Imagine you're a mother in India with a sick child. Your healthcare choices are dizzying: There's the traditional healer on your block, an expensive private doctor, several well-meaning health providers that may or may not have medical qualifications and a far-off government clinic. With no knowledge about the quality of each provider, you will likely be guided by the amount of money in your pocket and by knowing who is nearby.
Across low- and middle-income countries, people choose among a plethora of types of healthcare providers that make up large and chaotic health marketplaces, where consumers seek care from providers that don't always act in patients' best interests, and governments fail to effectively regulate quality and provide financial coverage for care.
Yet chaotic as they are, health markets in developing countries have also become a breeding ground for creative solutions to make quality health services affordable and accessible to the poorest and most vulnerable.
This week, the Center for Health Market Innovations (CHMI) issued a report on new approaches to improve health markets around the world.
The report describes how socially-driven businesses, nonprofits, faith-based organizations and governments are innovating to better organize, finance and regulate the delivery of care in health markets.
They are also piloting approaches to educate consumers and providers to seek and deliver better care, improve business practices to boost efficiency, lower costs and expand healthcare access to more people.
Notable areas of growth include networks of clinics delivering primary health services, mobile health facilities (on vans, boats, or motorcycles) bringing care to remote communities and mobile phone-based outreach programs improving care for women and children.
Growth in Market-Based Health Initiatives
Since its launch in 2010, the Center for Health Market Innovations has identified 1,250 innovative market-improving programs operating in 105 countries.
Local research partners in 16 countries in Latin America, Africa and Asia have visited and documented programs across these regions. Patterns are emerging from CHMI's growing, publicly available data set. (Crowd-sourcing and new entries from grassroots innovators keep it regularly updated.)
South Asia and East Africa are fertile ground for pioneering new practices in health markets. Of the 80 programs that are reported to have launched in the past year, 32 percent are in Kenya. And 45 percent of newly launched programs use information and communications technology as a core part of their business model.
Assessing Impact -- Major Questions Remain
With so many new ways to deliver and pay for health care, donors, investors and innovators want to know what really works and which programs are lowering costs, improving quality, boosting efficiency and developing sustainable businesses that can serve communities for decades to come.
Ideally, all these programs would be extensively evaluated, but deep evaluations are expensive and take years to complete. CHMI encourages programs to self-monitor and report publicly on their performance, and is working to develop better, readily adaptable metrics and get researchers to formally evaluate promising practices.
Scaling Up Solutions
If you find a solution that works, how do you scale it to reach more people?
Major health donors are now starting to focus on the challenges and the potential of health markets. For example, the Bill & Melinda Gates Foundation, USAID, the UK government, and other donors are jointly investing in programs harnessing private healthcare providers. Socially-minded investors like the Acumen Fund have been ahead of the curve, investing $29 million in health markets over the past 10 years.
Thought leaders at institutions including the Johns Hopkins Bloomberg School of Public Health, the UK's Institute for Development Studies, the World Bank and elsewhere are exploring how to make health markets work better for the poor. And health researchers are convening around the topic at an important health economics meeting next year.
Governments should focus more attention on health markets. Policymakers might consider a range of options, including smarter regulations, innovative training programs and contracting with good private providers through voucher programs or national health insurance. This could move countries toward universal health coverage.
Health markets present enormous challenges, but ignoring them doesn't make them go away. Innovators are developing promising solutions to make quality care accessible and affordable to the poor. Now is the time for governments and development partners to figure out what works and bring good quality care to communities in need.
Read more about cutting-edge health market innovations in Highlights: 2012.
David de Ferranti is president of Results for Development Institute. This blog post was written with R4D Managing Director Gina Lagomarsino