Health Franchising: Strengthening India’s Village-Level Private Providers
India is often portrayed as a rising “economic tiger,” yet many of India’s one billion+ inhabitants still live on the margin; approximately 30% live below the poverty line[i], and 70% live in rural areas[ii]. Communities in these remote, rural areas lack access to basic health care, and despite the existence of pro-poor government-mandated schemes the doctor to patient ratio is an abysmal 1:2,000[iii].
Filling this enormous gap are millions of informal providers operating in a highly fragmented private sector. Experience and training levels vary – from a local pharmacist to a young woman who worked at a hospital in a near-by town and returned to her village to set up shop. While they lack basic medical equipment and formal training, these men and women have strong social ties to their communities, and serve as the primary, and often the only, health care providers for the majority of India’s rural population. There are 30,000 doctors in India who provide services through the public sector[iv], versus the 450,000 doctors[v], 1.25 million rural medical practitioners[vi] and 12 million+ small chemists[vii] operating in the private sector. Today, approximately 80% of outpatient department cases in India are accounted for by the private sector.[viii]
To leverage this widely available village-level resource, World Health Partners (WHP) combines an effective commercial sector approach - franchising - to empower and motivate these existing private health workers to deliver higher quality care to their patients. We use low cost communication technologies and remote diagnostics to turn these providers into life-saving connectors between the high quality care available in India’s urban areas and the 70% still residing in rural communities where no care is available.
To join WHP’s social franchise network, branded “Sky,” providers must pay up to $2,000 – these fees cover the cost of telemedicine-related technologies and updating their clinics to meet WHP-set quality standards. This level of investment means these providers now have “skin” in the game. And membership also brings benefits: a link to our qualified doctors in Delhi via telemedicine; access to WHP’s last-mile supply chain, stocked with our own branded generic medicines (SkyMeds) to ensure immediate availability of affordable high quality drugs for the patient; as well as training, marketing and branding support.
In exchange for these benefits, WHP requires all members meet certain quality standards. We also mandate provision of preventive services, such as family planning and antenatal care. These services are simply not lucrative enough from the business perspective, yet critical to affect positive health outcomes in the long term.
All services are fee-based: Providers pay for membership and patients pay for products and services at a fee determined by our providers. Providers also earn profits on the medicines they sell. These same network providers service the very poor (those living below the poverty line) with help from donor and government subsidies.
All of this is done at scale, with a focus on sustainability. Reaching large numbers of poor, underserved communities is our highest priority. It is through high volume, wide range and critical mass that we are able to reduce the cost to our clients. To date, WHP operates in two North Indian states with over 5,000 Sky providers serving a population of over 25 million, and will soon replicate the model in East Africa.
Ultimately, organizations like WHP shouldn’t exist. But while governments work on strengthening public health care systems, a market-based approach in regions where the private sector already provides the majority of care makes for an effective supplement to the public sector. This approach allows us to bring care to the people who need it most, now.
[i] Planning Commission. Government of India. via bbc.com http://www.bbc.co.uk/news/world-asia-india-17455646.
[iii] Press Information Bureau. Government of India. http://pib.nic.in/newsite/erelease.aspx?relid=77859
[iv] Amarjeet Sinha, former head of National Rural Health Mission. (The total number of doctors in the public sector is approximately 85,000, but majority are in administrative or research positions)
[v] Presented to Indian Parliament by the Ministry of Health.
[vi] Estimated by Dr. Jon Rohde, former head of UNICEF in India.
This blog is part of a series highlighting unique perspectives from SOCAP 2013. SOCAP is a world-renowned conference series dedicated to increasing the flow of capital toward social good. SOCAP 2013 took place in San Francisco Sept 3rd - 6th. The Series is curated by Pauline Zalkin, Senior Advisor, Strategic Partnerships, Business Fights Poverty.