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Table 1 Innovative Private Sector Organizations Benefiting the Poor

From: Innovative health service delivery models in low and middle income countries - what can we learn from the private sector?

Organization (Country/Year Started)

Scope of services

Overall performance

Social Impact

↑ Improved

↔ No change

? Unknown

Quality of Evidence

Sources of Funding

  

Availability

Affordability

Quality of Care

  

Aravind Eye Care System

(India/1976)

Eye Care Services Manufacture of intraocular lenses; cataract surgery; vision screening

Largest and most productive eye care facility in the world; 2.5 million have received outpatient eye care and > 300,000 have undergone eye surgeries from April 2009 to March 2010

↑ Increased availability of services to rural areas through outreach camps, internet kiosks and vision centers

↑ Cost of cataract surgery reduced to $25; 70% of patients receive care subsidized or free

↑ High quality of services, with lower infection rate than UK

Self-reported evaluations; externally reviewed publications

Local entrepreneur

Dentista Do Bem

(Brazil/2002)

Dental Care for youths: Free treatment provided by existing practitioners

Reached > 12,000 children in 27 states in Brazil in 2009; model is being replicated in 6 Latin American Countries

↔ Existing practitioners provide free services

↑ Services provided by existing providers for free to poor youth

? Use of existing providers; provide systematic follow-up and feedback to ensure quality of care and motivate dentists

Self-reported questionnaire and review; foundation website

Local entrepreneur supported by partnerships with dentists and fundraising

Greenstar Social Marketing Pakistan

(Pakistan/1991)

Reproductive and child health: Education; intervention, monitoring and evaluation

2nd largest family planning provider after the Government in Pakistan with a franchise network of over 7,500 active providers

↑ Outreach workers reach over 2.5 million people every year

↑ Serves higher proportion of poor clients than the government and provide over 26% of all modern contraceptives at affordable prices

↑ Continuous training and monitoring result in higher quality services than existing private facilities

Self-reported review and questionnaire; third party evaluation

Initially funded by international NGO with support from various government and private foundations and user fees

Jaipur Foot

(India/1968)

Lower limb prosthetic: manufacture and fitting

Distributed > 200,000 artificial limbs in India and > 13,000 in 18 other countries

↑ Distribution through clinics and outreach camps, 24 hours a day

↑ Reduced cost of a prosthetic leg and fitting to $35; prosthetics are distributed to clients for free

↑ Prosthetics are designed to meet the daily needs of the poor; focuses on customer orientation and quality service delivery

Self-reported statistics; third party evaluation

Local entrepreneur supported by local government and donations

K-MET

(Kenya/1995)

Maternal and child care: Trains existing providers on reproductive health, family planning, safe abortion care

Network of 204 health providers and community-based workers

↑ Provides care for rural communities where government services are unavailable

↑ Serves clients slightly poorer than community average; services benefit all income quintiles

↑ Gives loans to clinics and provides training to improve facilities and ensure safety and high quality of care

Externally reviewed publications; third party evaluation

Local NGO with support from donations and international grants

Narayana Hrudayalaya Heart Hospital (NH)

(India/2001)

Coronary artery disease: Heart surgeries and cardiac care

The 800-bed hospital performs high quality surgeries with eight times more volume than average Indian hospitals

↑ High volume hospital; 54 telemedicine centers, outreach camps and buses reach out to the rural poor

↑ High-volume strategy allowed NH to reduce cost of cardiac surgery to Rs 65,000 from Rs 150,000 (average Indian private hospital); 18% of patients receive care subsidized and 1% free

↑ Ensures high quality and efficient services by training surgeons and nurses, use of top-quality equipment; higher overall success rate in coronary artery bypass surgery than the U.S average

Self-reported review; externally-reviewed publications; third-party evaluations

Local entrepreneur with the help of capital funding from family members and Asia Heart Foundation plus user fees

Population and Community Development Association (PDA)

(Thailand/1974)

Family planning and HIV/AIDS care: Education; contraceptive/vasectomy/pregnancy termination services

Contributed to the decrease of Thailand's population growth rate from 3.3% in 1970 s to 0.6% in 2005; helped establish national HIV/AIDS prevention program in Thailand which reduced potential new infections by 90%; model adopted by the governments of many countries

↑ Nation-wide public education campaigns; outreach and mobile clinics reach 10 million Thais in 18,000 villages and poor urban communities; provide blood tests, family planning and pregnancy termination services for the poor where services were previously unavailable

↑ Most services are free; owns innovative commercial ventures to fund community health and development projects

? Quality of care unclear; aims to improve safety of services(e.g. reinforced safe abortion practices etc) and provides health education to the public

Self-reported review; Gates Awards press release; published reports

Local entrepreneur with support through donations and revenue from their own commercial ventures ranging from restaurants to industrial health services

PSI's Top Reseau/100% Jeune/Centre Dushishoze

(Madagascar, Cameroon, Rwanda/1999)

Sexual/Reproductive Health: Peer counseling; education; contraceptive services; multimedia promotion

Increased contraceptive use among young men from 29% to 53%, among young women from 20 to 39%; increased number of people getting HIV test in Rwanda and reproductive services in Madagascar;

↑ Broad reach through multimedia campaigns and outreach

↑ Provide services at a subsidized rate (Madagascar) and cheaper than other health clinics (Cameroon)

↑ Continuous evaluation to ensure high quality and effective youth programs

Externally- reviewed publications; third-party evaluations

International NGO supported by grants and user fees

Vision Spring

(India/2001)

Vision correction: screening, provide glasses, adjustments

"Business in a Bag" strategy allows 1200 Vision Entrepreneurs to distribute > 100,000 pairs of glasses in 13 countries

↑ Entrepreneurs distributed glasses in poor communities and rural areas; door-to-door service with easy screening and testing methods

↑ Glasses are $4 a pair instead of $40-60 at optical shops

↑ Quality of glasses are in general lower than those from expensive optical retailers, but higher than competitors within their price-range

External case studies; externally reviewed publications

Foreign entrepreneurs supported by venture philanthropy, philanthropic investors and user fees

Ziqitza 1298

(India/2005)

Ambulance Services: transportation and emergency care; public education

70 ambulances in Mumbai and Kerala have served more than 60,000 patients.

↑ The first single emergency number for ambulance service in Mumbai; 24-hour ambulances with GPS tracking

↑ Cross-subsidization made services more affordable to the poor

↑ 90% of ambulances in urban India did not have adequate equipment and trained paramedics; Ziqitza's ambulances provide trained paramedics, life support equipments and continuous evaluation to ensure safety and quality of services

Self-reported review; funders' review

Local entrepreneurs supported by venture philanthropy and user fees