Transcript MARKETS FOR HEALTH - Health Systems Hub

Futures Group and the World Bank Institute
in collaboration with
Abt Associates, O’Hanlon Health Consulting,
University of California at San Francisco and Tropical Health LLP
JANUARY 2014
MARKETS FOR HEALTH
SESSION 10
Designing a Market
Intervention
Barbara O’Hanlon
Futures Group and the World Bank Institute
in collaboration with
Abt Associates, O’Hanlon Health Consulting, University of California at San Francisco and Tropical Health LLP
DESIGN PROCESS
DIAGNOSTICS
MARKET INTERVENTION
TOOLS
MARKETS FOR HEALTH
Strategic Framework
Equitable Health Outcome
Health Market Change
Strategic
Intervention(s)
Define equitable health outcome:
What is the anticipated health outcome?
Who is the target group?
Define market change:
How can the market address the poor’s
health needs?
What changes are needed in the health
market and enabling environment to better
serve the poor?
Define broad thrusts:
What actions can facilitate the changes in
the market and/or operating environment?
Strategic Framework / Market Intervention
Equitable Health Outcome
Health Market Change
Strategic
Intervention(s)
Systemic
Change
Step 5
Market #1
Step 4
Market #2
Step 3
Market #3
Step 2
Market #4
Step 1
Market Intervention Design Decisions –
Inception Report
 Market Selection:
Which market to intervene?
 Market Strategy:
Who is the target group?
What are the opportunities to
serve the poor?
 Market Facilitation: How to interact with the private
and public sector to unlock
this potential?
Market Intervention Design Decisions
 Market Selection:
Which market to intervene?
 Market Strategy:
Who is the target group?
What are the opportunities to
serve the poor?
 Market Facilitation: How to interact with the private
and public sector to unlock
this potential?
Process to Design a Market Intervention
Understand the poor and
their context
Select a specific market(s)
Health Market Change
Assess specific market(s)
Identify systemic constraints
Systemic
Change
Design Market intervention
DESIGN PROCESS
DIAGNOSTICS
MARKET INTERVENTION
TOOLS
MARKETS FOR HEALTH
Step 1: Learn About the Poor
What do we want to know in general?
 Who are the poor?
– Size
– Location
What is their socio-economic profile?
– Disposable income
– Household composition, characteristics
– Health decision-making
What is their demand for health?
– Demand for specific services and product
– Unmet demand for specific services and products
– Provider preference
MARKETS FOR HEALTH
Poor and Consumer Research Approaches
Overview of Health System
Health system assessment, partnership landscape assessment (PLA), Private sector
assessment (PSA), other private sector research, consumer use/preference (DHS)
Poor and their Context
Socio-economic studies, census date, poverty assessments,
livelihood analysis and consumer research
Private actors and their Context
Market research, competitive analysis,
and provider research
Health Markets
Landscape and
interviews of market
actors
...consumer research explains
who are the poor, their health
needs and barriers accessing
...consumer research is also the
starting point to define the poor
and to select markets
Step 1: Understand the Poor and their Context
1. Socio-economicgeographic “picture”
2. Trends, factors, drivers and
barriers to poor’s access to
healthcare
3. Donor priorities

Geographic focus

Service focus

Product focus

Target group focus
To identify specific
markets which offer
sustainable
opportunities for
the private sector to
serve the poor
MARKETS FOR HEALTH
Step 1: Understand the Poor and their Context
KENYA CONSUMER RESEARCH
MARKET IDEAS
“Top 5” illnesses cited diarrhea, cancer, HIV,
malaria and pneumonia (ARIs)
Diagnostic and
treatment of diarrhea
Barriers to access are high cost drugs, distance,
lack of understanding on “healthy behaviors”
Diagnostic and
treatment of malaria
Quality issues include self-diagnosis, many
counterfeit drugs, drug stock-outs, poor diagnosis
Drug supply
Seek care 1st with drug seller/pharmacists for small
problems;
Prefer private sector
MARKETS FOR HEALTH
Kenya: Example to Define the Poor
1st: Examine how
the government
defined the poor
— Abject poverty (< $2/day)
— Minimum standard of living
based on basic needs
— Progress Out of Poverty
Index (PPI)
— Subjective Measures of
Poverty
— Median monthly income
levels
v
Kenya Example to Define the Poor
Using different methods to set realistic definition
2nd: Ask private sector
how they segment the
market
One answer
Another answer:
5% Have a lot
65% Have less
35% Have nothing
Kenya Example to Define the Poor
3rd: Asked consumers how
they defined the poor
Below
5,500KHS
Above
4,500KHS
Below
4,500KHS
Above
3,000KHS
Below
3,000KHS
Above
1,400KHS
Characteristics: Work in the formal
sector, regular work, some disposable income
and savings
• Policeman • Teacher • Receptionist
Skilled
Labor
Unskilled
Labor
Casual
Labor
Characteristics: Work in the formal sector,
regular work, no disposable income or savings
• Security guards
• Maids
• Shop girls
• Rose farms
• Tea coops
• Construction
Characteristics: Work in the informal
sector, irregular work, no disposable
income or savings
• Jua Kali –
day laborers
• Artisans / tradesman
• Subsistence farmers
• Roadside vendors
All are one pay check away from following into poverty
Inception Report
 Usually occurs six to twelve months into project
 Inception Report details
 Basic understanding of the health system, health
priorities and system gaps
 Basic understanding of the poor and their health context
 Basic understanding of the private sector’s current
activities, capacity and interest in serving the poor
 Proposes target group, potential markets and possible
interventions
 Also reviews and discusses any differences between log
frame and more in-depth understanding
Step 2: Select Markets
Key Factors to Consider
SUSTAINABILITY
SCALE
Private sector interest
and capacity
Largest # of poor and/or
greatest health output
“Sweet
Spot”
SYSTEMIC
CHANGE
Feasibility of market
change
Tips in Market Selection
How many markets?
 Weak or thin market >>> pursue a multiple market approach
 Single market approach >>> exposes too much risk
 Specialized market >>> maybe difficult to create scale
 Multiple market approach >>> creates management burden
 Multiple market approach >>> spreads efforts too thinly
Calls for “groups” of related markets (e.g. geographic
concentration, similar constraints/solutions)
Step 3: Assess Market Conditions
and Dynamics
1. Market structure
 How does the market system work?
 What are its key functions?
 Who are the key players (private,
public, formal, information)
 What is the relationships between
these players?
2. Market dynamics
 What is the flow of goods and
services?
 What is competition?
 What are barriers to entry/ staying?
 What are consumer preferences?
 What is consumer ability to switch?
To identify where and
why the market is not
working for the poor …
“symptoms”
Health Market Systems Research
Approaches
Overview of Health System
Health system assessment, partnership landscape assessment (PLA), Private sector
assessment (PSA), other private sector research, consumer use/preference (DHS)
Poor and their Context
Socio-economic studies, census date, poverty assessments,
livelihood analysis and consumer research
Private actors and their Context
Investment climate surveys, competitive
analysis and provider research
Health Markets
Landscaping and
interviews of market
actors
…provider research
explains capacity and
incentives as well as
business setting
Step 3: Assess Market Conditions
KENYA CASE
Crowded market – MOH offering “free”
services; donor supported FBO/NGOs and
now private providers
Stiff competition from multiple sources –
informal providers, other small providers,
public sector, donors subsidies
MARKET SYMPTOMS /
CAUSES
What do you think?
Unfavorable business climate to enter and
sustain a private health business
Asymmetry of information – government
has most, private sector has little
Consumer substitution between sectors –
“shopping for a better deal”
MARKETS FOR HEALTH
Step 4: Identify Systemic Constraints
1. Key market functions and
players
2. Inceptives, capacity and
relationships
To identify underlying
reasons for market
underperformance
…… “causes” >>>
market interventions
3. Interconnected markets
MARKETS FOR HEALTH
Health Market Systems Research
Approaches
Overview of Private Health Sector
“Snapshot” of the private health sector, current use of private services and
products and enabling environment
Poor and their Context
Socio-economic studies, census date, poverty assessments,
livelihood analysis and consumer research
Private actors and their Context
Market research, competitive analysis,
and provider research
Health Markets
Landscape and
interviews of market
actors
…market research identifies
the causes why health markets
are failing the poor
DESIGN PROCESS
DIAGNOSTICS
MARKET INTERVENTION
TOOLS
MARKETS FOR HEALTH
Basic Concepts
What is an intervention?
 “softest part” of M4P approach
 Action taken to improve a situation – Oxford Dictionary
Understanding the difference between market and
direct interventions
DIRECT INTERVENTION
 Ideas?
FACILITATIVE INTERVENTION
 Ideas?
Basic Concepts
Understanding the difference between market and
direct interventions
DIRECT INTERVENTION
FACILITATIVE INTERVENTION
Donor funds Company “X” to
Establish an NGO in a developing
country to deliver mosquito nets
Staff the country office
Build its own distribution network
Market it own branded mosquito
net at a subsidized price
Donor funds Company “Y” to
Identify a local manufacturer
producing mosquito nets
Work with the manufacturer to
affordably price the mosquito net
and re-launch into the market
Help market the product at full
price
Use existing channels to distribute
the net
Other companies take note and
enter into the market
Basic Concepts
Guiding principles of a market intervention
 Flexible
 Temporary
 Catalytic
 Facilitative
Elements of a market intervention
 “Do no harm” to the market
 Commercial partners
Design Examples
Diarrhea
Drugs
Mothers and
children under 5
years in 4 rural
counties in /
near Mombasa
Malaria





Faulty diagnosis
Incorrect treatment course
Incorrect prescribing practice
Correct treatment (ZINC) not available
Or too expensive (reliant on imports)




Limited geographic access
Limited types available when in stock
Too expensive
Easy access to counterfeit





No lab facilities
Faulty interpretation of lab test
Incorrect treatment
Easy access to counterfeit drugs
Quality drugs too expensive
Design Examples
Similar constraint
Diarrhea
Drugs
Mothers and
children under 5
years in 4 rural
counties in /
near Mombasa
Malaria





Faulty diagnosis
Incorrect treatment course
Incorrect prescribing practice
Correct treatment (ZINC) not available
Or too expensive (reliant on imports)




Limited geographic access
Limited types available when in stock
Too expensive
Easy access to counterfeit





No lab facilities
Faulty interpretation of lab test
Incorrect treatment
Easy access to counterfeit drugs
Quality drugs too expensive
Design Examples
Diarrhea
Drugs
Mothers and
children under 5
in 4 rural
counties in /
near Mombasa
Malaria





Faulty diagnosis
Incorrect treatment course
Incorrect prescribing practice
Correct treatment (ZINC) not available
Or too expensive (reliant on imports)




Limited geographic access
Limited types available when in stock
Too expensive
Easy access to counterfeit





Common solution
No lab facilities
Faulty interpretation of lab test
Incorrect treatment
Easy access to counterfeit drugs
Quality drugs too expensive
Example of Market Logic
Crowd out counterfeit drug supply in 4 counties
Drugs removed from supply
Fake drugs detected
Quality drugs accessible
Drug sellers send results to NQL
Drug sellers price affordably
Drug sellers use equipment
Consumer use appropriate drugs
Drug sellers submit drug order
Drug sellers skilled/capacitated
Consumer switch from fakes
Drug sellers properly prescribe
Train drug sellers in equipment
Consumers test suspicious drugs
Drugs sellers use training
Drug sellers have equipment
Consumer appreciate benefits
Drug sellers trained
Drug sellers willing to participate
Consumer aware of fakes
Drug sellers willing to participate
Link to gov’t inspectors/NQL
Conduct consumer campaigns
Train in bulk purchase system
Facilitate reporting
Train prescribing practices
Provide and train in equipment
Establish bulk purchasing
Form/align with a networkUpgrade drug sellers status
DESIGN PROCESS
DIAGNOSTICS
MARKET INTERVENTION
TOOLS
MARKETS FOR HEALTH
Tools to Design Market Interventions
Concept Note
 Problem definition
 Expected impact
 Business Case
 Results chain
 Identification of partners  Budget/timeline
Partner Agreement
 Objectives
 Description of activities
 Who will do what
 Who will pay for what
 Data obligations
Action Plan
 Mutual objectives
 Activities
 Responsible party
 Deadline
 Expected output
Measurement Plan
 Linkages to log-frame
 Results chain
 Expected impact




Data requirements
Data collection approach
Responsible party
Timeframe
DESIGN PROCESS
DIAGNOSTICS
MARKET INTERVENTION
TOOLS
WRAP UP
MARKETS FOR HEALTH
Managing Change and Expectations
Portfolio Approach (Start)
Managing Change and Expectations
Portfolio Approach (Finish)
Portfolio Approach
MARKETS FOR HEALTH