Database at a Glance
CHMI presents cross-sections of the database to underscore trends our research is uncovering in countries where the private sector delivers the majority of health care.
Innovative delivery programs: What areas of health do they focus on?
What does a program’s primary funding source tell us?
How do programs mobilize funds and give purchasing power to the poor?
How do programs increase access to care for NCDs?
How is the private sector delivering TB care?
How do innovators deliver quality eye care to the poor?
How does mobile medical care extend healthcare to rural and remote populations?
Innovative delivery programs: What areas of health do they focus on?
In examining trends within the CHMI Programs database, many people are curious about how particular health services are being delivered. Take family planning. How do innovative health programs deliver contraceptive services? Or primary care: Given that primary care is sorely neglected in many settings, what kinds of private sector programs are filling the void, providing essential services without impoverishing the poor? Data from more than 800 programs in over 100 countries are beginning to answer these questions.
Of the more than 300 programs categorized as Organizing Delivery (see the full CHMI Framework), social franchises, networks of clinics, and standalone hospitals emerge as common types of innovative delivery models.
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Social franchising stands out as the prevailing method of delivering family planning services. This mechanism has proliferated in recent years, with more than 30 franchises operating across the world (read more about social franchising here). Many franchises are starting to expand beyond family planning and reproductive health, leveraging their platforms to deliver TB, HIV/AIDS and malaria interventions. It is also interesting to observe that while tertiary care facilities and specialty centers continue to provide treatment for chronic diseases, franchises are also starting to emerge as a potential service delivery mechanism for prevention, screening and ongoing monitoring.
Service delivery networks tend to dominate care provision for maternal, newborn and child health (MNCH), HIV/AIDS, tuberculosis and general primary care.
Hospital chains and standalone facilities are growing in numbers for specialty services, like eye care (Eye-Q), maternal deliveries (LifeSpring), and dentistry (Dentista do Bem).
But there is also an emergence of low-cost primary care chains and networks in rural and semi-urban settings. Some are funded by donors, like Kriti, while others are for-profit enterprises, like LiveWell, Vaatsalya, and CARE Hospitals which make their services affordable by cross-subsidizing between wealthier patients and the poor. Several new primary care chains are starting up in different parts of the world including Saúde 10 in Brazil, ComHealth in South Africa and Glocal Healthcare in India.
What does a program’s primary funding source tell us?
In this second blog post from the Inside the Database series, we look at a key variable from the CHMI Programs Database – primary source of funding. Many people ask us about funding: How can their programs get more, how other programs are funded and what are the best models for sustainable funding sources. Here, we share an aggregate picture of how programs in the CHMI database are funded.
First, we looked at the overall distribution of primary source of funding for all 667 programs with data in this field. Donor funding from bilateral agencies and private foundations is the primary source of funding for about 50% of the programs profiled in the CHMI database for those 667 programs. The remaining 50% comes primarily from government funding and out-of-pocket payments (34% in total), and a mix of other sources such as debt and equity investments, membership fees and in-kind contributions.
Then we wanted to know if there is a link between what health issues programs focus on and how they get the majority of their funding. We found that donor funding dominates the funding landscape for HIV/AIDS, malaria and TB. TB programs, however, also receive a significant portion (36%) of primary funding from government sources. Governments are also likely to be a primary source of funding for programs focusing on emergency care treatment (48%), secondary care (43%), and chronic disease care (26%). Along with government and donor funding, out-of-pocket payments are a significant source of revenue for programs delivering family planning/reproductive health services, maternal and child health as well as primary care. In eye care, a growing specialty service, out-of-pocket payments constitute the main source of funding. With 26 eye care programs currently profiled in CHMI’s database, it will be interesting to see how the funding profile of this emerging area will evolve if eye care continues to grow and scale across the world.
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- Finally, we focused on the 16 countries where CHMI partner organizations work to identify differences across countries and regions. As a proportion of total funding by country, donor funding for programs is most common in Vietnam, Tanzania, Kenya and Indonesia and less frequently the primary source of funding for programs in the Philippines, India and South Africa. Government funding, on the other hand, is more commonly the primary source of funding in Pakistan, India, Philippines, and Brazil. No significant regional differences appear; rather, differences in the distribution of primary funding seem closely related to country income. Generally, lower-middle income countries have a higher proportion of funding for health market innovations coming from government sources than low-income countries.
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A caveat to these preliminary conclusions: CHMI’s relationships with partner organizations in specific countries may result in data collection biases. For example, in countries where CHMI partners are not currently operating, donor-funded programs may be over-represented because they are better known and documented in the literature.
How do programs mobilize funds and give purchasing power to the poor?
In a blog post earlier this spring, we shared a story of a woman who named her newborn baby “Hygeia” after the health insurance plan that may have saved their lives when a complication during childbirth forced the mother to seek expensive hospital care. The Hygeia Community Health Plan now covers over 75,000 individuals in Lagos and Kwara State and allows members access to a broad package of services for about $2 a year. Hygeia is one example of over 200 Financing Care initiatives profiled in the CHMI database. Recognizing the essential role that financing programs and products play in the health market, this month’s “Database at a Glance” takes a look at how health market innovations are making care more accessible and affordable for the poor.
The CHMI database profiles seven types of health financing programs. These include demand-side financing – programs that direct funds to consumers in order to decrease financial barriers to care (government health insurance, private insurance, micro/community health insurance, and vouchers), contracting, a supply-side intervention that channels funds to existing providers in order to expand their reach, cross-subsidization, a popular pro-poor pricing model that redirects revenue from wealthy patients to cover those unable to pay, and health savings *, programs that encourage consumers to save for future healthcare needs. See full CHMI Framework and Definitions.
Some of these mechanisms, such as cross-subsidization and private health insurance, have long been used to protect against catastrophic health spending. Others, particularly micro/community health insurance (smaller, more targeted schemes) and vouchers, have gained important momentum in recent years.
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- The last decade has seen an important expansion in government health insurance, with a number of countries undergoing reforms to achieve universal health coverage. The Ghanaian National Health Insurance Scheme (NHIS), for example, has enrolled 12 million individuals – accounting for 61% of the population since 2004. In 2003, Rwanda’s Community-Based Health Insurance (CBHI) schemes were expanded into a national system, leading to a rapid uptick in coverage. By 2010, approximately 90% of the population was covered by the program.
- Complementing public financing are smaller micro and community health insurance programs, which are rapidly growing in number. Though they remain small-scale, schemes such as those offered by MicroEnsure, which recently expanded into Tanzania, and SKY Microinsurance, operating in Cambodia since 2007, often target the “last mile”, individuals not reached by larger financing programs.
- Finally, vouchers have emerged as a popular model to finance care for a specific set of services. The number of programs in the CHMI database that launched after 2006 is more than double the number launched in 2000-2006. This partially reflects an increasing trend in social franchises to adopt vouchers as an effective tool to generate demand and growing evidence that vouchers increase utilization of key health interventions such as maternal care packages. For now, vouchers remain a relatively small source of payment for most facilities, though a few standouts exist. Reproductive health vouchers account for 75% and 50% of the payment source for the ProFemina franchise in Madagascar and BlueStar Sierra Leone, respectively.**
Now that we’ve looked at the proliferation of programs over the last decade, let’s see what CHMI data tell us about the major health areas addressed by each financing mechanism. Mapping these two attributes reveals that most programs use a wide variety of financing tools to increase access to care, though a few, such as chronic diseases, family planning/reproductive health (FP/RH) and eye care, are dominated by one or two mechanisms.***
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- Cross subsidization is used to finance a wide range of services. However, it is particularly important in increasing the affordability of costly care in the absence of comprehensive insurance. Cross-subsidization is a key operational component of specialty eye hospitals such as Aravind and L V Prasad Eye Institute in India, and the ASEMBIS network of eye clinics in El Salvador. It is also the most common mechanism used to finance care for chronic diseases and general secondary/tertiary health services.
- Vouchers – either distributed free or sold for a small fee – have emerged as a key financing strategy to help the poor access family planning/reproductive health and maternal and child care services, accounting for about 75% and 50% of all CHMI-profiled demand-side financing programs addressing FP/RH and MNCH, respectively.
- Contracting appears to be a popular mechanism to finance emergency care, particularly in India where state governments have either contracted companies such as Ziqitza or groups of private providers such as in the Janani Express model in Madhya Pradesh to operate ambulance networks. Contracting is also frequently used to expand the availability of key health interventions such as basic primary care and maternal and child health services, health areas accounting for half of all contracting initiatives.
A caveat to these preliminary conclusions: CHMI’s data collection methodology and relationships with partner organizations in specific countries may result in data collection biases. Specifically, as CHMI focuses on profiling programs that are active at the time of data collection, the database does not contain comprehensive historical information about initiatives that have operated and closed over the years. The historical data set will evolve as we continue to follow the development of profiled programs.
As we gather more data about the universe of health market innovations, we will continue to track trends and highlight new insights gleaned from analysis of the aggregate. We invite you to do the same by downloading the CHMI Database and sharing your findings with us!
*Health savings – the newest CHMI category – was excluded from this analysis because of its small program sample.
**Schlein, K., Drasser, K. and Montagu, D. (2011). Clinical Social Franchising Compendium: An Annual Survey of Programs, 2011. San Francisco: The Global Health Group – UCSF.
***Mental health, nutrition, dentistry, rehabilitative care, and TB programs were excluded from this analysis because of a small program sample.
How do programs increase access to care for NCDs?
“The global community must work together to monitor, reduce exposure to risks, and strengthen health care for people with non-communicable diseases,” stated General Assembly President Nassir Abdulaziz Al-Nasser at the UN High Level Meeting on Non-Communicable Diseases (NCDs), held in New York September 19-20. This was just the second meeting of its kind on an issue related to global health. When the global community came together for the first ever United Nations General Assembly Special Session on HIV/AIDS in 2001, the momentum significantly strengthened the global AIDS response and led to creation of the Global Fund to Fight AIDS, Tuberculosis and Malaria. Can the same be done for NCDs?
NCDs accounted for close to two-thirds of all deaths in 2008, around 80% of which came from low and middle income countries. [See an interesting infographic on the issue from the Economist here.] According to current projections, NCDs will most likely overtake communicable diseases as the leading cause of death in rich and poor nations alike by 2030.
In response to these statistics, the UN General Assembly has adopted a declaration calling for a concerted global effort to prevent and control NCDs. Among the recommended steps are those aimed at expanding prevention such as curbing the marketing of foods high in fat, sodium and sugar to children, promoting physical activities, and enacting new tax measures to reduce the global consumption of tobacco, among others.
Prevention is undoubtedly an essential and often lacking component in combating the NCD epidemic. However, it is only one element of a broad continuum of care that includes more costly and complex services such as screening and diagnosis, ongoing monitoring, acute treatment, and long-term care. Unlike communicable diseases, however, NCDs draw relatively few donor funds. In 2007, only 3% of all donor assistance for health went to NCDs, amounting to approximately $.78/DALY, compared to $23.9/DALY attributable to HIV, malaria, and TB.
Taking a look at the most common source of financing for NCD programs profiled in the CHMI database, we note that while donor funding continues to dominate the primary funding landscape, government funding and out of pocket payments account for a much larger proportion of the payment source for NCDs than health areas such as HIV/AIDS, TB, malaria, and maternal and child health.
So what can be done to increase access to NCD care? Over the last year and a half, CHMI partners have identified a number of approaches that can play an important role in making NCD care accessible and affordable to the poor and underserved. Below, we highlight a number of initiatives aimed at addressing one or more segments of the NCD continuum of care.
Screening and diagnosis: Mobile clinics and health camps are emerging as a promising mechanism to expand access to preventative services, screening and diagnosis. In Kenya, the Afya Njema Project is developing a comprehensive community-based screening program for diabetes, hypertension and other preventable and manageable health issues. The project runs health screening and education camps. The Peruvian League to Fight Against Cancer (LPLC) operates a network Mobile Detector Centers for screening and treatment of pre-cancerous lesions of the cervix in urban, marginal and rural areas of Peru.
Management: Building on the high level of mobile phone penetration across the developing world, technology providers are increasingly rolling out mobile phone-based software (see GlicOnline, Mobile Phones for Health Monitoring, MediNet) to help patients manage conditions such as diabetes and cardiovascular diseases. In Tanzania, D-Tree International, is aiming to improve the quality of NCD care available to patients through the use of electronic algorithms that are linked to an electronic patient record. The application collects and store data about each patient, and then uses this data to tailor care for each patient based on their history, symptoms, and laboratory results.
Acute treatment: Access to financing for acute treatment of NCDs and a persistent lack of specialists in rural areas are important barriers to care for low-income and remote populations. To address a patient’s inability to pay, a number of large facilities - Cancer Institute (WIA), Indo-American Cancer Institute & Research Hospital, Narayana Hrudayalaya - have enacted cross-subsidization as a core component of the operational model, using revenue from wealthier patients to subsidize care for the poor. Where access to insurance coverage is available for the poor, partnerships with public insurance schemes is a promising method to increase patient access to care. In Brazil, for example, care in many secondary and tertiary care facilities such as the Hospital de Câncer de Barretos-Fundação Pio XII, and Nefrocare are covered by the Unified Health System (SUS). To address geographic access, a number of programs have implemented telemedicine models (Onctonet, the Heart Institute of the Caribbean) to help rural medical staff receive specialized support from experts in primarily urban centers.
Long-term care: Private chains paid through government contracts and other forms of public-private partnerships have the potential to deliver long-term disease management at a lower cost. In Andhra Pradesh, the government has partnered with B. Braun, a healthcare provider from Germany, to operate 11 dialysis centers across the state. In the Philippines, the National Kidney Transplant Institute (NKTI), a tertiary medical specialty center specializing in the treatment of renal diseases, has partnered with Freseneus Medical Care Philippines Inc. to operate a new Hemodialysis Center. The partnership has allowed NKTI to improve its care quality by acquiring the latest modern equipment, while continuing to cater to lower-income individuals as a public facility.
How is the private sector delivering TB care?
Treatment for tuberculosis (TB), a disease that causes 1.7 million deaths every year, is generally considered to be the responsibility of the public sector; in fact, many believe that treatment should remain in government hospitals and clinics because they are more easily regulated and are generally required to follow WHO treatment guidelines. Nevertheless, studies have shown that the private sector plays a significant role in providing care for TB in many countries. A study by the Global Alliance for TB Drug Development, IMS Health and the Bill and Melinda Gates Foundation found that the volume of first line TB drugs provided by the private sector in 10 high burden countries (HBCs) was sufficient to treat 66% of the countries’ estimated cases. The study concluded that several HBCs have sizable and stable private TB drug markets. Another study found that in India, the country with the highest absolute number of cases, 86% of patients first sought care for TB in the private sector.
A look into the CHMI database shows that programs that work to harness the private sector are displaying new levels of innovation. As of October 5, CHMI profiled 43 programs with a focus on TB. The chart below breaks down these programs by type of innovation.
Here are some key innovation trends:
- At least 15 private (or public-private mix) franchises and service delivery chains have included some form of TB care in their range of services, though the type of service provided varies. The Greenstar franchise in Pakistan provides health awareness education to help prevent TB, BlueStar (Bangladesh) has set up a referral system for TB cases, and Sun Quality Health Network (Myanmar), along with at least 9 other franchises and networks, provides TB treatment.
- Most programs that regulate the performance of private providers are unsurprisingly government-run or public-private partnerships (PPPs). These include policies for prevention, diagnosis and treatment, such as 3Is in the Continuum of Care, an integrated strategy which uses increased early detection and proper treatment to reduce TB-related morbidity, mortality and transmission, especially for those co-infected with TB and HIV/AIDS. Another form of regulating performance is the Public-Private Mix, as implemented in, for example, Vietnam and the Philippines, which aims to both supervise private sector provision of TB care and improve integration and communication between the private and public sectors.
- Although many people utilize the private sector when it comes to TB, private providers do not always deliver the best quality care: one study found that private providers in the Philippines used inappropriate drug regimens 89% of the time. Therefore, training of providers to deliver higher quality care has become extra important. Several programs, such as D-tree International and the Uganda Health Information Network (UHIN) use mobile phones and other technologies to provide health workers with guidance and protocols. Other programs strategically choose to train specific sectors of society in order to maximize health outcomes. For example, Leveraging the Private Pharmacy Sector trains pharmacists, who are often a patient’s first point of care, to be able to accurately diagnose and refer patients for TB treatment. Similarly, the Bambisani Project trains community members to provide home-based care for children living with TB and other diseases.
- Finally, a number of programs utilize information communication technology to improve care. Many of these deal with improving adherence to TB drug regimens, as this is crucial to ensuring successful treatment and preventing Multi-Drug Resistant TB. For example, Operation ASHA uses fingerprint scanners, X Out TB uses mobiles phones, and On Cue Compliance uses specially modified pill bottles to achieve this goal.
Other innovations range from the use of rats that diagnose TB using just their sense of smell to mobile clinics that test for and treat TB in rural areas. Check out the CHMI database to learn about these other innovations.
How do innovators deliver quality eye care to the poor?
According to the World Health Organization (WHO), 285 million people are visually impaired globally and nearly 40 million are blind. Alarmingly, 90% of these individuals reside in developing countries. While many of these cases—as much as 80%—can be prevented or cured, high prices and low availability of eye care services transform mild impairments into irreversible blindness. But there may be light at the end of the proverbial tunnel. The WHO has actually noted a decrease in the prevalence of infectious disease-related vision impairment in the last 20 years, and numerous innovative programs are joining the fight against avoidable blindness and transforming eye care for the poor in remarkable ways.
It is impossible to talk about innovations in pro-poor eye care without mentioning the Aravind Eye Care System. Its history has recently been chronicled in a book, Infinite Vision, co-written by the grandniece of Aravind’s founder, Dr. Venkataswamy. The much lauded India-based hospital chain is the largest supplier of eye care in the world, performing about 1,000 surgeries a day and restoring sight to 12 million people since its founding in 1976. What’s more, while the non-profit model earns enough revenue to be self-sustaining, the vast majority—approximately 70%—of its patients receive care for free.
Aravind may be the grandfather of eye care innovation, and indeed it is one of the oldest innovative models profiled in the CHMI database, but it is operating in good company. CHMI profiles 36 programs improving the accessibility and quality of eye care in the developing world. An overview of these programs’ basic characteristics is displayed in the chart below.
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Reducing the cost of care through higher volumes and cross-subsidization. Pioneered by Aravind and others, a significant number of eye care facilities are employing the standardized high-volume operational model to lower the cost of services. LV Prasad and Sadguru Netra Chikitsalaya in India, the new SalaUno clinics in Mexico, and the Lumbini Eye Institute in Nepal all provide services through the low-cost, high patient volume model. For example, staff at Lumbini’s 125-bed hospital performs up to 170 eye surgeries daily, accounting for 25% of all sight-restoring surgeries in Nepal. But the high-volume model alone does not make care affordable to the very poor. Complementing it are a variety of cross-subsidization schemes, quite common among pro-poor eye care programs, that charge full fees to patients able to pay in order to cover the cost of care to the poor. Of the eye care programs profiled by CHMI, at least eight 30% employ some form of cross-subsidization to cater to those unable to pay. Pakistan’s Al-Shifa Trust Eye Hospitals, for example, have treated 70% of their patients free of cost. Meanwhile, paying patients at Sadguru Netra Chikitsalaya—just about half of the total patients are charged fees based on a sliding scale—allow the hospital to provide free services to the poor.
Improving the availability of care through mobile outreach. While affordable eye care is becoming increasingly available to the urban poor through large hospitals or chains of clinics, services are still slow to reach rural and remote areas. To mitigate this problem, a number of hospitals are sending ophthalmologists into hard-to-reach areas through mobile outreach programs. In Bangladesh, Chittagong Eye Infirmary & Training Complex has organized hundreds of mobile eye camps which have treated over 7.5 million people. India’s Pushpagiri Eye Institute, a facility dedicated to treating various forms of preventable eye diseases with a special focus on diabetic, childhood, and corneal blindness in Andhra Pradesh, organizes outreach clinics, approximately 10 per month, and treatment camps in the state’s rural areas. Several independent programs—those not operated by base hospitals—are also helping to provide care to the rural poor. In Kenya, UHEAL operates mobile eye units that run fifteen eye camps a year. The units screen for diabetic retinopathy and provide eye examinations, follow-up care, and laser treatment at an affordable rate.
Earning a profit while serving the poor. Although eye care is a significant problem afflicting the world’s poor, it has never been a donor darling, particularly when communicable diseases continue to kill millions of people each year. In light of the relatively low influx of donor funds, a number of organizations—both non-profits such as Aravind as well as for-profit groups—have developed innovative revenue-based cost-recovery models, all the while providing care to those unable to pay. Several for-profit eye care chains are now catering to those willing to pay a small sum to receive quality care and avoid the long-lines and variable service quality customary of public hospitals. In Guatemala, Visualiza's three hospitals offer eye care at an affordable rate to the poor, focusing on preventable blindness, cataracts and ametropia. Although it charges fees about one third of the market rate by utilizing a high-volume model and employing other operational efficiencies, Mexico’s SalaUno is also catering to those not able to pay by partnering with a local cinema to provide 100 free surgeries per month. The company currently operates one pilot clinic and plans to open three more in 2012.
These programs are just a sub-set of the innovative eye care models operating globally and large-scale initiatives such as Vision2020 are aiming to prevent the estimated doubling of avoidable vision impairment by 2020. As we gather more data about the universe of health market innovations, we will continue to track trends and highlight new insights gleaned from analysis of the aggregate. We invite you to do the same by downloading the CHMI Database and sharing your findings with us.
How does mobile medical care extend healthcare to rural and remote populations?
We have all heard the stories: the mother walking for two days to take her sick child to the nearest health facility, the man losing two days’ pay to seek out medical care for a persisting pain, the millions upon millions of families that forgo care altogether because they don’t have the means to reach a traditional health facility. Mobile care—the delivery of services by health workers on the move—holds particular promise in extending health care to populations beyond the reach of static facilities. In certain cases, it has been shown to be more effective than static facilities, serving many more people with the same equipment and recovering a larger portion of its operating costs, and more efficient in utilizing staff time. Although much work remains to be done before we truly understand both the potential and pitfalls of mobile medical care, there is no shortage of models that have been developing and evolving the capacity of limited medical human resources to serve disperse and remote populations.
From a basic bicycle carrying health workers and medicine into rural villages to a fully mobile cardiac catheterization lab, CHMI profiles close to 80 mobile care programs. The majority of profiled programs operate in rural geographies and deliver basic primary care (50%), although significant focus is also placed on family planning and reproductive health (13%), HIV/AIDS (13%), general secondary care (12%) and maternal and child health (12%).* Interestingly, mobile care is also becoming a hotbed of eye care innovation; while eye care comprises only about 4% of all programs listed in the CHMI database, 11% of mobile care programs deliver eye care services.
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Basic statistics aside, what exactly do we mean when we say mobile care? Is it the health worker that delivers preventative care and basic screening at camps that attract hundreds of people? The team of doctors and nurses that hold regular office hours in a rural schoolhouse? Or is it the highly equipped van that brings traditional medical facilities to remote settings, providing local residents access to more complex treatment? A review of all mobile care programs profiled in the CHMI database reveals three common models:
Health Camps: Health camps are typically large-scale initiatives that aim to provide basic health education, preventative care and health screenings to a wide segment of the local population. Because their focus is more preventative than curative, camps are held every few months to a year in different locales and often do not operate on a set schedule. Moreover, as health camps are frequently run by health workers who do not have a wide range of medical expertise, many target just one or two health areas such as voluntary counseling and testing for HIV, basic health screening, or delivery of family planning services. Simple treatment is provided on-site while those who require follow-up care are referred to the nearest medical facility. The Afya Kenya Foundation, for example, has organized and financed several health camps in the country, with most serving well over 1000 people. Health camps organized by the Islamia Eye Hospital in Bangladesh provide treatment for minor eye diseases. Cataract cases are screened and referred to the hospital for operation at no cost to the patients.
Mobile Clinics: Unlike health camps, mobile clinics are usually smaller affairs and offer the same basic services as a primary health facility. They are often run by a team of doctors or nurses and are thus able to address a wider variety of patient complaints. Furthermore, mobile clinics typically operate on a set schedule and return to each location on a periodic basis, facilitating the provision of longer-term care and the development of closer patient-doctor relationships. Kenya’s Jacaranda Health runs regular mobile clinics that offer antenatal care and birth preparedness for women in urban slums, while the Fundación Adolfo Kolping in Bolivia uses ambulances to transport doctors and counselors to peri-urban and rural neighborhoods around the city of El Alto, offering low-cost or free medical attention.
Mobile Facilities: Taking mobile medical care one step beyond health camps and mobile clinics are mobile facilities, vehicles that come equipped with some of the same medical equipment present in a static primary care center or hospital, including laboratories and operating theaters. Mobile facilities are often staffed by trained doctors and nurses and are able to deliver higher-level curative care. In the Indian state of Bihar, Arogya Rath is operating mobile medical units that offer the same facilities as a basic hospital, as well as over 30 medications that are issued to patients free of cost. In Peru, Pro Mujer is providing dental and sonogram services out of adapted vehicles. Each vehicle has been converted into two consultation units, one for dentistry with an exam seat and accompanying dental instruments, and the other for gynecological exams. The clinics are operated by a team of specialists and doctors and allow Pro Mujer to provide advanced health services to rural areas.
Finally, we took a look at what makes mobile care programs truly “mobile”—the variety of vehicles leveraged by programs to deliver services. These are as varied as the geographies in which the programs operate, each one uniquely suited to the local topography. Off road trucks are used to traverse rough terrain (Mailafiya), boats navigate isolated rivers (Projeto Saúde e Alegria, Sailing Doctors), motorcycles pass through rural and unpaved roads (Health by Motorbike, Mama-Toto Mobile Clinic), and camels serve remote desert communities (CHAT). As mobile care advances, encompassing new technologies and offering more complex procedures, the delivery vehicles are likely to diversify, incorporating repurposed and adapted local transportation to extend the reach of health care beyond brick and mortar.
As we gather more data about the universe of health market innovations, we will continue to track trends and highlight new insights gleaned from analysis of the aggregate. We invite you to do the same by downloading the CHMI Database and sharing your findings with us.
*Percentages do not total 100 as programs may have more than one health focus.
**Caveat to these preliminary conclusions: CHMI’s data collection methodology and relationships with partner organizations in specific countries may result in data collection biases. Furthermore, programs that primarily transport patients (e.g., emergency care) were excluded from this analysis. We acknowledge that many programs provide eye care as part of their general primary, secondary, and tertiary health care services. Finally, CHMI cannot attest to the efficacy or impact of individual models.
As we gather more data about the universe of health market innovations, we will continue to track trends and highlight new insights gleaned from analysis of the aggregate. We invite you to do the same by downloading the CHMI Database and sharing your findings with us!