Services financiers et marchés

In Nigeria 500,000+ women give birth each year and two-thirds of them live in slums. Most deliver at home with an unskilled birth attendant or go to a public facility where conditions are often appalling – shared labor beds, delivering on the floor, understaffed or under-equipped with basic lifesaving supplies. As a result as many as one in 50 women die during childbirth and many more experience life-threatening complications. Secondly, poverty due to lack of livelihood has also contributed to poor health among women. We are working to save the situation by bringing in innovative solution into the picture.

Tomike Health is a social venture that aims to set a new standard for job creation and maternity care in West Africa. We are combining business, job training and clinical innovations to create a fully self-sustaining and scalable solution that provide reproductive health and antipoverty services to poor urban women. First of its kind in West Africa.
We are piloting our model in Abeokuta with a single clinic, mobile unit, and business incubation centre then once we have demonstrated that the model works, we will scale up to touch other cities across west Africa over the next five years.

Tomike Health vision is a world free from poverty, hunger, and diseases. The mission of Tomike Health is to enhance health and productivity in underserved rural communities among poor women and its goal is to transform healthcare and livelihood by demonstrating the commercial viability, long-term sustainability and social impact of the Tomike-Health model at scale.

The Tomike Health model is a sustainable social business enterprise with high degree of economic returns for the beneficiary communities. We will create Direct Social Impact through providing underserved women communities with greater access to high quality health-care, skills development and business incubation services resulting in better health & well-being, enhanced productivity and improved standard of living. Also providing alongside, multiple opportunities for employment generation in the local areas.

Tomike Health is basically targeting women of child-bearing age living in rural/urban slum. Our ambition is to integrate healthcare and antipoverty program together as a package for poor women and to change the way maternal healthcare is provided for the two million poor women giving birth each year in urban/peri-urban sector of West Africa.

We will basically reach out to our customers via our mobile unit and pool of volunteers. Mobile vans will bring services into the slums and increase awareness among our target population via creative marketing and ubiquitous mobile phones. This is critical for reaching women who would otherwise deliver at home, building a reputation among our target patients, and driving traffic to our facilities.

Tomike–Health will bring three tightly-integrated services into the communities to ensure that women receive the full continuum of maternal health care: (a) mobile vans that will create a direct link with our patients, boost demand for services and healthy outcomes through antenatal care and birth preparedness; (b) Tomike health centers near the slums where women can go for respectful obstetric care, safe delivery, family planning, and postnatal care; and (c) Tomike health business incubation centre where poor women can access job training and skills and revolving fund necessary to kickstart the venture of their choice.

Social venture dedicated to bring healthcare to the poorest communities in West Africa already exist and Easier Healthcare consult is a good example, but these initiatives remain limited. From our knowledge, there is no “social healthcare companies” integrating antipoverty program with martenal healthcare delivery in poor communities. Nevertheless, the model we propose will combine certain basic innovations that can’t be found anywhere in the region. The key specification that will distinguish our model from the individual initiative already available on the market will be the strong social, business, scientific and clinical background supporting the synergistic value of the model.

The other challenge is ensuring that payments are made for treatment or microcredit. For instance, If a woman comes to our healthcare center in pain, we cannot refuse treatment. So we have to ensure that there is a way of recovering the cost of the delivery. We will work to mitigate those risks by: (a) providing financial training during our antenatal care&business training, (b) options for advanced payment in installments (flexibly, to correspond with women's irregular income in these settings); (c) working with micro-insurance agencies and the National Health Insurance Scheme to defray out of pocket costs for women.

A comprehensive healthcare and antipoverty initiative has many moving parts. Wherever possible, we do not want to reinvent the wheel, but rather work with the organizations that are at the cutting edge of each service and element of our model. This will help us to grow and continue innovating

To date, we have completed market surveys, developed the model, and engaged volunteers and advisors. In fall 2012, we did an extensive market surveys and data collection to overlay facilities and population data to identify areas that are poorly served. We believe we are ready for pilot

The objective of Tomike Health is to enhance health and productivity in underserved rural communities among poor women and its goal is to transform healthcare and livelihood by demonstrating the commercial viability, long-term sustainability and social impact of the Tomike-Health model at scale.

2013
-Purchase and equip first mobile unit; lease a property for clinic,& business incubation center
-Develop protocols for mobile antenatal care and outreach, hire and train staff
-Complete protocols and internal systems for clinic, mobile unit, & business incubation centre
-Hire and train staff for first clinic; lease first site in eastern Abeokuta; setup equipment and space.
2014
-First clinic opens doors in early 2014.
-Begin monitoring impact and fine-tuning of operations and clinical and internal protocols.
-Experiment and adapt marketing and outreach
-By late-2014 evaluate success of pilot and secure funds for expansion.

Through the Uplift Model we have been trying
1)reduce obstacles in access of quality health care :in an unregulated medical environment, the poor have little capacity and information to access quality healthcare and make appropriate choices.
2)reduce health expenses:25% of Indian population fall below the poverty line with single hospitalization every year. The poor have to rely on out of pocket expenses not only to manage their health but their finances,making their livelihood very vulnerable.
3)the information asymmetry on health and health care:due to information asymmetries on health mechanisms and the lack of effective public healthcare systems, the poor rely on misinformation and superstition, beliefs favouring diseases and deaths that could have been easily avoided

1) To reduce obstacles in access of quality health care : our solution aims to reduce health expenses (see below, 2) and guide members to appropriate healthcare facilities (through access to Uplift 24x7 Helpline).
2) To reduce health expenses : we will offer a coverage of hospitalization expenses and we can rely on Uplift network HCP providing treatment at rationalized rates.
3) To reduce the information asymmetries on health : we will spread health preventives messages, through Health Check up camps organised by the HCP network, and information provided at the time of enrolment.
To ensure affordability of this product : in the first year, employer will contribute to the premium payment. In the following year, savings facilities will be there to facilitate payment of the premium.

Uplift vision : our health in our hands
Our overall objective : a better access to health for everyone
Our underlying objectives : improve access to quality healthcare (guide members to appropriate health care facilities and reduce health expenses and ) / improve health behaviour by spreading health knowledge and preventive message.
We apply this vision and objectives in all our projects we are implementing in Uplift, including this new project "Helping our hands".

Our value proposition with the project "Helping our helps" is health financing using micro-insurance through a community-based mutual model complemented by health savings.
This health financing is for a target population that is out of the reach of national health schemes, commercial insurance and microfinance providers. This is a segment vulnerable to high health expenses in the absence of proper information and guidance.
Access to health services is the second part of our value proposition. We propose to bring quality health services, information and access to the target population by means of a multi-layered health care provider network (providing concessions rates for Uplift members), a 24x7 helpline with a medical doctor and health check-up camps.

Currently, Uplift customers are slum dwellers.
The average monthly per capita income of the families we are working with in Pune is 1900 INR (about 27€). We also measure poverty level with a in-house tool taking into account house, food habits, education, health, economic activity, documentation, financial links, ranging from level 1 to 7 (1 being the lowest). 90% of our members are level 4 and below.
Furthermore, our customers are not familiar with insurance principles, therefore systematic client education effort is required.
The specific group of customers we target in this project "Helpling our helps" are the domestic workers (housemaid, nanny, drivers, etc.) and their families, working in Pune.

In this specific project, we plan to approach domestic workers by reaching out to "cooperatives housing societies" in Pune (families who employ domestic workers). These housing societies have an office and elected office bearers among the families living in the society. We will approach them, communicate about the scheme and orient them during their monthly meetings.
We will use the following tools during those meetings : Uplift movie on health mutual fund concept, brochures for employers and for domestic workers.

Uplift is providing technical support for implementing and managing health micro-insurance program :
- Back-office support: Back office processes design, Enrolment, Insurance card issuing, Claims processing (including medical checking), Enrolment and claims quality checking
- Front office support : Front office processes design (enrolment, claims, health services), Provision of preventive health care services, 24/7 helpline, HCP network building and management, Client education, Field activities assessment
- MIS:Data recording and back-up,MIS development
- Product pricing and design
- Risk Management and product design
- Trainings
Uplift has also consultancies activities (e.g. client education tools design) and is involved in international organisations (conferences, studies..)

Our peers are :
- NGOs working on the slum areas with communities and providing micro-loans and other financial services for low income people.

Our competitors are :
- Commercial insurers providing micro-insurance products
- Government schemes
So far, these competitors have not been impeding Uplift growth : commercial insurers in India are selling micro-insurance products that most of the time are not efficient and does not match the needs of the customers. Government schemes are not fully efficient nor universal. Even though we can think that those scheme will become more and more efficient, we can work with them since OOPEs for the families who benefit from government schemes can remain high and those schemes are not providing health services.

- Our main environmental challenge is regarding the micro-insurance regulation : currently, regulation in India regarding micro-insurance only identifies partnership between commercial insurers and organizations (MFI, NGO, etc.), like for microfinance. Community-based model are under discussion with the regulator (IRDA).
- Regarding organizational challenge, resources are a challenge. Fund-raising for this project is on-going.
- Getting skilled staff for our projects (including this new one) is an individual challenge, especially to find medical doctors.

With this project, we want to target new customers group - the domestic workers - and their families, accross housing societies in Pune. Later we will target Mumbai also.

Our business is ready for growth because we have achieved stability in our current business. Therefore, we can leverage :
- our 10 years experience in implementing and managing health micro-insurance program
- our quality health care provider network in Pune
- our 24x7 helpline facility
- our in-house micro-insurance software
- our experienced staff to lead the project

- Target new groups - domestic workers and their families
- Achieve scale to ensure sustainability of the scheme (2000 families is a minimum at the beginning) along with satisfaction of the members and planned social impact.

- Short-term : settle the program and achieve scale for sustainability (2000 families - 500 hundred families per quarter in the first year) in Pune
- Mid-term (3 years) : scale it up to other cities (Bombay)