Center for Health Market Innovations (CHMI)

At CHMI, we focus on the health market: the actors and interactions that define it, and the interventions that improve the way it works for the poor. To gain a better understanding of these mechanisms, CHMI commissions thematic studies on topics relevant to health markets. Two studies—on informal health providers and drug retail stores—are currently underway. Additional topics will be determined based on the interests of the CHMI audience.

STUDIES CURRENTLY UNDERWAY

Study of Informal Health Market Dynamics

Informal providers are individuals who are not formally trained or monitored to perform the full scope of services that they offer. They are an important contingent of the broader health market, comprising over 50% of the sector in India and close to 96% in rural Bangladesh, according to some estimates. While the quality of their services is often debated, informal providers are a significant source of care for many poor individuals in the developing world.

Studies completed by others have focused on understanding slices of the broader informal health market – who are IPs? Where do they practice? What type of services do they offer? But informal providers don’t work in isolation. They function within a network of peers (both formal and informal), suppliers, consumers and entire communities, each offering their own unique set of incentives and influences that impact IP behavior. CHMI is looking to better understand these interactions in an effort to identify opportunities where interventions can affect positive change.

To do this, CHMI has selected 3 grantees to study the dynamics of the informal market for health in a sample of locations. The aim of these studies will be to inform a set of recommendations for policymakers and practitioners about the potential opportunities to leverage informal providers for better health and/or mitigate the challenges they present. A detailed overview for this study is available here.

• Bangladesh: “The role of drug sellers in the informal medical markets: an exploratory study for effective interventions”
  Grantee: Nabeel Ashraf Ali, Shams El Arifeen, and colleagues, International Centre for Diarrhoeal Disease Research, Bangladesh (ICDDR,B); James P Grant School of Public Health-BRAC University; Institute of Development Studies; Bloomberg School of Public Health-John Hopkins University

• India: “A study to inform integration of informal rural health providers into the formal health system in India.”
  Grantee: Dr. Meenakshi Gautham, Garhwal Community Development and Welfare Society (GCDWS); Centre for Research in New International Economic Order (CRENIEO)

• Nigeria “A Study of the Role of Patent Medicine Vendors (PMVs) in the Informal Anti-malarial Market in Nigeria.”
  Grantee: Professor Oladimeji Oladepo, Faculty of Public Health-College of Medicine, University of Ibadan; Institute of Development Studies

Fieldwork for these studies has been completed and the preliminary results have been shared at a meeting in Dhaka, Bangladesh in March 2012. Read a summary of the event here.

A summary of the findings from these studies is attached.

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Study of Drug Quality and Health in the Indian Retail Pharmacy Market

Counterfeit and substandard drugs, pervasive in many developing countries, are therapeutically ineffective and often toxic, which can exacerbate the burden of disease in many poor communities. While conventional policies such as law enforcement or holograms on drug packaging have shown limited effectiveness against this problem, the high-quality pharmacy chains may be an alternative way to improve drug quality. To find out if these chains hold promise, CHMI is working with the Institute for Economic Development (IED) at Boston University to carry out a study to evaluate the effect of entry by MedPlus, a high-quality chain pharmacy, on drug quality in the health marketplace in Andhra Pradesh, India.

The research team will measure drug quality through a mystery shopper audit, in which surveyors will pose as actual consumers in order to purchase medicine under realistic conditions. Drug audits and chemical analysis of these drugs will be carried out before and after entry by MedPlus, at pharmacies in both treatment and control markets. Results of this study are expected to be released in early 2012.

For more information about CHMI Thematic Studies, please contact Maria Belenky at mbelenky@resultsfordevelopment.org.

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