CHMI Report 112711 High Links

8/3/2019 CHMI Report 112711 High Links

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HIGHLIGHTS: 201


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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-partners


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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/


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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


5/32CENTER FOR HEALTH MARKET INNOVATIONS5

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.pdf


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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 *



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-amfm



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
http://www.healthmarketinnovations.org/http://www.healthmarketinnovations.org/


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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-myanmar



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



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-scheme



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-asha


15/32



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-telemedicine



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



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/bike4care



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-asha



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/Analysis



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-livewell



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-ssc


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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-2386



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.



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-innovati


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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

[email protected].
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=fd7adc5569



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-unit


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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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