The WHCC Affordable Health Innovations Global Initiative recently spoke with The Center for Health Market Innovation about its exciting new initiative. (CHMI) — www.healthmarketinnovations.org – is a new, publicly accessible, global knowledge platform that collects, analyzes, and disseminates information about Health Market Innovations in the developing world. CHMI is the first database of its kind, providing aggregate, standardized, searchable information about hundreds of programs with potential to improve how health markets operate. It is part of the Results for Development Institute.
WHCC: What is a health market?
CHMI: A health market is the part of the health system where decisions about health care are made by both consumers and providers of services. When consumers seek out care for their symptoms, they usually have options about where to receive it, including numerous private providers. These providers also have choices about the quality and type of care they offer. Markets exist in any sectors, but health markets have two primary challenges that set them apart from others. First, unlike consumers of other products such as food or clothing, health care consumers are often not well-informed about the type of health care they need, so they struggle to distinguish between high-quality and low-quality care. Second, societies around the world value equitable access to health care more than equitable access to most other products. Although these challenges exist, health markets have the potential to deliver better results for the poor if well-harnessed. When well-monitored and regulated, health markets can be a source of creative new approaches with the potential to achieve greater efficiencies, greater quality, and increased access to care for the poor.
WHCC: What was the impetus for starting CHMI? Where did you see a need that wasn’t being addressed?
CHMI: The idea for CHMI came about following a 2008 study funded by the Rockefeller Foundation on the role of the private sector in health. One of the products of the study was the identification of several interesting health models that were delivering care and financial protection to the poor in innovative ways. This quickly led to the realization that there were many such models in existence, but that information about them was sparse, a potential result of the relatively little attention given to market‐based approaches versus traditional public sector delivery models. Speaking with individuals from various professional backgrounds, we learned that many saw this lack of centralized and complete information as an obstacle in carrying out their work. For example, funders have had difficulty identifying and evaluating programs for support, policymakers did not have enough information about the scale, scope, and effectiveness of specific models to leverage their potential, and researchers were not able to obtain a wide enough sample of health market programs, precluding high-quality impact research. CHMI works to fill this gap.
WHCC: You mention that in many developing countries – including ones with large populations – financing for health services comes largely from private sources and individuals pay for care out-of-pocket. This seems especially problematic since many individuals likely can’t afford this. What is the result?
CHMI: The poor in developing countries often rely on private providers and pay out-of-pocket for health services. In India, for example, over 70% of total spending on health is out-of-pocket payments. The result of this is that, often, illness pushes poor individuals deeper into poverty and impoverishes families living just above the poverty line. Also important to remember is that “private providers” are not always registered facilities staffed by trained doctors and nurses. Quite often, the poor rely on informal providers for care. Although the service fees charged by these individuals may be lower than those found in formal private facilities, the quality of care provided can be inappropriate, substandard and even dangerous. CHMI also works to documents programs that work with these informal providers – organizing, training and accrediting them to deliver better care to the poor.
WHCC: CHMI includes governments, NGOs, community organizations, social entrepreneurs and companies as the innovators that are integral to the goal of dramatically improving health markets. Why is each a vital part of the plan?
CHMI: The market for health is complex and includes many actors, both private and public, that interact to deliver health services to the poor. NGOs and community organizations often serve areas and population groups that are out of the reach of government programs. They also leverage resources of the international community, as well as local resources (e.g., community heath workers, community risk-pooling arrangements), to provide care and financial protection. Social entrepreneurs are key to promoting new approaches and technologies for service delivery and financing, often offering new solutions to longstanding challenges in health care. Governments can play a critical role in stewarding the health market, engaging private providers to achieve broader health systems goals. Although these roles aren’t always cleanly defined and often overlap, each actor has a specific set of resources and expertise at their disposal and is able to play a critical role in improving the market for health.
WHCC: Part of your approach includes a “wiki”-style contribution platform. Why is this important?
CHMI: Although CHMI is striving to document all approaches that improve the health market in the developing world, we have made it a priority to capture lesser-known and home-grown programs. To achieve this, we are relying on “eyes on the ground” to identify and profile these initiatives. CHMI is going about this in two ways: (1) in country partners and (2) contributions from the community. Currently, CHMI partners are working to document health market innovations in India, South Africa and Vietnam, and new partners will soon begin work in the Andean Region of Latin America, Brazil, Indonesia, Kenya (including a mapping of Tanzania, Rwanda and Uganda), Pakistan, and the Phillipines. These partnerships are critical to the success of CHMI and in-country institutions will contribute greatly to data collection and analysis. We are also relying on input from the community to keep the CHMI database up-to-date and add programs not captured by our partners, including those that operate in countries where we do not have a presence. Users are able to contribute in two ways: submitting program profiles for initiatives not currently profiled in the CHMI database, and providing updated information on current profiles.
WHCC: What the next steps for CHMI? What are the short-term and long-term goals? CHMI is constantly growing, both in terms of the breadth and depth of the database, as well as the features and additional research that will build on and supplement the data currently available. Current plans for future CHMI products include expanding the CHMI database with the addition of 6 new partners and contributions from the community; developing metrics to identify promising programs and producing country profiles to provide a context for the innovative programs profiled in the database; and publication of in-depth program case studies and thematic studies on exciting health market topics. CHMI will also work to create linkages among CHMI’s various stakeholder groups, including matching innovative programs with potential funding. For a more extensive view of CHMI’s future goals and plans, visit the http://healthmarketinnovations.org/content/chmi-roadmap.
CHMI is funded by the Bill & Melinda Gates Foundation and the Rockefeller Foundation, and is managed by Results for Development Institute in collaboration with a network of partners. CHMI partners include Access Health International in India, BroadReach Healthcare in South Africa, the Center of Investment in Health Promotion (CIHP) in Vietnam, and the Global Health Group at the University of California, San Francisco (UCSF).
