By: Rachel Neill and Cynthia Charchi
From 2015-2016, CHMI, in partnership with ACCESS Health International and the Africa Capacity Alliance, developed and managed Learn and Launch, a learning initiative for CHMI programs. This blog summarizes our lessons learned from the program.
Around the world, innovative health care programs are finding new ways to serve the poor—but they often face similar “operational roadblocks” in their path to scale. Overcoming these challenges will require pioneering new approaches, but program managers often lack the time, human resource capacity, and financing to test new solutions.
CHMI believes peer learning has the potential to unlock new solutions. A collaborative model gives programs a dedicated and safe space to share challenges, brainstorm solutions, and pilot new ideas. By helping programs across our network solve their operational challenges, CHMI aims to help promote the diffusion of promising practices that improve the way the providers grow and scale.
The Learn and Launch Process
The Learn and Launch learning initiative for CHMI programs kicked off in October 2015 to help address practical challenges that prevent programs from growing and reaching more people with quality care. Through the initiative, regional collaboratives in South Asia and Sub-Saharan Africa came together to develop and adapt practical solutions to common operational roadblocks. CHMI, ACCESS Health, and ACA supported the programs by facilitating in-person learning events, site visits, and a $5,000 award for each organization to pilot new ideas generated during the peer learning process. Click here for a list of participating programs.
Tackling the Operational Roadblock—Marketing and Demand Creation
The CHMI network prioritized the challenge of marketing and demand creation through the Learn and Launch initiative. Increasing the accessibility and affordability of quality care for the poor does not stop at the supply side. Often, program managers struggle with demand side interventions—how do you get people to utilize affordable, high quality care when it is being offered?
Over the three-day kick off process, all participating organizations shared their challenges relating to marketing and demand creation. Common themes included (1) a lack of trust in new healthcare facilities and a tendency to utilize long-standing but low quality drug shops for care; (2) difficulties balancing donor priorities with a need to become sustainable, which requires greater responsiveness to market needs; (3) difficulties in translating health education and awareness campaigns into increased utilization of health services; and (4) a need to better understand the link between customer satisfaction and increased usage of quality care.
Testing new solutions—What did programs learn?
At the conclusion of the kick-off process, cohorts in Africa [featuring Toto Health (Kenya), Purple Source Healthcare (Nigeria), MOBIcure (Nigeria) and PACE (Uganda)] and South Asia [featuring LifeCircle Senior Services, ayzh, iKure Techsoft, Swasth (India) and doctHERS (Pakistan)] developed individual program work plans to implement a new idea at their organization. Lessons learned from participating programs include:
- - Use new outreach channels to grow your reach: Inspired by a site visit to Swasth’s primary health clinic in Mumbai, ayzh initially planned to distribute their clean birth kits to more providers by tapping into primary health care chains. However, they quickly realized that while primary care providers would be a perfect audience for their newly developed Healthy Newborn Kit, their Clean Birth Kit was more appealing to maternity care providers. To reach this priority audience, they created a database of organizations in India focused on training maternal health providers. Ayzh is now working with several training organizations to pilot the use of their Clean Birth Kits.
- - Maximize the potential of your staff to drive expansion: Receiving health information through mobile technology is still a new concept to most women in Nigeria. In order to encourage women to sign up for the SMS service, MOBIcure utilizes “foot ambassadors”, youth sales agents that explain the service to mothers and encourage signups. Motivated by presentations in human resources and pricing, MOBIcure decided to test a new incentive structure for foot ambassadors in an effort to drive more SMS subscriptions, with great results. Four months after testing the structure, they surpassed their goal of subscribing 4,000 mother by 128 percent.
- - Reach rural patients through high-touch community engagement strategies: Primary care programs iKure (India) and doctHERS (Pakistan) both work in rural, hard-to-reach areas with patients that require extensive community engagement to improve healthcare utilization. After meeting in the South Asia collaborative, they realized they had much to learn from each other’s complementary strengths. With CHMI’s support through a follow on learning exchange, doctHERS mentored iKure’s staff on their approach to sensitizing new mothers in rural areas, including the use of street plays and customized messaging protocol. iKure has now rolled out a localized voice messaging system in local tribal languages, which provides educational messages and alerts mothers to the service available in their area. In turn, iKure provided doctHERS with training on their customized electronic medical system, WHIMS, which doctHERS is now working to implement in their clinics.
Lessons learned from CHMI
As organizers of Learn and Launch, CHMI has also reflected on what worked well, what didn’t, and how we can do even better in our next learning initiative. We’ve shared some of these reflections below:
- - Peer learning works best when participants drive the agenda. In Learn and Launch, the in-person meeting was kept relatively unstructured, with each participant presenting their organization’s priorities and challenges in a way they felt comfortable. This built trust and transparency. Organic experience sharing also got the ball rolling as programs identified themes that resonated with their own models, and participants highlighted key contextual differences. For example, in Nigeria, health care workers are not paid regularly, which creates challenges for MOBIcure to engage them in signing up women for their SMS service. In contrast, Toto Health in Kenya works closely with healthcare workers, who receive remuneration, as champions of their SMS service. The two program managers found that this contextual difference had an impact on their marketing strategy—TotoHealth could rely heavily on healthcare workers to promote the product, whereas MOBIcure required a separate marketing budget to support their sales ambassadors.
- - Identify mentors ready for long term engagement: In the kick off meetings, ACA and ACCESS Health identified valuable mentors to provide feedback, tools, and trainings on marketing and demand creation. These resources helped participants develop work plans and get started, but we quickly realized that follow-on support was needed to support programs in customizing the tools and providing real-time feedback. In the future, CHMI plans to consider the engagement of mentors that can provide customized support throughout the entire initiative.
- - Learning activities confirm program’s prioritization of learning and partnerships as a “good investment”: All of the participating programs pride themselves on being “learning” organizations and prioritize learning within their staff. Additionally, several of the Learn and Launch participants had previously participated in CHMI’s Learning Exchange initiative and had seen the benefits of peer learning first-hand. But for many, Learn and Launch was their first experience with a formal peer learning initiative. Reflecting on the process, Felix Kimaru, Co-Founder of Toto Health, said, “Learn and Launch is really exciting for us as Toto Health! For a long time, it has been us reviewing our own work. This has been good but it is definitely better when you have an external eye review what you do.” Similarly, when asked about the Learn and Launch workshop, Purple Source Healthcare’s Oludare Bodunrin said that his high point was joining peer program managers in an intimate and interactive discussion, noting it was “Probably the most impactful session that I’ve had in learning. Close, compact, and deep!” After Learn and Launch, five of the nine participating programs participated in a follow on Learning Exchange, sharing the lessons and experiences from Learn and Launch with new programs and partners across Africa and South Asia.
Where we go next
CHMI continues to be excited about the possibility of peer learning to unlock common challenges impeding scale. We see the impact of this work is a crucial piece of Results for Development’s (which manages CHMI) broader portfolio of initiatives that strengthen the development of strong mixed health systems. By supporting the improvement and scale-up of innovative models, CHMI profiled programs can be better positioned to partner with governments the delivery of priority health services.
We are currently planning the launch of new activities, building on the lessons and experiences of program managers in our network. Want to participate? Stay tuned to our blog and newsletter, or contact Rachel Neill at firstname.lastname@example.org