USING CLIENT POVERTY DATA AS A MEANINGFUL INPUT FOR HEALTH PROGRAMS Webinar 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

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

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, Avery Seefeld at

The moderator

Equity measurement Growing awareness that increased 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.

9 Equity Hub Webinar - June 2015 Matt Boxshall

10 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 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 Interviews 11 Do client profiles match strategy? High Impact CYPs Why HIC groups? Adopters How do we do? Youth How do we do? Poor How do we do? Before the visit How do we attract clients? How do clients hear about us? Why choose us? Satisfied? Will you return? Switchers How do we do? At the site How well do we serve clients? Counselling Follow-up After the visit Experience and Feedback What if we had not been there? Choice (new!) PAFP Partnershi p stats Health impact and sustainability + Quality (QTA, QAF) + Efficiency (SUN, cost calculator) PPFP Partnershi p stats

12 Lesson 1 - Equity Wealth quintiles of franchising clients, within national reference populations* QuintileMSI Nigeria Society for Family Health Population Services Kenya MS KenyaMSI Ghana n=458n=420n=445n=369n=321 1 (poorest) (richest) Sources: Nigeria- Malaria Indicator Survey 2010; Kenya- DHS 2008; Ghana- DHS 2008

13 Client Wealth Profiles in Context – Kenya MS Kenya QuintileNational Nairobi, Coast, Nyanza, Western Regions only PSK QuintileNationalUrban

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... 14

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 15 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... 16

17 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 SupplyDemand Lesson 3 : New Role for SF Organizations

Thanks 18

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 OPPORTUNITY Dr. 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.

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

Equity Data

Collection of data Heartfile's customized ERP collects, update and disseminates data on an ongoing basis. Usage of Data Internal 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

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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 ( ) 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 –

Percentage of clients who are MPI Poor 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: You can also contact the following for more information on this presentations:

Using client poverty data as a meaningful input for health programs Webinar June 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 for resources to learn, connect, and collaborate with people around the world. Visit 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.

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