Look no further than a clinic, hospital, pharmacy or kiosk to see the complexity in achieving better global health.
NGOs and governments spend a significant amount of time trying to better understand the people receiving health products and services, and much less time trying to understand those delivering it – especially private-sector health workers.
Here are the stories of three people who contribute significantly to improved health because of the strong support they have received in their own businesses.
Dr. Aye Aye: Franchising, strengthening health systems
Many years ago, Dr. Aye Aye Mu purchased a small clinic nestled next to her home in the capital city of Yangon, Myanmar. Dr. Aye Aye juggles her roles as a mother, a doctor and a small business owner as she runs her clinic to provide for her family.
More than 10 years ago, PSI/Myanmar approached Dr. Aye Aye with a business proposition. PSI was creating a network of franchised health centers, called Sun Quality Health, and was looking for dedicated clinic owners to join. The more Dr. Aye Aye learned about franchising, the more she felt it would help her and her clinic, and she became one of the first providers within the franchise network.
Through the Sun Quality Health network, Dr. Aye Aye has seen a marked improvement in her business. As a franchisee, Dr. Aye Aye is connected to training that might be out of reach for a stand-alone clinic in a poor neighborhood. She can stay up to date on the latest research and medical best practices and make sure she always has the necessary instruments, medicines and other products at hand to provide the highest-quality care
to her clients. Because she is part of a well-known network, Dr. Aye Aye has the added benefit of brand recognition. Clients know Sun Quality Health clinics and trust their quality. Community outreach workers within the network also educate people and communities about health issues and drive traffic back to these clinics, growing Dr. Aye Aye’s client base. The Sun Quality Health network allows PSI/Myanmar to invest in Dr. Aye Aye, not only in her clinical skills but also in the business skills to help her clinic meet the needs of her clients.
Today the Sun Quality Health network is Myanmar’s largest private health-care system, with 2,000 outlets serving more than 1 million people. PSI/Myanmar works with its franchisees – which provide more than 10 percent of the nation’s family planning services, and diagnose and treat 15 percent of the country’s tuberculosis patients – so they can offer a range of services at the highest quality of care.
Pharmacists: Facilitating markets, stopping drug-resistance
Boniface is a pharmacist in Ukundae, Kenya. He serves clients with a wide range of needs every day. One of his best selling products is antimalarial medication. Malaria is common in some parts of Kenya, so pharmacists are often quick to sell antimalarial medicines to customers with fevers. Malaria is not the only cause of fever, though, and unnecessarily treating someone wastes high-quality frontline malaria drugs and contributes to a growing resistance to those medicines.
Today, there is a quick and easy test available to diagnose malaria. Rapid diagnostic tests return results in mere minutes and can be safely administered by lower-level health-care providers. Pharmacists and other health workers can use the tests to accurately diagnose their clients and provide appropriate care. Nevertheless, in many countries, the tests are not readily available at pharmacies and drug shops, or are more expensive than the recommended malaria treatment when they are available.
For Boniface and other pharmacists, this can present a real problem. If Boniface doesn’t have the skills to administer the test or doesn’t know how important it is, he might presumptively treat for malaria. And if the tests are not financially viable for him to stock or sell, his business may suffer.
PSI and our partners are creating markets for these rapid tests in Kenya, Madagascar, Nigeria, Tanzania and Uganda. The project is supported by UNITAID, which uses innovative financing to increase funding for greater access to treatments and diagnostics for HIV/AIDS, malaria and tuberculosis in low-income countries. Together, we analyzed the market to identify the barriers that pharmacists face in using the tests to properly diagnose and treat customers.
PSI then addresses these barriers, enabling the market to grow on its own. We work closely with Boniface and other pharmacists to teach them how to administer tests and educate them on the benefits of testing before treating. We also work with local pharmaceutical importers and the Government of Kenya to ensure that the tests are of high quality, as well as affordable and realistic for them to stock and sell.
Today, when clients come in asking for antimalarial medicine or complaining of fevers, Boniface first talks to them about why it is important to diagnose then treat. He’s then able to administer the simple test at an affordable price to his customers and, if the results are positive, he can provide the proper antimalarial treatment. Boniface’s business grows because clients trust his judgment and respond to the right treatment. Because the market is beginning to function properly, he doesn’t need to choose between doing what’s best or what’s most profitable. Boniface can feel confident that he is properly treating his clients and running a good business.
Incentivizing product sales in Mozambique
Chefe owns a tiny kiosk near a bus stop and school in Maputo, Mozambique. The small shop is his livelihood. With limited cash at his disposal to invest in stock and little room to store extra goods on his shelves, Chefe needs to use all of the space he has for items that will consistently be purchased and rotated. This makes stocking a bed net, water treatment, or other health product – versus a soda bottle or small quantity of rice – a difficult and rarely possible choice for most shop owners.
This isn’t the case for Chefe. He sells several health products in his shop, including condoms, safe water treatment and micro-nutrient powder to fortify infants’ food with necessary vitamins and minerals. He’s able to do this because he joined the “Troca Aki” or “Exchange Here” network.
Troca Aki is part of a PSI/Mozambique initiative called Movercado. Through this initiative, health educators reach members of the community with important messages tailored to their lifestyles. For instance, a woman who has just given birth will be reminded about the importance of breastfeeding. Six months later, that same woman will receive a message about fortifying her child’s solid food to make sure his or her nutritional needs are met. To help her practice this healthy behavior, she receives a voucher for free micro-nutrient powder at a local Troca Aki-branded shop, such as Chefe’s.
Chefe saw immediate benefits to joining the program. He gets great satisfaction from knowing he’s helping people, but he has also seen real and immediate improvements to his business. When a customer redeems a voucher for one of the Troca Aki health products, Chefe validates the code by SMS with Movercado and makes a profit on the product. Because of the community outreach and vouchers, the products move quickly off of his shelves, translating into cash. He also sees new faces. Many of the customers who come for their free products have never been to Chefe’s shop and often buy other goods while there.
Chefe says he thinks of his shop as another child and puts incredible care and dedication into it. He takes the greatest pride seeing his own sons taking care of the business. He may not fit the typical image of a health worker, but Troca Aki allows and encourages Chefe to be both an entrepreneur and a health provider by continually improving his business while creating something that he is proud to share with his family.
Solutions like these work because they respond to individual health workers’ professional and financial needs.
When we take a human-centered design approach to better understand the providers of health, we increase quality, job skills and job satisfaction. Bringing private-sector solutions to scale at community and country levels helps us to build stronger health systems, more effectively allocate scarce donor resources, and integrate a variety of products and services in convenient locations.