Just back from Delhi: A new learning group all about primary care

A group of healthcare entrepreneurs have just announced a joint commitment to collaborate toward providing high quality and affordable primary healthcare in emerging economies.

In response to strong consumer demand for outpatient healthcare, these entrepreneurs have launched low-cost clinic chains and franchises delivering high quality primary care services in India and Africa. Now, they are working together in the new Primary Care Learning Collaborative to address challenges to rapid growth. The Learning Collaborative, convened by the Center for Health Market Innovations (CHMI) network, is the first ever to focus on market-based primary care organizations operating in multiple geographies.

Robust consumer demand in health markets around the world has put some emerging primary care organizations on a track to grow rapidly. Primary care chains and franchises deliver a wide range of outpatient services, often offering everything from chronic disease management, such as diabetes care, to preventive services, such as family planning services. Yet as an organization expands, it becomes necessary to formalize operational processes, often while fine-tuning and improving them to improve clinical quality increase the number of patients seen, and improve efficiency.

Led by CHMI, the Collaborative seeks to help participating pro-poor primary care chains and franchises more effectively scale and improve their business models. To accomplish this, the peer-learning network facilitates sharing knowledge, joint problem‐solving around key common challenges, and the collaborative development of promising approaches among organizations operating in primary care in low‐ and middle-income countries. By helping to shape the development of chains and franchises, there is potential to affect broader primary health care markets, ultimately improving quality, affordability, and efficiency.

Participating organizations included:


The Launch

Participants arrived at our meeting in New Delhi with specific goals for their organization in mind such as increasing patient satisfaction, achieving sustainability for clinics in the network, and ensuring providers at all clinics are up-to-date on the basics of patient safety. The group first reviewed various tools and frameworks that can be used to achieve these goals, such as driver diagrams (which help identify the key activities that influence a given goal or outcome) and Human-Centered Design (which prioritizes the end-user in the design process). Using these tools and frameworks, participants then identified activities that fed into their goals – such as back-end IT systems, patient follow up, and health camps – and discussed their experiences with these, including success, challenges, and innovative strategies.

“When we worked together, we were able to use structured approaches from CHMI to come to inventive solutions greater than any individual thought process,” said Monica Slinkard, Medical Director of LifeNet International, a franchise in Burundi. “We were also able to offer simple suggestions to common difficulties, like how to motivate personnel, cut day-to-day costs, and create working systems for effective medical record keeping,” she added.

A site visit to two clinics of Ross Clinics, one of the members of the Collaborative, offered participants the opportunity to see in-person how one of their peer-organizations is putting these ideas and other innovations into action.

Vincent Mutugi, Clinical Director of Access Afya in Kenya, examines medicines with a Clinic Manager at Ross Clinics during a site visit in Delhi.


Putting “Change Ideas” to work right away

As a result of these conversations, every organization left with at least one “change idea” (if not a whole list of ideas) that they felt would help them achieve their goal and would be feasible to begin implementing right away. Some of the change ideas that participants are pursuing include:

  • Creating standardized treatment options for clinicians
  • Adding additional services to increase revenue
  • Working with local schools to increase community reach


Unexpected Benefits

Participants said being out of their normal work environment and constraints helped them think creatively about solutions.

“Tearing myself away from operations seemed very costly, even for just a few days,” said Stefanie Weiland, Executive Director of LifeNet International. “But I needed to pull out of the daily urgency of these operations to look for every possible way to improve patient and business processes, technology and tools.”

“When working in the arena of health care development in the third poorest country in the world, at times it can feel that healthcare is beyond repair,” added her colleague Monica, referring to their work in Burundi. “By removing myself from my immediate environment, and meeting with colleagues that are striving toward the same goals of innovation and safe care in challenging environments, I could better strategize.” 

The launch meeting also provided an opportunity for the participants to take advantage of being in New Delhi by attending the EMS-IEH 2013 conference. At the conference, participants in the Collaborative had the chance to present on their organizations and their innovations, specifically focusing on how they can contribute to the national health goals of their respective countries. The participants also sat down with Jason Hwang, co-founder of Innosight, to have a small group discussion to learn more about disruptive innovation and how it applies to their organizations.


Moving Forward

The collaborative participants have met and decided on their first change ideas, and are back at work. They will implement their “change ideas”  and test their effectiveness—while connecting with each other regularly by email and phone to share ideas and receive advice.

Ultimately, with the collective power of five organizations at the forefront of health innovation on two continents, we expect that members of the Primary Care Learning Collaborative will develop solutions that will not only improve the way that they provide care to the poor, but serve as a model for other organizations with similar missions around the world. Participants seemed to agree. Monica Slinkard commented, “This initial weekend in Delhi has the potential to funnel a whirlwind of innovative ideas into real health impacts for the world’s poorest people. I am truly looking forward to continuing to work with this group to realize this goal.”


Click to see a slideshow of photos of collaborative members touring Ross Clinics in Delhi.

To read more about emerging primary healthcare chains, click here.

For more information, feel free to contact the author at tlewis@r4d.org.