Tuesday, November 24, 2015

FINDING ALTERNATIVE FUNDING FOR THE ONE FAMILY HEALTH INITIATIVE

 Chelsea Swanson and Caesar Lubanga-kene

The One Family Health (OFH) model is a phenomenal response to the health care worker shortage which is a perpetual challenge to the health care system of Rwanda. The model is well-thought out, effective, and requires comprehensive cooperation from a number of players both in the private and public sector both locally and internationally. OFH has adapted its practices to offer healthcare under the Mutuelle insurance, obtain essential technologies like Lifesense, and train its employees in quality treatments and additional skills like human resource, financial and supply chain management, while offering a sustainable plan.

However, despite all of these progressive and impressive qualities, OFH may be on the verge of a downward spiral. The recent withdrawal of Glaxo Smith Kline (GSK) a major partner from the financial support of the model is calling into question whether OFH can continue to be an effective player in the health care worker shortage and continue operations to improve health in Rwanda.

GSK, as the main funder, was a backbone for the OFH model. It gave the Rwandan government and local banks faith in the program. The loss of GSK as a funder may mean the loss of faith from the local government and local banks that deemed loans to the local enterprise to risky to provide loans a gap that GSK had well covered. It is a domino effect that is in urgent need of saving.

But how?

First we ask why GSK dropped out? Well, according to them, they felt the risk was too high, and that they would lose more than they gained. Next we ask what could have been done differently when recruiting and obtaining funders for the program?

Here is where some of the problem solving can begin. The back bone is made up of vertebrae, but with GSK as the backbone funder to OFH, there is no smaller vertebra to fall back on. By starting out with more investors and venture capitalists, the likelihood of failure due to one investor pulling out is much smaller.  There are many investors willing to invest small sums and if pooled this could incrementally fill the enormous funding gap left by GSK.

Another potential solution would be a government intervention through a co-operative incentive scheme. This would be where the government offers money to a group of health clinics at once. The goal of OFH would be to recruit and stratify the health clinics, possibly by geographic location like a district, and conform them into an association that the government can support financially. While governments in Africa have limited funds, the successes of the OFH model in strengthening the health system, demonstrates both the need and worth of funding.

This might also be a productive way to gain local support for the health clinics within each community. The combination of social support and accountability make it harder to misuse the money from the government to the association other than individuals.  


In sum, OFH still has time to find funders and hopefully get back on its feet in the wake of GSK’s exit. Government support and a multitude of smaller private investors are two potential solutions to the problem in order to sustain the model of OFH keeping its public private partnership goodwill while maintaining a source of health care workers and supply providing quality health care for the people of Rwanda. 

Picture: Rwandan health workers preparing for a ward round.

Source: www.mhtf.org

9 comments:

  1. This comment has been removed by the author.

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  2. Dear Chelsea and Caesar,
    Thank you for the information extension on the One Family Initiative.

    I am sorry to hear that the founder of the initiative has left and I hope this initiative could be able to sustain. I think the suggestions you provided sounds quite workable.

    I especially agree with the second suggestion, which encourages the incorporation of government's intervention and local support. This reminded me of one post from our classmate Brittney Sullivan about the bad situation when a global support left a African country. This happens as there is no local communities' support and no training was offered to the local people. So it is sad that once the external help was extracted from the country, no one could carry on the projects or the keep providing these help.

    It seems like the climate of global health assistance is well developed now, and we should start to think about what's next. It is necessary to think about the efficiency of these help and how to sustain and foster these external help for the future development. We as projected global health workers should always keep these thoughts in our minds.

    For your reference, here is a link about "Donor dependence and donor withdraw in Malawi, hope it will help!
    http://aiddata.org/blog/donor-dependence-donor-withdrawal-implications-of-malawis-cashgate-scandal

    Shaoqing Ge

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    1. Thank you Shaoqing Ge for the comments and for the posting that piece via Cash Gate. It is an interesting case for Malawi. Yes, we need to start thinking of how to fill the gap out side the donor community as they eventually pull out of funding due to unrelated circumstances but leaving interventions in balance.

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  3. Dear all,

    We had a really interesting opportunity to discuss the One Family Health case. I was wondering what would you think about widening the activities that health workers can perform in each unit. I remember that at some point the case study mentioned that vaccines and contraceptives are 2 key issues that motivate people to seek care.

    Although the government provides these services I was still thinking whether incorporating a -private- alternative would help the model by increasing the offer of services while maybe allowing a collaboration with the government.

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  4. I think Rosa's point about widening the services offered at the OFH units could be very beneficial to OFH but could also have some downsides. While I agree that it would be really great to have private healthcare alternatives, I have to wonder if expanding these services will put the nurses and other staff at already existing health centers out of business.

    On the other hand, I do also think this could be a really good thing, to introduce competition to the current structure, which in turn could also result in better healthcare provided at all healthcare centers, public or private.

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  5. Chelsea and Caesar, thanks for breaking down the case and sharing your ideas. In light of our recent reading on public private partnerships tacking social issues, the various stakeholders make for a complex web of relationships. Some key players include external foundations and funders, local NGOs and health clinics, the ministry of health and government, international organizations like WHO, World Bank, UNICEF, and private multinational corporations. I was wondering if you guys or anyone else have any success stories of organizations that have thrived in this context and have successfully leveraged support from their stakeholders to achieve a win-win for all. And in these situations, would there be a clear leader to keep each partner accountable? How do you see the role the local government would have to play to ensure its national priorities are met and to avoid multinationals pulling out and risk fragmenting this network?

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  6. Thank you Chelsea and Caesar,
    I concur with Rosa. Offering preventative services such as vaccines will be a good front to open as a business strategy. It is a service needed by a large proportion of the population with predictable costs thereby affording the clinics one more source of regular revenue. There are also potential strategic partners with whom to collaborate, such as Global access to vaccines initiative (GAVI)

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  7. Thanks Tito, Big Ben, Rosa and Olivia on including preventive services as another service that OFH can diversify to.

    Great path. Preventive medicine will always be the formidable front in Public health as long as the old adage still goes that "prevention is better cure." I believe this could lead to more leverage when bargaining for funding from government and even International development agencies like Ben mentions potential ones. Currently many vaccines are given free of charge by the government in public facilities with financial support from bodies like the WHO through its Expanded Program on Immunization and the Bill and Melinda Gates Foundation that has pledge billions to enable the world meet its vaccines MDG target.

    In the private sector vaccines are also subsidized. In that line, OFH would be working with government to meet its immunization target building a bigger case to even consider for funding both by government and those development agencies.

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  8. Thanks Tito, Big Ben, Rosa and Alex on including preventive services as another service that OFH can diversify to.

    Great path. Preventive medicine will always be the formidable front in Public health as long as the old adage still goes that "prevention is better cure." I believe this could lead to more leverage when bargaining for funding from government and even International development agencies like Ben mentions potential ones. Currently many vaccines are given free of charge by the government in public facilities with financial support from bodies like the WHO through its Expanded Program on Immunization and the Bill and Melinda Gates Foundation that has pledge billions to enable the world meet its vaccines MDG target.

    In the private sector vaccines are also subsidized. In that line, OFH would be working with government to meet its immunization target building a bigger case to even consider for funding both by government and those development agencies.

    ReplyDelete