USING CLIENT POVERTY DATA AS A MEANINGFUL INPUT FOR HEALTH PROGRAMSWebinar

June 16, 2015

About the organizers

We research, document and work to improve the performance of heath programs that are rolled out through

a mixed (public and private) approach

www.sf4health.org

http://healthsystemshub.org/

http://healthmarketinnovations.org/

About the webinar series

• This webinar is the first in a series of webinars we will jointly host quarterly on topics that can support private sector healthcare interventions and programs, including social franchises, better measure, evaluate, and improve performance.

• A calendar of webinars can be found at http://healthsystemshub.org/news_events/global_calendar

About the webinar technology• Use a set of headphones for maximum audio clarity

• Make sure your volume settings on your computer are sufficiently high

• You can (and should!) send messages and questions to the moderator. No other participants will be able to see the messages. However, you cannot speak or be heard.

• If you are having technical difficulties, email Avery Seefeld

at aseefeld@ucsf.edu.

The moderator

Equity measurement

• Growing awareness thatincreased national wealth is often not shared equally

• Better measurement tools

• Re-invigorated global emphasis on targeting effort, and subsidies, on those most in need

The agenda

• In the first 30 minutes: 3 case studies will be presented

• Presentations will be followed by a Q & A period.• To pose questions to the presenters: Type them into the

chat box at the lower left-hand corner of your ReadyTalk interface at any time.

Case Study 1: Insights from African Health Markets for Equity (AHME) partnership

• The AHME partnership strives to improve access to high-quality private healthcare to the poor in Ghana, Kenya, and Nigeria. Equity measurement has been a critical ingredient in shaping and informing the way the program is implemented.

• Matt Boxshall, Director of this program, will present case study 1.

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EquityHub Webinar - June 2015

Matt Boxshall

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Program Overview

rope and Asia. They understand, and have catered for the health needs of professionals working in those regions.

Demand Side

Functioning Health Markets for the Poor

Demand SideSupply Side

Increase “value for money” in the health sector Cost/ DALY

Increased use of relevant health technologies DALYs

Policy Context+ ICT

+ICT• Scale and scope

through franchising

• External Quality / accreditation

• Access to capital

• Increase demand for health services

• Remove financial barriers through demand side financing

• Engage policymakers • Improve evidence base• Improve regulatory capacity • Improve capacity to contract non-state sector

Client Exit Interviews11

Do client profiles match strategy?

High Impact CYPsWhy HIC groups?

AdoptersHow do we do?

YouthHow do we do?

PoorHow do we do?

Before the visitHow do we attract clients?

How do clients hear about us?

Why choose us?

Satisfied?Will you return?

SwitchersHow do we do?

At the siteHow well do we serve clients?

CounsellingFollow-up

After the visitExperience and Feedback

What if we had not been there?

Choice (new!)

PAFPPartnership stats

Health impact and sustainability

+ Quality (QTA, QAF)+ Efficiency (SUN, cost calculator)

PPFP Partnership stats

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Lesson 1 - Equity

Wealth quintiles of franchising clients, within national reference populations*

Quintile MSI Nigeria

Society for Family Health

Population Services Kenya

MS Kenya MSI Ghana

n=458 n=420 n=445 n=369 n=321

1 (poorest) 0.2 0 0 0.5 0.6

2 0.7 0 1.8 5.7 0.9

3 6.3 0.5 12.8 14.4 8.7

4 15.5 7.1 24.9 31.7 24.6

5 (richest) 77.3 92.4 60.4 47.7 65.1

Sources: Nigeria- Malaria Indicator Survey 2010; Kenya- DHS 2008; Ghana- DHS 2008

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Client Wealth Profiles in Context – KenyaMS Kenya

Quintile National Nairobi, Coast, Nyanza, Western Regions only

1 0.5 1.7

2 5.7 4.0

3 14.4 31.4

4 31.7 34.7

5 47.7 28.2

PSK

Quintile National Urban

1 0 14

2 1.8 23.4

3 12.8 25.9

4 24.9 18.2

5 60.4 18.5

Equity continued• Find out more?

• Run DHS2014 for Kenya• Compare with lower level providers eg

PPM• Compare in local area with Public

Sector• Disaggregate the ‘private sector’ more

effectively?

• And . . .

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Lesson 1 – Review Franchisee selection

• Review SF strategy • Go to the right places

• Go to lower level providers

• Go small, go local

• MSI 2015 SF guidelines; a new archetype

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• Improved reach to the poor

• Stronger Value Proposition to provider,

• Max impact on business viability through small providers (UCSF Berkeley)

• But – explicit compromises – SF ‘efficiency’, and potential to link to NHI?

Lesson 2 – Design SF to link to DSF• NHIs historically biased to big providers • Service package challenge;

“Provide what the payer wants to buy” • Expand scope• Capitation packages, tailored services packages

• Empanelment tools• Often biased against small providers• Process subjective

• Pick your battles . . .

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Social Franchising• Bridge to NHI

• Value Proposition• Business – Catchment• Status – Accreditation• Principles – more Poor

• Leverage

Quality

National Health Insurance• Expand cover, enrol the poor• Contract private providers

• Equity• Access• Sustainability

Demand for Insurance

Supply Demand

Lesson 3 : New Role for SF Organizations

Thanks

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Case Study 2: Insights from Heartfile Health Financing

• Heartfile Health Financing is an IT-supported, automated health financing instrument that can be accessed by health care workers in Pakistan to seek urgent financial support for patients that run the risk of spending, catastrophically. This NGO aims to link equity measurement with an efficient and transparent means of transferring cash subsidies to the poor.

• Dr Anis Kazi, Senior Manager, Policy Advocacy and Research at Heartfile, will present case study 2.

HEALTH IN PAKISTAN: A NEW OPPORTUNITYDr. Anis Kazi

Senior Manager

Policy Advocacy and Research

Heartfile

How can client wealth profile data add value to health program interventions? A conversation on promoting equity in service-use

Pakistan’s many health systems

Nishtar S. The Lancet 2013.

Natural calamities,

7%Agricultural shocks, 4%

Economic shocks, 28%

Law and order, 3%

Family matters, 4%

Health shocks, 54%

The need for Heartfile Financing

Heartfile Financing has five important elements

• Technology interface integrated with mobile phones

• System of validating poverty

• Public-private partnerships with hospitals

• Process, characterised by transparency, traceability, accountability and checks and balances

• Risk based monitoring mechanism

Programme Overview

Program Overview

Equity Measurement

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4

3

7

5

67

Equity Data

Equity Data • Collection of data• Heartfile's customized ERP collects, update and disseminates data on an

ongoing basis.

• Usage of DataInternal usage For daily operational deacons.

• For organizational strategic decisions for resource mobilization and scale up.

• External usage• For external actors, including donor, healthcare professionals and medical

suppliers.

• Limitations of the data Due to a response time of within 72 hours, we cannot do a household assessment.

International perspective

THANK YOU!For more information: • www.heartfile.org• www.heartfilefinancing.orgFor further questions and queries anis@heartfile.org

Case Study 3: Insights from MSI Madagascar

• Marie Stopes Madagascar conducted a pro-poor voucher initiative to increase uptake of family planning services through social franchise clinics.

• James Wumenu, Research Officer at Marie Stopes International, will present case study 3.

USING EQUITY DATA TO IMPROVE TARGETING OF SERVICES TO POOR

CLIENTS

James Wumenu

Marie Stopes International

How can client wealth profile data add value to health program interventions? A conversation on promoting equity in service-use

Project Overview

• Project involves client referrals to social franchise facilities through

voucher schemes (2011-2012)

• Aimed at reaching poor women with FP Services

• 90% poor clients

• Potential clients complete a poverty scorecard to determine

eligibility for the free vouchers

• Beneficiary clients receive free services upon presentation of

vouchers at social franchise facilities

• Equity was measured in 2011 and 2012 to assess our reach to the

poor

Equity Measurement• Muliti-dimensional Poverty Index (MPI) was used to assess

poverty profile of clients

Sample size

2011 – 5740

2012 - 2600

Percentage of clients who are MPI Poor

2011 20120%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%

76% 85%

National Pop. 67%

Target =90%

Evidence to action

• Results in 2011 & 2012 were shared with project team

• MSM team, voucher distributors, service providers, donors

• 2011 results informed strategies for effective targeting of

the poor

• Retraining of voucher distributors to effectively administer poverty

scorecard

• Compulsory home visits to ascertain poverty status of beneficiaries

• These strategies led to significant improvement in our

reach to the poor in 2012 (from 76% to 85%)

Way forward on poverty measurement

• MSI Madagascar currently measures clients poverty

annually since 2010 for all channels

• Results are used to estimate High Impact CYPs every

year

• Inform strategies to reach more poor clients

• MSM may switch to use Progress out of Poverty Index

(PPI) this year for its poverty assessment

• This is the standard poverty assessment tool for MSI globally

THANK YOU!

For more information on MPI and MSI Madagascar, visit: • http://www.ophi.org.uk/policy/multidimensional-poverty-index/• http://mariestopes.org/where-in-the-world#madagascar

You can also contact the following for more information on this presentations:• odile.hanitriniaina@mariestopes.mg• rijalalaina.rasolofonirina@mariestopes.mg• James.Wumenu2@mariestopes.org.uk

Using client poverty data as a meaningful input for health programs

WebinarJune 16, 2015

Case study 1: AHME

Case study 2: Heartfile Health Financing

Case study 3: Marie Stopes Madagascar

QUESTIONS?

• Type them in to the chat box in the lower left-hand corner of your screen.

For further information• Visit SF4Health.org for the newly released 2015 edition of

the Compendium of Social Franchises. 63 social franchise programs report data on their scale, health specializations and health impact. A sub-set report equity data.

• Visit http://www.healthsystemshub.org/ for resources to learn, connect, and collaborate with people around the world.

• Visit http://healthmarketinnovations.org/ to discover more than 1,400 health programs in CHMI's data set, which employ promising practices that can be scaled‐up or adapted in other countries.

THANK YOU!

To view a recording of this webinar, visit

http://bit.ly/EquityData