Reproductive health

95.8% of all health care spending in Nigeria is done through out of pocket payment, including maternal health services. This often leaves the poor open to financial ruin due to health bills and sometimes prevents them for seeking health services even when they are already showing symptoms of ill health. Each year, Nigeria loses 545 women for every 100,000 births. Only 58% of Nigerian women have access to antenatal services which saves lives before and during birth, most of this is due to the inability to pay for health services. Our company solves this problem by providing micro health insurance for the poor and middle class who are unbanked for maternal health services using mobile money technology.

Sweet Mothers Inc. aims to build a social enterprise to deliver micro insurance for maternal health services for low to middle income women. 95% of health care spending in Nigeria is through out-of-pocket payment that often leaves poor families destitute or permanently in debt. Further, most women make major health and lifestyle changes during pregnancy and we plan to help them build a habit of planning ahead for health expenditure using mobile money technology that allows them to save for their health conveniently.

Sweet Mothers Inc. is committed to the reduction of maternal mortality rates by improving access to prenatal, delivery, and postnatal health care through a range of micro insurance products for low to middle income pregnant women.

Providing access to decent healthcare services before, during and after pregnancy, without the crippling out-of-pocket expenses.

Currently pregnant women who fall into the low income bracket in Lagos, Nigeria.

Our company plans to use mobile technology and direct marketing using radio ads to reach our customers.

Educating women on the importance of [maternity/maternal] health insurance, selling insurance premiums, fulfilling claims, inspecting and validating partner-hospitals to ensure customers are provided with decent, satisfying health care services.

Our peers are the insurance company and they a decision to target our customers might pose a risk to our success. Also, a Lagos health insurance for our target market might also pose a threat.

The general business culture in Nigeria leaves all businesses operating out of this country open to huge risks, however, with a strong strategic plan, a focused team, and efficient leadership will help us mitigate all these risks.

– Continually educating women on the importance of our insurance product. – Provide all the support needed by our partner-hospitals to ensure our customers get the best services. – Form new partnerships with financial institutions, NGOs etc., using their platforms to increase our customer base.

Our business is ready for growth because our target market is untapped by current players in the sector and our innovation is strong and solely focused on this target market.

Groth Objectives: To provide micro health insurance service for 10,000 pregnant low income women in choice hospitals in Lagos by 2020. To reach $1 million in revenue by 2020.

Short term - Launch the business and have our first paying customer. Time frame: 6 months.
Mid-term - Reach a revenue of $1million and serve 10,000 women. Time frame: 5 - 7 years.

Safe Motherhood is key focus area of the National Socio-demographic goals adopted by the Government of India.
Unfortunately, indicators of safe motherhood are not at desired level due to inaccessible and unaffordable maternal health care. National Health Accounts (2004-05) shows out-of-pocket expenditure was incurred while availing services at public and private facilities making quality care unaffordable for lower income groups.
Private sector, though available, is unaffordable, unregulated and show poor adherence to quality standards. Public sector has limited geographical coverage and capacity to meet the existing need. The solution, MGHN, aims to bridge this gap between private and public sector.

MGHN is network of franchisees under which private providers are trained on quality standard protocols and contractually obligated to follow them. Services, under the network, are priced at 50 to 60% lower than market prices to drive volumes ensuring franchisee’s financial viability and affordability for the beneficiaries. Additionally, the franchisor makes certain that the government schemes are converged into network to cover service provider and acceptor cost.
MGHN also increases the number of Maternal and Child Health service delivery points in the geography by capacity building of non conventional medical providers i.e. AYUSH and bringing them to mainstream MCH provision.

The vision is to significantly contribute to the reduction of Maternal Mortality Rate by establishing an economically sustainable, easily scalable and innovative social franchising model for providing high quality delivery of affordable MCH and family planning services; promotion of safe motherhood and institutional deliveries for the poor and vulnerable sections of the society.

The objective of the network is increase access to equitable, affordable and quality healthcare services for low income groups by engaging private sector through sustainable partnerships and by developing a network of franchised hospitals.

Value proposition to the beneficiaries is lower price of the services i.e. 50-60 percent lower than market price. Thus, the brand promotes” Quality Maternal and Child health services at an honest price”. The business proposition to the franchisee is the capacity building on quality protocols, extensive branding and communication of the network and multi-pronged communication strategy to generate demand for services by the franchisor to drive volumes for financial viability.
Unique proposition of MGHN to the government is engagement of private sector to supplement the public sector and regulation of private sector, both in terms of, quality and prices of the services.

The customers of the services are low income groups from the urban poor or the rural populations. The customers of the services, at times are also the government or donors, when a facility is accredited and the cost of availing services are covered by government based incentive schemes or voucher systems. In such cases, the beneficiaries do not incur the cost of services.

Multi- pronged communication strategy has been developed to reach to the last mile for demand generation including Mass Media & Mid- Media with Radio spots, Jingles, Newspaper advertisements, Communication Collaterals.

A toll free help line is established for reaching out to the customers/ beneficiaries. SMS based follow-ups are done with the beneficiaries for increasing compliance. At the local level, the MerryTarang members educate the beneficiaries about the need of quality healthcare services and refer them to the facilities.

For liasoning with Government/Donors, MGHN team leader is responsible for sensitization.

Primary Activities for the franchisor includes:
1) Partnerships and linkages
2) Quality Assurance Audits at the facilities to ensure quality of services
3) Continuous Medical Education & Management Development Programes for franchisees
4) Brand Promotions
5) Demand Generation Activities by MerryTarang members like home based visits, community meetings etc.
6) Out Reach Camps at the village level
7) Community Godh Bharai or Baby Shower celebrations at the facilities for promoting institutional deliveries
8) Inter-Tier meet for handholding and support
9) Release of quarterly newsletter for network based communication
10) Linkages with Government Schemes
11) Hospital Information Management Systems
12) Monitoring e.g. Client Satisfaction Surveys

The unique positioning of the model, as a partnership of Public and Private, poses minimum competition. Network offers a distinctive mix of qualities from both sectors i.e. high quality services of the private sector and affordable services of the public sector which is inimitable. Only, short term cultural barrier are faced likes practice of traditional birth attendants at the village level but it is a reversible behaviour issue and not perceived as a competition to the network.

Major environmental challenge faced is poor level of awareness and demand in the community for the quality maternal health care services which is addressed by demand generation strategies.
Secondly, every private provider in the network has two interests a) Entrepreneur interest leading to profit making interest b) Social Interest to offer services. The challenge for the franchisor is to maintain balance between both the interests.
Lastly, the challenge is to sustain each provider in the network till financial sustainability is achieved. Majority of attrition occur during this phase. To overcome these, Franchisor provides business training to explain the breakeven time.

Phase I: Set-up and Operations
Phase 2: Evaluation
Phase 3: Consolidation
Phase 4: Scale-up
The project has completed its ‘Consolidation Phase’ where the recommendations were incorporated. Revised model will be dovetailed into the government system for long term sustainability. Also, the model will be scaled-up to newer geographies in India.

The proof-of-concept has been established in terms of successful business model, client satisfaction, improved quality of service provision and social impact through various third party evaluation studies. The project is entering phase-4 for scale-up which is the growth phase.

There are dual growth objective a) horizontal scale-up of the innovation to newer geographies to supplement the public healthcare system by increasing access to quality maternal and child healthcare b) Vertical Scale-up for strengthening the model by introducing newer innovations.

Phase I (Year 4): Set-up & Operations Phase
• Creation of the network
• Achievement of set targets of service output
Phase 2 (Year ½): Evaluation Phase
• Evaluating the key achievements and gaps (if any)
Phase 3 (Year ½): Consolidation Phase
• Incorporation of the key recommendations
Phase 4: Scale-up Phase
• Scale-up of the revised model to newer geographies

With a maternal mortality rate of 162 out of 100,000 live births and an infant mortality of 25 per 1,000 live births, the Philippines has a long way to go on meeting the 2015 Millennium Development Goals.

Using the collaborative PPP model, MBBCs gear towards the betterment of the status of maternal and infant health in the country. It also aims to lessen the congestion of pregnant patients on hospitals and decrease, or eventually stop, the practice of home-based deliveries.

On the same context, being able to deliver on a decent and quality facility, the women are being empowered as their human dignity is preserved.

Being strategically located on areas needing complementary aid/ support, MBBC networks countrywide provide accessible, affordable, quality, and safe facilities for maternal and infant health services

Through the prioritization of those economically constrained clients sponsored by various insurances or government programs, more MBBCs’ income can be generated to support the facilities’ operation and to build more facilities.

The PPP model of the MBBC is also a good way to increase awareness of both the private and public sector regarding the existing problems in maternal and infant care, and so soliciting more support for its improvement and sociopolitical responses.

Vision: An ideal facility for quality maternal health care service that is committed to respect and promote the legitimate rights of every mother.

Mission: It shall provide accessible, affordable, and quality health service for mothers during pregnancy, delivery, and as well as post natal care.

Philosophies:
“That in all things, GOD may be glorified.”
“Of all the rights of women, the greatest is to be a mother.”

General Objective:
To provide accessible and affordable maternal and infant health care services to the poor through the establishment of a network of birthing clinics.

MBBCs serve as socially-oriented institutions providing holistic and quality maternal and infant health care services. The facilities serve as supports and front liners to prevent the build-up of patients in existing local hospitals, government and private, in the delivery of maternal and infant health care service.

Thus, with the assured quality of service, the maternal and infant mortality rate can be controlled to meet the MDGs set targets and each mother and child will be aptly treated, and so making them a possible asset for the betterment of the society’s human resource.

Being a pro-poor targeting organization, MBBC caters and prioritizes the poorest among the poor pregnant mothers and their infants who are most vulnerable to maternal and infant deaths due to the possibility of unsafe home deliveries.

The male partners of the mothers, their families, and significant others are also considered as clients as there are regarded to play a very vital part in the whole pregnancy and delivery experience.

Primarily adapting a community-based approach, to easily reach their target clienteles, the MBBCs are strategically located in densely populated poor areas, with high maternal and infant mortality incidences, and with other four to five adjacent barangays that could possibly be service recipients.

Aside from various advertisements and promotion activities such as IEC materials distribution by the MBBC staff, the commissioned midwives also coordinate with the barangay’s Community Health Teams to track all the pregnant mothers in the community, and refer them accordingly to the clinics. Field works are being done by the MBBC staff.

Implementing a holistic program, the key implementation steps for MBBC establishment involve: barangay selection with high maternal mortality rate; appraisal and clinic renovation; consultation and negotiation with local government unit; manning and training of midwives; licensing and accreditation under Philhealth; operation and supervision by KaKaK.

With 24-hours, 7 days a week available services, MBBC offers: prenatal care; nutrition and family planning; newborn care and screening; care for malnourished mothers and children; PhilHealth enrollment assistance; postnatal care; guidance counselling and catechism; live birth registration; free marriage validation for unwed couples; and free baptismal assistance for infants.

At MBBC, the considered allies are the volunteers, professional, individuals, organizations, and community people, particularly the members of the Community Health Teams, and referral institutions interested and involved on increasing the health care service for the mother and infant and in support and in complement of the operations of the facilities.

On the other hand, MBBCs see other non-government organizations (NGOs) applying the same or nearly the same program as a threat only on the manner of financial sponsorship and or competition on the possible funding sources, as other birthing clinics are connected to and funded by foreign organizations.

Situated on densely populated areas, one of the recurrent problems that the implementers are encountering is the place where the facility will be built. Thus, in the Memorandum of Agreement, one of the set responsibilities of the local government unit is to find for an available lot for the facility.

Also, in a deliberately growing health service delivery network, lack of manpower becomes a problem. Thus, scholarships, particularly for the midwives to-be, are being supported by the surplus funds of the MBBCs. Furthermore, volunteerism, affiliations, and more employment are also to be implemented so as to supplement this lacking.

All the revenues of the MBBCs shall be directed to support the operations, improvement, and establishment of more facilities. More so, the organization shall use various media so as to flaunt the success of the innovation to inspire other stakeholders to support the drives and causes of the advocacy.

With the successful implementation of MBBC in the province of Leyte, and along with the fact that this innovation is deliberately spreading up to the different places in the Philippines prove that is more ready for growth in terms of operationalization.

The MBBCs’ key growth objectives are as follows:

• Establishment of partnerships to pharmaceutical companies and laboratory equipment providers.
• Augmentation of MBBC staff, particularly designating a resident physician per facility.
• Engagement on researches for the tracking and evaluation of all MBBC facilities and services.
• Establishment of more MBBCs in the country.

In three-six months, MBBC will invest on staff development, capacity building, and trainings to develop their personnel more on the field of recording and reporting, research, and community immersion. MBBC will also commence the coordination to the DOH for its Doctors to the Barrio (DTTB) Program for aiding them on the need of physicians.

In a year, partnerships to various pharmaceutical companies and laboratory equipment providers shall be established to be able to expand the services of the MBBC facilities.

True enough, in the course of time, more MBBCs shall be opened in the country, or in other countries, with the same PPP model.

Access to free HIV testing is becoming more and more difficult in Greece. Services once offered for free from public structures thery are now no longer available. Moreover there was never a cultivated ground for accompanying services of counseling for safer sex practices and harm reduction. When it comes to key populations affected by HIV, like men who have sex with men, things are getting worse. The response to the needs of this group was never targeted, as they were practically invisible by public health pro-test interventions. As a result, such structures were less accessible to MSM creating phenomena like late presenters (diagnoses at a late state) and high prevelance within that population, as there was no timely diagnoses and infections were multiplied

Ath Checkpoint aim to address the beforementioned issues. Ath Checkpoint:
- offers free services of HIV testing and counseling on sexual health
- is targeted to men who have sex with men, without excluding other key populations or the general public
- overcomes obstacles to smooth and regular HIV monitoring (convenient working hours, easily accessible by public transport being situated in the heart of the city near the gay venues)
- fits modern lifestyle of young and active people as it offers a concise service of rapid saliva test for HIV and counseling
- helps to link people to the health system when there is a reactive test (positive antibodies test)
- offers follow up services, reminding clients to repeat test accordingly
- does frequent outreach to the community

We aim to provide free sexual health services to the main key population that is affected by HIV in Greece, men who have sex with men. We try to do this not only by providing very friendly and accesible services in an accomodating environment, but also by cultivating a sexual health conscience to people that are most active and engaging to most risky sexual practices. We also try to entrench the LGBT community with positive attitudes towards prevention habits as regular use of condoms and regular HIV monitoring

We want to make Ath Checkpoint a beacon of prevention for men who have sex with men . A stable reference for the LGBT community, cultivating a culture of safer sexual practices and prevention

Within the key population of men who have sex with men:

- young men
- gay men
- sexually active men who regularly or occasionaly engage with sex with other men

As we scale up we will explicitly move towards the general public:

- other key populations : women, youngsters, IDUs
- the general public

We approach our main target group moving in the frame of their everyday lifestyle. Thus, we use various ways to make Ath Checkpoint recognizable:

- audiovisual campaigns to social medias
- outreach to gay and gay-friendly venues with flyer campaigns
- outreach to the general public and our main target group by distributing condoms and lubes
- participation to gay events and parties with distribution of materials
- constant co-operations with gay enterprises and gay media
- constant presence to gay dating sites
- positioning of condom dispensers with Ath Checkpoint logo to all gay venues
- word of mouth and networking

- testing for HIV
- counseling for safer sex practices
- linking newly diagnosed to the health system
- producing printed and audiovisual material
- outreach with informative materials, condoms and lubes for sex
- research and surveillance on MSM behaviours
- creating events to promote sexual prevention
- presence in gay venues, parties, events

We feel that Ath Checkpoint is positioned in a market niche where there are few overlappings.
HIV testing and monitoring trageted to MSM comes to compliment actions targeted to other key populations -like IDUs and migrants- carried out by other organizations.
Our peers to the response to HIV in Greece are other private organizations like Center for Life and PRAKSIS. We also feel that we do not try to compete with traditional state provision services but to overcome shortcomings, trace and cover needs of the MSM population

The main obstacle for community based structures in Greece is the current model of providing health prevention services. It is rather a systemic and institutional inertia of traditional state centralized services. For example, introducing alternative technologies for HIV testing (saliva test vs blood test) is not easy, since there are certain health specialties and professionals that monopolise such methods. In co-operation with institutions and by showcasing a consistent body of work, we try to overcome such issues. By scaling up we will be ready to employ more professionals to operate various methodologies.

Our plan is to scale up gradually, and to move forward expanding towards two directions:

- expand geographically: open new checkpoint structure to the second largest greek city and hopefully continue expanding
- encompass more vulnerable groups: we want to address our services to more groups that are affected by HIV

We have already a designed and tested model of operating. It is a matter of using current resources to expand the checkpoint project in order to cover more people. Our project has a vast momentum making it a fertile ground for growth

We aim to:

- scale up the rate of test and couseling sessions
- communicate and make the structure visible to more than 50% of the MSM population living in Greece
- open a second structure
- cover new key populations and move towards covering the needs of the general population

For 2013 we aim to:

- achieve 2,500 testing and counseling sessions
- inaugurate the second checkpoint in Thessaloniki, targeted to the general population
- be present in every big LGBT and MSM-orianted event
- have condom dispensers installed in all gay and MSM-orianted venues in Athens, Thessaloniki and other big cities in Greece

Lack of health education and accessibility of facilities are barriers to health-seeking behavior in Kenya. Lack of access to quality, affordable healthcare is a huge issue. Even if a clinic is physically accessible, low medical quality or high prices are often prohibitive to seeking care. Subsequently, low-income women and families do not have a healthcare resource they trust and can afford.

Insufficient healthcare education in community and clinic settings causes two problems. First, low health literacy results in people not practicing health-promoting behaviors or using preventative services. Second, it perpetuates misconceptions about healthcare . For example, many women do not use family planning because they have heard so many frightening myths about various methods.

Penda Health provides high-quality and affordable medical services to low-income families in Kenya, including family planning, preventive services, and broad education about healthy living. Clinical officers use evidence-based protocols and are constantly being trained and challenged to improve their clinical reasoning and patient interaction skills. Penda providers are also trained in patient-centered counseling and use exam room interactions to inform patients about ways to maintain and improve their health. Other patient education initiatives include training receptionists to provide health education and holding community health talks at churches, schools, and businesses. Most importantly, this comprehensive care is aimed at being affordable for low and middle income families.

At Penda Health, we believe that all women and families have a right to quality healthcare. Our mission is to provide affordable, accessible, high quality outpatient medical care in an exceptionally friendly, professional, confidential environment. At Penda Health, we believe that all patients should feel comfortable asking questions and should feel confident that we care about the long-term well being of them and their families. Ultimately, we aim to raise the standard of healthcare across Africa.

By using a for-profit model we have to be accountable for all business decisions we make. This requires us to build the best product possible and to structure our clinic operations and expansion to be sustainable and scalable. We predict that if people see that it's possible to make a profit from providing quality healthcare, they will open clinics with a similar model to Penda, thereby improving the overall level of care and access in Kenya.

Our customers are low income men, women and children in Kenya. Our first clinic is located in a peri-urban area outside Nairobi, Kenya. The catchment area is the Kitengela and Athi River community (population 150,000) and surrounding rural areas.

Penda Health currently operates one clinic in Kitengela, Kenya. In 13 months of operation, we have treated more than 6,500 patients. We also hold free mobile clinics to bring outpatient care to populations where there is not an adequate medical facility or where people cannot afford to travel for care. Finally, Penda serves hundreds of business people, teachers, students, church congregations, and other community groups through our community outreach programs.

Penda Health provides comprehensive outpatient medical treatment, antenatal care, immunizations, preventative screenings, laboratory tests, health education, and family planning services to low income men, women, and children in Kenya.

Our competitors are private and government run clinics and hospitals. However, we feel that these facilities are not direct competitors because we offer equally high (or higher) quality services as all these facilities at a lower price than all but the free government hospitals. We also do not see competition as an impediment to growth because there is such a high demand in Kenya for access to healthcare.

One of our main challenges is deciding which services to add. We have high demand for a number of services such as dental, radiology, optometry, inpatient, and 24 hour service. Since we cannot roll out all these services at once or in all clinics it is essential for Penda Health's long term success that we invest in the right services or find an appropriate distribution of services among clinics.

With over a year of experience successfully running our first clinic, we are expanding to a second location and are poised to open three additional clinics in quick succession this year. New locations will target low and middle income populations in a range of more urban and more rural communities than our current, peri-urban environment.

We have standardized our medical care and our service model to a point that we are ready to scale. Our management, clinic operations, and drug procurement infrastructure have also been reinforced to accommodate the demands of more clinic locations.

Our primary objective is to expand throughout the Nairobi area. We will also use our next few clinics as an opportunity to learn how to successfully expand into different customer groups and how to maintain our same personalized, high-quality care even as we begin to serve many more patients.

We will open our second clinic in May, followed by third and fourth clinics in September and October, respectively. The only rate limiting factors to this growth are the speed with which we can hire and train staff, and with wich we can do market research and secure new clinic facilities.

The links between poverty, health, and development are well established. Poverty impacts an individual’s health, including the ability and opportunity to engage in health-seeking and health-promoting behavior. At the same time, poor health can deepen poverty by diminishing an individual’s ability to be economically productive and through catastrophic health costs. Apart from economic barriers, poor households face additional structural barriers that result in a lack of access to, and utilization of, effective and affordable health education and services. Often, it is the poor, particularly the rural poor, who must incur additional costs to travel long distances to reach the nearest health facility.

Global Partnerships works closely with identified microfinance institution and cooperative partners to develop and scale sustainable business models for providing essential, high quality health services, which generally includes some combination of education, early detection exams, primary level medical consults,and other products and services such as basic medicines. Not only do we provide the knowledge capital to help develop sustainable business models, but we supply the seed capital necessary to bring the organization from pilot to scale. We anticipate that the business models of our partner organizations will demonstrate that health outcomes are improving for clients and that the business models will be financially sustainable by the end of the project (roughly three years).

Based on early success in developing a revenue-sustained model for delivering health education, diagnostics, and low cost services through the village bank model in Nicaragua, Global Partnerships has launched a $2.6 million initiative aimed at expanding health services with six partners in six countries by June 2015. Our initial goal is to create business models that directly and sustainably bring essential health services to more than 100,000 people, most of them low income women, with the potential to scale to reach millions.

We provide direct technical assistance to develop sustainable business models for delivering health services and well as the necessary seed capital to bridge the gap between the start-up and scale of services.

Our customers are microfinance institutions (MFI) and cooperatives whose leaders are committed to integrating health into their service offerings. MFIs and cooperatives already serve millions of people living in poverty, and we believe can serve as effective, low cost and market sustained channels for expanding access to health education, disease screening, consultations and essential medicines.

Global Partnerships becomes aware of potential Health Services Fund (HSF) partners because they have been screened as candidates for GP's Social Investment Fund based on their programmatic and financial profile. The HSF focuses on identifying partners that have aligned missions, institutional commitment and capable management to develop sustainable and scalable business models. We anticipate that within the upcoming year and as our portfolio of partners grows we will reach future customers through conferences and publications about the success of the models.

After we select a partner and complete a due diligence visit we move forward to develop a business model for delivering health services. The model includes: a definition of a high impact core health services package, low-marginal cost operational strategies and its associated cost-revenue structure, a detailed implementation plan, financial sustainability projections, and a monitoring and evaluation plan. Once the model is complete our partners pilot while we closely monitor key indicators of success and provide the gap in necessary funding, as the model is designed to be financially sustainable at scale, Once the pilot is complete we have adapted the model and develop detailed expansion plan and move forward to expand/scale the program.

There are other organizations and institutions that deliver education modules via the village bank channel or offer additional non-financial services along with financial services in order to attract and retain clients, therefore, the idea is not necessarily new to microfinance practitioners or donors in the region. However, there are few, if any, organizations that have achieved a holistic sustainable business model approach to their programs that allows them to offer services sustainably at scale.

We are currently piloting in three countries (Haiti, Honduras, Ecuador), and scaling in one country (Nicaragua). Each model requires constant monitoring as we find ourselves continually adapting as new information is learned or as assumptions of the model are tested. We are currently a team of two full staff and in order to maintain the level of engagement and quality we'll have to add additional staff.

We currently have four partners and aspire to have 6 partners in the next year. We are actively adding potential partners into our pipeline and starting to perform due diligence visits to see if we have aligned goals and vision.

We are currently piloting and scaling in four countries and have learned a great deal about business models that work and that can be replicated in other markets.

We want to build a diverse, yet strategic portfolio of partners that allows us to share and replicate best practice.Our goal is to create business models that directly and sustainably bring essential health services to more than 100,000 people, most of them low income women, with the potential to scale to reach millions.

We currently have four partners and aim to have six partners that are reaching more than 100,000 people with sustainable, quality health services by June 2015. In the mid-term are striving to catalyze additional interest by other MFIs, Cooperatives as well as other stakeholders to implement and/or enable the implementation of similar sustainable health services business models in other contexts. In order to achieve this we are participating in conferences to bring awareness around our work and writing up case-studies to highlight best practices and lessons learned.

VSI brings practical health solutions to women and health care workers in their homes and communities. VSI works within the health infrastructure to maximize investment impact, and builds local capacity - including of health workers - to save lives.
VSI’s activities include advocacy and support to governments and partners, including manufacturers and pharmaceutical distributors, to register and integrate quality technologies and medicines into health care systems and policies through pilots and operations research programs. Beyond product integration, VSI collects and analyzes country-specific data on product availability to determine gaps and opportunities to improve the everyday availability of essential medicines and supplies for women.

VSI assesses requirements for registering a new technology and the level of political support needed to achieve product registration, a critical first step for integration into the health system. VSI then identifies a quality manufacturer and distributor motivated to make the product available in the public, private and nonprofit sectors at an affordable price, and guides the preparation and submission of the product’s technical dossier. VSI identifies optimal distribution channels by designing demonstration programs that evaluate delivery mechanisms such as task-shifting, task-sharing, community-based distribution and self-administration. With a goal of improving product access over time, VSI assesses five factors that influence healthy system availability and draws from assessment data.

VSI has developed and tested a model for health product access rooted in three fundamental components: Registration, Introduction and Availability. The impact of this model is illustrated below with VSI’s most successful program, the introduction of misoprostol to prevent postpartum hemorrhage (PPH) in developing countries. VSI’s model can be applied to other maternal and neonatal commodities such as but not limited to: chlorhexidine for umbilical cord cleansing and magnesium sulfate for pre-eclampsia and eclampsia, or misoprostol in a formulation appropriate for labor induction.

VSI’s expertise spans the spectrum from country level regulatory approval to providing access to the hardest to reach populations. This includes gaining regulatory approval, updating policies and designing delivery mechanisms that impact product access. VSI, working in partnership, identifies and overcomes challenges in providing effective maternal and neonatal health products and services at the primary health care and community levels.

VSI brings practical health solutions to women and health care workers in their homes and communities. VSI works within the health infrastructure to maximize investment impact, and builds local capacity - including of health workers - to save lives.

VSI works with ministries of health, professional medical associations and in-country experts to inform and advance policies in support of product introduction and correct use. VSI identifies optimal distribution channels by designing demonstration programs that evaluate delivery mechanisms such as task-shifting, task-sharing, community-based distribution and self-administration. Selecting from proven assessment methodologies for each technology and setting, VSI identifies gaps and opportunities across the total market. Drawing from assessment data, VSI develops strategies and activities to increase product and/or service availability in collaboration with partners.

VSI assesses requirements for registering a new technology and the level of political support needed to achieve product registration, a critical first step for integration into the health system. VSI then identifies a quality manufacturer and distributor motivated to make the product available in the public, private and nonprofit sectors at an affordable price, and guides the preparation and submission of the product’s technical dossier. VSI works with ministries of health, professional medical associations and in-country experts to inform and advance policies in support of product introduction and correct use. VSI identifies optimal distribution channels by designing demonstration programs that evaluate delivery mechanisms such as task-shifting, task-sharing, community-based distribution

VSI has managed over 150 agreements with a range of partners, including organizations such as Ifakara Health Institute (Tanzania), the Zimbabwe Ministry of Health and Child Welfare, and the Association of Obstetricians and Gynecologists of Mozambique. In each partner agreement or contract, VSI works closely with the respective organization or individual to develop a clear scope of work, deliverables, reporting requirements, and deliverable-based payment plan. A VSI employee supervises each partner or individual to ensure deliverables are met, and to follow up on delays or challenges. VSI hires local financial firms to oversee adherence to contract and accounting practices in program countries, and VSI conducts financial reviews and consultancy evaluations.

To be successful in bringing new health innovations to women in underserved areas, VSI relies on broad and deep engagement with key stakeholders, including governments, NGO partners, health professionals, etc. When circumstances change politically, economically or otherwise, VSI must be prepared to change strategies to ensure ongoing and meaningful engagement and impact.

VSI is committed to expanding during 2013 to include not less than 2 new products/services in its work portfolio, and to diversifying its donor base.

VSI’s fundamental tool for internal accountability and monitoring is the Organizational Scorecard. Using metrics related to stakeholder engagement, financial stewardship, internal processes and capacity, VSI’s scorecard provides the framework for annual departmental metrics, team metrics, and individual performance metrics and goals.

To expand our product and service portfolio, as well as our donor base. VSI will continue to strengthen and expand its programs to meaningfully address the some of the major health challenges facing women and girls in the developing world, especially as relates to maternal mortality and morbidity.

VSI is currently drafting an updated organizational Strategic Plan for the coming 3 years (2014-16). This plan will include product portfolio and service expansion, as well as a strategy for donor diversification. In the short term, for 2013 VSI aims to add not less than 2 new products/services into its workstream, and secure the support of not less than one new donor.

Given poor economic status,sanitary pad is last thing on mind of rural women,use all kinds of rags leading to prevalence of RTI.What makes idea of clean cloth pads successful is familiarity to women. Mass scale replication of existing usage patterns possible.We remove risk elements, do value addition in terms of cleanliness& awareness.Given strength of network & expertise in management of old cloth,replication on wide scale makes it cheaper.Non-biodegradable market napkins unaffordable by rural women.We provide appropriate option, preventing problem of disposal.NJPC works with material lying idle in urban homes.Easy channelising for good cause with small financial aspect,makes people happy. Other Goonj initiatives address clothing issue & ensure regular supply.

Women start menstruating from age 12years till around 50 years. They need napkins all though this period &need to be aware about hygiene issues connected with menses. By reaching My Pad, we get women who use all kinds of rags, to experience first hand what it feels like to use clean cloth as pad. When Cloth for work activity carried out, we ensure that her family gets cloth which can be used as pad later. Once women feel safety of clean cloth, correct way of using cloth as pad, she feels happy in continuing practice,with whatever cloth she has,even if she doesn’t get GOONJ pad for long.As they talk of taboo topic, feel emboldened & talk about their infections, feel empowered to shun taboo, use cloth sensibly & give attention to own health.

GOONJ sees clothing as an ignored basic need,similarly sanitary pads is a basic need for a women.Absence of adequate clean cloth turns menses into a monthly disaster for her. We envision last shreds of cities cloth as an empowering tool for motivating women to work on their own challenges,bringing about a long term behavioral change of giving priority to her own health.Given the availability of surplus cloth across globe in cities & universality of menses,our vision is for idea to spread beyond India’s geographical boundaries.Our objective is to alleviate village women out of hardships,indignity & huge health risk they face every month as also using this work as an employment generation activity for women, breaking the taboo in the process.

Rural women treat their needs as last priority thereby receiving less health care& education In scenario where they struggle for daily survival,NJPC brings awareness about fundamental issue,highlighting high-risk behavior that puts their health in jeopardy.Influencing health seeking behaviour by giving empowerment to influence their own health. Rural women socialized to tolerate suffering & this mindset is constraint to get adequate health for themselves.Exposure & interactions on taboo issue is key in highlighting possibilities available to them. Essence of NJPC is not just to provide clean napkin or making women aware, but to address clothing holistically. Addressal of clothing help free meager resources for pressing needs like food. This reinforces Goonj’s mission.

Adolescent Girls:Nutrition Foundation of India says that average age of menarche is around 13 yrs yet 50%of both urban &rural girls aged 12 yrs have no understanding of this process (India chapter Women of the World).Adolescent girls face problems like low literacy level,sexual vulnerability contributing to dismal health. Young married women in reproductive/child bearing age:In India 1 in 6 girls begin child bearing between 13-19yrs. India has 10 million pregnant adolescents & adolescent mothers. Maternal mortality accounts for 15% of all deaths of women. (India chapter Women of the World,South Asia).Older women:Most studies on reproductive health & menses say older women in family are primary source of information about menses practices.This segment plays key role as knowledge leader.

1.Sensitizing urban masses to bring attitudinal changes towards menses as taboo subject & show power of old clothing for women by initiating discussion through forums2.making MY Pad at processing centers3.Partners give information about community needs4. meeting with partners highlighting need,solution& process.5.Village meeting organized with community women to talk about health risks & solution offered by My-Pad6. Provide exhibition material with relevant information to partners to put up locally7.Sends 1st dispatch to women &general clothing for cloth for work activity for village community 8.Distribution of pads tied with awareness meeting9.Training to local women on how to make pads, where cloth material provided.10.other organizations buy pads for giving in their areas

1.sensiting urban masses -discussions through lectures, addressing kitty parties,etc. 2.collection of material- Generating material through awareness cum collection camps. Every camp leads to new contacts & volunteers. We organize monthly sponsorship campaigns,touch base with hospitals & hotels for large quantities of old cloth.3.Process- Collected material is sorted, packed at GOONJ’s processing center & sent to our partner groups according to requirements of their target communities. 4.Education- Partners provided them relevant information like illustrative posters 5.Replication on local level; Over a period of time share our learnings with them & help them replicate small scale.6.A part of it is available for sale, increases reach, sustains work.

We are not aware of any organization which is using old cloth as raw material for making sanitary pads. Most organizations working in this field are either using new cloth,cotton or some other man made or natural fibre. It mostly attracts an added cost which gets transferred to the receiver.Very few organizations give attention to awareness aspect. In any case we feel that given the vast scale of need in India & other countries,there is need for more organizations to work.Hence Goonj focuses on idea spread.Sanitary napkins that are practical are needed in rural India yet its not available at any village market. Uniqueness about Goonj’s work is that it succeeds only when it complements and supports whatever work is being done in different sectors by our grassroots partner groups.

1.Communicating a new idea to urban & rural audiences is a slow process;unhealthy practices,huge taboo,mindsets of partner groups call for long term behavioral change communication.2.Planning Risk in generating material from masses;we are approaching different channels for committed supplies3.tackling & changing the attitude of urban masses of acting as if they are doing greatest deed in giving away their discard.Sustained communication & awareness building on giving with dignity has helped4.we have turned lack of sustained funding into our greatest strength;growth owed to people who are giving material, time and money.5.Risk is not using full potential of the idea; opening up idea and processes for wider audience for others to adopt and spread the work with our minimal expense.

Long term growth strategy– sustain organizational spread plus focusing on more partners & village women starting to make pads with Goonj’s cloth raw material. We would like to put energy in idea spread,through knowledge sharing with partners, sharing replication kit & documenting, sharing impact with international academia to get rest of world excited about potential of idea.

Idea working for 5 years. Impact visible at many places,national & international agencies awarded work after rigorous due diligence, evaluation process. Demand much ahead of supply, ensuring long term sustenance. Overall volume growing, raw material ensured. Evolved multiple strategies for napkin distribution. Right juncture of knowing what we want with understanding of strengths & weaknesses.

1. Work in backward areas directly, knowledge sharing in others
2. Cross subsidize costs by selling to organizations not directly working
3. Urban sponsorship for rural implementation
4. Speak at national and international forums
5. Open systems to enable replication
6. Work to motivate bulk suppliers for generating material, tie up with big brands for co-branded campaigns for idea spread.

Short-Term: next 1-3 years
1. Focus on some areas & key partners,who show interest & capacities to work.2. Strengthen systems 3. Document impact through case studies.4.Work on replication kit 5.Get involved at policy level to bring this as key women’s health issue 6. Communication plan to target more sponsorship 7.Increase production capacity to 2 lakh napkins monthly by end of 2 years
Mid Term
1.Strategy brainstorm for scaling up.2. Replication of idea-women produce napkins-income generation-Goonj provides cloth for napkin making 3. Involve village women to identify their challenges; work on issues & get napkins in return. 4. bring out first major documentation report.5. Connect NJPC with village level health interventions.6. Equipping partners to generate material.

In India not everyone can afford access to medical facilities. However, since goverment is reimbursing costs of detection, mobile MRI van is appropriate solution which would eliminate problem for rural population to travel to district capitals.

Access Bridge would operate vans that have MRI technology built-in. The van could reach remote areas (600 mln people are living in villages) that do not have medical facilities. People could undergo MRI procedure for free since goverment sponsored insurance is in place. The scan would be sent to radiologist in one of the medical centers who would analyse and sent back the results. Access Bridge would get reimbursement from the goverment 400SEK for each scan.

Appropriate solutions for accessable healthcare wherever you are

Accessible healthcare to rural population, no queues.

Rural Indian population, i.e. 60% of Indian population.

Currently in India Health Camps are organised, i.e. doctors are sent to the villages to assess the health because people are not coming. Currently if these doctors subscribe MRI, patients do not neccessarily travel to district capitals to do it. We will learn rural population that needs MRI from these Health Camp doctors and come to do the procedure.

I am making a research about health care in India.

Indirect competitors are hospitals that have MRI. However, rural population cannot afford to reach those hospitals.

Funding to buy mobile MRI van to launch a pivot study in one state.

Start with one state in India
Add product scope offered in the mobile MRI van
Expand in India
Expand to other middle and low income countries with reimbursement systems

I have relevent expertise and networks in the field. India is experiencing disruptive change in the health care system. Goverment sponsored insurance enables from the point of cost persective to launch health care services to the poorest part of the population.

Cover the state of Uttarpradesh by the end of 2013

The state has Short-term growth prospective. Covering the state of Uttar Pradesh within 2013. The state has 1,4mln rural population. Our goal is to do 10 scans a day in the last 3 month of 2013.

Up to 80% of rural Indians rely on unqualified local providers (quacks) for everyday healthcare because while rural areas are home to 72% of India’s population, only 26% of licensed doctors live there. For most families, their everyday healthcare "relationship" is still with the local quack. Sadly, most quacks treat symptoms and not ailments, and often misdiagnose, so patients get temporary relief but do not get cured. After repeated visits to the quack, getting quality advice comes too late and even routine illnesses get worse. Many patients end up spending thousands of rupees to resolve simple illnesses. In 2004, 63 million people slipped below the poverty line due to health spending. MeraDoctor solves this problem my making high quality health advice accessible for all Indians.

MeraDoctor makes high-quality health advice easy and affordable by offering consultations with licensed doctors over the phone 24 hours a day.
Customers buy unlimited doctor advice for as little as Rs 149 ($3) per month at chemists, mobile shops, banking agents, and government service outlets. After giving us a free missed call, the customer immediately receives a call from our staff and is quickly transferred to a trained doctor. The doctor listens to all of the customer’s issues and concerns, asks probing questions, and makes a diagnosis and recommendations with the support of MeraDoctor’s clinical software. After the consultation, a prescription for over-the-counter drugs and summary advice is sent by SMS. When required, the doctor refers the patient to a specialist.

Our overall vision is for MeraDoctor to gain mass recognition in healthcare by delivering a unique value proposition, an easy way to get reliable health advice that embodies four key values that are missing in much of healthcare today: reliability, honesty, simplicity and compassion. To deliver on this vision, we will generate awareness and loyalty, and advance towards our company’s mission of becoming the trusted primary healthcare advisor for one million families in India by 2017. In the next twelve months we will acquire 100,000 new customers and validate a low-cost rural customer acquisition strategy.

Compared to our competitors we are easier-to-use (24x7, free missed-call), more accessible (available for cash purchase at thousands of locations), and higher quality (only trained and licensed doctors supported by clinical software). To start, we offer unlimited consultations for a single price, seeking to build a reliable, trusted relationship with each family that will grow over time. Second, we only employ licensed, carefully selected and trained MBBS doctors to ensure our medical advice is accurate. Third, we believe in face-to-face contact with our customers as best, most simple way to sell our service. This is why we have partnered with companies with physical or financial relationships with our customers. Overall, we believe our product offers value on cost, care, and quality.

Our target customers are the 84 million families in rural India that own a mobile phone and earn over Rs 7,500 ($137) per month, but lack ready access to licensed doctors. They spend Rs 8,000 crore ($1.5bn) annually on out-of-pocket primary care and outpatient fees.
U.P. state is our first target market due to its size (nearly 200 million people), population density, cell phone penetration, poor access to healthcare, and moderate levels of disposable income. Here, we strive to sell to men, ages 25 to 45, who are family decision-makers, have the disposable income and education to want good medical advice, and are comfortable using services on a mobile phone. We seek to become trusted advisors for them and their family members, particularly women who typically get less medical care.

Most rural customers we meet have little faith in local providers, but still find them to be convenient for apparently minor ailments. For MeraDoctor to compete, it must be equally easy to access. We have already begun implementing this strategy by signing up many of India’s largest rural distribution networks in the financial and retail world. With a total of about 17,000 sales points signed up in U.P. alone, these partners (e.g., FINO, Eko, SREI Sahaj, Oxigen, Beam, Vayamtech, etc) allow us to reach our customer quickly and at a low cost. We will add to this reach by leveraging community members such as teachers, ASHA workers and part-time agents who themselves use our service, and can endorse and sell it to neighbors who need quick medical advice.

Our primary activity is to manage and monitor a team of doctors who are serving patients remotely. As part of this activity we operate a call center, create and manage health records, and have built medical decision support software that links patients and doctors easily and seamlessly. Beyond the actual provision of medical advice we also manage a number of marketing and community outreach initiatives, as well as distribution and sales relationships with large channel partners.

In terms of delivering primary care health advice MeraDoctor competes with local doctors and quacks, telemedicine start-ups, and mobile operator hotlines. Our most direct competition is the local quack, since our customers tell us they don't feel comfortable taking health advice from their airtime provider and want to speak to a licensed doctor (which other start-ups don't offer). With regards to the quacks, one might worry that they might malign our service in the community, but experience suggests quacks use and even market our service. Our hypothesis is that MeraDoctor will actually grow the number of doctor consults in a community due to its convenience, and that since customers will still use them for minor ailments, quacks won't suffer so much so at to motivate hostility.

Since 2011 we have steadily identified and resolved key unknowns in our business model. On the revenue side, we have shown that customers will pay to be able to consult with licensed MBBS doctors by phone. We have also demonstrated how to set up large-scale networks of transaction points where customers can purchase our services. On the cost side, we have validated various near-term variable cost levels (e.g., doctors, telecoms, telecallers) and identified those costs that will decline over time or with scale. Our focus now, therefore, is to validate acquisition models that can take us to scale.

To understand customer perceptions and usage we will acquire 100,000 new semi-urban and rural low-income customers in U.P and Maharashtra in the next twelve months. Our strategy is 3 fold:
1. Expand availability of MeraDoctor at retail outlets and community agents
2. Develop additional features that appeal directly to target segments
3. Engage communities with compelling stories/characters

We have an experienced team, a track record of operations, and scalable technology. Also, we have:
- proven demand across segments
- seen strong uptake (60% repeat consultations)
- learned how to manage doctors remotely
- built software to guide consultations and conduct analytics
- recruited a world-class management team
- created distribution partnerships

To acquire 100,000 new customers in U.P. and Maharashtra in the next 12 months, in the course of which we will build our understanding of customer usage and perceptions, and validate a standardized, low cost customer acquisition model for rural India.

By the end of 2013, we anticipate acquiring 25,000 new customers and by March 2014, we will have acquired 100,000 new customers. This will require: 1) building operational capacity (in terms of medical staff) to handle growth, 2) validating a sales and marketing approach across our distribution partnerships, 3) developing more rigorous research and monitoring capacity internally to carefully track MeraDoctor usage and impact, and 4) continuing to develop service features that appeal to specific target segments in our market.