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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
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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
WHP Service Delivery Structure S p e c i a l i s t s T h i n k T a n k 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 9 W H PO f f i c e D I a g n o s t I c C e n t e r s SKY HEALTHT e l e m e d i c i n e C e n t e r s S h o p s 9 0 0 1 0 0 S u p p l i e s SKY CARE V i l l a g e P r o v i d e r s 1 , 0 0 0 V i l l a g e s
Impact • Project aims to address over 20% of unmet need in year 1 • 33% increase in contraceptive prevalence rate in 4 years