovative, market-based health programs based on CHMIs initial phase o
operation. We hope you will nd this inormation useul in advancing your work.
Our recent progress includes:
Or1000romiinHlhMrkInnoionidnidinmorhn100conri. CHMIs partners in 16
countries identiy programs that are aggregated on our website in an interactive, downloadable Programs Database.
RordRliniiilnchdodicorwhworkin.CHMI is beginning to create an evidence base
to identiy eective programs through our new Reported Results initiative. Programs now report their results in such
areas as quality, cost, and eciency.
Nwinihohlhmrk. Weve identied promising practices and new program models spreading
around the world. CHMI also commissions research about market challenges like drug quality in India and inormal
providerspracticing in Bangladesh, India, and Nigeria.
Nworkokykholdrcrd. More than 300 program managers, unders, researchers, and policy makers
have attended CHMI events in Indonesia, Brazil, Pakistan, the Philippines, and Kenyato discuss innovations in their
countries.
CHMI will continue to identiy and analyze market-based innovations and connect people to acilitate the scale up o
whats working. We invite you to:
Lrnmor onwmrk-drorm. Search our Programs Database to locate health initiatives by
Program Type, Health Focus, Target Population, or Legal Status.Knowoninnoirorm?Adda new program
prole, update a listing, or write about it on the CHMI Blog.
Lknowwhwork.Report results or programs that you manage, und, or study.
Conncwihinnoor. Join CHMI to directly contact people running programs listed in CHMIs database. Have
conversations with the Health Market Innovations community on CHMIs Blog.
Downlodord. The CHMI database is reely available or the public. Use CHMI lters to browse the Programs
Database or a slice o interest, or download the entire databasetoconduct analysis.
We welcome your suggestions and eedback and look orward to sharing uture updates on topics relevant to health
markets in developing countries.
Sincerely,
Gina Lagomarsino
Results or Development Institute (R4D)
On behal o the CHMI Network
http://www.healthmarketinnovations.org/http://healthmarketinnovations.org/about/chmi-partners/analytic-partnershttp://healthmarketinnovations.org/http://healthmarketinnovations.org/programshttp://healthmarketinnovations.org/analysis/reported-results-initiativehttp://healthmarketinnovations.org/programs/browse?sl=environment-chmi_programs%252Cterm_data_tid_features_reported_results-2386http://healthmarketinnovations.org/emerging-health-market-innovationshttp://healthmarketinnovations.org/health-market-studies#drugretailhttp://healthmarketinnovations.org/health-market-studies#informalprovidershttp://healthmarketinnovations.org/health-market-studies#informalprovidershttp://healthmarketinnovations.org/blog/2011/aug/24/dispatch-indonesiahttp://healthmarketinnovations.org/blog/2011/jun/16/what-innovators-brazil-can-learn-flexible-dynamic-indian-subcontinenthttp://healthmarketinnovations.org/blog/2011/may/23/asia-foundation-roundtable-islamabadhttp://healthmarketinnovations.org/blog/2011/jul/14/philippines-institute-development-studies-works-identify-key-health-market-innovatihttp://healthmarketinnovations.org/blog/2011/feb/28/just-back-kenyahttp://healthmarketinnovations.org/programshttp://healthmarketinnovations.org/node/add/program-summary-formhttp://healthmarketinnovations.org/node/add/program-summary-formhttp://healthmarketinnovations.org/node/add/program-change-requesthttp://healthmarketinnovations.org/bloghttp://healthmarketinnovations.org/analysis/reported-results-initiativehttp://healthmarketinnovations.org/user/registerhttp://healthmarketinnovations.org/programshttp://healthmarketinnovations.org/bloghttp://healthmarketinnovations.org/programshttp://healthmarketinnovations.org/programshttp://healthmarketinnovations.org/programs/browse/csv?search=http://healthmarketinnovations.org/programs/browse/csv?search=http://healthmarketinnovations.org/programshttp://healthmarketinnovations.org/programshttp://healthmarketinnovations.org/bloghttp://healthmarketinnovations.org/programshttp://healthmarketinnovations.org/user/registerhttp://healthmarketinnovations.org/analysis/reported-results-initiativehttp://healthmarketinnovations.org/bloghttp://healthmarketinnovations.org/node/add/program-change-requesthttp://healthmarketinnovations.org/node/add/program-summary-formhttp://healthmarketinnovations.org/programshttp://healthmarketinnovations.org/blog/2011/feb/28/just-back-kenyahttp://healthmarketinnovations.org/blog/2011/jul/14/philippines-institute-development-studies-works-identify-key-health-market-innovatihttp://healthmarketinnovations.org/blog/2011/may/23/asia-foundation-roundtable-islamabadhttp://healthmarketinnovations.org/blog/2011/jun/16/what-innovators-brazil-can-learn-flexible-dynamic-indian-subcontinenthttp://healthmarketinnovations.org/blog/2011/aug/24/dispatch-indonesiahttp://healthmarketinnovations.org/health-market-studies#informalprovidershttp://healthmarketinnovations.org/health-market-studies#informalprovidershttp://healthmarketinnovations.org/health-market-studies#drugretailhttp://healthmarketinnovations.org/emerging-health-market-innovationshttp://healthmarketinnovations.org/programs/browse?sl=environment-chmi_programs%252Cterm_data_tid_features_reported_results-2386http://healthmarketinnovations.org/analysis/reported-results-initiativehttp://healthmarketinnovations.org/programshttp://healthmarketinnovations.org/http://healthmarketinnovations.org/about/chmi-partners/analytic-partnershttp://www.healthmarketinnovations.org/8/3/2019 CHMI Report 112711 High Links
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TABLE OF CONTENTS
5MappINgHeaLtHMaRKetINNOvatIONs
7 OveRvIewOfHeaLtHMaRKetINNOvatIONs
10 ObseRvatIONsabOutHeaLtHMaRKets10 Organizing private providers to deliver priority health interventions
12 Giving purchasing power to the poor
14 Using technology to improve access, quality, and eciency o care
18 Funding or innovative programs
20 fIveINNOvatIveMODeLsappeaRINgaROuNDtHewORLD
24buILDINgtHeevIDeNCebaseabOutwHatwORKs
26 CReatINgagLObaLNetwORK26 Personal connections
26 Virtual connections
28 useCHMItOsuppORtYOuRwORK
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Mapping HealtH MarketInnovatIons
The Center or Health Market Innovations (CHMI) was established in 2010 to accelerate innovative
health initiatives around the world by inorming and connecting program managers, unders,
researchers, and policy makers who strive to create better health markets or the poor. CHMIs long-
term aspiration is to improve the access, quality, and aordability o privately delivered health care
or the poor.
CHMI works through a network o in-country partners1 to identiy, document, and promote
the diusion oHlhMrk Innoion. These are promising programs and policies
implemented by governments, non-governmental organizations (NGOs), social entrepreneurs,
or private companiesthat have the potential to improve the way health markets operate or
the poor.
Hlhmrkri. In many countries, most health care expenditures occur through private transactions
even when governments oer ree care at public acilities. In at least 17 countries in Asia and 16 countries in A-
rica, more than halo all health spending is made up o out-o-pocket payments rom consumers.2
thooronrlyonhlhmrk. In most developing countries, the poor rely on private health care provid-
ers or a large portion o their care. In Sub-Saharan Arica and South Asia, they use the private sector just as much as
the rich.
Hlhmrkcncrmnychlln.Patients do not always seek the kind o care that will make them
healthier, and providers do not always act in patients best interests.4 Appropriate care is oten expensive and pushes
people urther into poverty. According to the World Health Organization, each year, 150 million people globally
ace severe nancial hardship, 100 million are orced into poverty, and many orgo or delay care because they lack
nancial resources.3
Hlhmrkcnhrndoimrohlhorhoor.When well-monitored and regulated, health
markets can be a source o creative new approaches with the potential to achieve greater eciencies, improved
quality, and increased access to care or underserved populations.
WHy ocus on IMprovIng HealtH Markets?
http://users/Home/Dropbox/CHMI-FirstYearReport/CHMI-report-112711%20Folder/sh%20HD/Applications/Adobe%20InDesign%20CS5/Adobe%20InDesign%20CS5.app/Contents/Applications/Adobe%20InDesign%20CS5/Adobe%20InDesign%20CS5.app/Contents/Applications/Adobe%20InDesign%20CS5/Adobe%20InDesign%20CS5.app/Contents/MacOS/Users/R4D/AppData/Local/Adobe/InDesign/Version%207.5/en_GB/Caches/InDesign%20ClipboardScrap1.pdfhttp://healthmarketinnovations.org/sites/healthmarketinnovations.org/files/Table_OPP.pnghttp://healthmarketinnovations.org/sites/healthmarketinnovations.org/files/Table_privatebyquintile_2.pnghttp://healthmarketinnovations.org/sites/healthmarketinnovations.org/files/Table_privatebyquintile_2.pnghttp://healthmarketinnovations.org/sites/healthmarketinnovations.org/files/Table_OPP.pnghttp://users/Home/Dropbox/CHMI-FirstYearReport/CHMI-report-112711%20Folder/sh%20HD/Applications/Adobe%20InDesign%20CS5/Adobe%20InDesign%20CS5.app/Contents/Applications/Adobe%20InDesign%20CS5/Adobe%20InDesign%20CS5.app/Contents/Applications/Adobe%20InDesign%20CS5/Adobe%20InDesign%20CS5.app/Contents/MacOS/Users/R4D/AppData/Local/Adobe/InDesign/Version%207.5/en_GB/Caches/InDesign%20ClipboardScrap1.pdf8/3/2019 CHMI Report 112711 High Links
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8/3/2019 CHMI Report 112711 High Links
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Overview of HealtH MarketInnovatIons
The CHMI database contains online proles o more than 1000 programs and policies with the
potential to improve the quality and aordability o privately delivered health care or the poor
in low- and middle-income countries (Figure 2). Each prole provides inormation about the
programs operational design, including health ocus areas, targeted populations, unding sources,
and where available, results to date. Inhr,CHMIrormrolyildmcro-ll
inormiono innoionin hlhmrklolly. With the collection o data over
time, CHMI will continue to identiy, analyze, and report on Health Market Innovations and provide
insights into patterns observed.
prormty:CHMIs rst year o scanning has yielded more than 1000 programs in 107
countries. Most programs organize delivery, change consumer and provider behavior,
or enhance operational processes (Figure 3); some multi-aceted programs do all three.
Programs that leverage inormation technology or health represent more than a quarter o
all documented programs.
Fu 2: cHMI Db oiw (smb 2011)
nmb pfd pm 1015
nmb ci d 107
*Some programs are categorized into more than one program type.
Fu 3: nmb cHMI pm b m *
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Hlhfoc:Health Market Innovations cover a wide array o health areas. Programs ocusing
on general primary care are prevalent among those proled by CHMI in its rst year. Programstargeting HIV/AIDS, amily planning and reproductive health, and maternal and child health
make up about hal o the database. CHMI identied ewer market-based programs ocusing
on inectious diseases such as malaria and tuberculosis, though some large and infuential
initiatives, such as the Aordable Medicines Facility or Malaria (AMFM) have recently launched.7
Chronic disease care, emergency care, eye care, nutrition, dental care, rehabilitative care, and
mental health were also identied as areas o market-based activity in health (Figure 4).
Lls:A little over hal o CHMI-proled programs are operated by private, not-or-prot
organizations, and one out o ve operates as a public-private partnership. Pro-poor, or-prot
health care models represent 10% o the database. Programs in this category are largely service
delivery organizations (e.g., hospital chains and retail pharmacies) and technology-enabled
programs (e.g., telemedicine networks and health hotlines). Government-led initiatives such
as health nancing programs and accreditation policies make up 7% o all proled innovations(Figure 5).
ConryoOrion: CHMI has identied innovation in all regions, particularly in South
Asia and East Arica, with many programs in India and Kenya, refecting high private-sector
activity as well as the presence o CHMI partners.However, a variety o innovative models can
be ound across all countries scanned by CHMI: rom Vietnam to Uganda, rom Pakistan to
Peru, and rom Indonesia to Brazil (Figure 6). An interactive map o all CHMI programs is online
at tinyurl.com/CHMImap.
Fu 4: nmb cHMI-fd m b hh
General Primary Care
HIV/AIDS
Family Planning & Reproductive Health
Maternal & Child Health
General Secondary/Tertiary Care
Tuberculosis
Malaria
Chronic Diseases
Emergency Care
Eye Care
Nutrition
Rehabilitative Care
Mental Health
Dentistry
Other/Not Applicable
264
256
190
181
120
60
59
46
42
37
32
19
15
7
81
http://healthmarketinnovations.org/program/affordable-medicines-facility-malaria-amfmhttp://healthmarketinnovations.org/programs/browse?sl=environment-chmi_programs%252Cterm_data_tid_features_country_ies_of_operation-169&display=views-mode-map&display=defaulthttp://healthmarketinnovations.org/programs/browse?display=default&sl=environment-chmi_programs%252Cterm_data_tid_features_country_ies_of_operation-177http://healthmarketinnovations.org/programs/browse?sl=environment-chmi_programs%252Cterm_data_tid_features_country_ies_of_operation-276&display=views-mode-map&display=defaulthttp://healthmarketinnovations.org/programs/browse?display=default&sl=environment-chmi_programs%252Cterm_data_tid_features_country_ies_of_operation-269&display=defaulthttp://healthmarketinnovations.org/programs/browse?sl=environment-chmi_programs%252Cterm_data_tid_features_country_ies_of_operation-229&display=views-mode-map&display=defaulthttp://healthmarketinnovations.org/programs/browse?sl=environment-chmi_programs%252Cterm_data_tid_features_country_ies_of_operation-226&display=defaulthttp://healthmarketinnovations.org/programs/browse?sl=environment-chmi_programs%252Cterm_data_tid_features_country_ies_of_operation-166&display=views-mode-map&display=defaulthttp://healthmarketinnovations.org/programs/browse?sl=environment-chmi_programs%252Cterm_data_tid_features_country_ies_of_operation-114&display=views-mode-map&display=defaulthttp://healthmarketinnovations.org/programs/browse?search=&display=views-mode-maphttp://healthmarketinnovations.org/programs/browse?search=&display=views-mode-maphttp://healthmarketinnovations.org/programs/browse?sl=environment-chmi_programs%252Cterm_data_tid_features_country_ies_of_operation-114&display=views-mode-map&display=defaulthttp://healthmarketinnovations.org/programs/browse?sl=environment-chmi_programs%252Cterm_data_tid_features_country_ies_of_operation-166&display=views-mode-map&display=defaulthttp://healthmarketinnovations.org/programs/browse?sl=environment-chmi_programs%252Cterm_data_tid_features_country_ies_of_operation-226&display=defaulthttp://healthmarketinnovations.org/programs/browse?sl=environment-chmi_programs%252Cterm_data_tid_features_country_ies_of_operation-229&display=views-mode-map&display=defaulthttp://healthmarketinnovations.org/programs/browse?display=default&sl=environment-chmi_programs%252Cterm_data_tid_features_country_ies_of_operation-269&display=defaulthttp://healthmarketinnovations.org/programs/browse?sl=environment-chmi_programs%252Cterm_data_tid_features_country_ies_of_operation-276&display=views-mode-map&display=defaulthttp://healthmarketinnovations.org/programs/browse?display=default&sl=environment-chmi_programs%252Cterm_data_tid_features_country_ies_of_operation-177http://healthmarketinnovations.org/programs/browse?sl=environment-chmi_programs%252Cterm_data_tid_features_country_ies_of_operation-169&display=views-mode-map&display=defaulthttp://healthmarketinnovations.org/program/affordable-medicines-facility-malaria-amfm8/3/2019 CHMI Report 112711 High Links
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Fu 6: ghi diibi m*
* Numbers and sizes o dots indicate number o programs by country. An interactive version o the map can be ound online at www.healthmarketinnovations.org.
57%
22%
10%
7%
3%
2%
Private (not- for-profit)
Public-private partnership
Private (for-profit)
State/government
Private (unspecified)
Corporate program
Fu 5: p cHMI-fd m b
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socilrnchi.CHMI documents over 60 social ranchises operating in over 30 countries
around the world. Franchising has gained popularity in recent years as an eective mechanism
to organize independent private providers to oer a range o quality health services. Family
planning and reproductive health services are key areas o ocus or most documented
ranchises, but many programs are beginning to expand beyond these two areas, leveraging
their platorms to deliver TB, HIV/AIDS, and malaria interventions. Franchises are also emerging
as a potential service delivery mechanism or the screening and treatment o chronic diseases.
In Myanmar, Sun Quality Health is beginning to oer low-cost cervical cancer screenings and
cryotherapy (the use o cold temperatures to destroy abnormal tissue) through its network oranchised clinics. Similar initiatives are underway in Kenya and Uganda.8
aordlroidrchin.Over 150 programs documented by CHMI are service delivery
chains managing multiple sites that rely on standardized operational processes. The majority
o these programs provide general primary care at rates aordable to the poorAkhuwat
Clinics in Pakistan and Kriti Arogyam Kendram in India are two recently launched examples
o this model. Other chains choose to ocus on low-cost specialized services. Jacaranda Health
in Kenya and LieSpring in India provide sae delivery services. Eye-Q Hospitals in India and
ASEMBIS in Costa Rica oer eye care services while SorridentsandDentista do Bemprovide
dental care in Brazil.
pro-oorhoilndclinic.Close to 90 programs in the CHMI database are standalonehospitals and clinics that aspire to serve the poor. Many o these programs work in the areas
o chronic disease and secondary and tertiary care, but a large number also provide general
primary care and maternal and child health services. Specialized service models such as
Narayana Hrudayalaya Cardiac Hospital in India, the NICE Foundation Institute o Newborn Care
also in India, and the Lumbini Eye Institutein Nepal use standardized operational processes to
allow more patients to receive care while keeping costs low. Some o these institutions pair
the high-volume approach with cross subsidization, directing revenue rom wealthy patients
to cover the cost o care or the poor.
More inormation about innovative delivery models, including retail pharmacy chains, telemedicine
models, aordable primary care models, and health hotlines, is provided on page 20.
pid h id h ih i h nIce di Ii nwb c iHdbd, Idi.
http://healthmarketinnovations.org/program/sun-quality-health-network-myanmarhttp://healthmarketinnovations.org/program/akhuwat-healthhttp://healthmarketinnovations.org/program/akhuwat-healthhttp://healthmarketinnovations.org/program/kriti-arogyam-kendramhttp://healthmarketinnovations.org/program/jacaranda-healthhttp://healthmarketinnovations.org/program/lifespring-hospitals-private-limited-lhplhttp://healthmarketinnovations.org/program/eye-qhttp://healthmarketinnovations.org/program/asembishttp://healthmarketinnovations.org/program/sorridentshttp://healthmarketinnovations.org/program/dentista-do-bem-0http://healthmarketinnovations.org/program/narayana-hrudayalaya-hospital-nhhttp://healthmarketinnovations.org/program/nice-foundationhttp://healthmarketinnovations.org/program/lumbini-eye-institutehttp://healthmarketinnovations.org/program/lumbini-eye-institutehttp://healthmarketinnovations.org/program/nice-foundationhttp://healthmarketinnovations.org/program/narayana-hrudayalaya-hospital-nhhttp://healthmarketinnovations.org/program/dentista-do-bem-0http://healthmarketinnovations.org/program/sorridentshttp://healthmarketinnovations.org/program/asembishttp://healthmarketinnovations.org/program/eye-qhttp://healthmarketinnovations.org/program/lifespring-hospitals-private-limited-lhplhttp://healthmarketinnovations.org/program/jacaranda-healthhttp://healthmarketinnovations.org/program/kriti-arogyam-kendramhttp://healthmarketinnovations.org/program/akhuwat-healthhttp://healthmarketinnovations.org/program/akhuwat-healthhttp://healthmarketinnovations.org/program/sun-quality-health-network-myanmar8/3/2019 CHMI Report 112711 High Links
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g u o o ooApproximately 200 programs in the CHMI database are categorized as finncinCr (Figure 8). Demand-
side nancing programs such asornmnhlhinrnc,riinrnc,microndcommniy
hlh inrnc, and ochr decrease nancial barriers to care by enabling consumers to access
services rom their choice o provider, who is then reimbursed. Other nancing tools include conrcin,
a supply-side intervention that channels government unds directly to selected private providers to expand
their reach, cro-idizion,making care aordable or the poor by channeling unds rom wealthier
patients, and mHlhinprograms that encourage consumers to save or uture health care needs,oten through cell phone payment plans. Figure 8 shows how programs use dierent kinds o nancing tools
to improve access to health services or the poor.
A closer look at ve common types o nancing care programs documented by CHMI provides more insight
into promising initiatives that help poor amilies to pay or care:
Fu 8: p m fi b hh
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gornmnhlhinrnc.CHMI proles 27 national insurance schemes that target the
poor to move toward universal health coverage. While some schemes, such as Ghanas National
Health Insurance Scheme and Indonesias Jamkesmas, oer comprehensive benets, others
such as Indias RSBY scheme, the Philippiness PhilHealth,9 and Kenyas National Hospital
Insurance Fundcover primarily inpatient services, though each o these schemes is now
working to expand to outpatient benets. (The Joint Learning Network or Universal Health
Coveragehas produced case studies on national health insurance reorms being implemented
by low- and middle-income countries.10)
Micro nd commniy hlh inrnc. CHMI documents 53 micro and community
health insurance programs. They are common throughout parts o Sub-Saharan Arica, South
Asia, and Latin America. Though they remain small in scale, schemes such as those oered
by MicroEnsure, which recently expanded into Tanzania, and SKY Microinsurance, operating
in Cambodia since 2007, oten target specic geographic or economically linked communities
like armers cooperatives. Micro health insurance programs may have the potential to
complement or become integrated with national schemes. Twenty-two programs are ro-
oor, ri inrnc chm, allowing employers, various organized groups, and
amilies to purchase health insurance at low rates.
Cro-idizion. Forty-two programs use this popular pro-poor pricing model that
redirects revenue rom wealthy patients to cover those unable to pay. Specialty eye hospitals,such as Aravind and L. V. Prasad Eye Institute in India, oer vision screening and treatment
at tiered rates so that better o patients subsidize the care o lower income patients. Cross-
subsidization is also commonly used to provide access to chronic diseases and in-patient
health services.
vochr. Twenty-nine programs use vouchers to help the poor access reproductive health
and maternal and child-care services. O all CHMI-proled programs nancing reproductive
health services, 75% are vouchers that women can redeem or services like amily planning. O
all nancing programs improving access to maternal and child care, 50% are voucher programs.
While they are still small in scale, the number o CHMI-proled voucher programs launched
ater 2006 is more than double the number o voucher programs started between 2000 and
2006. The Kenya Output-Based Aid Voucher Program or amily planning and reproductive
health services is a well-known example o this model.
gornmnconrcin.CHMI proles 73 programs that contract with private providers.
Contracting is oten used to nance emergency care, particularly in India where state
governments have contracted companies such as Ziqitzaor groups o private providers such
as the Janani Express model in Madhya Pradeshto operate ambulance networks.Contracting
is also oten used to expand the availability o key health interventions such as basic primary
care and maternal and child health services, health areas accounting or hal o all contracting
initiatives. In Bangladesh, the government implements theUrban Primary Health Care Project,
which contracts out primary health care services to non-governmental organizations working
in low-income urban areas.
http://healthmarketinnovations.org/program/ghana-national-health-insurance-schemehttp://healthmarketinnovations.org/program/ghana-national-health-insurance-schemehttp://healthmarketinnovations.org/program/ghana-national-health-insurance-schemehttp://healthmarketinnovations.org/program/jamkesmas-schemehttp://healthmarketinnovations.org/program/rashtriya-swasthya-bima-yojana-rsbyhttp://healthmarketinnovations.org/program/rashtriya-swasthya-bima-yojana-rsbyhttp://healthmarketinnovations.org/program/philhealthhttp://jointlearningnetwork.org/content/national-hospital-insurance-fundhttp://jointlearningnetwork.org/content/national-hospital-insurance-fundhttp://www.jointlearningnetwork.org/http://www.jointlearningnetwork.org/http://www.jointlearningnetwork.org/http://healthmarketinnovations.org/program/microensure-0http://healthmarketinnovations.org/program/sokapheap-krousat-yeugn-sky-micro-health-insurancehttp://healthmarketinnovations.org/program/aravind-eye-care-system-aecshttp://healthmarketinnovations.org/program/l-v-prasad-eye-institute-lvpeihttp://healthmarketinnovations.org/program/national-hospital-insurance-fund-nhifhttp://healthmarketinnovations.org/program/bangladesh-second-urban-primary-health-care-projecthttp://healthmarketinnovations.org/program/bangladesh-second-urban-primary-health-care-projecthttp://healthmarketinnovations.org/program/bangladesh-second-urban-primary-health-care-projecthttp://healthmarketinnovations.org/program/national-hospital-insurance-fund-nhifhttp://healthmarketinnovations.org/program/l-v-prasad-eye-institute-lvpeihttp://healthmarketinnovations.org/program/aravind-eye-care-system-aecshttp://healthmarketinnovations.org/program/sokapheap-krousat-yeugn-sky-micro-health-insurancehttp://healthmarketinnovations.org/program/microensure-0http://www.jointlearningnetwork.org/http://www.jointlearningnetwork.org/http://jointlearningnetwork.org/content/national-hospital-insurance-fundhttp://jointlearningnetwork.org/content/national-hospital-insurance-fundhttp://healthmarketinnovations.org/program/philhealthhttp://healthmarketinnovations.org/program/rashtriya-swasthya-bima-yojana-rsbyhttp://healthmarketinnovations.org/program/rashtriya-swasthya-bima-yojana-rsbyhttp://healthmarketinnovations.org/program/jamkesmas-schemehttp://healthmarketinnovations.org/program/ghana-national-health-insurance-schemehttp://healthmarketinnovations.org/program/ghana-national-health-insurance-scheme8/3/2019 CHMI Report 112711 High Links
14/32CENTER FOR HEALTH MARKET INNOVATIONS4
U oloy o mo , quly, dfy o eHealth, the use o inormation and communication technology or health, has become
increasingly common in recent years. CHMI has identied more than 260 technology-enabled
programs, such as a health insurance scheme whose client interactions are entirely through smart
cards and primary care clinics that use cell phones or patient ollow-ups. CHMI analyzed these 260
programs to better understand the types o technologies most commonly used and the reasons
technology was employed. These programs can be ound worldwide with larger clusters in Southand Southeast Asia and East Arica (Figure 9).
Devices That Programs Use
In recent years, mHealth, the use o mobile technologies or health, has sparked much interest
due to the penetration o cell phones in developing countries. As Figure 10 shows, the cell phone
is the most commonly used device, but programs also use other devices. Operation ASHA uses
ngerprint scanners to help monitor compliance with TB treatment. Comprehensive Medical
Emergency Response Services in Punjab, India, uses GPS to coordinate its ambulances. Changamka
uses smart cards to help pregnant women save or care.
Fu 9: ghi diibi m i h*
* The size o the dots indicates number programs by country. An interactive version o the map can be ound online at www.healthmarketinnovations.org.
http://healthmarketinnovations.org/program/operation-ashahttp://healthmarketinnovations.org/program/comprehensive-medical-emergency-response-services-punjabhttp://healthmarketinnovations.org/program/comprehensive-medical-emergency-response-services-punjabhttp://healthmarketinnovations.org/program/changamka-microhealth-limitedhttp://www.healthmarketinnovations.org/http://www.healthmarketinnovations.org/http://healthmarketinnovations.org/program/changamka-microhealth-limitedhttp://healthmarketinnovations.org/program/comprehensive-medical-emergency-response-services-punjabhttp://healthmarketinnovations.org/program/comprehensive-medical-emergency-response-services-punjabhttp://healthmarketinnovations.org/program/operation-asha8/3/2019 CHMI Report 112711 High Links
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How technology improves program effectiveness
eHealth has garnered much interest rom the global health community in recent years, yet there
has not been a systematic eort to examine why health programs use technology. CHMI identied
six reasons programs choose to use technology (Figure 11). Increasingly, program managers and
policy makers can use technology to improve program eectiveness in these areas.
Many programs extend orhicccocrby connecting remote rural populations
to trained health proessionals in urban areas. OTTET Telemedicine in India enables doctorvisits via video. Medical help lines, such as Healthline in Bangladesh and MeraDoctorin India,
provide phone access to health proessionals (more examples can be ound on p. 23).
Programs such as Cell-PREVEN in Peru, GATHER in Uganda, and Handhelds or Health in India
imro d collcionndmnmn by replacing paper orms with remote data
collection devices and sotware.
WelTel in Kenya and other similar programs use text messages to cili in
commnicion by allowing health proessionals to maintain contact with patients outside
o traditional oce visits.
D-Tree International and others use clinical decision support sotware to imrodinoindrmn o minimally trained health workers.
Programs aiming tomiirdndthrough the use o innovative technologies are
beginning to appear. Initiatives using cell phones to help detect countereit medications, such
as Unique Identication Mobile Verication, Sproxil, and mPedigree, have launched recently.
A handul o programs such as Mamakiba in Kenya, which uses text messaging to help women
save money or health care during pregnancy, rmlinnncilrncion by enabling
payment or care.
a i h phiii Wi a Hh i d. I i hm hcHIts i d m, whih d d i im.
http://healthmarketinnovations.org/program/ottet-telemedicinehttp://healthmarketinnovations.org/program/healthline-bangladeshhttp://healthmarketinnovations.org/program/meradoctorhttp://healthmarketinnovations.org/program/cell-prevenhttp://healthmarketinnovations.org/program/gatherhttp://healthmarketinnovations.org/program/handhelds-for-healthhttp://healthmarketinnovations.org/program/weltel-technology-providerhttp://healthmarketinnovations.org/program/d-tree-international-0http://healthmarketinnovations.org/program/unique-identification-mobile-verification-uimvhttp://healthmarketinnovations.org/program/sproxilhttp://healthmarketinnovations.org/program/mpedigreehttp://healthmarketinnovations.org/program/mamakibahttp://healthmarketinnovations.org/program/mamakibahttp://healthmarketinnovations.org/program/mpedigreehttp://healthmarketinnovations.org/program/sproxilhttp://healthmarketinnovations.org/program/unique-identification-mobile-verification-uimvhttp://healthmarketinnovations.org/program/d-tree-international-0http://healthmarketinnovations.org/program/weltel-technology-providerhttp://healthmarketinnovations.org/program/handhelds-for-healthhttp://healthmarketinnovations.org/program/gatherhttp://healthmarketinnovations.org/program/cell-prevenhttp://healthmarketinnovations.org/program/meradoctorhttp://healthmarketinnovations.org/program/healthline-bangladeshhttp://healthmarketinnovations.org/program/ottet-telemedicine8/3/2019 CHMI Report 112711 High Links
17/32CENTER FOR HEALTH MARKET INNOVATIONS7
Technology is used to prevent raud and abuse. (e.g., using texts and pin codes to veriy a drug is not countereit; using biometricdata to conrm that a health worker has actually visited a patient). Subcategories in CHMIs database include:
Verication o: medical product, patient identity, nancial transactions Tracking human resources or operations
Figure 11: six reao health program ue iformatio techology
2. FACILITATING PATIENT COMMUNICATIONS
Technology is used to acilitate communications between health workers/programs and patients outside o regular visits.Examples include using technology or general health education, texting patients to encourage drug compliance and to ollow upater an appointment. Subcategories in CHMIs database include:
General health education Encouraging patient compliance Protecting patient privacy
4. IMPROVING DIAGNOSIS AND TREATMENT
Technology is used to allow a health worker to improve clinical perormance, during training or in real-time in the eld. Examplesinclude the use o technology to enhance actual training or connect health workers to a clinical decision-support application toassist with patient diagnosis.
5. STREAMLINING FINANCIAL TRANSACTIONS
6. MITIGATING FRAUD AND ABUSE
Technology is used to increase the eciency o nancial transactions, allowing the patient to pay or care more easily and thedoctor to receive payments more easily. Examples include mobile insurance premium payments and phone-based vouchers.
1. EXTENDING GEOGRAPHIC ACCESS
Technology is used to overcome distance between doctor and patient and replaces a traditional visit to the doctor. It includes what
is oten called telemedicine. Examples include videoconerencing with patients in rural areas, automated helplines, and instantmessaging with a health practitioner or medical advice.
3. IMPROVING DATA MANAGEMENT
Technology is used to improve the collection, organization or analysis o data, resulting in increased speed, enhanced transmissiono data, and the enabling o remote collection. Examples include using PDAs to electronically collect inormation about certaindiseases or or tracking patient records. Subcategories in CHMIs database include:
Data collection Data organization and analysis
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Fud o o omO the 667 programs that have reported a primary source o unding (Figure 12), about 50% receive a
inicnorionohirndinromonorohowoorc:ilrldonornci
ndriondion . 34% o all programs are unded primarily by government contracts or
through out-o-pocket payments by patients. The remaining 16% are unded through a mix o
debt and equity investments, membership ees, and in-kind contributions. The large number o
donor-unded programs may indicate their greater visibility, which has made inormation about
them easier to capture during CHMIs rst year o operation. Going orward, CHMI will continue to
ocus eorts on identiying non-donor-dependent and lesser known programs, which may lead
to dierent conclusions about the prevalence o donor unding or health market innovations.
However, CHMIs initial data suggest that a large proportion o health market innovations in almost
all 16 countries where its partners are present are donor-dependent.
Donor are the primary source o unding or 82% o CHMI-proled HIV/AIDS programs,75% o malaria programs, and 72% o TB programs, representing donor priorities around
the prevention, diagnosis, and treatment o high-burden communicable diseases.11 Donor
unding is a less prevalent source o unding or secondary care, including chronic diseases and
specialized services such as eye care. While grants and donations are the main source o unding
or a relatively small portion o emergency care programs, donor unding supports innovative
ambulatory transportation initiatives such as Bike4Care, a bicycle-based system aimed at helping
patients reach health acilities in rural Kenya, and Riders or Health, a program that manages and
maintains the vehicles used in the delivery o health care across Sub-Saharan Arica.
Chronic
Diseases
Family
Planning...
Emergency
Care
HIV/AIDS Malaria Tuberculosis General
Secondary
Care
Eye Care General
Primary
Care
Maternal &
Child Health
100%
90%
80%
70%
60%
50%
40%
30%
20%
10%
0%
Figure 12: peretge o rogrms by rimry soure o udig, b hh
Funding (primary)
Donor
GovernmentIn-kind of contributions
Membership/Subscription fees
Other 3rd party (e.g. debt, equity)
Out-of-pocket payments
Revenue (e.g., interest on loans
contributions
)
FamilyPlanning
andReproductive
Health
Membership/subscription fees
Other 3rd party (e.g., debt, equity)
http://healthmarketinnovations.org/program/bike4carehttp://healthmarketinnovations.org/program/riders-for-healthhttp://healthmarketinnovations.org/program/riders-for-healthhttp://healthmarketinnovations.org/program/riders-for-healthhttp://healthmarketinnovations.org/program/bike4care8/3/2019 CHMI Report 112711 High Links
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Figure 13: peretge o rogrms by rimry udig soure, by outry
Vietnam Uganda Tanzania South
Africa
Phil ippines Kenya Indonesia Ghana Cambodia Brazi l Bol iv ia Bangladesh Peru Ind ia Ecuador Pakistan
100%
90%
80%
70%
60%
50%
40%
30%
20%
10%
0%
Funding (primary)
Donor
GovernmentIn-kind of contributions
Membership/Subscription fees
Other 3rd party (e.g. debt, equity)
Out-of-pocket payments
Revenue (e.g., interest on loans
)
gornmnare a primary source o unding or many CHMI-proled programs ocusing on
emergency care (48%), secondary care (43%), and care or chronic diseases (26%). Although
largely donor-unded, 10% o TB programs receive their primary unding rom government
sources. Operation ASHA, or example, is channeling unds provided by the government o
India to establish local TB treatment centers in slum areas. These subsidies allow patients to
seek care or ree.
O-o-ock ymn are the primary source o revenue or approximately 30% o
programs delivering amily planning and reproductive health services. They are also the
primary unding source or 15% o maternal and child health programs and 25% o primary
care programs. Over 50% o specialty eye care programs receive most o their unding rom
out-o-pocket payments, whereas TB and malaria programs are much less likely to be nanced
by consumer payments.
Dndqiynncinare generally used by programs ocusing on secondary and tertiary
services to support investments in growth, capital equipment, or inormation technology. Capital
nancing is also used in emergency care, general primary care and maternal and child care.
In nearly all countries where CHMI partner organizations operate, donorndinihrimry
orconncinorinicnorionororminmocmorhn50% . Yet
the most common sources o primary unding vary slightly rom country to country (Figure 13).
http://healthmarketinnovations.org/program/operation-ashahttp://healthmarketinnovations.org/program/operation-asha8/3/2019 CHMI Report 112711 High Links
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Five innOvative MODeLsappearIng arounD tHe WorlD
CHMI identies and tracks the development o innovative market-based models in health. A new
model is uncovered when CHMI identies multiple programs in dierent countries with similar
goals, services, organizational structures, and operational processes. Examples o well-known
models include social marketing, social ranchising, and micro insurance, which have existed or
some time and have increased their global scale in recent years. Others, like technology-based
programs oering telemedicine, have more recently begun operating in low- and middle-income
countries.
Below, we prole ve innovative models that have emerged during the past decade, with examples
o specic programs and details on their dates o launch, countries o operation, legal status, and
some indicators o their scale. CHMI will continue to identiy and track the development o these
and other new health market models. More groupings o noteworthy program models are online at
www.healthmarketinnovations.org/Analysis.
1. Low-cost retaiL pharmacies
Low-cost pharmacy chains and ranchise networks improveoperational eciency while keeping prices low. Manyoperate through a or-prot model, generating revenueby adding on low-cost clinical and laboratory services andlowering prices by substituting expensive brands withlow-cost generic drugs.
t Gn p
Launched in 2007 | PhilippinesFor-prot | 1160 outlets
mdpl
Launched in 2006 | IndiaFor-prot | 880 outlets
m F Nnl
Launched in 2003 | MexicoFor-prot | 57 outlets
Generics is a growing pharmacy ranchise providing access to quality and afordablegeneric drugs throughout the Philippines. Drugs are provided on consignment andsourced through a network o domestic manuacturers.
MedPlus is a pharmacy chain operating in ve Indian states. MedPlus has alsolaunched diagnostic lab services to aid in the prevention, detection, or managemento a wide range o illnesses and started clinic services to provide one-stop access tohealth consultation.
Mi Farmacita Nacional is a pharmacy ranchise providing access to generic drugs or common conditions. The ranchise
supplements revenue by selling beauty and hygiene products. Some outlets also ofer medical consultations or $2.
Similar programs: Farmacias Similares in Mexico andBotika ng Bayan in the Philippines.
http://www.healthmarketinnovations.org/Analysishttp://healthmarketinnovations.org/program/the-generics-pharmacyhttp://healthmarketinnovations.org/program/medplushttp://healthmarketinnovations.org/program/mi-farmacita-nacionalhttp://healthmarketinnovations.org/program/farmacias-similareshttp://healthmarketinnovations.org/program/farmacias-similareshttp://healthmarketinnovations.org/program/botika-ng-bayan-bnbhttp://healthmarketinnovations.org/program/botika-ng-bayan-bnbhttp://healthmarketinnovations.org/program/botika-ng-bayan-bnbhttp://healthmarketinnovations.org/program/farmacias-similareshttp://healthmarketinnovations.org/program/mi-farmacita-nacionalhttp://healthmarketinnovations.org/program/medplushttp://healthmarketinnovations.org/program/the-generics-pharmacyhttp://www.healthmarketinnovations.org/Analysis8/3/2019 CHMI Report 112711 High Links
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2. aFForDaBLe primary care cLiNicchaiNs
Chains o afordable primary care clinics expand access toquality care or low-income groups. Many operate in urbanand peri-urban areas, generating revenue rom higherpatient volumes and targeting those able to pay a smallsum or services. A number o or-prot examples o thismodel have launched over the past ew years.
cg Lvwll
Launched in 2008 | KenyaFor-prot | 1 Anchor Clinic, 3 Satellite Clinics
sd 10
Launched in 2010 | BrazilFor-prot
chl
Launched in 2011 | South AricaFor-prot
LiveWell uses a hub-and-spoke primary care clinic model to serve densely populated,low-income areas. The anchor clinic is ully automated to reduce waiting times andprovides consultation, diagnosis, and treatment or a wide range o illnesses, while thesatellite clinics are run by qualied clinical ocers and registered nurses. The satellitesare electronically linked to the anchor clinic or medical reerrals and advice.
Sade 10 is a start-up chain o primary health clinics in Rio de Janeiro that oferlow-cost, high quality medical services. Clinics are located in densely populated areasand are easily accessible through public transportation. Units have our medicaloces designed to serve up to 200 people per day. Services ofered include pediatrics,geriatrics, general practice, gynecology and otorhinolaryngology (ENT).
The ComHealth initiative aims to make high-quality health services accessible and afordable or the people o SouthAricas townships. ComHealth will build and operate acilities (beginning in 2011/2012 in Soweto) that ocus onbasic care. The acilities will include a clinic or primary care, maternity wards, ENT and ophthalmology specialistservices, and theaters or simple procedures that can be done on an outpatient basis or that require less than 24hourshospitalization.
a wom reeivig tiets t liveWes hor ii i nirobi.
Similar programs: Kriti Arogyam Kendram andGlocal Health Care, India,Por Ti, Familia, Peru.
http://healthmarketinnovations.org/program/carego-livewellhttp://healthmarketinnovations.org/program/sa%C3%BAde-10http://healthmarketinnovations.org/program/comhealthhttp://healthmarketinnovations.org/program/kriti-arogyam-kendramhttp://healthmarketinnovations.org/program/glocal-healthcarehttp://healthmarketinnovations.org/program/por-ti-familiahttp://healthmarketinnovations.org/program/por-ti-familiahttp://healthmarketinnovations.org/program/por-ti-familiahttp://healthmarketinnovations.org/program/por-ti-familiahttp://healthmarketinnovations.org/program/glocal-healthcarehttp://healthmarketinnovations.org/program/kriti-arogyam-kendramhttp://healthmarketinnovations.org/program/comhealthhttp://healthmarketinnovations.org/program/sa%C3%BAde-10http://healthmarketinnovations.org/program/carego-livewell8/3/2019 CHMI Report 112711 High Links
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3. Vouchers For heaLth serVices
4. teLemeDiciNe
Vouchersdistributed or ree or sold or a small eeincrease access to key health services, such as amilyplanning and reproductive health, by allowing individualsto purchasea specic package o services rom a networko clinics. The networks oten include both public andprivate acilities.
Technology-enabled networks help increase accessto primary care or the poor by bridging the distancebetween doctors and patients through Internet and othertelecommunication technologies. Some ofer patients videoconsultations with distant doctors, others work to supporthealth proessionals in rural areas through tele-advice,
and yet others ofer chat-based virtual clinic services withround-the-clock access to health inormation.
s sl cd
Launched in 2009 | PakistanPublic-Private Partnership | Vouchers are redeemable in over 100 acilities across twodistricts
wld hl pn
Launched in 2008 | IndiaNon-prot | 1300 shops, 120 telemedicine centers, 9 diagnostic centers, 16
ranchisee clinics
cnjv yjn
Launched in 2005 | IndiaPublic-Private Partnership | 294,635 clients served
e hl pn
Launched in 2009 | IndiaNon-prot | 8 E Health Points
Sehat Sahulat Card, or Health Facilities Card, is a public-private partnership modelbetween the district governments o Kasur and Rawalpindi and Contech International. Itis a voucher scheme that increases accessibility to quality maternal, newborn, and child
health services or expecting mothers rom disadvantaged backgrounds. The servicepackage covers antenatal care, delivery, and postnatal care.
World Health Partners (WHP) uses telemedicine to connect rural patients with little accessto ormal health care to trained doctors based remotely. The our-tiered network includessmall village shops, ranchised telemedicine Skycenters connected to a central medicalacility in Delhi, diagnostic centers, and ranchised clinics or reerrals. Initially launchingin Uttar Pradesh, WHP is replicating the model in Bihar, ocusing on management oinectious diseases like TB and childhood pneumonia.
Chiranjeevi Yojana was created to signicantly reduce maternal and inant mortality byworking with the private sector to provide delivery and emergency obstetric care at nocost to amilies living below the poverty line. Under the scheme, the government contractswith private providers that volunteer to render their services by signing a memorandum ounderstanding with the district government.
E Health Point is a chain o clinics that provide amilies in rural villages with cleandrinking water, medicines, comprehensive diagnostic tools, and advanced tele-medicalservices that bring doctors and modern health care to their communities. Tele-medicalconsultations are assisted by local health workers at the village level. The programconnects patients with licensed medical doctors in the urban telemedicine centeroperated by HealthPoint Services India.
rdv hl
oBd ad pg
Launched in 2005 | KenyaGovernment | 145,333 vouchers used
s F
Launched in 2010 | PakistanFor-prot | 3 centers
The Reproductive Health Output-Based Aid Voucher Program is a perormance-based reproductive healthprogram that incentivizes access to womens health care. The program is currently in its second phase(2009-2012) and is being implemented in rural and peri-urban districts in Kenya, representing a populationo approximately three million. The program works with both private and public sector acilities, allowing orgreater competition and better service coverage.
Sehat First provides access to basic health care and pharmaceutical services in Sindh province throughsel-nancing ranchised tele-health centers. The model consists o a health clinic, pharmacy, multipurposetele-center, and general store, with 80-90% o revenues coming rom the pharmacy and general store. SehatFirst has plans to expand in 2012.
Similar programs: Bangladesh Demand Side Financing Pilot Program, Uganda Reproductive Health Voucher Program,Tanzania National Voucher Scheme.
Similar programs: OncoNETin India,Buddy Works in the Philippines, Markle Telemedicine Clinic in Cambodia.
http://healthmarketinnovations.org/program/sehat-sahulat-card-sschttp://healthmarketinnovations.org/program/world-health-partners-whphttp://healthmarketinnovations.org/program/chiranjeevi-yojana-cyhttp://healthmarketinnovations.org/program/e-health-point-0http://healthmarketinnovations.org/program/kenya-output-based-aid-voucher-programhttp://healthmarketinnovations.org/program/kenya-output-based-aid-voucher-programhttp://healthmarketinnovations.org/program/sehat-firsthttp://healthmarketinnovations.org/program/bangladesh-demand-side-financing-dsf-pilot-programhttp://healthmarketinnovations.org/program/uganda-reproductive-health-voucher-program-rhvphttp://healthmarketinnovations.org/program/tanzania-national-voucher-schemehttp://healthmarketinnovations.org/program/onconet-india-sanjeevani-mobile-telemedicine-unitshttp://healthmarketinnovations.org/program/onconet-india-sanjeevani-mobile-telemedicine-unitshttp://healthmarketinnovations.org/program/buddyworkshttp://healthmarketinnovations.org/program/buddyworkshttp://healthmarketinnovations.org/program/markle-telemedicine-clinic-a-model-for-remote-health-care-in-cambodiahttp://healthmarketinnovations.org/program/markle-telemedicine-clinic-a-model-for-remote-health-care-in-cambodiahttp://healthmarketinnovations.org/program/buddyworkshttp://healthmarketinnovations.org/program/onconet-india-sanjeevani-mobile-telemedicine-unitshttp://healthmarketinnovations.org/program/tanzania-national-voucher-schemehttp://healthmarketinnovations.org/program/uganda-reproductive-health-voucher-program-rhvphttp://healthmarketinnovations.org/program/bangladesh-demand-side-financing-dsf-pilot-programhttp://healthmarketinnovations.org/program/sehat-firsthttp://healthmarketinnovations.org/program/kenya-output-based-aid-voucher-programhttp://healthmarketinnovations.org/program/kenya-output-based-aid-voucher-programhttp://healthmarketinnovations.org/program/e-health-point-0http://healthmarketinnovations.org/program/chiranjeevi-yojana-cyhttp://healthmarketinnovations.org/program/world-health-partners-whphttp://healthmarketinnovations.org/program/sehat-sahulat-card-ssc8/3/2019 CHMI Report 112711 High Links
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bUiLDing the eviDence baseaBout WHat Works
For the past year, CHMI has been documenting health market innovations across the developing
world. The CHMI database currently proles more than 1000 programs rom 107 countries.
While much rich descriptive inormation has been captured, iiloimornondrnd
whichrormrcllyworkinimroinhcc, qliy, ndordiliy
orilydlirdhlhcror hoor. These results are important to national and
global health policy makers, donors, investors, and other program managers wanting to replicate
proven models. Ideally, each CHMI-proled program would have a rigorous third-party evaluation,
including baseline data and/or a control group. However, given the cost o such studies, the reality
is that ew innovative programs are or ever will be evaluated to academic standards.
But this does not mean that no inormation exists about how well programs are working. Many
initiatives track perormance through in-house monitoring. While this type o inormation is
imperect and may be unreliable at times, it is better than no inormation at all. Frequently, these
data are lost in internal documents and grey literature, thus becoming a missed opportunity to
promote the growth o successul programs.
Recognizing these realities, in June 2011, CHMI launched an initiative to collect, record, and publicize
programmatic resultsclear, quantiable, and sel-reported measures o program perormance
across key dimensions. This initiative will inorm longer term activities such as the development
o program perormance metrics and the acilitation o ormal program evaluation. Since June,
more than 80 programs have reported results to CHMI. See Figure 14 or more inormation about
the types o results captured by CHMI and visit the website to participate in the Reported Results
initiative.
c m oi asHa hd d hwi i h b d tB. th m h dd tB d i m i Dhi.
http://healthmarketinnovations.org/programs/browse?sl=environment-chmi_programs%252Cterm_data_tid_features_reported_results-2386http://healthmarketinnovations.org/programs/browse?sl=environment-chmi_programs%252Cterm_data_tid_features_reported_results-23868/3/2019 CHMI Report 112711 High Links
25/32CENTER FOR HEALTH MARKET INNOVATIONS5
Fu 14: ci d i cHMI rd r Iiii
AvAilAbility
UtilizAtion
HeAltH oUtpUt
HeAltH oUtcome
QUAlity
User sAtisfAction
cost
pro-poor tArgeting
efficiency
sUstAinAbility
Evidence of increased availability of services in previously underserved areas.
Evidence of increased use of key health interventions at the population level (e.g., increase in institutional
deliveries).
Quantitative evidence about services provided, including change in service provision over time and
modeled estimates of impact based on number of products sold.
Evidence of impact as demonstrated by improvements in health indicators.
Evidence of improvements in the quality of services to the patient, possibly including improved
adherence to established protocols, increased appropriate diagnoses, and/or decreased issuance of
incorrect prescriptions.
Evidence of good service quality as perceived by the patient.
Evidence of a decrease in the price of products or services to the patient.
Quantitative evidence that (1) a large portion of a programs clients come from lower income brackets
and/or (2) the proportion of poor clients served has increased over a given time period.
Evidence of a decrease in operational cost or time to providers of health care services or improvements in
operational processes leading to the provision of better or less expensive care.
Quantitative evidence of ability to cover costs in the long-term, including a broad donor base or other
secure revenue streams.
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creating a gLObaL netwOrk
CHMI is creating a global network that connects organizations and people working to improve
health marketplaces. Below are highlights o CHMIs eorts to oster greater connections among
program managers, unders, researchers, and policy makers and encourage virtual interactions
through the CHMI web platorm.
Personal connections
CHMIs partner institutions oten host small, ocused interactions in their countries o operation to
promote greater awareness, open discussion, and connections among innovators, policy makers,
and private care providers. In the past year, more than 300 people attended CHMI events around
the world. Highlights include:
eninlicndricoroHlhMrkInnoion.A competition
held in Manila by the Philippine Institute o Development StudiesCHMIs partner in the
Philippinesbrought together government health ocials, academics, HMO representatives,
and program managers to present and review twenty programs considered highly promising
in the Filipino context. Selection criteria included measurable impact, sustainability, use
o appropriate technology, and a demonstrated ability to target the poor. PIDS researcherspresented their ndings at several national and international conerences.
Conncin hoil mnr o imro orionl roc. ACCESS Health
International-India connected doctors, nurses, and quality managers rom eleven Hyderabad
hospitals seeking to improve service delivery. Managers rom L.V. Prasad, Care, and LieSpring
were among those who gathered to learn about ways to improve operations and boost eciency.
exlorin link wn micronnc nd hlh. Ater documenting numerous
micronance institutions providing health services, Freedom rom Hunger is designing a
community o practice or micronance and health, initially in the Andean region and later,
globally. The group will publish a report on its ndings and organize a regional workshop on
the subject in early 2012.
For reports rom other activities in Indonesia, Brazil, Pakistan,
Kenya, and more, visit the CHMI blog.
Virtual connections
To encourage networking that promotes the growth and
adaptation o promising programs and practices, CHMI allows
web visitors to contact program managers through its website.
This unction has produced many virtual interactions. See
Figure 15 or a map showing some o the connections made
globally. prormmnr connected with others running
similar programs to exchange inormation about sustainingrevenue, overcoming technical challenges, and assuring
quality. Inor connected with candidates or unding.
Rrchrconnected with program managers and technical
experts to exchange detailed inormation about input cost and
program design issues.
ri k m, d, dh izi d wih iim m i 2011.
http://healthmarketinnovations.org/blog/2011/jul/14/philippines-institute-development-studies-works-identify-key-health-market-innovatihttp://healthmarketinnovations.org/program/l-v-prasad-eye-institute-lvpeihttp://healthmarketinnovations.org/program/care-hospitalshttp://healthmarketinnovations.org/program/lifespring-hospitals-private-limited-lhplhttp://healthmarketinnovations.org/blog/2011/aug/24/dispatch-indonesiahttp://healthmarketinnovations.org/blog/2011/jun/16/what-innovators-brazil-can-learn-flexible-dynamic-indian-subcontinenthttp://healthmarketinnovations.org/blog/2011/may/23/asia-foundation-roundtable-islamabadhttp://healthmarketinnovations.org/blog/2011/oct/5/kenya-forum-health-innovationshttp://healthmarketinnovations.org/blog/2011/oct/5/kenya-forum-health-innovationshttp://healthmarketinnovations.org/blog/2011/may/23/asia-foundation-roundtable-islamabadhttp://healthmarketinnovations.org/blog/2011/jun/16/what-innovators-brazil-can-learn-flexible-dynamic-indian-subcontinenthttp://healthmarketinnovations.org/blog/2011/aug/24/dispatch-indonesiahttp://healthmarketinnovations.org/program/lifespring-hospitals-private-limited-lhplhttp://healthmarketinnovations.org/program/care-hospitalshttp://healthmarketinnovations.org/program/l-v-prasad-eye-institute-lvpeihttp://healthmarketinnovations.org/blog/2011/jul/14/philippines-institute-development-studies-works-identify-key-health-market-innovati8/3/2019 CHMI Report 112711 High Links
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Use chMi to support your Work
CHMI can support your work, andyou can contribute to make this resource even more useul:
sy ono o CHMI nw. Sign up or CHMIs newsletter to receive the latest updates
rom the CHMI network, including program developments, analyses, and upcoming events.
Read CHMIs active blog, eaturing commentary rom CHMI partners, program managers,researchers, and others in the global health community.
Lrn mor o mrk-d rorm. Search in Programs to locate innovative
health initiatives in your area o interest (Figure 16). Case studies, produced by CHMI partner
organizations, oer a deeper look at the structure, activities, and impact o proled Health
Market Innovations, and explore program successes, challenges, and lessons learned. Know
about an innovative program? Add a new program prole, update an existing listing, or write
about it on the CHMI Blog.
Lknowwhwork.CHMI is collecting Reported Results to create a preliminary evidence
base about what works and encourage programs to track and share their perormance. Report
results or programs that you manage, und, or study.
Chckonmrklcdi. CHMI commissions thematic studies to take a deeper look
at health markets. Two studies o health marketplace challenges are currently underway: 1) A
study on the dynamics o the inormal provision o care in Bangladesh, India, and Nigeria and
2) an evaluation o the eect o MedPlus, a new high-quality chain pharmacy, on drug quality
in the broader health marketplace in Andhra Pradesh, India.
Conncwih innoor. Join CHMI to directly contact people running programs listed
in CHMIs database. Have conversations with the Health Market Innovations community on
CHMIs Blog.
Downlodhd.The CHMI database o more than 1000 programs can be downloaded
or ree. Browse in Programs or a topic o interestlike or-prot primary care enterprisesor emergency helplines operated under government contractsor download the entire
Programs database. Data can be combined with additional variables, adapted or modied,
with citations. See box at right or an example o how researchers have used CHMI.
Tell us how CHMI can better support your work. CHMI strives to provide relevant, timely, and
useul inormation to the Health Market Innovation community. We welcome eedback on the
content o this report, the CHMI website, or the initiative more broadly. Please send comments to
chmi@resultsordevelopment.org.
http://resultsfordevelopment.us1.list-manage.com/subscribe?u=6c3212a6ca42b75aaead60ceb&id=fd7adc5569http://healthmarketinnovations.org/bloghttp://healthmarketinnovations.org/programshttp://healthmarketinnovations.org/program-case-studieshttp://healthmarketinnovations.org/node/add/program-summary-formhttp://healthmarketinnovations.org/node/add/program-change-requesthttp://healthmarketinnovations.org/bloghttp://healthmarketinnovations.org/analysis/reported-results-initiativehttp://healthmarketinnovations.org/analysis/reported-results-initiativehttp://healthmarketinnovations.org/health-market-studieshttp://healthmarketinnovations.org/user/registerhttp://healthmarketinnovations.org/programshttp://healthmarketinnovations.org/bloghttp://healthmarketinnovations.org/programshttp://healthmarketinnovations.org/programs/browse/csv?search=http://healthmarketinnovations.org/programs/browse/csv?search=http://healthmarketinnovations.org/programs/browse/csv?search=http://healthmarketinnovations.org/programs/browse/csv?search=http://healthmarketinnovations.org/programshttp://healthmarketinnovations.org/bloghttp://healthmarketinnovations.org/programshttp://healthmarketinnovations.org/user/registerhttp://healthmarketinnovations.org/health-market-studieshttp://healthmarketinnovations.org/analysis/reported-results-initiativehttp://healthmarketinnovations.org/analysis/reported-results-initiativehttp://healthmarketinnovations.org/bloghttp://healthmarketinnovations.org/node/add/program-change-requesthttp://healthmarketinnovations.org/node/add/program-summary-formhttp://healthmarketinnovations.org/program-case-studieshttp://healthmarketinnovations.org/programshttp://healthmarketinnovations.org/bloghttp://resultsfordevelopment.us1.list-manage.com/subscribe?u=6c3212a6ca42b75aaead60ceb&id=fd7adc55698/3/2019 CHMI Report 112711 High Links
29/32CENTER FOR HEALTH MARKET INNOVATIONS9
Fu 16: cHMI m h i
prorminloliiiliyndoorniioxnd:The CHMI website is one o the [reasons why]
we are known outside India, said Rajeev Kumar o the health technology company Neurosynaptic. We have been
receiving inquiries rom hospitals and individuals outside India to know more about the ReMeDi telemedicine kit,
the Bangalore-based business leader continued. Because o CHMI, Kumars company was eatured in the BBC Horizon
program on innovations.
fndridniyromiininmncndid:Impact Investment Partners, o Mumbai, used CHMIs database
to idniyndconcromiinro-oor,or-rohlhrormorininIndi . CHMI helps educate
everyone on what is happening in the sector and can help industry participants identiy channel partners, said Amit
Sharma.
Rrchrccrdonmrk-dhlhrorm:Onil Bhattacharyya, a researcher at theUniversity o Toronto, used CHMIs database to identiy the percentage orormmrinimcincori
likin,cincy,o,ndocom. In a presentation at the 2011 International Health Economics As-
sociation (iHEA) meeting, Bhattacharyya noted the diculty o assessing programmatic perormance without strategic
indicators. (See page 24 to learn how CHMI is tracking results.)
policymkrxchnidohoworwrdhricor:In Islamabad, a roundtable organized
by CHMIs Pakistan-based partner, the Asia Foundation, provided a unique opportunity or government and private sector
practitioners to meet and discuss policy issues. The orum served as a neutral platorm to rankly discuss issues such as ri-
hlhrlionndmrk-ldinnoion , which are being debated by at least two provincial governments.
HoW people are usIng cHMI
http://healthmarketinnovations.org/program/remedi-%E2%80%93-mdau-multi-parameter-data-acquisition-unithttp://www.horizonsbusiness.com/#playlisthttp://www.horizonsbusiness.com/#playlisthttp://www.horizonsbusiness.com/#playlisthttp://www.horizonsbusiness.com/#playlisthttp://healthmarketinnovations.org/program/remedi-%E2%80%93-mdau-multi-parameter-data-acquisition-unit8/3/2019 CHMI Report 112711 High Links
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1. CHMI partners operate in the ollowing countries:
Bangladesh, Bolivia, Brazil, Cambodia, Ecuador, India,
Indonesia, Kenya, Pakistan, Peru, the Philippines, Rwanda, South
Arica, Tanzania, Uganda, and Vietnam. See list at let.
2. WHO National Health Accounts data or 2006.
3. Van Doorslaer E., et al. (2006). Eect o payments or health
care on poverty estimates in 11 countries in Asia: an analysis o
household survey data. Lancet, 368:1357-1364.
4. Goodman C, Kachur SP, Abdulla S, Bloland P, Mills A. (2007).
Drug shop regulation and malaria treatment in Tanzaniawhy
do shops break the rules, and does it matter? Health Policy Plan,
22:393403.
5. CHMI does not document private practices o individual
providers, instead proling organizations that make health
care delivery less ragmented. For an explanation o the kinds
o programs included in and excluded rom CHMIs Programs
Database, visit www.HealthMarketInnovations.org/about
6. CHMI strives to collect inormation about innovative programs in
all low- and middle-income countries. In practice, the database
contains more comprehensive inormation or countries in
which CHMI partners operate. See all at www.tinyurl.com/
CHMIpartners.
7. Currently, CHMI statistics are primarily based on numbers
o programs.This measurement is imperect because some
programs are small and others are large. CHMI aims to collect
more data on scale in the coming years.
8. More inormation about social ranchising can be ound on
s4health.org.
9. PhilHealth beneciaries have access to a package o services
that include inpatient care, catastrophic coverage, ambulatory
surgeries, deliveries, and outpatient treatment or malaria and
tuberculosis. Those identied as indigent and Overseas Filipino
Workers are also entitled to outpatient primary care.
10. The Joint Learning Network or Universal Health Coverage is
a network o low- and middle-income countries in the midst
o demand-side health nancing reorms aimed at achieving
universal health coverage. The JLN is ocused on linking
practitioners and policy makers to help disseminate best practices
and provide targeted assistance in specic technical areas. More
inormation is available at jointlearningnetwork.org.
11. Percentages in this section correspond to the number o programs
reporting a particular source o unding as their primary source
rather than percentages o overall revenues coming rom that
source.
COVER PHOTO: A young mother at the Nice Foundations Institute or
Newborn Care, taken by Andr J.P. Fathome or CHMI.
Page 11 and 24: Photos by Andr J.P. Fathome or CHMI.
Page 15 and 16: Photo by Nacho Hernandez or CHMI.
Page 20: Photo by Ida Marie Pantig/PIDS or CHMI.
Page 21 (top let): Advertisment or Sade 10, courtesy o program.
Page 21 (bottom): Photo by Chris Whiteman or CHMI.
Page 22 (top let), 23 (bottom): Photos by Richard Lord, used courtesy
o the Population Council.
Page 23: Photo rom MeraDoctor.co.
Page 26: Photo by Alex Kamweru or CHMI.
Page 27: Map design by Gizelle Gutierrez or CHMI.
END NOTES PHOTO CREDITS
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Washington, DC 20005
chmi@resultsfordevelopment.org
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