WHP’s social franchise consists of a tiered health and family planning service delivery network that brings together individual private providers, both formally and informally qualified. Existing informal providers (SkyCare providers or better resourced SkyHealth Centres), situated deep in rural areas and in parts of towns where the poor predominate, are linked to highly qualified formal doctors, in virtual Central Medical Facilities. Sky providers are also linked to nearby urban formal
providers at WHP-owned or approved Franchised Clinics and Franchised Diagnostic Clinics for referrals. Clients pay out of pocket for most services, offered at low prices. For the neediest clients, services are subsidized by WHP which are currently supported by donors or from government pro-poor programs. The private providers’ commitment to providing quality services, especially for certain mandated services (depending on program objectives), is obtained by co-opting them into a
profitable health franchise.
Flagship Program: Engaging Private Providers to Improve Management of Tuberculosis, Visceral Leishmaniasis, Childhood Pneumonia, and Diarrhea in Bihar
A 5-year project, funded by The Bill and Melinda Gates Foundation, was launched in December 2011 in Bihar - the third largest state in India, and one of the poorest. A central characteristic of this program is its focus on improving the detection and treatment of four focus diseases: tuberculosis, visceral leishmaniasis, childhood pneumonia, and diarrhea. The project’s goal is to increase coverage of appropriate interventions for the four diseases by 15 to 20 percent among the region’s population through WHP’s social franchise network that would cover at least 25 out of the 38 districts in Bihar, and serve up to 70 million people. Furthermore, WHP projects that by the end of year five, ~60% of program costs will be covered through program revenue and government subsidies.
While WHP has incorporated lessons learned from its Uttar Pradesh (UP) pilot in its Bihar project, conscious steps have been taken to ensure higher levels of commitment, work discipline, and better receptivity among the providers. The franchise start-up costs are now fully borne by the village entrepreneurs, as extension of subsidy dilutes efficiencies and undermines WHP's mandate for efficient management. Stricter enforcement of norms and standards have been
institutionalized to increase adherence to policies and achieve greater credibility for the WHP brand. Other modifications include increased integration with the public sector to capitalize on existing government programs providing free TB and VL treatment. In addition, new technologies utilizing telediagnostic capabilities (ReMeDi™) via cellphones will be introduced in late 2012 to compensate for lower Internet penetration in Bihar. Above all, WHP’s focus remains on increasing affordability and access to the poor.
Pilot Program in Uttar Pradesh
WHP’s pilot program was launched in 2008. The WHP social franchise model was implemented in three districts of UP, covering an estimated 3.6 million people, 2 million of whom reside in rural and remote villages. The franchise network provides comprehensive health services, but focuses on delivering family planning products and services to the rural poor. In less than 18 months, the project established a health service delivery network covering 1,300 rural villages of Uttar Pradesh through 1,300 shops, 120 telemedicine centers, 9 franchised diagnostic centers and 16 franchises clinics. Recently, WHP has scaled down its UP pilot, decreasing it program size from 120 to 80 SkyHealth Centers.
While the pilot program was largely used to experiment with various new strategies and approaches, the program delivered significant results: it generated increased caseloads for rural providers, while also serving as a platform for family planning service provision. At 60% less of the cost, IUD coverage has increased by eleven times and sterilization by five times relative to comparable programs. The major lesson learned during this pilot is that rural clients are willing to adopt family planning if services are provided close to home.
WHP plans to replicate their model in other parts of India, and in the near future, Sub-Saharan Africa or other low resource countries. Apart from using the model to deliver general health services to hard-to-reach populations, WHP would also like to use its model to increase access to other verticals such as maternal health.