Innovations In Privately Delivered MNCH Care: Exploring The Evidence Behind Emerging Practices
This analysis is excerpted froma research brief produced by the T-HOPE Group at the University of Toronto in partnership with CHMI.
Organizations are using innovative delivery and financing approaches to improve access to quality healthcare for mothers and children – through private sector mechanisms. Of the 45 million home births that occur annually, the majority are conducted by private sector attendants and family members. Private sector providers are frequently consulted for child illnesses in these countries. And the private sector plays a key role in family planning, abortion services, nutrition, and antenatal care – all of which are integral components of integrated service delivery for mothers and children.
The private sector—comprised of NGOs, hospitals, individual physicians, community health workers (CHWs), traditional birth attendants, village healers, and many other formal and informal entities—has emerged as a source of new and innovative approaches to the delivery of maternal and child health services in many LMICs.
The Center for Health Market Innovations (CHMI) has documented over 200 such approaches, ranging from vouchers improving access to basic health services, to chains of clinics that provide low-income mothers with affordably-priced services such as pre-natal care, deliveries, and newborn care. Many of these programs provide integrated services – 68% of CHMI’s MNCH programs are also documented as providing health services in other areas.
What We Know About Better-Studied Market-Based Models
Among the emerging practices CHMI identified around the world were:
Social franchising to organize providers and improve MNCH care for the poor
• Several CHMI-profiled programs, such as Mahila Swastha Sewa and BlueStar Ethiopia, are using social franchise models to provide independent providers with access to franchise branding, training, certain drugs, and other membership benefits. These benefits are contingent on meeting the delivery of quality of care. In a review of 52 social franchises, the Global Health Group found that almost half offered MNCH services – nearly double the number over a four-year period.
• In Pakistan, the social franchise model Greenstar Social Marketing has been found to serve 50% more poor clients than in government facilities, at a higher quality than other private facilities in the country.
Health microinsurance to provide financial protection and access to priority MNCH services
• While microinsurance typically covers a small proportion of the population,22 it is growing rapidly, with potential for expanded access to priority interventions, particularly in West and Central Africa.23 Many of these schemes cover routine maternal care, and a small but growing number cover emergency obstetric care.24
• Hygeia Community Health Plan offers micro-health insurance in Lagos and Kwara State, Nigeria, including 40,000 female members of local market associations. The program reports that the microinsurance plan has resulted in decreased costs for the poor in its target market.
Voucher schemes to Increase financial access to safe MNCH care
• MNCH voucher programs typically target poor women and often cover services such as deliveries, antenatal and postnatal care, child immunizations, and nutrition services.
•Chiranjeevi Yojana is focused on provision of delivery and emergency obstetric care at no cost to families living below the poverty line in India. Evaluators of the CHMI-profiled program estimated that its voucher program in India saved women an average of $75 in out-of-pocket expenditures.
Service delivery chains to provide high quality, low-cost MNCH delivery models
• Service delivery chains can provide high quality, low-cost care in MNCH. To keep prices low, this business model creates economies of scale by generating demand through offering respectful, responsive, and affordable care, and engaging in efficient organizational processes.
• In India, LifeSpring Hospitals Private Limited operates 12 hospitals in its service delivery chain, providing core MNCH services to lower-income women and children.
Mobile phones to connect health workers to skilled providers for MNCH care
• mHealth platforms, such as mobile phones and internet applications can improve the capacity of lesser-trained health workers working in MNCH care by connecting them with better-trained medical staff. This can increase the capacity of less-trained health workers, such as midwives, and reduce response times.
• The mHealth platform, Childcount+, supports community health workers delivering MNCH services across ten Sub-Saharan African countries.
Which of these approaches is demonstrating evidence?
Providing quality MNCH services is an ongoing challenge, reflected in the stubbornly high rate of maternal mortality seen in LMICs – even those that have successfully achieved other MDG targets. The effectiveness of these approaches is dependent on the ability of the supply side to provide adequate health workers, quality services, and other key resources to provide necessary MNCH services. The private sector is implementing a wide range of new practices, from vouchers improving access to basic health services, to mobile phones connecting community health volunteers to skilled health practitioners in delivering care. Programs are also increasingly taking an integrated approach to service delivery for mothers and children, recognizing the need to address the continuum of care for RMNCH.
CHMI will continue to monitor, document and report on new information as it emerges, while identifying critical evidence gaps for setting MNCH research priorities. Going forward, CHMI will continue working with its partner organizations on the ground to identify more innovative health programs; and with research institutions to explore the evidence around such models. In doing so, CHMI hopes to showcase which health programs have the greatest potential to improve how private markets work for the poor.