Working with Traditional Providers in Improving Health ... · PDF fileRx Audit –ORG All...
Transcript of Working with Traditional Providers in Improving Health ... · PDF fileRx Audit –ORG All...
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Abt Associates Inc. in partnership with:Data Management Services Inc.
Dillon Allman and Partners. LLC
Family Health International
Forum One Communications
Global Microenterprise Initiatives
IntraHealth International
London School of Hygiene and Tropical Medicine
O’Hanlon Consulting
Population Services International
Tulane University School of Public Health and Tropical Medicine
Working with Traditional Providers in Improving Health Outcomes in India
Sanjeev Vyas
Abt Associates Inc.
GHC Conference, 27th May ’08
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Who are Traditional Providers?
� Not a very well defined group
� Comprises of a diverse set of providers including� Rural Traditional Healers
� Indigenous Systems of Medicine Providers (ISMPs)
� ISMPs � Less Than Fully Qualified (LTFQ ISMPs) providers
� Qualified practitioners of a combination of a traditional Indian system of medicine and modern allopathy (AYUSH ISMPs)
� Serve a large urban and rural populace without access to formal and affordable medical system
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The Caste System Among Private Healthcare Providers
Specialists - MS, MD
GP’s - MBBS
AYUSH - ISMPs
LTFQ ISMPs
Rural Traditional Healers
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Who are AYUSH ISMPs?
• AYUSH providers have degrees in Ayurveda, Unani, Siddh Tibb or Homeopathy from central, state or private colleges
• Including Surgery, Ob/Gyn, Anesthesiology, ENT, Ophthalmology, etc.
• Only AYUSH recognized by government and allowed legal practice
• Other ISMPs excluded and often prosecuted
• Over 800,000 registered AYUSH ISMPs in India
• Clients are charged for dispensed medicines and consultancy is included
• ISMPs ignored by pharmaceutical firms and most health programs
• Some pharma companies now realizing their importance
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AYUSH ISMPs
• IMCC, 1970 (Indian Medicine Central Council Act) allows supplementation of Indian medicine by ‘modern advances’
• Institutionally qualified ISMPs eligible to practice respective systems with modern scientific medicine including Surgery and GynecologyObstetrics, Anesthesiology, ENT, ophthalmology, etc. based on training and teaching
• CCIM (Central Council of Indian Medicine) – Statutory body under GoI, MoHFW to frame, implement and regulate curricula for Indian Systems of Medicine and standards of conduct of practitioners
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Why Work with ISMPs?
• High penetration across lower income communities and rural areas
• Enjoy high degree of credibility and acceptance
• Offer better accessibility and affordability
• Consulted mostly for everyday illnesses and certain chronic conditions
• Comparatively more customer oriented
• ISMPs regarded as qualified doctors by the lower income communities and across rural areas
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ISMPs: Filling in the Gap for Trained Medical Providers
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Our Experience with ISMPs
� Saathiya Youth-Friendly Network
� WHO ORS & Diarrhea Management Program
� Zinc Therapy Pilot Program
� Others
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Saathiya Youth-Friendly Network
• Model based on CELSAM Youth-Friendly Pharmacy network, Mexico
• Formative research conducted to explore feasibility of Retail Pharmacists as Youth-friendly providers
• For a pilot program in Lucknow, Uttar Pradesh
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Reality Check: Chemists: Privacy and Confidentiality?
A Typical Chemist Store –
Lucknow
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Access For Young Women too…?
Manned by Male Salesmen –
Lucknow
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What Potential Clients Thought about Pharmacists…
� Information sought will be limited to product level and referrals:
� “He can impart product knowledge but not counseling on reproductive health”
� Chemists level of involvement in offering this service is doubted:
� “Chemist is a businessman at the end… He won’ t be keen to solve queries
when customers have lined up”
� Apprehensions about their competence on reproductive health issues:
� “For simple information I have media and friends/cousins, for serious issues I
will always consult a doctor, where will chemists fit in?”
� Concerns about privacy and confidentiality:
� “We don’ t go to the chemists in our neighborhood to even buy condoms…how
can we go and ask?”� “ I will send my husband to get the information on the topics I want to know”
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ISMPs: Offer Privacy
AYUSH Allopathic Practice -Lucknow
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Most Dispense Products as Well
Homeopathic practice –
Lucknow
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They are Trusted and Easily Accessible…
ISMP Clinic -Lucknow
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…and Some of them are Women
Ayurvedic practice - Lucknow
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� FP not a regular service provided by ISMPs
� ISMPs can offer a friendly and private atmosphere � Clients want friendly but expert and reliable information
� Lady ISMPs preferred by young women
What Potential Clients Thought about ISMPs…
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� Score higher than Pharmacists in terms of
� privacy
� convenience
� reliable information
� Also score higher than Ob/Gyns and GPs on
� accessibility and
� affordability
What Potential Clients Thought about ISMPs…
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ISMPs: Keen to Participate…but had Concerns
� Issues of credibility
� Not regarded as registered/ legal medical practitioners by some and MBBS doctors have greater credibility
� ISMPs consulted mostly for every day problems like cough & cold, fever or for special chronic dieses like Arthritis and Diabetes
� Do not offer FP services
� Rarely infertility and potency issues are tackled
� At present a visit to an ISMPs gives the patient the satisfaction of visiting a doctor
� that too at a lower cost and without having to seek an appointment
Self-Image:
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ISMPs: Keen to Participate…but had Concerns
� “But chemists may become consultants at free of cost in family planning and contraceptive issues after this”
� Increasing the credibility of chemists may reduce the footfalls to ISMPs
� Sense of insecurity among ISMPs� MBBS doctors are irreplaceable… now I’ ll be seen at par with
the chemist
Commercial Aspects:
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Outreach activities
Clients
In-clinicPOS
WOM
Mass Media
Helpline
Chemists
ISMPs
Ob/Gyns & GPs
Product
s
Counse
ling
Products
Clinical Service
Saathiya YF Network Model
Clin
ical Serv
ice
Counse
ling S
upport
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Mystery Client Study
• ISMPs showing greater propensity to maintain privacy
• More patient in answering numerous client queries
• On an average spent more time with clients
• Displayed better quality of interpersonal skills
• Proactive in providing program reference materials to clients
• Better display of program signage and POS materials
Mystery Client Survey, GFK Mode, March-April ’08
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Elements of the Diarrhea Management Program
Celebrities
Mass Media
Govt.&
Regulatory
CommunityOutreach
Promotions&
Tie-ups
ORSManufacturers
Professional Associations
Saathi Bachpan Ke
Celebrity Endorsements
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Role of ISMPs in Diarrhea Management
0
1,000,000
2,000,000
3,000,000
4,000,000
5,000,000
6,000,000
7,000,000
Prescriptions
Any ORS 979,319 273,839 425,566 262,345 9,794
Others 4,884,865 2,215,604 1,591,333 986,916 42,578
All doctors GP (non-MBBS) Paedatricians GP (MBBS)Consulting
Physicians
Prescriptions for Symptoms/Diagnosis of Diarrhea (0-2 Age bracket)
Rx Audit – ORGAll India – 1 lakh+, Nov 2001
43%
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Interventions with ISMPs
• Training on diarrhea management practices
• Detailing to 30,000 ISMPs
• ORS prescription drives in diarrhea season
• ISMPs volunteered to counsel mothers in growth monitoring camps
• Merck conducted ISMP trainings and special prescription drives
• Most commercial ORS manufacturers initiated stocking with ISMPs
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ORS Sales Volume Growth
0
5000
10000
15000
20000
25000
30000
35000
2001 2002 2003 2004 2005 2006 2007
Vo
lum
e in
th
ou
san
d l
iter
s
Non-WHO WHO
Industry shift to single formulationCAGR 8%
ORS Sales Volume Growth: India
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ISMPs Role in Promoting Zinc Therapy
• Designed a variety of community pilot interventions in urban slums across three states with ISMPs as Zinc Champions
• Trained ISMPs on role of Zinc Therapy in diarrhea management
• Updates on Diarrhea Management and Zinc by PSP-One field personnel and mailers
• ISMPs participated in demand generation through prescription drives
• Actively counseled caregivers on Zinc therapy by participating in
diarrhea management camps
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Engaging with ISMPs: Key Findings
� Offer a high degree of engagement and support
� Eager to acquire new knowledge and updates
� Open to working with different sets of providers
� Keen to support social marketing programs
� Offered free consultancy on diarrhea management
� Reduced fee for Saathiya referral card holders
� Accepted as additional retail channel by pharmaceutical partners –
OTC products: ORS, Zinc, Condoms, ECs, CycleBeads
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Working with ISMPs: Key Learning's
� Very diverse set of providers, need to be screened carefully vis-a-
vis target clients and program objectives
� Need to ensure role clarity
� To be considered as credible channel require training, counseling
skills and repositioning
� Regular monitoring on quality parameters and compliance issues
� Regulatory issues can create barriers for some pharma companies
to work with ISMPs
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Thank you!