using client poverty data as a meaningful input for health programs webinar june 16, 2015
TRANSCRIPT
About the organizers
We research, document and work to improve the performance of heath programs that are rolled out through
a mixed (public and private) approach
www.sf4health.org
http://healthsystemshub.org/
http://healthmarketinnovations.org/
About the webinar series
• This webinar is the first in a series of webinars we will jointly host quarterly on topics that can support private sector healthcare interventions and programs, including social franchises, better measure, evaluate, and improve performance.
• A calendar of webinars can be found at http://healthsystemshub.org/news_events/global_calendar
About the webinar technology• Use a set of headphones for maximum audio clarity
• Make sure your volume settings on your computer are sufficiently high
• You can (and should!) send messages and questions to the moderator. No other participants will be able to see the messages. However, you cannot speak or be heard.
• If you are having technical difficulties, email Avery Seefeld
Equity measurement
• Growing awareness thatincreased national wealth is often not shared equally
• Better measurement tools
• Re-invigorated global emphasis on targeting effort, and subsidies, on those most in need
The agenda
• In the first 30 minutes: 3 case studies will be presented
• Presentations will be followed by a Q & A period.• To pose questions to the presenters: Type them into the
chat box at the lower left-hand corner of your ReadyTalk interface at any time.
Case Study 1: Insights from African Health Markets for Equity (AHME) partnership
• The AHME partnership strives to improve access to high-quality private healthcare to the poor in Ghana, Kenya, and Nigeria. Equity measurement has been a critical ingredient in shaping and informing the way the program is implemented.
• Matt Boxshall, Director of this program, will present case study 1.
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Program Overview
rope and Asia. They understand, and have catered for the health needs of professionals working in those regions.
Demand Side
Functioning Health Markets for the Poor
Demand SideSupply Side
Increase “value for money” in the health sector Cost/ DALY
Increased use of relevant health technologies DALYs
Policy Context+ ICT
+ICT• Scale and scope
through franchising
• External Quality / accreditation
• Access to capital
• Increase demand for health services
• Remove financial barriers through demand side financing
• Engage policymakers • Improve evidence base• Improve regulatory capacity • Improve capacity to contract non-state sector
Client Exit Interviews11
Do client profiles match strategy?
High Impact CYPsWhy HIC groups?
AdoptersHow do we do?
YouthHow do we do?
PoorHow do we do?
Before the visitHow do we attract clients?
How do clients hear about us?
Why choose us?
Satisfied?Will you return?
SwitchersHow do we do?
At the siteHow well do we serve clients?
CounsellingFollow-up
After the visitExperience and Feedback
What if we had not been there?
Choice (new!)
PAFPPartnership stats
Health impact and sustainability
+ Quality (QTA, QAF)+ Efficiency (SUN, cost calculator)
PPFP Partnership stats
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Lesson 1 - Equity
Wealth quintiles of franchising clients, within national reference populations*
Quintile MSI Nigeria
Society for Family Health
Population Services Kenya
MS Kenya MSI Ghana
n=458 n=420 n=445 n=369 n=321
1 (poorest) 0.2 0 0 0.5 0.6
2 0.7 0 1.8 5.7 0.9
3 6.3 0.5 12.8 14.4 8.7
4 15.5 7.1 24.9 31.7 24.6
5 (richest) 77.3 92.4 60.4 47.7 65.1
Sources: Nigeria- Malaria Indicator Survey 2010; Kenya- DHS 2008; Ghana- DHS 2008
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Client Wealth Profiles in Context – KenyaMS Kenya
Quintile National Nairobi, Coast, Nyanza, Western Regions only
1 0.5 1.7
2 5.7 4.0
3 14.4 31.4
4 31.7 34.7
5 47.7 28.2
PSK
Quintile National Urban
1 0 14
2 1.8 23.4
3 12.8 25.9
4 24.9 18.2
5 60.4 18.5
Equity continued• Find out more?
• Run DHS2014 for Kenya• Compare with lower level providers eg
PPM• Compare in local area with Public
Sector• Disaggregate the ‘private sector’ more
effectively?
• And . . .
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Lesson 1 – Review Franchisee selection
• Review SF strategy • Go to the right places
• Go to lower level providers
• Go small, go local
• MSI 2015 SF guidelines; a new archetype
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• Improved reach to the poor
• Stronger Value Proposition to provider,
• Max impact on business viability through small providers (UCSF Berkeley)
• But – explicit compromises – SF ‘efficiency’, and potential to link to NHI?
Lesson 2 – Design SF to link to DSF• NHIs historically biased to big providers • Service package challenge;
“Provide what the payer wants to buy” • Expand scope• Capitation packages, tailored services packages
• Empanelment tools• Often biased against small providers• Process subjective
• Pick your battles . . .
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Social Franchising• Bridge to NHI
• Value Proposition• Business – Catchment• Status – Accreditation• Principles – more Poor
• Leverage
Quality
National Health Insurance• Expand cover, enrol the poor• Contract private providers
• Equity• Access• Sustainability
Demand for Insurance
Supply Demand
Lesson 3 : New Role for SF Organizations
Case Study 2: Insights from Heartfile Health Financing
• Heartfile Health Financing is an IT-supported, automated health financing instrument that can be accessed by health care workers in Pakistan to seek urgent financial support for patients that run the risk of spending, catastrophically. This NGO aims to link equity measurement with an efficient and transparent means of transferring cash subsidies to the poor.
• Dr Anis Kazi, Senior Manager, Policy Advocacy and Research at Heartfile, will present case study 2.
HEALTH IN PAKISTAN: A NEW OPPORTUNITYDr. Anis Kazi
Senior Manager
Policy Advocacy and Research
Heartfile
How can client wealth profile data add value to health program interventions? A conversation on promoting equity in service-use
Pakistan’s many health systems
Nishtar S. The Lancet 2013.
Natural calamities,
7%Agricultural shocks, 4%
Economic shocks, 28%
Law and order, 3%
Family matters, 4%
Health shocks, 54%
Heartfile Financing has five important elements
• Technology interface integrated with mobile phones
• System of validating poverty
• Public-private partnerships with hospitals
• Process, characterised by transparency, traceability, accountability and checks and balances
• Risk based monitoring mechanism
Programme Overview
Equity Data • Collection of data• Heartfile's customized ERP collects, update and disseminates data on an
ongoing basis.
• Usage of DataInternal usage For daily operational deacons.
• For organizational strategic decisions for resource mobilization and scale up.
• External usage• For external actors, including donor, healthcare professionals and medical
suppliers.
• Limitations of the data Due to a response time of within 72 hours, we cannot do a household assessment.
THANK YOU!For more information: • www.heartfile.org• www.heartfilefinancing.orgFor further questions and queries [email protected]
Case Study 3: Insights from MSI Madagascar
• Marie Stopes Madagascar conducted a pro-poor voucher initiative to increase uptake of family planning services through social franchise clinics.
• James Wumenu, Research Officer at Marie Stopes International, will present case study 3.
USING EQUITY DATA TO IMPROVE TARGETING OF SERVICES TO POOR
CLIENTS
James Wumenu
Marie Stopes International
How can client wealth profile data add value to health program interventions? A conversation on promoting equity in service-use
Project Overview
• Project involves client referrals to social franchise facilities through
voucher schemes (2011-2012)
• Aimed at reaching poor women with FP Services
• 90% poor clients
• Potential clients complete a poverty scorecard to determine
eligibility for the free vouchers
• Beneficiary clients receive free services upon presentation of
vouchers at social franchise facilities
• Equity was measured in 2011 and 2012 to assess our reach to the
poor
Equity Measurement• Muliti-dimensional Poverty Index (MPI) was used to assess
poverty profile of clients
Sample size
2011 – 5740
2012 - 2600
Percentage of clients who are MPI Poor
2011 20120%
10%
20%
30%
40%
50%
60%
70%
80%
90%
100%
76% 85%
National Pop. 67%
Target =90%
Evidence to action
• Results in 2011 & 2012 were shared with project team
• MSM team, voucher distributors, service providers, donors
• 2011 results informed strategies for effective targeting of
the poor
• Retraining of voucher distributors to effectively administer poverty
scorecard
• Compulsory home visits to ascertain poverty status of beneficiaries
• These strategies led to significant improvement in our
reach to the poor in 2012 (from 76% to 85%)
Way forward on poverty measurement
• MSI Madagascar currently measures clients poverty
annually since 2010 for all channels
• Results are used to estimate High Impact CYPs every
year
• Inform strategies to reach more poor clients
• MSM may switch to use Progress out of Poverty Index
(PPI) this year for its poverty assessment
• This is the standard poverty assessment tool for MSI globally
THANK YOU!
For more information on MPI and MSI Madagascar, visit: • http://www.ophi.org.uk/policy/multidimensional-poverty-index/• http://mariestopes.org/where-in-the-world#madagascar
You can also contact the following for more information on this presentations:• [email protected]• [email protected]• [email protected]
Using client poverty data as a meaningful input for health programs
WebinarJune 16, 2015
Case study 1: AHME
Case study 2: Heartfile Health Financing
Case study 3: Marie Stopes Madagascar
For further information• Visit SF4Health.org for the newly released 2015 edition of
the Compendium of Social Franchises. 63 social franchise programs report data on their scale, health specializations and health impact. A sub-set report equity data.
• Visit http://www.healthsystemshub.org/ for resources to learn, connect, and collaborate with people around the world.
• Visit http://healthmarketinnovations.org/ to discover more than 1,400 health programs in CHMI's data set, which employ promising practices that can be scaled‐up or adapted in other countries.