The second quarterly issue of the RH Vouchers project newsletter is now available for download [PDF]. In this issue

• we profile the Kenya OBA program and share updates on the evaluation’s population and health facility baselines
• we highlight Anrudh Jain’s recent commentary on two key indicators to monitor in RH programs that incentivize facility based delivery, and
• we summarize several new publications with management lessons for healthcare finance projects.

DOWNLOAD PDF HERE

The USAID Strengthening Health Outcomes through Private Sector (SHOPS) and mHealth Alliance is currently showcasing a Pre-Conference Hall of their inaugural annual e-Conference that seeks to advance private sector innovations in the sustainable provision and use of quality family planning/ reproductive health products and services.

Registration is still open for the May 5 event. Highlights will include panel presentations from Grameen Foundation, Pesinet, Catholic Relief Services, Millennium Villages Project, and other mHealth implementers throughout Africa and Asia. Be sure to check out the chat sessions and the resource center.

Register to learn more about how you can collect and share more timely and accurate field health information, reach your target beneficiaries with personalized text messages and help health workers improve treatment quality at the point of care. Participation requires only internet connectivity.

More information about the eConference

You can also visit the Global Health Ideas blog for a text version of the original announcement

AidWatch awarded the “Best in Aid” prize to the Smart Giving movement for its efforts to promote effective and accountable giving.

There will be those who insist on giving shoes (including such high profile experts as Jessica Simpson and Kim Kardashian). Still others offer used yoga mats, or baby formula. Ports and roads clogged up with shoes and yoga mats cannot deliver essential medicines, food and supplies…

But now there is a small but growing chorus of voices dedicated to equipping individual donors with information on how to help effectively in a crisis. This movement has the power to harness the generosity of individuals, change ingrained giving practices, and create positive pressure on NGOs and aid agencies to demonstrate the impact of their work.

That’s why the award for Best in Aid goes to…the Smart Giving movement, nominated by Saundra Schimmelpfennig of the blog Good Intentions are Not Enough.

USAID and several USG departments are taking the global pulse through a 3 day series of e-conversations on issues related to global development. Topics range from citizenship in the 21st century to empowering women to promoting global health and investing in science and technology and others listed here.

– Inspiring a New Generation Developing Global Citizens of the 21st Century
– Empowering Women and Girls Making equality a reality
– Enabling the Essential Education What everyone should learn to succeed in the 21st century
– Building Stronger Partnerships Explore new ways to promote partnerships between societies, citizens, community organizations, and businesses as a means of creating sustainable solutions to shared development priorities
– Exercising Political and Civil Rights Understanding rights, increasing citizens participation and expanding accountability
– Promoting Global Health Connecting and empowering individuals and communities to take charge over their own health and well-being
– Advancing Entrepreneurship, Trade & Economic Opportunity Find new ways to advance entrepreneurship, job creation, and economic opportunity
– Fostering Science, Technology & Innovation Discover new ways to support societies and build capacity by leveraging science and technology
– Supporting a Sustainable Planet Exchange lessons learned on how to address global climate change
– Pursuing Grand Challenges Identifying the “grand challenges” of the next decade

Check it out and register at GlobalPulse2010.gov

Creative finance may have got a bad rap in 2008 but the finalists in the Marketplace on Innovative Financial Solutions offer compelling, and certainly creative, models to improve access to capital for low-income populations. Take some time to read the proposals and pick your favorite.

Paul Collier in Foreign Policy (“How to Fix Haiti’s Fixers“) had a rather short piece arguing for a greater stewardship role of the Haitian government and increased transparency of NGOs’ service delivery outputs.

Although it’s true that the Haitian state cannot run mass service provision, the government could realistically allocate the funding for it. So, instead of donating to NGOs, donor money would all be streamed into a common pool. A new government agency would be charged with overseeing the common pool, setting clear criteria for NGO performance, monitoring the NGOs, and giving out money from that pool based on the set standards and community needs.

Lest we think it a simple matter of empowering state stewardship, the Lancet’s Jan 30th report (“Financing of health systems to achieve the health Millennium Development Goals in low-income countries“) from the High Level Taskforce on Innovative International Financing for Health Systems adds a strong dose of political reality on the challenges to reforming healthcare finance. Many of these points can be generalized to other public services.

This report summarises the key challenges faced by the Taskforce and its Working Groups. Working Group 1 examined the constraints to scaling up and costs. Challenges included: difficulty in generalisation because of scarce and context-specific health-systems knowledge; no consensus for optimum service-delivery approaches, leading to wide cost differences; no consensus for health benefits; difficulty in quantification of likely efficiency gains; and challenges in quantification of the financing gap owing to uncertainties about financial commitments for health. Working Group 2 reviewed the different innovative mechanisms for raising and channelling funds. Challenges included: variable definitions of innovative finance; small evidence base for many innovative finance mechanisms; insufficient experience in harmonisation of global health initiatives; and inadequate experience in use of international investments to improve maternal, newborn, and child health. The various mechanisms reviewed and finally recommended all had different characteristics, some focusing on specific problems and some on raising resources generally. Contentious issues included the potential role of the private sector, the rights-based approach to health, and the move to results-based aid.

In this post, we summarize promising work at Results for Development Institute and suggest keeping an eye on R4D for deployment of new information delivery mechanisms in the coming months.

The Rockefeller Foundation and the Bill and Melinda Gates Foundation through the Results for Development Institute are supporting a global knowledge access initiative – the Center for Health Market Innovations (CHMI) - that seeks to collect, analyze and disseminate information about health market innovations in developing countries to facilitate the creation of strategic linkages among entrepreneurs, funders, policy makers and researchers.

Motivated by the lack of adequate information about the scale, scope and effectiveness of the innovative health financing and delivery models, the initiative targets mainly the complex and largely unregulated health markets in low and middle income countries. A number of studies have found that many patients in various countries – including populous nations such as China, India, Pakistan, Bangladesh and Nigeria – rely on formal and informal private providers for key services such as treatment of malaria, diarrhea and acute respiratory infections with more than half of the total health expenditures largely being private, out-of-pocket transactions.

CHMI’s goal is to accelerate the diffusion of market-oriented health financing and delivery models that effectively facilitate the delivery of priority health interventions, improve quality of care and/or financial protection for the poor with a primary focus on programs in large and vibrant private health sectors. Of particular interest are innovative programs in service delivery, financing, regulation or accreditation, use of technology, supply chain and strengthening immunization programs.

See blog source from: Role of the Private Sector in Health Systems

Additional resources including interesting reports and conference news releases are under “Products“

Reposted from the African Network for Health Research and Development (AFRO-NETS)

The Maternal Health Task Force at EngenderHealth and Ashoka’s Changemakers are offering a new opportunity to the global Changemakers community and inviting entries for solution for Maternal Health.

The ultimate goal for this partnership is to harness innovation around Maternal Health issues in a bid to foster the next generation of leaders in this field  as well as to foster a strong community.

The Maternal Health Task Force is using the Changemakers’ online platform to identify new innovations and creative projects that are working to make the 5th Millennium Development Goal (MDG 5) a reality.

The existing opportunities for those  working in the Maternal Health sector include:

1.      Three (3) final prizes for Maternal Health Projects valued at US $5000 each for the attendance of the 2010 Maternal Health Change Summit in India to include flight, accommodation, transportation and meals.

2.      Sixteen (16) Young Champions of Maternal Health Mentorship (professionals ages 18 – 35 years) for the attendance of the 2010 Maternal Health Change Summit and a nine-month mentorship program with an Ashoka Fellow valued at US $40000 each. This scholarship will also cover flight, accommodation, transportation, meals in addition to the visa fee and stipend for the nine months.

3.      Early Entry Prize for Best Innovation (Deadline expired on January 27th, 2010)  for Young Professionals ages 18 – 35 years and non-Young Professionals – valued at US $1000, offering a homepage feature on Changemakers.com, a choice between MS Office Suite or Adobe Creative Suite, an  iPod and a digital camera.

The Change Summit will allow the winners to share their idea and projects with leaders and investors in the Maternal Health field.

More about the 2010 Maternal Health Change Summit

See original post

Idea to use vouchers to increase access to contraception and prevent youth pregnancies with Pass’contraception initiative in high schools

The issue of high teenage pregnancies throughout France (about six thousand young girls each year with 455 girls in 2007 in one region of France alone) remains critical and the regional government decided it can no longer be ignored. Moreover, nearly one in ten women having an abortion is young. Field workers, health professionals and professional associations acknowledge the continuing difficulties in gaining access to free contraceptive services that are both confidential and close by.

After extensive consultations with teacher trade unions, parents and school leaders associations, several regions of France now want to develop a voucher initiative to promote access to contraception in high schools. In addition to interventions already adopted by the family planning centers and the education departments, the Pass’contraception seems to be the practical tool to ensure confidential free contraceptive services to young and adolescent girls in poor regions.

This action, taken in conjunction with the Health Professionals College Councils proposes to make the “Pass’contraception” voucher available to school nurses and social workers to hand out to adolescent women in high school in need of free reproductive health services and contraceptives.

Read more from “Le Portal Jeunes Poitou Charentes”

Reposted from Melissa Ho’s ICTDChick blog, which among other tidbits, documents the birth pangs of a PhD dissertation in western Uganda.

Dembbe Clinic WECARE Solar and Netbook Deployment

While my study hasn’t quite officially started yet (most of my equipment is en route via Cairo right now) I’ve started deploying some computers and mobile phones in a few health facilities, just to give them some time to familiarize themselves with the equipment, and to give myself and idea of what I’m going to run into with the other clinics when they get the equipment too.

Here’s how my research works: There’s a lot of complicated stuff about claims and claim processing. However, what I actually do is a lot of qualitative research on how people do their work, perceive information technology, and manage information. Then I introduce new technologies, and then ask them what they think of them, and see what they do with them. Sometimes I’ve done weird things with these technologies (like umm.. written them or installed specific software), and I definitely have a specific approach – I interfere with my subjects a lot in terms of computer training, and in the case of my partnering agency, being an IT consultant in this office for 15 months.

My baseline studies and are showing that my target user base 1) has a high interest in using information technology for patient information management but 2) very little training (for the most part). So if I were to introduce a new system, let’s say a laptop/netbook, 1) they would be very interested in learning how to use it, even paying for it but 2) they would have little to no background knowledge on where to start.

This has deep implications for user interface design. For many people, they choose a “kiosk” approach, making computers that have only one application (also known as the “appliance”). However, this has implications on sustainability. For private health facility owners who need additional skills, or for programs that cannot be expected to finance the equipment externally – paying for purpose-built machinery when the computers are capable of general purpose applications is impractical.

In this case – Claim Mobile is probably not a sufficiently valuable application to motivate purchase of laptops or phones. However – the phones, bundled with a camera, medical calculators, bible readers, internet browsing capabilities, etc, and the netbooks, with Microsoft Office, and Hesperian ebooks, and other medical resources, Barack Obama’s speeches, and the ability to access the Internet are of great value to the health facilities, and to the program management of the Uganda OBA project, even without the claims processing component.  However – we hope to find out in this study how this value will actually play out against real purchasing decisions: laptops vs phones, Internet subscriptions vs pay per kb Internet use.  In addition, we will observe over time how the health facilities and the Uganda OBA project will make use of their ownership of these devices, and how the new uses play into relationships, communications, and the management of the OBA program in general.

Some caveats about the deployments so far.  Out of the first three deployments, two facilities did not have power.  In one location, we donated a solar suitcase to Dembbe Clinic through WE CARE, an organization I’m involved with that seeks to provide improved electricity and communications for maternal health care.  The two 20W panels provide sufficient power to charge the netbook, phone and lights for the facility.

In the second location, we are experimenting with the Barefoot Power Powapak, which provides solar led lighting sufficient for rooms (not quite surgery), and a cigarette adapter to charge phones. However I went back on Monday to check on the solar deployment, and discovered that the battery was completely discharged – probably because the solar panel was failing to charge the battery.  I’ll introduce some solar logs to have them track usage more closely in January. The phone is being charged every few days from the clinician’s other place of work, which has access to electricity.

• Daily WE CARE Solar Logsheet
• Daily Usage Log

The third location, Kathe Medical Care, has very reliable access to electricity, because they are on the power line connecting to Rwanda. However, what interests me about this particular clinic is their innovative uses of ICTs prior to the study.

During my baseline surveys, I was introduced to Kathe Medical Care’s many colorful computer generated graphs and charts, all produced from the government-mandated monthly summary data.

There were charts showing trends of increasing numbers of antenatal visits over the past year, since the beginning of the OBA program, charts, comparing non-OBA deliveries to OBA deliveries, and charts showing from which  sub-counties patients were coming.

I learned that the clinician did all of these from an Internet cafe, taking his monthly reports to Mbarara each month, entering them into Excel, to produce the charts.

Based on these charts, I assessed this clinic, and had high hopes that I would be able to learn from him how other clinics could use their data to benefit from computers.

I also assumed that he had a usb flash drive.

But to my surprise – one of his statements upon entrance into this study was that he had been giving people these charts for a while and hoped that at some point  someone would think to give him a flash drive. You see it turned out that each time he produced one of these charts, he was entering in another year’s worth of data, all over again – he had nothing on which to save the Excel spreadsheet that he was using to create this chart. I think none of us ever imagined he could achieve so much without a flash drive in the first place!

This sort of begs a question: clearly he has enough income to purchase a flash drive, if he’s willing to purchase a netbook, and even a printer… What stopped him? (This is another blog entry entirely, maybe a paper or two).  There’s a lot to be said at this moment about 1) trust in electronics purchased in Uganda and 2) the perturbation that I am as a ethnographic researcher in this environment.  But I won’t say it now.

In the meantime… given what he was doing without a flash drive, and with the nearest Internet cafe an hour away at $1.50/hour,  let’s just imagine what he’ll do with his own netbook and Internet access.  Or perhaps not imagine… we can wait and see.