an increasingly broad range of
creative solutions is being developed
to provide greater health care
options for poor populations.
ADDO provides shop owners with business training
and technical support, which has not only increased
the number of customers but improved the quality of
pharmaceutical services. A 2004 evaluation4 of the program by Strategies for Enhancing Access to Medicines
Program, a project developed by a for-profit consulting
firm, showed that inappropriate dispensing of antibiotics declined from 39 percent in 2001 to 14 percent in 2004.
The Americas, with a burgeoning private health sector and a large low-income population, is a vibrant laboratory for new private-sector models of health care.
Centro Ginecológico Integral (CEGIN) in Argentina’s
Jujuy province, a for-profit high-volume/low-cost hospital that provides high-quality medical services to poor
rural women at half of the market price, has reported
The center serves 130 patients a day, administers 1,000
tests for cervical and ovarian cancer and estimates that
it has prevented the development of 300 cancer cases
since its founding in 1989. In addition to a medical center, CEGIN runs a microinsurance plan, the SER system,
which for a small fee-per-person gives low-income communities access to discounted CEGIN services and lower
prices at pharmacies and other local shops.
Other pro-poor models in Latin America create new
partnerships with the government that build on what is
already in place. Andean Health and Development (AHD)
in Ecuador is an example of this. In 2000, AHD built a sec-
ondary care hospital in a rural area of northwest Ecuador
to provide a range of services, including maternity care,
emergency care, diagnostic services, and specialized sur-
geries. The hospital became fully self-sustaining seven
years into its operation thanks to an innovative mix of
financing mechanisms that combine revenue generated
from the social security system, municipal contribu-
tions and out-of-pocket payments. In 2008, the Minis-
try of Public Health approached AHD with a proposal to
jointly operate an existing rural public hospital located
in the city of La Mana in central Ecuador and introduce
the established AHD secondary-care model to the public
system with the goal of improving its efficiency
and lowering costs.
not a Quick Fix, but a
promising step Forward
Despite their relative newness, health market innovations have started to attract increased attention from the global health community. In May 2009, the Results for Development Institute5 investigated the global landscape
for pro-poor innovative health models and profiled a
selection of 33 market-based programs, ranging from
donor-driven initiatives to large-scale government-sub-sidized efforts and for-profit businesses. This research
found that, while unable to transform health systems on
their own, these models can successfully complement
government-run health financing and delivery platforms and effectively support a country’s health goals.
All the models mentioned here, as well as others profiled in the still-sparse literature on the subject, have
reported some positive results, ranging from improvements in efficiency and quality of service to increasing
access for poor populations and greater consumer choice.
But our understanding of these models continues to be
limited. There are still questions about their significance
and value. Research points to many programs that have
failed to achieve any results and stresses the unproven
track record of health market innovations. Indeed, while
positive preliminary results are a promising step for ward,
very few programs have been rigorously studied to better understand their success factors, business and financial models, paths to scale, and ultimately, their potential
to make a significant contribution to improving lives.