Beyond Scaling Up: Making markets work for the poor

1,049
-1

Published on

This presentation was given at the 'Beyond Scaling Up: Pathways to Universal Access' workshop which was held at the Institute of Development Studies, Brighton on the 24-25 May, 2010. This event was co-sponsored by the Future Health Systems Research Programme Consortium and the STEPS Centre. Gibson presented on the making markets work for the poor approach.

0 Comments
0 Likes
Statistics
Notes
  • Be the first to comment

  • Be the first to like this

No Downloads
Views
Total Views
1,049
On Slideshare
0
From Embeds
0
Number of Embeds
0
Actions
Shares
0
Downloads
50
Comments
0
Likes
0
Embeds 0
No embeds

No notes for slide
  • Point 1 : Interveners often fail to understand elementary aspects of economics and everyday human economic behaviour. The nature of demand and supply of goods and services in differing contexts; the poor as an economic decision-maker (rational or irrational), consumer, and user; how preferences can be constructed and dynamic; the impact of information asymmetries, etc. Point 2 : Delivery mechanism – whether public or private providers are preferred is about our understanding of industry/sector structure, the incentives and capacities of providers (institutions and individuals) and potential providers, what supporting functions and rules of the system are required for effective provision, where we are now, etc. Point 3 : Scaling-up – you agree with the workshop paper’s view that scaling up is about expanding impact, not just ‘becoming larger’ – particularly when we consider the heterogeneity of beneficiaries, rural/urban divides, country and sector histories, etc. Point 4 : Sustainability is not about finding the holy grail – it should be commonplace and is very achievable. The examples I come to later will demonstrate how different analysis at the outset and different approaches to intervening have resulted in long-lasting outcomes and substantial, systemic change.
  • You might find some resistance to the terms “market” – particularly when the theme is universal access.
  • were to extend and rehabilitate the existing infrastructure, and search for an alternative management option as the previous model of public sector management and implementation had not worked
  • Commercial sector activity provides an option to reach more people, quicker, though the conditions that allow for equity and sustainable provision require an additional set of prescriptions and focus. Programmes that have achieved all of the above have better factored into the equation the system around the market for health-related goods. What environment should the core transaction between buyer and seller take place? How can we build the capacities of existing market players (net manufacturers and retailers) without excluding new entrants and competitive pressures? How can such a market be regulated and what needs regulating? Yes, you may have commercially-orientated, private providers, but can their business models be adapted to be pro-poor and still profitable?   Despite some donors being more experimental than others in terms of programme design, it is in actual fact contractual mechanisms that add the level of flexibility to allow implementers to find “what works best.” USAID Cooperative Association Agreements and alike have empowered implementers to have greater room for experimentation in delivery, greater authority to establish partnerships, and work at different levels. Mechanisms that specify outputs and delivery means are finite and have a finite impact. The workshop paper discusses “alternative strategies” for building effective health systems and “pathways towards” universal access to important health-related goods and services. Pluralistic delivery of health goods is a reality that has to be worked with, not against – we have to make sure that the donor-drops that are in full-swing do not undermine the sustainability of the supply-side in the future. It is possible for both to be done in a complementary way and for co-existence.
  • Commercial sector activity provides an option to reach more people, quicker, though the conditions that allow for equity and sustainable provision require an additional set of prescriptions and focus. Programmes that have achieved all of the above have better factored into the equation the system around the market for health-related goods. What environment should the core transaction between buyer and seller take place? How can we build the capacities of existing market players (net manufacturers and retailers) without excluding new entrants and competitive pressures? How can such a market be regulated and what needs regulating? Yes, you may have commercially-orientated, private providers, but can their business models be adapted to be pro-poor and still profitable?   Despite some donors being more experimental than others in terms of programme design, it is in actual fact contractual mechanisms that add the level of flexibility to allow implementers to find “what works best.” USAID Cooperative Association Agreements and alike have empowered implementers to have greater room for experimentation in delivery, greater authority to establish partnerships, and work at different levels. Mechanisms that specify outputs and delivery means are finite and have a finite impact. The workshop paper discusses “alternative strategies” for building effective health systems and “pathways towards” universal access to important health-related goods and services. Pluralistic delivery of health goods is a reality that has to be worked with, not against – we have to make sure that the donor-drops that are in full-swing do not undermine the sustainability of the supply-side in the future. It is possible for both to be done in a complementary way and for co-existence.
  • Commercial sector activity provides an option to reach more people, quicker, though the conditions that allow for equity and sustainable provision require an additional set of prescriptions and focus. Programmes that have achieved all of the above have better factored into the equation the system around the market for health-related goods. What environment should the core transaction between buyer and seller take place? How can we build the capacities of existing market players (net manufacturers and retailers) without excluding new entrants and competitive pressures? How can such a market be regulated and what needs regulating? Yes, you may have commercially-orientated, private providers, but can their business models be adapted to be pro-poor and still profitable?   Despite some donors being more experimental than others in terms of programme design, it is in actual fact contractual mechanisms that add the level of flexibility to allow implementers to find “what works best.” USAID Cooperative Association Agreements and alike have empowered implementers to have greater room for experimentation in delivery, greater authority to establish partnerships, and work at different levels. Mechanisms that specify outputs and delivery means are finite and have a finite impact. The workshop paper discusses “alternative strategies” for building effective health systems and “pathways towards” universal access to important health-related goods and services. Pluralistic delivery of health goods is a reality that has to be worked with, not against – we have to make sure that the donor-drops that are in full-swing do not undermine the sustainability of the supply-side in the future. It is possible for both to be done in a complementary way and for co-existence.
  • Beyond Scaling Up: Making markets work for the poor

    1. 1. Alan Gibson, The Springfield Centre Learning from the ‘Making Markets Work for the Poor’ (M4P) approach
    2. 2. Objectives <ul><li>The M4P approach as a framework to conceptualise “scaling-up” </li></ul><ul><li>Examples of interventions in other sectors where: </li></ul><ul><li>- things have been done ‘differently’ </li></ul><ul><li>- larger, more sustainable impact achieved </li></ul><ul><li>Potential implications for the health sector </li></ul>Springfield Centre | Making markets work
    3. 3. Different sectors …. but familiar issues <ul><li>The poor as consumers </li></ul><ul><li>How to expand access (and not just “more of the same”) </li></ul><ul><li>Impact now and the future (sustainability) </li></ul><ul><li>Need to make systems more effective/inclusive </li></ul><ul><li>Roles of key players - the state, private sector, other etc </li></ul><ul><li>‘ Public goods’, ‘merit goods’ </li></ul>Springfield Centre | Making markets work Health is distinctive….. … .. but there is common ground Finance Agriculture Land Water Services Energy, Commodities Education Etc
    4. 4. Example 1: Financial Services in South Africa Springfield Centre | Making markets work Problem Low access to financial services Approach : set-up and fund organisations to provide directly. Outcome Minimal increase in access Weak organisations Limited sustainability Conventional aid programme Different analysis : causes not symptoms Poor coordination, weak information services, inappropriate ‘rules of the game’ (formal and informal) - undermine incentives and capacities Different actions: introduce new syndicated info service, technical assistance for better regulation and new coordination mechanisms, selected support for innovation Different outcome Access grows by 8m people (38% to 60%) New information service Better regulation New business models/innovation Systems approach
    5. 5. Improving access to financial services in South Africa
    6. 6. What happened? - looking through the systems framework Springfield Centre | Making markets work RULES Laws Informal rules & norms Standards Regulations Informing & communicating Setting & enforcing rules Demand Supply CORE SUPPORTING FUNCTIONS Information Stakeholder Coordination Related services Product Dev’t Conventional focus Intervene to address constraints
    7. 7. What happened? - enhancing the ‘access frontier’ Have now Existing system can reach now Existing system can reach in future Beyond reach of existing system Don’t want it Changing the system – expanding access Usage Time
    8. 8. Example 2: Horticultural information in Bangladesh Springfield Centre | Making markets work Systems approach Problem Output and productivity low among small farmers because they lack access to appropriate information. Different analysis: causes not symptoms Identify - existing info providers, incentives to provide accurate advice, constraints to better advice Different actions : Introduce new training programme provided by input suppliers for agriculture retailers, Build on retailers incentive to offer good advice, work with several suppliers Different outcome : 4,000 retailers - up to 1 million farmers Increased yields on average one-third Crowding-in more suppliers with incentive to grow a Approach : provide information directly or support government extension services Outcome : low coverage limited sustainability Info. constraint not addressed Conventional aid programme
    9. 9. Where to Intervene: Expanding Impact 1,500,000 farmers 500,000 farmers 50,000 farmers 5,000 farmers Prospects for: leverage, scale and sustainability Market 2 Productivity-related information Market 3 Retailer training Market 4 Supply chain dev’t services Market 1 Vegetable farming inputs
    10. 10. Example 3: health worker training in Bangladesh Springfield Centre | Making markets work Systems approach Problem A shortage of qualified health personnel caused by lack of access to appropriate training. Different analysis: causes not symptoms Inappropriate rules on curricula, entry criteria and performance. Different actions : Series of actions to work with private and public players to ‘move’ govt from provision to oversight/regulation. Different outcome : More registered training providers (more access) More standardised quality More acceptance of pluralistic system Approach : set up or fund public or NGO training providers Outcome : low coverage limited sustainability ‘ bifurcated’ training market Conventional aid programme
    11. 11. Other initiatives of interest (without the M4P label) <ul><li>Ultra-low cost private start-up enterprise enters slum area </li></ul><ul><li>Model for expansion aims for 150 schools across Kenya alone </li></ul>Primary education in urban slums Competitive markets for bed-nets <ul><li>Local diagnosis finds local, workable solution </li></ul><ul><li>Donors supported infrastructure rehabilitation; delivery options left open </li></ul><ul><li>New private company established to manage municipal delivery </li></ul>Working together for water <ul><li>New partnerships in the supply chain </li></ul><ul><li>Crowding-in competing actors </li></ul><ul><li>Technology transfer and investment in domestic manufacturing </li></ul>Substantial price drops for ITNs Large retail sale increases High equity levels In-demand and affordable even to slum parents Free schools aren’t free Household connections increase eight-fold Water available 24 hours/day
    12. 12. Learning from other spheres <ul><li>External facilitator – as catalyst for change </li></ul><ul><li>Engaging with different players in system </li></ul><ul><li>Driven by vision of systemic change </li></ul><ul><li>Interventions shaped by analysis of constraints </li></ul><ul><li>Implementation arrangements that allow flexibility </li></ul><ul><li>Key question – ‘what’s wrong with the system’? </li></ul>Springfield Centre | Making markets work Key ‘how to’ points
    13. 13. Implications for health? Springfield Centre | Making markets work Potential advantages <ul><li>Fits reality of pluralistic systems </li></ul><ul><li>- multi-player </li></ul><ul><li>- multi-system </li></ul><ul><li>Approach = analysis + actions (understanding and changing) </li></ul><ul><li>Sustainability and scale </li></ul><ul><li>Acknowledge the general message - not a panacea but applicable in health as any other system </li></ul><ul><li>Opportunities for action? </li></ul><ul><li>- existing programmes through M4P lens </li></ul><ul><li>- new action-research-pilot programmes </li></ul>Challenges
    14. 14. More information? <ul><li>You can access the suite of M4P documents on the SDC website: </li></ul><ul><li>http://www.sdc-employment-income.ch/en/Home/Making_Markets_Work_for_the_Poor/Resources_on_the_M4P_approach </li></ul>Springfield Centre | Making markets work
    1. A particular slide catching your eye?

      Clipping is a handy way to collect important slides you want to go back to later.

    ×