Extending performance-based financing to improve access to integrated contraception & nutrition services
The World Bank
Challenge: The World Bank with the Government of Burundi is developing a 5-year project focused on community-based programming in nutrition and family planning, to mitigate the impact of the humanitarian crisis and offer social interventions to build resilience.
Approach: Building on the recent successes of performance-based financing initiative (PBF) for clinical primary care, Impact for Health and local partners co-designed recommendations to strengthen the PBF scheme in six provinces. In particular, recommendations focused on extending the financing mechanism to formally engage new cadres of community health workers in the integrated delivery of contraception and nutrition services.
Increasing accountability and trust between providers and patients through user data: strategies for optimization
Challenge: Triggerise runs a digital platform that allows adolescent girls to find health care providers in their area who have been highly rated by their peers, and obtain digital vouchers to cover the cost of their care. Triggerise wanted to optimize their user feedback system to provide an asset-light approach to quality assurance for services as their platform scales. We sought to help strengthen their use of data to build accountability and trust between adolescent patients and a range of health care providers.
Approach: Drawing from examples from diverse industries including ClassPass, OPower, Yelp, Shift, Expedia, Postmates, Opencare, Virgin Mobile, ebay and more, we designed and executed a workshop with key staff to understand the key capabilities they might build to empower the patients, providers and vendors who engage in the digital ecosystem.
Investigating innovative health product distribution models in sub-Saharan Africa
Bill & Melinda Gates Foundation
Challenge: A range of technology-enabled innovations in health product distribution are emerging across sub-Saharan Africa. The Gates Foundation was unsure what innovations are emerging, how to think about the promise of these companies, and how to engage – if at all. Importantly, the Foundation was asking if these companies offer an asset-light approach to strengthening the provision of care in fragmented markets.
Approach: In partnership with Health Systems Consult Ltd we uncovered 58 companies innovating in product distribution across Nigeria, Kenya, S Africa and Ghana. We spent in-depth time with the leadership of the 30 most relevant companies, studying their business models. We also solicited input from 20 leaders across industry, academia and investors to understand how experts expect the markets will evolve. We presented to the Foundation a framework through which to understand innovations emerging and recommendations on how they might engage. An external-facing synthesis of our findings is available publicly here.
Translating global innovations in digitally-enabled adolescent sexual health service delivery to a rural US context
Children’s Investment Fund Foundation, with the Sherwood Foundation and a large anonymous donor
Challenge: Adolescents in rural America struggle to access contraception and safe abortion, and it is likely that access will become increasingly restrictive over the coming years. Digital platforms offer innovative opportunities to extend information, financing and care to teens without typical investments in health system infrastructure. The Children’s Investment Fund Foundation, Sherwood Foundation and a large anonymous donor sought to learn from digital platforms emerging in other contexts to inform investments to serve the rural US.
Approach: We brought together experts from the US, Kenya, Europe and the UK to participate in a 2 day interactive design workshop. Using customer journeys for adolescent girls based in rural Kenya and rural Nebraska, the group analyzed the obstacles they face in seeking information, financing, care and follow-up. The participants collectively determined the ways existing digital platforms in other contexts might help overcome the challenges faced by American girls.
Designing strategy to engage the pharmacy sector to scale user-controlled sexual health commodities
Children’s Investment Fund Foundation
Challenge: In many contexts a large proportion of the consumers accessing care in retail pharmacies and drug shops are adolescents and young adults. The Children’s Investment Fund Foundation seeks to expand access to user-controlled commodities among adolescents, including but not limited to DMPA-SC, HIV self-tests and emergency contraception. Given the accessibility and acceptability of the pharmacy channel to its target consumers, CIFF sought to understand how the sector could be leveraged to increase coverage.
Approach: Impact for Health studied the markets for care-seeking and provision in four contexts on the African continent: Uganda, DRC, Nigeria and Kenya and developed a report and series of key insights on the potential of the channel. We brought together a multi-disciplinary group of international and local experts in a design intensive to craft prototypes for programs in response to each insight for use by CIFF and to help inform and expand their own work. Already, two funded programs have emerged from this session.
Designing strategy to engage the private sector to accelerate access to contraception & primary care in Nigeria
Bill & Melinda Gates Foundation
Challenge: Most women in Nigeria seek primary care for themselves and their families in the private sector – clinics, pharmacies and drug shops. The Gates Foundation’s Integrated Delivery and Family Planning teams sought strategic advice on how to engage private providers to improve coverage of contraceptive products and services, while strengthening the provision of primary care overall.
Approach: Impact for Health believes health system strengthening and delivery strategies should be built from the customer, upward. Thus, through quantitative analyses of patient flow at various levels of the health system we created common customer journeys for care in two focus states. From this analysis we identified the highest-impact areas of intervention across the sector, and co-designed interventions to address each opportunity. Co-investments by both teams followed.
Analyzing health financing models for contraception across 22 countries
Challenge: In most low- and middle-income countries contraception is financed through supply-side, input based approaches. Although evidence is limited, demand-side financing is thought to reduce out-of-pocket expenditure for contraception users, expand uptake and improve method mix (especially longer-acting methods) amongst those with fewer resources. The Gates Foundation wanted to understand the opportunities to increase coverage of contraceptives through the expansion of demand-side financing schemes.
Approach: Leading a team of 15, we analyzed demand-side financing schemes for contraception in 22 countries. In-depth case studies were conducted in 6 countries to elucidate the challenges and opportunities related to covering the right people, right providers, right services with the right payment approach. A workshop for presentation and debate of the findings ensured they were understood by other major actors in the space, including UNFPA, SHOPS Plus and more. Impact for Health then developed an investment recommendation for the Gates Foundation that grew into a $10M grant for strategic purchasing of family planning, which is now implemented by ThinkWell.
Developing global social enterprise strategy (2016-2023) for 14 member associations
International Planned Parenthood Federation
Challenge: The IPPF Secretariat recognized the changing operating environment 14 of its members were facing, shaped by the dual pressures of declining donor support and high demand quality services from clients. The challenge was to create a global business approach today so that member associations were able to provide sustainable, equitable and quality services in the future.
Approach: Impact for Health worked with the IPPF Secretariat and member associations to build a vision for social enterprise models. Through a creative workshop, members identified opportunities for joint businesses, partnering with private sector and learning from existing models. A strategic framework was developed with agreed guiding principles and a results-based framework. Based on this foundational work, IPPF received USAID support to further its social enterprise agenda.
Developing pay-for-performance models to improve investment effectiveness
Children’s Investment Fund Foundation
Challenge: CIFF wanted to strengthen the application of performance and results-based payments within its investments in adolescent sexual health, nutrition and child survival. The goal was to support a more ‘commercial’ mind-set, influencing how CIFF did business by using tools that more effectively incentivise individuals and organisations, and create greater ‘shared risk’ between CIFF and its partners. The challenge was how to translate this to contractual agreements with grantees.
Approach: Impact for Health developed an evidence-based model for analyzing proposals and determining opportunities to introducing pay-for-performance that would help align incentives and increase shared risk. Program managers were individually supported and coached through the process. Lessons learned from one investment were shared to help set of a culture of continuous process improvement.
Analyzing pro-poor approaches of current HANSHEP programs
Challenge: Donors and countries supporting a joint fund for private sector programs had invested in 14 projects in low- and middle-income countries. Following the initial tranche of investments, the organization wanted to sharpen the focus on programs that made a demonstrable impact on those who were poor. The committee sought to understand how programs worked to ensure a pro-poor focus, and the strengths and challenges of each approach.
Approach: Impact for Health reviewed investments and interviewed a set of key stakeholders. We assessed the programs focus on the poor in terms of design, results, implementation and future potential. Lessons learned included ensuring the right people were targeted, the right providers included, the right package of services offered, and the right financing scheme was linked. At the portfolio level we made recommendations to ensure the group maintained a balanced portfolio.
Developing investment strategy to engage drug shops in provision of contraceptives in Kinshasa
Bill & Melinda Gates Foundation
Challenge: In DRC, pharmacies and drug shops are the first point of care for 48% of women seeking contraceptives. At these outlets the quality of care and products can be low, and the costs to consumers can be high. The sector is highly fragmented and poorly regulated and traditional actors such as social marketers or social franchises do not exist at scale to help organize the channel. The Bill & Melinda Gates Foundation’s Family Planning team sought strategic advice on how to engage the channel to expand access to high-quality, low-cost products and basic services.
Approach: Impact for Health complete a strategic analysis of the challenges and opportunities, and in consultation with more than 30 key stakeholders in Kinshasa and globally, developed a strategic framework and set of investable concepts for the Family Planning team to advance.
Designing innovative programs to engage drug shops in sexual & reproductive health care for adolescents in Uganda & DRC
Challenge: Adolescents in both Uganda & DRC struggle to access sexual and reproductive health care within the traditional health care system: clinics, hospitals, faith-based and NGO clinics. PATH was seeking to build on its experience leading programs engaging pharmacies in the provision of basic care in Asia, and translate this expertise to new programs in sub-Saharan Africa.
Approach: After analyzing the landscape of challenges and opportunities, we worked hand-in-hand with PATH’s country offices and networks of experts to move our analysis into a set of actionable, budgeted program designs that advanced access and were well-aligned with the government’s goals, funders strategies and PATH’s capabilities. Program designs were informed by primary data collection (designing and executing pharmacy survey), primary data analysis, secondary data analysis, key informant interviews and co-design sessions.
Optimizing advisory support for innovators seeking scale
Grand Challenges Canada
Challenge: Grand Challenges Canada provides post-deal advisory support to companies that receive $1M in financing and are in a position to scale. To date, advisory support has not been accessed broadly by companies receiving funding. Grand Challenges Canada sought to improve their post-deal support to help ensure they were meeting the needs of investees.
Approach: Impact for Health studied the current advisory support process, identifying challenges and opportunities. We identified 20 organizations providing support to commercial and social start-ups. Drawing from the best examples internationally, we crafted tailored recommendations for how Grand Challenges Canada might improve their approach to supporting innovators as they scale.
The School Clinic
Challenge: Evidence shows that it is more difficult for families to access primary care in Canada than in other comparable countries. Models that simplify access to integrated mental and physical care are sorely needed.
Approach: School-based clinics may be such a model – meeting kids where they are with the care they need. Robust evidence supports the impact of school clinics on educational and health outcomes, however, clinics have been emerging in a piece-meal fashion across the country. Impact for Health feels digitally-enabled school clinics can be positioned for scale. We are currently assessing opportunities for partnership to test digitally-enabled school-based clinics in rural and remote areas of British Columbia and Ontario. Track our progress here!