Sustaining a Social Business Model and Optimizing Public Health Impact - Lessons Learned From the Field

How can successful public health projects transition to financially sustainable social business models? In this part of the series on the September 2014 IRD-CHMI Health Market Innovations Hub meeting in Amman, Jordan, we provide learnings from three TBXpert projects in Karachi, Pakistan, Dhaka, Bangladesh, and Jakarta, Indonesia that are relevant to innovators looking to expand their social business and generate revenue. 

Overview

Innovative private healthcare delivery often requires a two-pronged approach, designed to generate revenue to ensure financial sustainability while optimizing public health impact. To implement a successful social business model, public health experts must think outside the box, often relying on insights from individuals with business backgrounds. Similarly, scaling-up public health programs requires the development of partnerships and engagement with multiple stakeholders to truly create impact.

Promoting Regional Integration in Private Healthcare Delivery- A Case Study on the TBXpert Initiative

Tuberculosis claims three lives every minute. A curable disease, 95% of patients live in low- and middle-income countries, and weak and fragmented health services can often delay or compromise treatment, allowing the disease to spread, and/or multi-drug resistant TB to develop. Engagement with the private sector is limited in developing countries and reaching case-notification targets remain a challenge for public health departments and TB control programs. 

To meet this challenge, the TBXpert Initiative, a project funded by UNITIAD and TB REACH at the Stop TB partnership, aims to increase the diagnosis and treatment of TB in the private sector by using  a social business model that focuses on selling services, such as digital chest X-rays, at subsidized rates to achieve social objectives while simultaneously scaling GeneXpert testing for TB in the private sector. UNITAID has donated 500,000 GeneXpert test cartridges to these countries for increased tuberculosis case detection and treatment in the private sector through mass screening and testing. This approach has been piloted in  Pakistan, Bangladesh and Indonesia, with the goal of developing a revenue-generating model that can sustain itself beyond the grant horizon. These three sites were chosen for several factors, including their large populations, a private sector led healthcare delivery system, and a high disease burden of TB.  At the IRD-CHMI Hub meeting in Amman, Jordan, these three sites presented the progress, challenges and opportunities in terms of the respective social business models.

The three sites have been confronted with similar organizational and strategic challenges in implementing the project. During the meeting, the representatives from Pakistan, Bangladesh and Indonesia presented their marketing strategies, business plans and financial projections to highlight key challenges and opportunities. Consultants provided target-specific practical solutions to address the recurrent challenges faced by the partners, and break-out sessions were held between individual partners and consultants to discuss country-specific challenges. Consequently, action plans were drafted for the next year to make tangible progress in sustainability of the respective social businesses without compromising their public health impact.

Pakistan

Interactive Research and Development (IRD), CHMI’s partner in Pakistan and the project lead for the TBXpert Initiative, launched a social enterprise, Community Health Solutions (CHS), to roll out its public health concern. CHS introduced Sehatmand Zindagi (or Healthy Life) centers  in low and middle-income areas of Karachi with the aim of starting a sustainable revenue-generating model. The centers provide diagnostic and treatment services for TB,COPD, Asthma and Diabetes, and the revenue stream of the centers is based on the service subsidization model for financial sustainability. Charging for the diagnostic and treatment services for COPD, Asthma, Diabetes, and digital X-rays screening finances the provision of free GeneXpert testing, which is a highly accurate, yet costly, form of TB diagnosis. At the IRD-CHMI Hub meeting, IRD staff provided a financial and marketing overview to evaluate the progress of  the Sehatmand Zindagi  social business model. The primary challenge involves obtaining larger number of referrals to the centers in order to generate sufficient operational revenue to cover costs. Therefore, the communications strategy was reevaluated in detail as well as   incentive structures, key promotional events and pricing strategy. Consultants proposed alternative strategies such as diversifying disease diagnostic and treatment portfolio, organizational restructuring, expanding the catchment area and doctor referral networks, sliding scale pricing strategy and revising marketing and communications strategies.

Bangladesh

IRD’s regional partners in Dhaka, Bangladesh (ICDDR-B, the TBXpert Bangladesh team)  also provided their financial overview and revenue projections for the next year. Similar to their colleagues in Karachi, the key take-away was that there are problems in meeting the revenue targets and recovering operational costs. The team shared its comprehensive marketing strategy that comprised of advertising, centers working under the banner of the already well-established ICDDR-B brand to capitalize on consumer trust and brand visibility, and a roadmap for executing marketing plans. Consultants lauded the market strategy and stressed using flexible approaches for mass screening and testing to move towards sustainability. The team agreed to revise the financial model and function like a business with social objectives. Expanding catchment area and adding revenue streams were also proposed as a way forward.

Indonesia

Remdec, IRD’s Jakarta partner, also provided financial projections of their social business model for TB. Their project centers are not functional yet due to regulatory challenges in importing the Delft x-ray machines to the country. Despite these setbacks, the team predicted to achieve financial sustainability with surplus revenue by the end of year 2016, through a variety of approaches such as renting sites to setup new pulmonary clinics for revenue generation, which will have pulmonologist(s), GeneXpert machines for TB diagnosis, and x-ray machines. The intended sources of revenue are chest x-rays (at pulmonologist clinics), clinic management fees, insurance coverage for TB screening and diagnostics (to be covered under Indonesia’s new universal health coverage scheme), and other X-ray services. Remdec also aims to conduct workplace screenings for TB that will support revenue generation.  Key to the Indonesia team’s strategy will be advocacy to include TB screening in the new government insurance coverage scheme, which would help the Jakarta centers achieve full financial sustainability without relying as heavily on out of pocket revenue from their patients.

The Way Forward

 Although the centers are operating in unique local contexts with some location specific challenges and opportunities, there was a consensus amongst the stakeholders in the meeting that the partners still faced similar challenges in terms of creating a revenue-generating model, marketing, branding and communication strategies, acceptability and scaling up these innovations. The need for greater cooperation both within the country and externally was recognized as being an instrumental factor in realizing the dual objectives of sustainable social business model and optimal public health impact.

Post and photo - ©2014 Obaid Arshad.