Delivering (and Sustaining) Services on Scale. Anywhere.
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Delivering (and Sustaining) Services on Scale. Anywhere.
November 20, 2008 Gopi Gopalakrishnan
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Time to Go Rural
• Challenge: How to deliver services on scale in any part of the world, however rural or remote
• Primarily in areas where the public sector is ineffective or unavailable
• Private sector is the only other option for large-scale service delivery
Using private sector to target the poor needs ability to reconcile two naturally divergent forces
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Using Private Sector -- A Quick Review
• 20 years ago, focus was primarily urban. Demand creation was difficult, supply was relatively easy
• For products—we just used supply infrastructure created by private companies
• For services—the challenge was day to day management but personnel, premises and communication vehicles were more easily available
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Delivery in Rural Areas—Need is for New Set of Paradigms
• Demand is a given—even for family planning, unmet need is estimated at 20%. Health care is even more
• Adequate finances available
• Binding constraint is providers—for subsidised products, volumes are too small; for services, the appropriate providers are unavailable or unwilling
• Clients will some services only if available closeby
• Vertical provisioning is unviable and unsustainable
• Preventive care (and low level curative care) has not much attraction
• Public sector is willing to support provision through private providers
• Skilled providers not willing to stay in rural areas—will work only for short periods
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Programmatic Structure
• Create a viable package which will leverage and sustain interest
• Curative part of package will anchor it financially
• Preventive part is a non-negotiable part
• Develop technology to fit service delivery and not vice versa
• Flexibility to adapt to uncertainties that come with the territory
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Overview
• Create a basket of services that combines preventive with curative services
• Identify and induct a range of providers on the basis of competency and inter-link them financially
• Three broad functions for providers: Provide services directly Facilitate services through other networks (and
earn) Manage provision by WHP (and earn)
• Use financial instruments to leverage public sector support
Determine services that are of primary interest, quantify and work toward achieving them
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SKY CAREV i l l a g e
P r o v i d e r s
SKY HEALTH
T e l e m e d i c i n e C e n t e r s
F r a n c h i s e e D o c t o r s
C e n t r a l M e d i c a l F a c i l i t y
S h o p s
T h i n kT a n k
V i l l a g e s
S p e c i a l i s t s
S u p p l i e s
9 0 0
9
1 0 0
1 , 0 0 0
WHP Service Delivery Structure
D I a g n o s t I c C e n t e r s
W H PO f f i c e
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Impact
• Project aims to address over 20% of unmet need in year 1
• 33% increase in contraceptive prevalence rate in 4 years