Leveraging the Private Sector to Strengthen Maternal Health

R4D Managing Director and COO Gina Lagomarsino spoke Thursday at the Wilson Center’s series on gender, sponsored by the Environmental Change and Security Program. Lagomarsino was joined by fellow panelists Dr. Priya Agrawal, Executive Director of Merck for Mothers, and Carl Hofmann, CEO of Population Services International. Maternal and child health is a major focus of CHMI’s programs database, which documents over 300 innovative approaches to maternal health in developing countries’ private sectors.

Private sector health innovations are lauded as a potential solution for countries with high maternal mortality rates, but a lack of data and national dialogue means that private maternal health providers continue to be understudied and overlooked.

Merck for Mothers

Merck for Mothers has been supporting private sector solutions to maternal health for four years. Dr. Agrawal spoke to the necessity of studying successful private sector approaches to health to scale these solutions to more people. According to her organization, labor and delivery present the greatest obstacles to increasing quality services for women in the private sector. These services come at higher costs to private providers, and quality assurance is a constant problem. Solutions for improved quality care include accreditation models, 3^rd party payment structures, and social franchising. Dr. Agrawal also spoke to the empowerment of women through private clinic services. Citing ProFam franchise operators in Uganda, she remarked that private providers are entrepreneurs, serve as models to their communities and families, and lead healthier lives.

Center for Health Market Innovations

Gina’s presentation covered the wide spectrum of services in the maternal care market, underlining challenges and opportunities in the private sector. While these providers often lack oversight and reporting standards, the potential for care that is personal and scalable is great. Gina presented innovations in the health markets of India, Kenya, Indonesia, and elsewhere in low- and middle-income countries that have facilitated connections between private and public maternal care. These examples included LifeSpring Hospitals, Jacaranda Health, and Bidan Delima.

At the conclusion of her presentation Gina asked, “How can we help shape health markets to improve the private sector, and ultimately improve health systems overall?”  Her suggestions included:

1. We need to enable development of the entire market, and create “enabling environments.” Improving just one program is a drop in the bucket, and the venture capital model only goes so far.
2. We need to diffuse and adapt innovative practices to existing providers, and change the way we think about “scale.” The challenge of organic growth is a major barrier. Are there ways to expand promising practices beyond the programmatic level? Are there “receptor sites” for certain core elements of an innovation?
3. We need to expand government purchasing – this is the “Holy Grail” for most private providers operating at scale.
4. We need to foster development of intermediaries – the organizations that can help bring these core promising practices to similar organizations.

Population Services International

Carl Hofmann of Population Services International added the question of entrepreneurship and profit models to the panel. PSI’s long-standing social franchising approach has been moving towards a model of sustainable recovery for entrepreneurs, but the next step moves even closer to profit for social franchise operators. Profitability depends on business skills and overcoming barriers to innovation, but entrepreneurs are inherently scrappy, and are eager to try new models.

All three panelists presented a vision of private sector maternal health that relies on data, innovative design, and advocacy for government purchasing leading to sustainability. The three organizations featured are working with many others to bring this vision to life, and continue to research and share innovations that increase and improve quality care for mothers in low- and middle-income countries.

To see the archived webcast of the presentation, visit The Wilson Center’s website.