Banking on Health Strategies for Building RHFP Champions: The Role of Private Midwives

1
Banking on Health Strategies for Building
RH/FP Champions The Role of Private Midwives

• Meaghan Smith
• October 27, 2006

2
Outline

• Overview of Banking on Health (BoH)
• Philippines Midwives Case Study

3
Banking on Health Project

• Five year, USAID funded global project under the
  PSP IQC.
• Awarded September 30, 2004.
• Team Abt Associates in consortium with Banyan
  Global, IntraHealth, ACDI/VOCA, and Bitran and
  Associates.
• Objective Improve the ability of private health
  care businesses to access credit, thereby
  improving their capacity to deliver high quality
  RH/FP services in a financially sustainable
  manner.

4
The Issue

• Access to finance has been identified by private
  providers and public health practitioners as a
  major barrier to the growth of the private
  sector.
• Banks dont lend to the health sector.
• Risk, public good, collateral, poor quality
  applications.
• Many private providers do not have the skills to
  prepare a bankable business plan.

5
Four Outcomes

• Banking on Health will address these
• barriers
• Improve financial viability of private health
  service providers.
• Expand the range of services offered by private
  providers to include RH/FP.
• Extend private services to underserved, hard to
  reach communities.
• Increase quality of care through improvements in
  facility, capacity or commodity supply.

6
Our ApproachExpanding RH/FP in the Private
Sector is a Dynamic Process

• Provide technical assistance to local financial
  institutions to promote health sector lending.
• Provide technical assistance to private providers.

7
Philippines Midwives Case Study
8
Philippines Background

• Private sector provision of reproductive health
  and family planning products and services (RH/FP)
  can mitigate womens vulnerability to
• changes in the political environment, and
• government budgetary constraints.
• Many women prefer midwives for their reproductive
  health needs.
• Midwives play important roles, providing primary
  and emergent services in addition to reproductive
  health and maternal and child health care
  (RH/MCH).
• Estimated 40,000 certified midwives nationwide,
  at least 40 with some private activity
• Establishment of accredited clinic now a viable
  goal with new Birthing Home requirements of
  Department of Health.
• USAID was interested in new strategies to expand
  and improve sustainable private midwife
  practices.

9
Survey of Private Practice Midwives

• In 2005, BoH initiated the design of a project to
  expand and improve private midwife practices in a
  sustainable manner.
• BoH surveyed over 500 private practice midwives
  from 15 of 17 regions in the country.
• 41 work exclusively in private practice. Others
  work in both public private sectors.
• 50 own clinic
• Deliver between 2 and 10 babies/month
• 84 offer family planning products

10
Private Practice Midwives Service Offerings
11
Midwife Financial Information

• 89 want to grow their businesses
• Average business income US 3,360 - 4,800 per
  annum. Average household income US 4,800 -
  6,240 per annum.
• Compare to Philippines national average family
  income (2003) of US 2,975
• Average profit per annum is 1,547.
• Midwives working exclusively in private practice
  earn more than twice as much as midwives in both
  public/private practice or just in public sector.
• Midwives cite a number of obstacles to the growth
  of their businesses lack of funding (65),
  business skills (38), clinical skills (22),
  difficulty finding suppliers (11), not enough
  demand (4).

12
Midwife Financing Needs

• 65 say funding is biggest obstacle to growth
• Only 17 had received a loan
• 73 wanted to borrow now
• Loans mainly wanted for
• - equipment, clinic renovation
• - 80 wanted to purchase contraceptives for
  resale using financing
• 53 have collateral available
• Most didnt know where to go for a loan
• Less than half produce financial statements

13
BoH Assessment of Financial Institutions

• Assessment of financial institutions offering
  suitable loans
• 46 respondents representing cooperatives,
  microfinance institutions (MFIs), rural banks,
  financial institutions, lending corporations and
  fund wholesalers.
• Only 9 have lent to midwives
• Cite lack of applications and lack of market
  information
• 78 were interested in lending to midwives

14
BoH Activities in the Philippines

• To assist midwives throughout the Philippines to
  expand and improve the delivery of sustainable
  reproductive and other health services by
  accessing appropriate, timely financing and
  technical assistance.
• Organizational strengthening of national midwife
  association
• Provide market information/links to financial
  institutions, suppliers, business development
  services
• Tools and training for midwives
• Work with financial institutions to promote
  health sector lending

15
Strengthen Midwives Association

• Organizational strengthening of national midwife
  association
• Conducted organizational assessment, examining
  possibility of developing midwife credit coops.
• Recommended developing capacity to support
  private practice members.

16
Support Business Fairs

• Private Midwife Business Fairs
• Provide market information and access to business
  information, including links to financial
  institutions, suppliers, pharmaceutical
  companies, business development services,
  Ministry of Health and Philhealth (health
  financing).
• Host four fairs
• Metro Manila 900 midwives tried to attend,
  capacity for 600.
• Davao 250 midwives
• Cebu150
• Iloilo next week

17
Tools and Training for Midwives

• Tools for Midwives
• Directory of financial institutions
• Enterprise growth monitoring tool
• Dissemination of Requirements for Private
  Practice Midwives and Clinic Accreditation
• Basic and Advanced Business Trainings
• Trained 72 midwives in Financing the Private
  Midwife Practice
• Working with USAID PRISM Project to roll out
  basic and advanced business training.

18
Work with Financial Institutions

• Trained 69 bankers from 8 financial institutions
  in lending to private midwives.
• Provided networking opportunities at business
  fairs.
• Provided TA to OMB, microfinance bank with DCA
  guarantee for loans to midwives.

19
Preliminary Results

• At least 17 loans received by private practice
  midwives to expand their abilities to provide
  quality maternal and child health care and
  reproductive health and family planning products
  and services. At least 2 midwives opened clinics.
• The development of an initiative to provide
  finance to private midwives by a Philippines
  government development bank.
• The jump-start of a long unused USAID guarantee
  for loans to midwives through a local bank.

20
We are all in business, most of us have private
clinics, but up until now we didnt know we
needed to keep such records and information. Just
like we keep patient records to know how they are
doing and to know whether there is risk of
complications and to be able to communicate with
others the status of our patient. We need to keep
these records for the same purposes for our
business. Jean, Private Midwife Clinic Owner
and Operator Participant, Financing the Midwife
Clinic, Manila, Philippines - August 2005