Public policy

The two biggest barriers preventing the blind from getting treatment are awareness and affordability.

Indonesia has 9100 primary care clinics but the clinics’ role is passive, treat only patients who come. Many blind patients don’t go to clinics, believing it is not treatable, doubtful over the quality or the treatment is not affordable.

The cost of cataract surgery is USD450/eye at public hospital, too prohibitive for the 120 million Indonesians (50% of the population) who earn less than USD2 a day* (*source: The Jakarta Post, Beyond Statistics of Poverty, Iin P. Handayani, February 13 2012)

Thus, surgery output is very low (averaging less than 10 cataract surgeries/hospital/week), making Indonesia the country with one of the lowest Cataract Surgical Rate in the world.

Solution: break the awareness and affordability barriers.

Awareness:
* Regular training to grass roots resources (Babinsa, village chiefs etc.)
*Use media to help improve public awareness on avoidable blindness.
* Increase accessibility to treatment by providing transportation to the hospital.
*Improve the surgery quality by training and incentivising medical and hospital staff.

Affordability:
* Make available high quality and affordable community eye hospitals.
* Targeted free (charity) cataract surgery to ensure the unreached is reached.
* Document surgery output and outcome; share this data with the public and policy makers. This is useful in advocating eye health to policy makers.

Our vision is a world where no one is blind needlessly.

Technology and accessible treatment are available for 80% of blindness (cataracts and refractive errors; source: Vision2020, International Agency for Prevention of Blindness).

No one should remain blind simply because of lack of awareness or inability to pay.

Utilize our international and local network to mobilize local community to take part in ending avoidable blindness.

ANV is a young organization with little resources but we have made good impact in local community and we are well known for high volume and high quality cataract surgeries. We are on the right track to take the work to the next level – drive the building of sustainable community eye hospitals.

We can collaborate with non-traditional partners (Babinsa and private social enterprise). We also collaborate with large INGOs - The Fred Hollows Foundation (www.hollows.org.au) to share knowledge and compliment each other’s work.

Our customers are:
1. Paying patients
2. Non-paying patients

Profits made from paying patients are used to fund subsidized or free treatment to the unreached.

The quality of treatment is the same for both paid and free patients. Only the level of comfort in service differentiates the two categories of patients.

Community education – basic eye health training for Babinsa, village chiefs, local women associations, religious and community leaders.

Publicity – media (radio), stage play, flyers, banners.

Making accessibility easy – provide scheduled and regular transportation to the hospitals.

Referral by shareholders – members of the private social enterprise and local ophthalmologists association are likely to refer customers to this hospital.

Word of mouth – high quality yet affordable treatment with good service experienced by patients will be invaluable referral for future patients.

- Community education on basic eye health.

- Build the capacity of local medical team by funding intensive quality training on cataract surgery.

- Equip trained local medical team with mobile equipment and encourage them to actively take part in community work including charity surgery events held by other NGOs.

- Drive private social enterprise to start the building of sustainable community eye hospitals.

- Connect the private social enterprise with other INGO (eg. The Fred Hollows Foundation) for additional support.

- Advocate policy makers by presenting record and output and outcome data from our activities.

There are no real comparable peers or competitors in what we try to do. Private for-profit eye clinics/hospitals may see us as a threat and competitor but it is a misguided because there are so many patients who are currently not serviced due to lack of awareness, trust (quality) and affordability.

For the middle to upper middle class patients, their trust in the local quality of surgeries is low. Many choose to have their cataract surgeries abroad even though it costs a lot (Malaysia, Singapore)

Our challenges are For-Profit eye hospitals who are going to view low cost high quality eye hospitals as a threat to their business and they might use local ophthalmologists association to influence the authority to stop this hospital from operating.

To overcome, we encourage private social enterprise to invite local ophthalmic association to have profit shares in this hospital.

The local ophthalmic association keep their share of profits. Only share of profits owned by private social enterprise will be used to subsidize free treatment for the poor.

As a result, local ophthalmologists will also help refer patients to this hospital and help it grow.

Overtime, the market will prove that the greater the public awareness, the more patients for everyone.

The strategy is to have one sustainable community eye hospital operating by year 2014, this gives us one year to secure crowd funding, recruit and train personnel, refurbish the hospital, increase the training to the community.

Once the hospital is running, the operating model can be quickly applied to the second and third hospital in other provinces.

There are public demands and interest from social enterprises.

First three years: new regions (other provinces)

After three years: with good reputation established, the hospital can:
* Expand the scope of treatment to include other eye sub-specialties.
* Reach to customers who currently seek treatment overseas.

The growth objectives we envisage are:
* To replicate this hospital model across Indonesia’s 33 provinces.
* To influence policy makers to place greater resources on eye health and put eye health on priority health list.

Please kindly refer to answers in 3.2.a and 3.2.b above.

Depends on the scope development regarding services to be provided to Communities

NGOs will provide to Companies services on surveys and reports:
• Consumers Insights
• Focus Groups • Products “testing”
• Field observations and trends
• Customized researches
Companies will pay for these services (as already do in their daily business) and this will be the founding for NGOs to provide the services to Community

Create a connection platform between individuals from Society, Companies, Government
and NGOs that enables the interaction of them converting the challenges and needs from one into
immediate and sustainable Benefits to other Partners.
NGOs units as central points of interaction and providing services to all Partners.
All partners count on direct and sustainable benefits, but also have responsibilities
Financial resources will come from the Companies that will acquire from NGOs the customized survey and researches and pay a monthly fee for receiving frequent reports with insights and highlights from the society.

NGOs being as a service provider, and being paid for it. These payments will be converted in benefits to the Society, with support from Government.
Health is reached mainly through a holistic approach and prevention.

Benefit
Society
• Cultural Activities, Sports and Technical trainings available direct inside your community, for free
• Better/ faster first Health attendance
Companies
• Deeper understanding of individuals and society dynamics
• Closer/ Direct relation to Middle Class
• Faster “testing” process and feedback from surveys
• Long term relation to communities
NGOs
• Increase financial support amount
• Mid to long term financial support granted in contracts as a service provider
• Professionalization of collaborators/ employees
• Better services provided to Society
Government
• Delegation of management of some activities related to Health
• Better knowledge about communities
• Reduce number of people in Hospitals, can focus on more severe cases – being more effective

Mutual benefits for all involved parties, without any relevant additional spending

Idea creation

Research companies

Bureaucracy and lack of support from Government. The mitigation approach would be to show them their benefit with this project

Increasing the number of NGOs partners when more founding comes. It is beneficial for all parties: more communities are attended, better and more robust researches/ surveys/ reports to companies and Government

Set of services clearly defined and people skilled

Biggest number of communities supported keeping the quality standard of services provided to all parties

First year: one community implemented
Second year: 3 additional communities

Patient leaders have a valuable role to play in tackling the problems facing health and social care at a national and local level, but we need to improve the development of and access to learning opportunities in order to grow this pool of talent, Amidst chaos of reform and unprecedented challenges to improving health, the biggest asset we have - people who live with health problems and use services - remains untapped. Instead, patients are a problem to be solved, not the solution. Meanwhile, patient and public engagement has been co-opted by institutional interests as a buffer against change, rather than as a co-production engine for it. We need a new generation of 'unusual suspects' who can act strategically to help tackle crises in health and social care

Patient leadership is:
Rooted in self-leadership - patients learning about themselves to steer their own life.
A work in progress - good leaders develop through continuous learning
Dependent on context - involves a complex mixture of interdependent behaviours

Our learning approaches incorporate:
Co-design and co-delivery
More than ‘chalk and talk’ - We use highly interactive methods
Working with what happens in the room - Leaders learn from practicing and reflecting on how they behave
Acting into a new way of thinking - We help people to construct meaning and knowledge from experiences by practicing on their ‘live’ issues
Working with others – integrating dialogue and inquiry
Process skills of leadership - skills of relationship-building and influencing

We provide patient leaders - patients, service users and carers who influence change with:
Learning and Support - a variety of face to face offers and facilitated e-learning
Network and Community of Practice - Patient Leaders become Members of The Centre for Patient Leadership
Ongoing support to take next steps

We provide healthcare organisations with support based on co-production principles to foster patient leadership

Equipped with the capability to influence change, PLs will help shift power relationships underpinning healthcare to a truly patient-centred model. This will transform:
Patient experiences and outcomes (responsiveness)
Quality of decision-making (transparency, governance and accountability)
Trust and confidence
Financial viability of healthcare systems

We are in a unique position with regards to the UK and international market, as
Thought-leaders (around the policy and practice of patient leadership)
Pioneers in providing learning and support to a new generation of health leaders able to shift the very fabric of how health and healthcare is delivered.
Offering constructive and sustainable solutions to healthcare organisations in the current economic climate

Our customers are two-fold:
1. Health and healthcare organisations (customers) - local, regional, national, international - these organisations resource individual beneficiaries (patient leaders) who are:
2. Patients, service users and carers (direct beneficiaries)

We have run learning programmes for organisations at national, regional and local level (e.g. NHS Commissioning Board, now NHS England; NHS Institute for Innovation and Improvement; Midlands and East Strategic Health Authority; National Voice - the umbrella organisation for the health voluntary sector; various commissioning organisations and provider trusts). We have undertaken a variety of programmes, ranging from one day workshops to five month programmes (with coaching) to over 500 patient leaders.

We have marketed progammes to commissioners, providers & national agencies. Given the shifting policy environment, our marketing strategy will segment in the following ways, towards:
1. National agencies (in service development, research, third sector) - these will also help ceate the environment for patient leadership
2. Commissioners of health and social care
3. Providers (acute hospital trusts, community and primary care providers)
4. Condition-related organisations/initiatives (eg. building on recent success in renal field) & moving towards focus on long term conditions
5. Locality and regionally based work (building on recent successful programmes in the Midlands)

Each of the above require bespoke business cases that focus on relevant incentives (e.g. safety for hospitals)

We provide
Learning and support for Patient Leaders
Networks and communities of practice;
Information, advice and support for Patient Leaders

For organisations:
We provide organisational development support that fosters the cultures and systems for patient leadership (NB. We have just produced the first Guide for NHS organisation to foster patient leadership - see 'resources' section on our website)

We also undertake research and policy with partners that will help create the wider cultures and systems and enviornment for patient leadership

We are unique thus far. National professionally-led training organisations are beginning to take an interest in patient leadership, but don't (and may never) truly understand the model; Patient-led & Third Sector organisations are at an early stage of being able to deliver training programmes and these are based on very different learning models to those we believe in and offer.

There is a window of opportunity (3-5 yrs) to create a social movement for patient leadership before an idea like this is 'captured' by mainstream organisations and distorted to fit institutional needs and the status quo. In this time, In this time, our work needs to support & develop a critical mass of patient leaders who share the values and have the skills necessary to radically shift the face of healthcare

The current policy and practice environment is volatile and organisations do not yet recognise the value of patient leadership - and may not want it if they truly understood it! On the other hand, the steep rise in demand demonstrates that another set of players want us to step up to the mark. To overcome this paradoxical state of affairs, we need to:
Hone and articulating the vision - communicate the business case to all stakeholders
Build capacity for delivery at scale and pace
Refine the operating and business model
Clarify roles & responsibilities;
Move to mixed investment strategy
Ensure quality
Beware of mission creep (eg other areas of citizen/lay leadership)
Stick to our values
Develop range of accessible learning offers/curriculum (incl. facilitated e-learning)

These phases are largely being run in parallel:
Phase One: Market Research & marketing strategy based on refined assessment of current landscape and potential funders (including assessment of investment and philanthropic options)
Phase Two: Building infrastructure, operating model and capacity for delivery at scale;
Phase Three: Developing the offer (to patient leaders, organisations)

We have significant interest in our work from organisations & Patient Leaders themselves; hugely positive feedback from programmes (500 'alumni') Recent experience of delivery at scale and pace; Proof of concept of operational and delivery model (incl train the trainers; online network; virtual learning environment); high profile (e.g. articles and network interest)

In the next 3-5 years, we aim to grow from £100k/yr turnover to £1-2m/year (yr 2) and double that by year 5. This will depend on developing 'Patient Leaders' as the 'go to' place for an expanding range of learning programmes and establishing the Centre for Patient Leadership as a non-profit making research & policy organisation.

Short term (1-2 yrs): £500,000 turnover, six new learning programmes (300 alumni); development of online network; six new core associates; Establishment of operational model to deliver at scale and pace (with financial director on board at least p/t and project manager f/t)
Medium Term (3-5 rs): £1-2m turnover, 40 programmes, expansion of offers; Thriving membership of community; UK-wide delivery;

NB. There will be a general election in 2015 and this will inevitably lead to shifts in policy and practice. We will need to adapt our work and growth plans for these circumstances.

Community health centers deliver critical health care services to families and communities throughout the country. As such, large volume of public health data is being processed and submitted to higher-level health departments like. Traditionally, patients’ information is recorded manually on paper. As a result, paper-based reporting becomes prone to errors, inconsistencies and incompleteness. Accessing and managing information in this manner is not only time-consuming but labor-intensive, and the data can often be outdated and are less relevant to policymakers. Since patient-­level information is critical for effective delivery of patient care, it requires quality information and easy access at all levels of the health care system.

WAH is designed to improve health care by reducing the time required for reporting and by improving access to accurate and relevant patient information for clinicians and decision-makers. To improve data quality and timeliness at rural health clinics, WAH leverages innovative technologies such as 3G technology, low-cost hardware and an open-source Electronic Medical Record (EMR) software. An appropriate EMR system streamlines patient flow by integrating normal clinical activities. It can also improve data use since it can display clinical information at appropriate times. This leads to improvements in data quality and in patient care. When patient data are in electronic form, reports can be generated on demand, which can also be beneficial for local governments and higher health offices.

WAH envisions to help realize universal health care through innovative health information system management and technology products aimed at transforming the Philippine local public health landscape. Specifically, it aims to improve local health management and patient care among health personnel and to improve access to higher quality health data and promote evidence-based health policy planning and intervention among decision-makers.

The WAH is an open, adaptive, and adoptable technology that is patient-centered, user-oriented and results-driven. However, we believe that technology is not the only answer. We have a unique open partnership platform that puts premium on the sharing of expertise and pooling of resources. Moreover, WAH is inclusive and supportive. We put our faith on people, processes, and passion. We aim to inspire people—and move them to action. We offer modular on- and off-site training programs and responsive tools for regular progress and management monitoring and feedback because we believe that the process is as important as the result. We seek to empower our RHU client-partners to do more, efficiently—and happily—because our end-users and beneficiaries are our most important agents of innovation.

Public health data in the Philippines originate during patient care at barangay (village) health stations and health clinics in the city (CHU) and municipalities (RHU). These CHUs and RHUs are the beneficiaries of the WAH e-Health platform as patient-level information enables health care workers in these public clinics to provide individual patients with more effective, efficient and comprehensive care, and ultimately, better health outcomes.

WAH relies on the willingness of local government units (LGUs) and local chief executives to support the establishment of the WAH platform in the health centers (CHUs/RHUs) in their locality. Along the public-private partnership principle, each WAH site is financed, or otherwise invested in, partly by all stakeholders, with LGUs customarily covering equipment and installation costs while the private, academic, and non-government partners handle the training, technical support, operational, and other related expenditures. This setup encourages the active involvement of each stakeholder and lends LGUs, for their part, ownership of the project.

The WAH e-Health platform offers practical solutions to local health information management issues. Following advocacy meetings with the LGU, a technical site assessment, and the procurement of equipment, the project team proceeds with systems deployment and training. One feature of the platform, i.e. EMR, SPASMS, Statistics Aggregator, Mobile Midwife, corresponds to one level of training. Health personnel at the partner RHUs are expected to finish up to at least Level 3 within 8 months of the adoption of the system. However, trainings are progressive and certain technical and equipment requirements for each level must be met. The project team then regularly takes on various monitoring mechanisms, e.g. RHU scorecards and bimonthly visits, in the project sites to track health data quality.

Several other private and profit-oriented EMR developers and implementers are present in the Philippines. WAH, however, takes pride in being the only one that has developed a relatively advanced array of value-added features centered on the EMR system itself, and at the same time, offering seamless integration to the two national health institutions’ electronic health reporting frameworks. Until such a time that the Department of Health adopts a standardized platform for health data management and reporting, WAH will find it challenging to inter-operate with both public and private institutions employing other EMR systems.

WAH is presently sustained by resources and contributions provided by partners. Amid decreased funding from Qualcomm and diminishing technical assistance grants by USAID, LGU partners and other stakeholders are continually encouraged to leverage resources and take more concrete steps to ensure that WAH continues to prosper and expand. Additional local and perhaps international funding sources will also be explored. Meanwhile, a Long-term Sustainability Plan is being devised with the Asian Institute of Management to provide more guidance on WAH’s move forward.

Pending adoption of a standard HIS by the DOH, WAH will continue to take part in its consultative body in order to lobby for and possibly influence the agency to make WAH platform THE standard in health clinics across the country.

Selling the WAH idea is easier owing to the presence of champions from the pilot sites, e.g. LCEs and RHU personnel, and their publicly acknowledged success in terms of meeting the set goals and commitment of local partners. WAH will bank on this to continue engaging new and current partners alike to commit financial, human, technical and other resources to scale up the project nationwide.

WAH has had the impact of changing perceptions and behaviors of those whom the Initiative and the WAH platform have touched. First, RHU personnel feel and work with more pride. Second, due to the success of the pilot, LCEs have begun investing on e-Health since 2010. And third, requests for adoption outside Tarlac from those who visited WAH sites have been pouring in continuously.

We are set out to make Tarlac the first province in the Philippines with all of its RHUs running on and interconnected by a modern HIS like WAH. Ultimately, our goal is to advance the clamor and commitment to the transformational effects of WAH, and e-Health in general, to the national level. WAH partners shall continue to collaborate to make the WAH system a standard in RHUs across the country.

The Department of Health in Region 1 has agreed to replicate WAH in at least one clinic in each of the four provinces of the region this year. The Zuellig Family Foundation, one of WAH’s NGO partners, has also pledged to adopt WAH in 26 of its partner municipalities for 2013. And under the new Integrated MNCHN/FP Luzon project of the USAID, 14 more provinces and 42 cities will likewise have implemented the system by 2018.

Only 60% of America's Medicaid-eligible children see a dentist regularly, due to a lack of access to care. In Alabama, 66 out of 67 counties have a shortage of dentists, according to federal guidelines. The dentist shortage, compounded by those dentists not wanting to see Medicaid eligible children, further exasperates the problem. Due to the poor US economy, we have ever-increasing Medicaid roles and more children going unseen, and Sarrell Dental has experienced 31 consecutive quarters of record patient growth, serving over 130,000 patient visits in Alabama only during 2012.

By using a motto of "treat every child as your brother, sister, son or daughter" we have created a patient-centered model, where the child truly comes first, not just in words but deeds. As an example, our larger offices are open 8-6 daily, utilizing an 8-5 and a 9-6 shift to stay open 10 hours a day. Over 80% of our patients are not old enough to drive, so they arrive, in general, via transportation provided by an adult. If a patient shows up late for an appointment at 6pm (closing time), if the dentist is still present, we turn back on the equipment and treat the child.
On the business side, we handle all non-clinical functions, freeing our dentists and hygienists to provide world class care. All personnel, financial, support functions (IT, etc), are handled by business side personnel.

Our vision is to provide quality oral healthcare to communities that have an underserved population. We believe in treating every patient with dignity and respect, and it is our goal to eliminate the access to care problem in every community that we open our doors.

Traditional non-profits often fail to achieve their objectives because they rely on donations and volunteer efforts. While these may contribute to the overall good in some scenarios, we believe a complete business model that focuses on organizational efficiency, accountability, and hard work will be more effective in creating a long-term, sustainable solution. By combining a talented workforce, proven business principles, and clinically-focused dentists, we can achieve what other non-profits and governmental entities have not.

Sarrell treats the dental and optical needs of lower income children in underserved communities that might otherwise not have access to dental care. Generally, these are Medicaid and SCHIP eligible patients ages 1-20.

Sarrell operates 14 clinics in underserved communities as well as a state-of-the-art mobile dental bus that travels to areas where dental care is not otherwise available. This dental bus has two fully-functional operatories and digital radiograph equipment linked to electronic health records.

Our Community Outreach personnel provided dental education and screened over 50,000 Alabama children in 2012.

We provide dental education, screenings and comprehensive dental work (everything but orthodontics) to under served Alabama children between ages 1-20. We do so without the need for cash donations or grants. We grow organically using best demonstrated business practices and have created a new, effective and proven dental model. The first self sufficient, not for profit, dental model of this kind in the USA.

Competitors are: for profit Medicaid dental providers, FQHC's, dental schools and private practice dentists who see Medicaid/SCHIP patients. However, we feel we have no competition because of the lack of access to care in Alabama and the USA. The majority of Medicaid/SCHIP children still cannot access a dentist for their needs. With Medicaid roles growing, the need will only worsen.

The single biggest hinderrance to our growth out of Alabama is individual states' Dental Practice Acts (DPA). Most do not allow non-profit organizations to operate, even though we use only fully licensed dentists. In fact, We had to change, via Sarrell Dental legislation, the law in Alabama in 2011. Even though most dentists in Alabama do not see Medicaid patients on a regular basis. This was a battle covered numerous times by prestigious journals such as The Non Profit Quarterly (type Sarrell Dental in the search box on their website), PBS Frontline (see PBS Frontline website) and many other publications (search Sarrell Dental).

Dentistry is about 20 years behind the medical field, as far as consolidation and the use of alternative providers (i.e. nurse practioners). DPA's must change.

We are currently poised internally to expand our model to other states. At this point we are seeking partners to help us accelerate our growth and optimize community impact before we open our next office.

We have developed our infrastructure, particularly in IT and management know-how, to be scaleable. We currently have no long-term debt and have a large, sustainable, growing record of growth.

To expand our services outside of Alabama. Particularly into nearby states where we can manage our culture, business and clinical practices to ensure continued our proven track record in serving children who need our care the most.

We are ready, willing and able to expand at the moment. The ONLY resistance we receive is from dental trade organizations, both on the state level and nationally.