Innovative Health Service Delivery Models for LMICs

The report reviewed the literature on a number of innovative health service delivery models, isolating business processes that could be applied more broadly, including marketing strategies (communications, customer orientation, franchising), financing strategies (reduced operating costs, high volume/low cost, cross-subsidization, capital funding, revenue generation), and operating strategies (human resource management, knowledge-development, telemedicine). The authors find that successful organizations tend to innovate across several of these business processes.

After years of disease-focused initiatives in global health, there is a growing interest in strengthening health systems so that they work better for the poor. Low- and middle-income countries have mixed health systems, often with large private sectors widely used by the poor. The lack of availability, high out-of-pocket expenses, and poor quality of care in these systems result in low utilization and sub-optimal health outcomes. Harnessing the existing private sector—a mix of licensed for-profit and nonprofit organizations as well as informal providers—may be an efficient way of improving services. The example of social enterprises that aim for social impact, financial sustainability, and rapid scale-up has created enthusiasm to explore the potential of investments in this sector in health, with specific efforts from the International Finance Corporation and the Rockefeller Foundation. We have undertaken an extensive review of print and online sources to identify private sector organizations that have used innovative business models to improve care for the poor, in order to characterize their models.

This study reviewed many examples of private sector organizations that have improved care for the poor and created a model to characterize their business and medical process innovations. These organizations all innovate across marketing strategies aimed at more closely targeting the poor, financial models to dramatically reduce costs, and novel delivery processes to make services more available. Their work can be expanded to fill gaps in health services, and elements of these models can be replicated or promoted by governments or foundations to improve care in other institutions. Future work should assess the degree to which leadership and organizational culture have contributed to their success. Though most organizations have a narrow disease focus and have filled gaps in public service delivery, some of their approaches could integrate with or be adapted to horizontal public services. In this respect, they may act as a complement to the public system rather than an alternative.

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