Delivering (and Sustaining) Services on Scale. Anywhere.
description
Transcript of Delivering (and Sustaining) Services on Scale. Anywhere.
Delivering (and Sustaining) Services on Scale. Anywhere.
November 20, 2008 Gopi Gopalakrishnan
Time to Go Rural
• Challenge: How to deliver services on scale in any part of the world, however rural or remote
• Primarily in areas where the public sector is ineffective or unavailable
• Private sector is the only other option for large-scale service delivery
Using private sector to target the poor needs ability to reconcile two naturally divergent forces
Using Private Sector -- A Quick Review
• 20 years ago, focus was primarily urban. Demand creation was difficult, supply was relatively easy
• For products—we just used supply infrastructure created by private companies
• For services—the challenge was day to day management but personnel, premises and communication vehicles were more easily available
Delivery in Rural Areas—Need is for New Set of Paradigms
• Demand is a given—even for family planning, unmet need is estimated at 20%. Health care is even more
• Adequate finances available
• Binding constraint is providers—for subsidised products, volumes are too small; for services, the appropriate providers are unavailable or unwilling
• Clients will some services only if available closeby
• Vertical provisioning is unviable and unsustainable
• Preventive care (and low level curative care) has not much attraction
• Public sector is willing to support provision through private providers
• Skilled providers not willing to stay in rural areas—will work only for short periods
Programmatic Structure
• Create a viable package which will leverage and sustain interest
• Curative part of package will anchor it financially
• Preventive part is a non-negotiable part
• Develop technology to fit service delivery and not vice versa
• Flexibility to adapt to uncertainties that come with the territory
Overview
• Create a basket of services that combines preventive with curative services
• Identify and induct a range of providers on the basis of competency and inter-link them financially
• Three broad functions for providers: Provide services directly Facilitate services through other networks (and
earn) Manage provision by WHP (and earn)
• Use financial instruments to leverage public sector support
Determine services that are of primary interest, quantify and work toward achieving them
SKY CAREV i l l a g e
P r o v i d e r s
SKY HEALTH
T e l e m e d i c i n e C e n t e r s
F r a n c h i s e e D o c t o r s
C e n t r a l M e d i c a l F a c i l i t y
S h o p s
T h i n kT a n k
V i l l a g e s
S p e c i a l i s t s
S u p p l i e s
9 0 0
9
1 0 0
1 , 0 0 0
WHP Service Delivery Structure
D I a g n o s t I c C e n t e r s
W H PO f f i c e
Impact
• Project aims to address over 20% of unmet need in year 1
• 33% increase in contraceptive prevalence rate in 4 years