My starry-eyed, healthcare-from-the-heart, “free for service” self is having a real world wake-up call. I wanted to share a drop from the flood rushing through my head and quite literally around me.
The CARE-GSK Community Health Worker Initiative is a donor-funded NGO project. And although there is a network of Private-Community Skilled Birth Attendants (P-CSBAs) who generate income from selling their services, this means that social impact trumps financial considerations. These agents must provide services to BoP populations, regardless of ability to pay. But as we well know, donor money doesn’t pour from the sky like these monsoon rains.
This poses an interesting setup as the project seeks to transition to a sustainable social business model, where tradeoffs exist between profit maximization and social impact. This setup has led me to many questions, of which I will share one: How can you have financial sustainability while maintaining equity in healthcare delivery at the BoP?
Here are two brief thoughts within this context.
Entrepreneurs are the Sun in the (solar) system.
If the agents cannot and do not perform their tasks, the system will fail. No service and no money. I have been observing for many weeks now the difference between achieving and not achieving service and financial goals. The balance point lies at the interface of the agent and her surrounding structures.
She is a mother with young children and social norms dictate her presence in the household. She needs be mobile to reach dispersed service recipients. Procuring quality supply involves a long and expensive trip. Oh, opportunity costs…the list goes on. Suffice to say, the value proposition of the organization (or potential franchisor) to these P-CSBAs must have in-built contingencies to address these barriers to equitable care, while yet promoting a stable income.
Taking the blinders off of sustainability.
In discussions I am finding the need to clarify what people mean by “sustainability” when they articulate their future vision for the system. Through this process I am also clarifying my own understanding.
When asked to elaborate on sustainability, I often hear a solely financial scope and that too, the traditional definition of a competitive and self-sufficient franchise. But when 60% of service recipients are in national wealth quintiles of poor and extreme poor designations and the services are essential and often lifesaving, is this a realistic conceptualization? I am quickly seeing the need to broaden the scope of financial sustainability in my discussions to even begin to accommodate equitable healthcare delivery.
Perhaps financial sustainability in this model includes a certain dependency on donor funds? Perhaps it means harnessing partnerships in a voucher program for the poor and extreme poor? Or transportation subsidies for P-CSBAs to reach the dispersed population?
And to extend this past the money, I am learning to conceptualize a sustainability ecosystem. Leveraging community and political structures such as local government and village groups as accountability mechanisms for equity. Honing a skill set that ensures a competitive advantage of mobility and quality unlike quack central, the Village Doctors and Traditional Birth Attendants. Designing a lifestyle that addresses barriers to equitable care provision while fulfilling the entrepreneurial spirit.
This is an intricate, crucial balancing act.
This poses an interesting setup as the project seeks to transition to a sustainable social business model, where tradeoffs exist between profit maximization and social impact. This setup has led me to many questions, of which I will share one: How can you have financial sustainability while maintaining equity in healthcare delivery at the BoP?
Here are two brief thoughts within this context.
Entrepreneurs are the Sun in the (solar) system.
If the agents cannot and do not perform their tasks, the system will fail. No service and no money. I have been observing for many weeks now the difference between achieving and not achieving service and financial goals. The balance point lies at the interface of the agent and her surrounding structures.
She is a mother with young children and social norms dictate her presence in the household. She needs be mobile to reach dispersed service recipients. Procuring quality supply involves a long and expensive trip. Oh, opportunity costs…the list goes on. Suffice to say, the value proposition of the organization (or potential franchisor) to these P-CSBAs must have in-built contingencies to address these barriers to equitable care, while yet promoting a stable income.
Taking the blinders off of sustainability.
In discussions I am finding the need to clarify what people mean by “sustainability” when they articulate their future vision for the system. Through this process I am also clarifying my own understanding.
When asked to elaborate on sustainability, I often hear a solely financial scope and that too, the traditional definition of a competitive and self-sufficient franchise. But when 60% of service recipients are in national wealth quintiles of poor and extreme poor designations and the services are essential and often lifesaving, is this a realistic conceptualization? I am quickly seeing the need to broaden the scope of financial sustainability in my discussions to even begin to accommodate equitable healthcare delivery.
Perhaps financial sustainability in this model includes a certain dependency on donor funds? Perhaps it means harnessing partnerships in a voucher program for the poor and extreme poor? Or transportation subsidies for P-CSBAs to reach the dispersed population?
And to extend this past the money, I am learning to conceptualize a sustainability ecosystem. Leveraging community and political structures such as local government and village groups as accountability mechanisms for equity. Honing a skill set that ensures a competitive advantage of mobility and quality unlike quack central, the Village Doctors and Traditional Birth Attendants. Designing a lifestyle that addresses barriers to equitable care provision while fulfilling the entrepreneurial spirit.
This is an intricate, crucial balancing act.
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