Health Franchising: World Health Partners’ strategy to strengthen India’s village-level private providers
India is often portrayed as a rising “economic tiger,” yet many of India’s 1 billion-plus inhabitants still live on the margin; approximately 30 perecent live below the poverty line (i) and 70 percent 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 nearby 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-plus small chemists (vii) operating in the private sector. Today, approximately 80 percent 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 lifesaving connectors between the high-quality care available in India’s urban areas and the 70 percent 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.
(Left: TheSkyHealth Clinic in Uttar Pradesh, India).
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 more than 5,000 Sky providers serving a population of more than 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.
Jacqueline Kingfield is a project manager in the U.S.-based World Health Partners team where her work focuses on strategic management and operations.
(i) Planning Commission. Government of India. via bbc.com http://www.bbc.co.uk/news/world-asia-india-17455646.
(ii) 2011 Indian Census. Government of India. http://censusindia.gov.in/
(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 the 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.
(vii) Presentation by TechnoPak. http://www.technopak.com/
(viii) NSS (2004-05). Ministry of Statistics and Programme Implementation. Government of India. http://mospi.nic.in.
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