News & Insights
What Does it Take to Deliver Health Services in Haiti?
by Lara Diaconu, vice president of the Health Services Fund at Global Partnerships
During my visit to Haiti last month, I met with a Haitian social entrepreneur named Dr. Ronald LaRoche, who manages DASH (Développment des Activités de Santé en Haïti), a network of health facilities that currently provides preventive, primary and secondary health services to 40,000 people living in the country’s two largest cities—Port-au-Prince and Cap Haitien.
Meeting with Dr. LaRoche was fascinating because we’re always eager to learn about effective, sustainable and scalable services that expand opportunity for people living in poverty, and the capital required to catalyze them. Delivering sustainable health care services in an economic and political environment as complex as Haiti’s is no small feat. As in many Latin American countries, the government’s health system simply does not have the capacity to deliver health care to everyone, everywhere; an overwhelming majority of health care in Haiti is currently delivered by the private sector, often linked to religious missions or NGOs supported by donor funding. And yet, 50% of the population continues to lack access to health care and essential drugs. The need in Haiti for a sustainable health solution persists, paradoxically while a substantial amount of aid money donated following the 2010 earthquake has yet to be spent. At the same time, we are painfully aware that charity can sometimes do more harm than good– Dr. LaRoche referenced several private hospital closures due to the influx of “free” health services that came with earthquake response funding—begging the question, how can philanthropy be invested well to support sustainable scalable health care models?
It appears that DASH’s current strategy might be one example. Dr. LaRoche founded DASH 30 years ago and has sustained and grown this private health care business using an HMO-like system, whereby subscribers gain access to different packages of services for either $1 or $10 per month. To date, these packages have scaled by marketing them to employers – factories and private enterprises – who purchase them for their workers.
DASH also offers a $5 per month package for individuals, which provides the same access to preventive and unlimited primary care consults covered by the $1 per month package, but also covers medicines and diagnostic lab exams with a reasonable co-pay. To date, this package has exclusively been purchased by international humanitarian agencies using donations; the beneficiaries among the hundreds of thousands of Haitians still living in temporary settlements. What will happen when aid runs out and these healthcare subsidies end? Will this population continue to purchase the health services package on their own? If not, what would the effect be on DASH operations? Would DASH need to close facilities if demand drops off? Where will this population go for health services, and how will they pay for them?
In anticipation of these two plausible events, Dr. LaRoche plans to launch a massive door to door marketing campaign to sell the $5 per month package, with a goal to enroll 100,000 new users and invest in an additional 10 new health facilities in the next two years. Their business plans achieve sustainability when each health facility serves at least 10,000 clients. In order to achieve this growth in subscriptions, however, with this new product and sales channel, up front capital is needed to: build the infrastructure; hire and train medical and sales personnel; and to roll out the marketing campaign.
DASH will invest grant monies from the Inter-American Development Bank/Multilateral Investment Fund (IDB/MIF) to launch this marketing effort, while investing its own profits to expand infrastructure. Although DASH may have grown to 100,000 additional clients enrolled and 10 additional sites established without any grants or donations, it certainly would have taken much longer. What happens when this two year grant expires? If successful, 100,000 new subscriptions will be active within two years, representing $6 million in annual revenue that presumably will sustain the delivery of health services to those clients over time. The difference between DASH’s venture philanthropy approach and a traditional charity approach is that the DASH model catalyzes a sustainable business plan (assuming there is demand for the product), thus benefitting more people—sooner—and over the long run.
We look forward to staying in touch with the DASH efforts, and to learning more about:
- What costs and strategies are involved in launching a successful marketing campaign to reach this market segment with this product;
- Does a commission-based model deliver results in terms of sales of health services packages, and what is required to sustain this model?
- What are the elements of a $5/month services package that are most appealing to the BoP population in Haiti, and is there sufficient economic capacity for this price point?
Question for our readers:
What do you think it takes to build a sustainable & scalable health solution in Haiti or other developing regions of the world? We'd like to hear from you! Please leave us a comment/question below so that we can start a conversation with you!