Sustainable Health Solutions for People Living in Poverty in Latin America

A multi-country case study on building market-based models to deliver access to health services for low-income communities in Latin America

It is estimated that 1.3 billion people worldwide1 have no access to quality, affordable health services. Despite government resources spent on health services, individuals continue to bear most of the burden of health services costs, a reality that hits the poor the hardest. To improve access to healthcare for the poor at this large of a scale, we need to explore financially sustainable models. In 2012, Global Partnerships launched the Health Services Initiative to test out market-based health solutions. 

Overview of Case Study

Introduction: The Link Between Poor Health and Poverty

Poor health deepens poverty by reducing an individual’s ability to work, study and be productive. And the public health care system in many Latin American countries is broken, making it difficult and/or too expensive to get care. The financial burden of obtaining healthcare can be catastrophic, draining families of their limited resources.

What’s the Challenge?

Lack of affordable health care traps families in a cycle of poverty. Many social enterprises try to address the need by offering low-cost, high-quality health education, screenings, treatment, insurance and medication. But they face steep challenges in designing impactful health education/services packages that clients will want to purchase and be able to afford. Another big challenge is reaching clients that live in remote communities.

What’s the Opportunity?

Global Partnerships teamed up with several social enterprises who were each interested in either launching a new health education/services package, or fixing an existing offering so that it would become financially sustainable. For four years, we worked together to co-design, pilot and scale the delivery of market-based health solutions to poor communities.

Who Did GP Partner With?

All of the social enterprises with whom GP partnered are microfinance institutions, except for FUDEIMFA, which is a nonprofit organization.

What Did We Aim to Accomplish?

Our goal was to co-develop the health business models required to connect 100,000 women living in poverty with affordable access to health education, screenings, treatment, insurance and medication. We then wanted to share our experience and insights with other social enterprises, helping them think critically about their health services offerings from the perspective of impact, sustainability and scale.

An Overview of the Health Solutions

Each partner had a different package of health education and services designed to meet their clients’ needs, with tailored delivery and payment schemes to affordably reach those clients.

PARTNER
HEALTH PROGRAM
CLIENT PAYMENT COMPONENT


Fundación ESPOIR
Ecuador, MFI

Health education delivered in loan repayment meetings
 
Health care services delivered through a network of third-party providers and one Fundación ESPOIR clinic

Mandatory health microinsurance purchased by Fundación ESPOIR clients; cost bundled with microcredit loan repayments


Pro Mujer in Nicaragua
MFI

Health education and basic screenings delivered in loan repayment meetings Health care

services delivered through Pro Mujer in Nicaragua clinics and third-party providers

Optional prepaid package of health services purchased by client Fee-for-service paid by client for individual health services


FUDEIMFA
Honduras, Nonprofit Organization

Community pharmacies operated out of women’s homes that sell essential medicines in rural communities

Rural clients purchase medicines
from community pharmacies


Friendship Bridge
Guatemala, MFI

Health education and mobile health services delivered in loan repayment meetings

No additional charge to client as cost is included with microcredit loans

What Did We Learn?

There is no “one size fits all” solution. Here are three high-level lessons from the perspective of impact, sustainability and scale.

Lesson #1: Impact

Are the Health Services Designed With the Clients in Mind?

Product design and delivery need to be client-centric, which requires a deep understanding of client needs, acquiring client trust and establishment of feedback loops. For example, in Ecuador, where Fundación ESPOIR operates, a majority of microfinance institutions combine mandatory health microinsurance with loans. This helps protect clients from paying astronomic costs during health emergencies. But if clients take multiple loans from multiple MFIs, they end up overpaying for services they don’t need. It’s important to have strong communication channels so that MFIs can understand how to best help their clients avoid becoming over-indebted and oversubscribed to insurance policies.

Lesson #2: Sustainability – the Potential of Partnerships

It can be tempting to establish a new clinic to deliver health services. However, forming partnerships between microfinance institutions and third-party health services providers can be a more effective way of sustainably delivering high-quality health services than establishing proprietary clinics. For example, Friendship Bridge partnered with the non-governmental organization Maya Health Alliance to deliver health services in mobile clinics. Working together, Friendship Bridge and Maya Health Alliance were able to structure their Health for Life program to account for cultural, language and economic barriers to seeking services such as PAP exams. The mobile clinics send women health professionals to deliver health services directly to women in their village bank leaders’ homes, in indigenous Mayan languages, at no additional cost.

Lesson #3: Scale

How to Reach Thousands or Millions of People

Any social enterprise interested in scaling their services needs to build in regular evaluations to assess what’s working, what’s not working and change the approach as needed. For example, FUDEIMFA quickly expanded the number of pharmacies it operated from 200 to 301 and as a result faced many financial sustainability challenges. It had to dig deep to understand the program’s cost and revenue drivers, and where it could cut costs without compromising on impact or sustainability. For instance, it had considered cutting back on training its community pharmacists to reduce costs, but realized that ultimately, poorly trained pharmacists would jeopardize the pharmacists’ ability to build trust with clients and sell medicine to them. Instead, they figured out other cost-saving measures such as negotiating refunds for unsold medicines from their suppliers.

footnotes

1        Global Economic symposium: http://www.global-economic-symposium.org/knowledgebase/the-global-society/financing-health-care-for-the-poor/proposals/improving-access-to-health-care-for-the-poor-especially-in-developing-countries