My colleague Rebecka described a scaling up strategy that thus far has focused primarily on the first of these two groups, so I will focus on the next two - the private sector, and communication technologies. The latter is not strictly speaking a &quot;sector&quot;, but the growing use of several communication technologies suggests that it holds great potential to support scaling up of health innovations. The particular innovation that was the subject of Rebecka's presentation - the Standard Days Method - is alo the subject of mine, so I will not spend time describing the innovation per se, although you will see in the second part of my presentation - on communcation technologies - the innovation may undergo significant change.
National Health Programs (NHP) is that services being provided under them are free for all – but underfunded inadequate provisioning of critical inputs like drugs, equipment, and facilities Does not reach all the population 71 percent of the health budget is contributed by the private sector, of which households alone spend 68.8 percent. This is because the government’s health sector policies encourage the growth of the private healthcare sector, especially for curative services, by investing resources in medical education, providing subsidies and tax exemptions, and offering soft loans to set up hospitals.
% who access private sector is even higher in urban areas.
Family planning services and supplies in India are provided primarily through a network of government hospitals and urban family welfare centres in urban areas and Primary Health Centres (PHC) and sub-centres in rural areas. Family planning services are also provided by private hospitals and clinics and nongovernmental organizations (NGO). From time to time, sterilization camps are organized to provide sterilization services. Pills and condoms are also available in pharmacies, and condoms are also available in shops.
Initiative by Abt Associates to get private sector engaged in providing quality reproductive health services to young people. Network members include pharmacies and private doctors.
Merrygold network: Franchising of private clinics Xxx clinics in xx districts Standardization of quality services and products District and block levels with referrals (“Merry Silver” Run by HLL’s Trust with USAID support Plans to include SDM/CycleBeads are under development
6 in 10 people around the world now have a cell phone subscription. Two-thirds of the world’s 4.1 billion cell phone users live in developing countries! SMS represents a way to transmit timely, personalized health messages directly to a person’s cell phone. A cellular industry body Wednesday said it expects India to have some 492 million mobile phone users by the year-end, compared with 392 million at the end of March. TheCellular Operators Association of India – which represents more than a dozen telecommunications companies offering GSM services – expects the industry’s mobile subscriber base to reach close to 900 million by 2012. GSM is short for global system for mobile communications technology, and three of four of India’s 391.76 million users are on this platform http://www.thebestdigital.com/india-to-have-492-million-mobile-phone-user-by-end-2009.html Going by the recent data compiled by industry watchdog Telecom Regulatory Authority of India (TRAI), the growth is being powered with equal fervor by rural areas, once regarded as low-end, low-volume markets with modest purchasing power. http://abcnews.go.com/Technology/wireStory?id=6986939 http://www.tradingmarkets.com/.site/news/Stock%20News/2141955/
There is significant potential to help them avoid unplanned pregnancy and improve their reproductive health by providing them with timely, actionable, personalized Mobile4Good sends text messages to personal cell-phones to inform individuals about opportunities for free exams or treatment. It also provides a question-and-answer service that allows individuals to ask sensitive health questions in private. This has proven especially effective among young people.
CycleTel is an mHealth solution that will pioneer supplying a modern family planning method directly to a user’s mobile phone.
54 participants interviewed: 4 groups of women (n=32) 2 groups of men (n=16) 1 group of couples (n=6) All focus group participants: Were married and between the ages of 18-28 Owned a mobile phone of their own Had a need for family planning
Use of private sector approaches and ICT as a scale-up strategy for family planning:
Use of private sector approaches and ICT as a scale-up strategy for family planning: Focus on India Priya Jha, Katherine Lavoie, Victoria Jennings, Meredith Puleio, Rebecka Lundgren APHA–2009
Presenter’s statementI have no relationships to disclose.
Scaling up requires a multi-sectoral approach• Public sector• NGOs• Private sector (includes social marketing and private sales)• Communication technologies
Private sector is primary source of health care • Free services of national health program inadequate due to underfunding, poor quality and lack of reach • 65% of households report primary source of health care as private sector The main provider of care among private providers is a private doctor or clinic
Private sector is most common source of temporary family planning methods Pill IUD Injectable Condoms (%) (%) (%) (%) Public medical 15.3 45.6 11.2 13.3 sector NGO <1 1.0 <1 <1 Private medical 63.7 51.8 82.7 45.8 sector Other (shop, 20.2 <1 4.7 40.4 spouse, friend, etc.) Source: NFHS-3
What do we mean by private sector?• Private medical sector – includes formal (registered) and informal (unregistered) sector – Private hospital/clinic – Private doctor – OB/GYN, General Practitioner, other – Ayurvedic practitioners / homeopaths – Traditional healers – Pharmacy/drugstore – Dai (traditional birth attendant)• Other private sector – Retail shops, online sales, etc.
CycleBeads: Significant private sector potential• Low cost• Available in large quantities through manufacturer• Visual appeal• Supported by simple explanatory materials• Promising results in other countries
Other experiences worldwide• Private sector nurse midwives in Peru• Pharmacy sales in DR Congo, Rwanda, Mali, Ecuador• Philippines: A growing market – Licensed local distributor – Initiation of marketing through pharmacy chain – Sold by private nurse midwives and NGOs• U.S.A.: Internet and retail sales (Whole Foods, etc.)
Be advised when working with the private sector… Characteristics of Marketing considerations: private medical • Profit potential sector: • Demand • Heterogeneous • Willingness to pay • Variable quality • Potential to affect • Limited regulation condom sales • Sustainability • How to position the concerns after product training • How to market the product
Strategic selection of local CycleBeads manufacturer• Largest contraceptive manufacturer in country• Offer a range of family planning products and other health care products• A “Government of India enterprise” with distribution networks across country• Product lines for free distribution, social marketing, and private sector retail• Internet sales for condoms
Engaging private doctors and medical professional associations• Participate & present at scientific meetings• Train OB/GYNs and medical practitioners at project sites• Involve private doctors and leaders of associations in partners meetings, stakeholder interviews, etc.
Preparing for sales throughAbt Associates’ “Saathiya” Youth-Friendly Network• Trained pharmacists and private doctors• Trained helpline counselors• Developed promotional materials• Conducted willingness-to-pay study• Hosted outreach activities to build awareness and generate demand
Plans are being developed for: • Social franchising through “Merrygold” –branded network of private clinics • Voucher program to obtain family planning products from private clinics • Social marketing pilot project • Advertisements and editorial columns in magazines • Internet sales
Mobile phones• 4.1 billion users worldwide; 2/3 of this in developing countries• Majority of subscribers men and women ages 15-49• 3 billion use SMS• India has fastest growing telecom market in the world – more than 492 million cell phone users by end of 2009
“mHealth”• Limited resources and fragile health systems in many developing countries are not adequate to meet the needs of people for health information.• Uses of SMS technology for health have been successful at reaching people with the information they need. – Information about opportunities for free exams or treatment (e.g., One World’s Mobile4Good in Kenya) – Reminders for people to take medicines at regular intervals (e.g., SIMpill® Medication Adherence System in South Africa and Botswana).
CycleTel™• mHealth solution• Based on the Standard Days Method (SDM)• Woman sends the date of her menses• User receives text messages with fertility status• Additional messages support correct use, info on other RH issues
Proof-of-concept testing: Lucknow, Uttar Pradesh Phase Objectives1) Focus group • Understand phone use patterns discussions • Determine potential interest among target audience • Explore appropriate messaging and preferences for the service2) Cognitive Verify comprehension of messages interviews3) Manual testing • Assess feasibility of use, satisfaction with ~30 couples with service, and correct use • Troubleshoot problems • Determine how to improve the service
Preliminary results: 54 focus group participants• Need and demand for CycleTel exists• Messages should be precise, non-technical• Men interested in receiving messages• People are willing to pay for the service (15-35 rupees/month) “This is an idea that can change your life.” -Male participant
Next steps…• Completion of proof-of-concept testing• Software development• Pilot testing• Scale up within India; replication of process in other countries
Conclusions• Private sector and information technology approaches show potential to maximize diffusion and reach the tipping point quickly. , These approaches should form part of the scale-up plan• Apply the guiding principles of the ExpandNet model during scale up: participatory, systems approach, evidence based, quality, sustainability, and rights-oriented
References• Holtz, C. Global health care: issues and policies. Sudbury, MA: Jones and Bartlett, 2008.• India To Have 492 Million Mobile Phone User By End-2009. 5/17/09 http://www.thebestdigital.com/india-to-have-492-million- mobile-phone-user-by-end-2009.html• International Institute for Population Sciences (IIPS) and Macro International. 2007. National Family Health Survey (NFHS-3), 2005– 06. India: Volume II. Mumbai: IIPS.• Jordans, F. World’s Poor Drive Growth in Global Cell Phone Use. http://abcnews.go.com/Technology/wireStory?id=6986939• Out-of-pocket spending on health care high: Report. http://www.thehindubusinessline.com/2008/12/10/stories/200812 1051490600.htm• Waters H, Hatt L, Peters D. Working with the private sector for child health. Health Policy and Planning 2003; 18(2): 127-137