The United Nations Millennium Development Goals provide healthcare providers with ambitious objectives ranging from reversing the spread of the HIV virus, to reducing child and maternal mortality rates. Unfortunately, meeting these goals is highly contingent upon an adequate supply of health care professionals. Health Affairs estimates that Africa alone lacks 800,000 healthcare professionals necessary to meet the United Nations Millennium Development goals. This shortage represents an expensive impediment to global development, the reversal of which requires billions of dollars in healthcare infrastructure investment. Not to worry: new and innovative approaches to this issue are a cause for optimism.

One of the main issues contributing to health care professional shortages worldwide is the so-called “brain drain.” Health care professionals that are trained in the developing world are emigrating in increasing numbers to developed nations in search of better jobs. Indeed, as of 2010 there were more Ethiopian doctors in Chicago than there were in all of Ethiopia. The effect of this mass exodus of doctors is doubly damaging, costing developing nations the resources invested in training doctors as well as the utility of a trained doctor. While the issue is both prevalent and well documented, it proves difficult to address. Indeed, in 2010 the World Health Organization (WHO) issued a document covering the global migration of health care professionals. The issue is wrought with the inherent tension between the pernicious effects of migration and the right of individuals to pursue work wherever they choose.

High women and infant mortality rates continue to burden the developing world. Although international organizations have called for an increased focus on maternal health, more than 500,000 women in developing nations die during pregnancy or childbirth annually. In Asia, one out of every 43 women will die of maternal-related causes, compared to one in 2,500 in the United States. The fifth Millennium Development Goal (MDG) aims to reduce the maternal mortality ratio (MMR) by one-third in the next four years; however, India’s efforts—and those of many developing nations—lag woefully behind. According to PLoS Medicine, between 1990 and 2005, global maternal deaths decreased by only 1% per annum instead of the 5% needed to reach MDG 5. Training programs and technology to dramatically reduce these numbers are widely available, though appropriate funding, infrastructure and resources for maternal health have been lacking in countries that need it the most.

India, for example, has seen tremendous economic growth over the last decade, although government spending on healthcare—less than 2% of GDP (China spent 5.8% in 2002)—has not kept pace. With an estimated US$40 billion market that is expected to grow to US$80 billion by 2013, India’s healthcare sector has seen an increase in private sector investments to fill the quality and supply gap. Currently, private investments account for nearly 80% of the healthcare industry, resulting in a new crop of privately funded and -run hospitals and medical facilities that are changing the face of the Indian healthcare industry.

Nick Pearson has a great background for what he’s doing–business school, Path and then the Acumen Fund. He and his partners are pioneering a maternal health franchise system for East Africa, beginning in the slums of Nairobi. The want to create a sustainable and scalable operation to change the way antenatal and maternal health services are provided to women living in urban slum areas. The vision for Jacaranda includes mobile antenatal care outreach to build women’s trust in the health care providers and then well-run, low-cost services structured around strong referral systems (providing family planning, delivery care and PMTCT).

The team will begin with 1 clinic and 1 ANC van by the end of summer 2010 and wants to expand to 20-30 clinics at the end of five years. The first Jacaranda clinic will have 5-6 nurses/midwives and about 4 deliveries a day. Their approach has been to study the market in depth–finding access to low-cost, quality maternity care to be an enormous gap in urban Nairobi. Though plenty of well-trained health workers exist, the services are not organized to be accessible to the poor. The team has a vision of a highly organized set of services, checklists to ensure quality and consistency, strong training regimens, clinical algorithims to help with early identification of complications. Jacaranda is set up as a social enterprise in order to attract capital and make the concept sustainable.

When I spoke with Nick Pearson a few months ago he had not yet become a finalist in the Changemakers contest but was already fundraising to launch Jacaranda Health. As someone just advised me, new business models and structures for providing health care to women are just as important as the emphasis Maternova has on tools and techniques. We’ll continue to follow Jacaranda, LifeSpring and others to see how their paths unfold.

See Jacaranda on Facebook: http://www.facebook.com/posted.php?id=117793488249643&share_id=126195507390628&comments=1#!/pages/Jacaranda-Health/117793488249643?v=app_7146470109

Hyderabad, India ― The Business Call to Action (BCtA) today announced that LifeSpring Hospitals ― a chain of small hospitals providing low-income clients in India with access to maternal and child healthcare services ― has committed to provide an estimated 82,000 Indian women and their families with access to quality healthcare. In the next five years, LifeSpring will increase the number of hospitals serving mothers and children throughout India from 9 to 200, which will improve overall standards of care and reduce rates of maternal and childhood deaths.

LifeSpring Hospitals is the first healthcare chain to join the BCtA ―a global leadership platform for companies that leverage core business expertise to meet the Millennium Development Goals (MDGs) ― a set of eight goals designed to reduce poverty, hunger, disease, and maternal and child deaths by 2015. Specifically, this initiative will contribute to MDG 5 which seeks to reduce the maternal death ratio by three-quarters.

“Meeting the health needs of women and children is especially important as the MDG to improve maternal health has made the least progress so far,” said Natalie Africa, the Programme Manager for the Business Call to Action. “Innovative business models such as LifeSpring Hospitals are helping to make real, sustainable progress by providing women with quality, low-cost healthcare.”

She added that while such measures were not cost free, the evidence suggested that they can have results which go beyond the temporary alleviation of suffering. “Well designed, they can help make societies more crisis-resilient over the longer term, and contribute to more stable and equitable growth.”

Women in India often face devastating risks during pregnancy due to poor health, unsafe home births, and inadequate access to quality healthcare. More than 100,000 pregnancy-related deaths occur each year. Another 100,000 women suffer from infections due to pregnancy. Most of these deaths and complications could be averted by providing a standardized level of care. Unfortunately, in much of India, quality healthcare is associated with high prices and is out of reach for many of the country’s poorer citizens.

“The opportunity to provide women a safe, dignified and affordable birth is at the heart of LifeSpring,” said Mr. M. Ayyappan, Chairman of the Board of LifeSpring Hospitals. “LifeSpring is revolutionizing maternal care by offering affordable and superior services to the increasing population of lower middle class Indians seeking high quality healthcare.”

LifeSpring Hospitals, which accommodate 20-25 beds each, provide lower income mothers with high-quality, healthcare and delivery services at 30-50 percent of market rates. LifeSpring Hospitals also provide paediatric care, including immunizations, as well as diagnostic services, a pharmacy and healthcare education to the communities in which they are located.

About LifeSpring: Created in response to the dearth of opportunities available for low-income women to access both affordable and high quality healthcare, LifeSpring is an expanding chain of small maternity hospitals specializing in core maternal health services. With a dual goal of fulfilling its social mission while achieving financial sustainability, LifeSpring aims to serve as a model for providing high quality health services to the poor in India and worldwide.

The Business Call to Action is a global initiative that seeks to challenge companies to develop inclusive business models that offer the potential for development impact along with commercial success. The initiative is the result of a partnership between the United Nations Development Programme (UNDP), the UN Global Compact, the Government of the United Kingdom, the Government of Australia, the Clinton Global Initiative and the International Business Leaders Forum to meet the Millennium Development Goals by 2015. The BCtA tracks commitments companies make and lessons-learned on what works well for both businesses and poor communities that can be replicated globally.

In this photo, LifeSpring Hospitals CEO, Anant Kumar, stands proudly by a sign listing LifeSpring’s twelve Hyderabad hospital locations. LifeSpring opened up its first flagship hospital in Hyderabad in 2005, and has since operationalized 8 hospitals in the city. By the end of June, LifeSpring will have opened four more new units. This year, because of the efforts of Anant and the LifeSpring team, the hospital chain brought approximately 4,000 new lives into the world, serving a market of families that on average earn between $2-$5 per day.

This photo was taken last week at LifeSpring’s second new hospital opening of the month. The hospital will provide a safe, clean and affordable place for expecting mothers to give birth in Amberpet, Hyderabad, India.

Manasa Tanuku is a Portfolio Associate in Acumen Fund’s India office.

The Photo of the Week series features images chosen by Acumen Fund staff, Fellows, and community members — favorite photos they’ve taken in the field or pulled from the archive. Look for it in the middle of every week.

For $130, you can provide a full delivery package of antenatal, delivery, and post-natal care to help guarantee the health of a woman and her newborn in India.

LifeSpring Hospitals has developed a business model that aims to provide affordable birth care to low-income women. Normally, I don’t promote a specific organization or product on the Hub, but I spent a a few months in 2008 working at LifeSpring and believe this would be a worthy cause to donate.

There is an ideological divide between those who believe institutional deliveries are the answer to reducing maternal and infant mortality and those who believe training more community midwives to deliver services in the home is the answer. While I’m far from an expert on the topics, I’m sure both sides have their valid points.

I believe that women should be able to choose their preferred method, but right now hospital births are far too expensive for many women. LifeSpring aims to make giving birth in a hospital an affordable option. For more about LifeSpring see this previous post on the Hub.

Now, the LifeSpring Foundation has partnered with Global Giving to raise money and sponsor antenatal care and delivery for women who cannot afford even LifeSpring’s low delivery fee of about $80. (Learn more here.)

LifeSpring has reached about 40% of its goal of raising $65,000 through Global Giving and sponsoring the safe deliveries of 500 women.

My friend, Tricia Morente, the head of strategy and marketing for LifeSpring, sent me this story about Geeta, the 20-year-old woman in the picture who was the first woman to be sponsored.

“On January 22, 2011, Geeta delivered a healthy baby girl for free at LifeSpring Hospital Bowenpally. This is Geeta’s first child and LifeSpring Foundation’s first sponsored childbirth. Geeta is 20 years old and has been married to Mallesh for three years. Mallesh irons clothes for a living and earns between INR 1500 and 2000 each month ($38-$42). They live in a jhopdi – a temporary structure made of tarp and thatch and often find it hard to make ends meet.

Ameena, LifeSpring’s outreach worker at Bowenpally met Geeta when she was nine months pregnant and had not yet visited a doctor. Ameena helped Geeta through the complete sponsored childbirth process at LifeSpring including prenatal visits and tests, hospital delivery and infant vaccinations. Geeta was delighted to have had the support of trained health workers and grateful for the free service.

Geeta is looking forward to watching her baby girl, Mallika, grow up to be a strong and confident woman like Ameena. Geeta hopes to send her to school, so she may receive an education, unlike herself or her husband.

To find women who are in need of birth sponsorship, LifeSpring Foundation leverages community outreach workers, who go out into urban slums and peri-urban communities and meet pregnant women too poor to afford prenatal care and delivery. The main criteria for a woman to receive a sponsorship from LifeSpring Foundation is a government-sponsored white ration card, signifying her family lives below the poverty line.

To date, 26 women have had their deliveries sponsored through LifeSpring Foundation. An additional 20 women are currently receiving sponsored prenatal care at LifeSpring, with their deliveries set for the coming months.”

While I’m perusing the magazines at an O’Hare bookstore, waiting for my final flight back to Cleveland, I come across this week’s issue of The Economist. Ironically, the cover is about India. I open the magazine to the article focusing on how private companies & small businesses are the drivers behind India’s economic growth. The article reflects on the problems facing India’s economy, but also remarks on private industry’s ability to create  “novel ways to make management more responsive to customers”. This statement is apropos for our last clinical visit at a LifeSpring hospital.

LifeSpring hospitals (LSH) are a group of private hospitals utilizing effective business practices to

provide quality women’s health care to low-income populations. Much like HMRI, I find learning about LSH exciting, as “it is serving the poor through business”. LSH is also one of the best examples of minimizing cost while maximizing quality and access in health care delivery (indeed, multiple case studies have been written on the LifeSpring model, including one by Columbia Business School; check out the web site http://www.lifespring.in/). It achieves this maximization through its mission and focus, which creates a unique health care company culture in India and requires meticulous planning. The major areas of focus, in order of importance at LSH, are quality, price, and growth.

In addition to the quoted line in the previous paragraph, “never compromise quality” is one of the comments made to us by Priya, a young, vibrant, & knowledgeable assistant manager at LSH, as well as our hostess for the visit. She gives us a tour of one of the hospitals where the corporate office is also located. Quality, as well as transparency and terminology, are what

define the company culture at LSH.  We see this at the beginning of our tour, where Priya shows us the equivalent of a patients’ bill of rights. On one long corridor, posters line the walls explaining the quality, services, and prices customers can expect. Nowhere else have we seen such transparency. Nor have we heard of patients referred to as customers. Priya explains, “pregnancy is a condition, not a disease.” Not surprisingly, providers have the most difficultly in using this word. However, according to Priya, staff and patients don’t notice the difference in terminology. Instead, customers appreciate the difference in care and quality. With the patient as a customer, the staff has a customer-first mentality that puts the needs of patients first, a concept that is not as evident at other institutions. Furthermore, as customers pay for services, this model avoids the potential for moral hazard that can be associated with free services.

Like HMRI, LifeSpring also monitors its quality. The head of clinical quality, Dr. Rama, spoke with us about the international guidelines (NICE > ACOG) and quality measures

(IHI) that LSH uses to establish its best practices. In addition to surveying customers via the call center, its top quality indicators include infant and maternal morbidity/mortality (in absolute numbers, India has the highest maternal mortality rate), postpartum infection, overstay, and primary cesarean section. It’s important to keep in mind that LSH specializes in vaginal deliveries and cesarean sections; it refers IVF, high risk, VBAC, & HIV cases and currently does not provide gynecological or preventive health care (ie yearly well woman’s exam).

The second major focus of LSH is affordable pricing. The target market is women who earn US$3-5 daily. LSH defines affordability as one month’s income. I found it interesting that although government hospitals are “free”, patients are expected to pay tips to staff (housekeeping, nursing, clerks, etc). The costs of these tips can reach INR 3000 and quality, sometimes even a bed, is not guaranteed. At LSH, the cost of delivery is INR 4000. Priya notes that pregnancy is an assumed family cost in

Indian culture given the emphasis on childbearing. As such, customers typically prepare for this cost. Because of its cultural and general importance, Priya says, “women want a quality delivery”. At LSH, customers have a three-tier choice for delivery: first tier is the general ward (lowest cost, 80% of customers choose this tier); second tier is a semi-private room (double occupancy), third tier is a private room (most expensive). Each hospital has at least 20 beds, with 30 beds available at the original facilities. Operations are based on a high throughput model. Length stay is typically 3 days for a vaginal delivery and 5 days for a cesarean. Like other facilities, fees are collected before services are rendered, but an option exists (on a case by case basis) for payment afterwards. A fund is also available for women who deliver, but are unable to pay. As of yet, no woman has been turned away. Maintaining such quality while charging low prices keeps the margins low. Priya notes that management must be innovative to keep the company sustainable. With 50% market share, the organizational mission to help those in need, and quality and sustainability as top goals, it’s easy to understand why innovation is crucial.

To keep up with demand, LSH plans on developing 6 more hospitals this year. Priya refers to this growth as bulk expansion. LSH performs market analysis through its community outreach program prior to selecting new hospital sites. Each hospital serves no more than a 5 km radius in a densely populated area. Extending the parameter would increase opportunity costs to its customers (ie increased travel costs) and would not support its mission.

On the growth-share matrix, LSH is a star given its high growth rate and high market share. It’s not surprising that margins are low, as by definition, a star’s income is used to support its growth and meet its mission. LSH not only identified a new market, it created one and is set up to eventually become a cash cow. When the organization reaches this stage where growth slows and market share (hopefully) remains the same, its margins will likely increase. At that time, perhaps the company can expand to other women’s health areas, such as gynecological exams or preventive health. For now, they are filling a tremendous need by keeping a sharp focus on deliveries.

Many undergraduate students in the US choose medicine with the desire to help people. While I was making this decision, I had physicians tell me not to pursue medicine as it is now a business. They’re right. Even if heavily regulated by a government, the delivery of medicine is a business. NGOs, governments, private institutions all have to manage their assets, debts, and expenditures in order to remain sustainable and reach their mission (which is hopefully to help people). But this necessity shouldn’t keep one from pursuing the practice of medicine; instead, one should at least be aware of how business influences the practice of medicine before making the dedication inherent to medical training. I believe it is important to realize that personal and organizational success in helping people is largely due to the environment and systems in which we work, in addition to one’s personal work ethic and determination. The efficiency, innovation, mission & culture of HMRI and LSH in delivering health care to the poor and underserved are what make them so exciting to me. These are also reasons why they perfectly fit the description provided by The Economist. Seeing the success of these private institutions “using business to help the poor” obtain quality health care is invigorating to me. As a result, I’ll take what I’ve seen and learned during this trip and adapt it to the environments where I practice … which I believe is the purpose of such international medical electives.

Overall, this has been an incredible, well-rounded, educational, fun experience that allowed us to

intensely evaluate health care delivery in India and experience Indian culture. As Gomes pointed out during our final day, we were in India during the Festival of Ganesha, the Ayodhya verdict, the national holiday celebrating Gandhi’s birthday, and the beginning of the Commonwealth Games. These events, in addition to our clinical experiences, provided a wide range of experiences, emotions, and discussions. What truly defined this experience are the people who were part of it. I value most my friends and the people that we met, including Shobha, Neena Auntie, Kumar, and all the amazing providers, leaders, patients and children. I’ll miss being able to walk out of a room and having someone to talk with who had the same experience that day, but presents a different perspective. I’ll miss our family-style dinners and their associated discussions and shenanigans (don’t make Gomes laugh while she’s eating). I’ll miss learning daily about the small things that make my friends great. I’m so happy to have been part of this experience and to be able to share it with people at home through this blog and other social networks. I recommend similar traveling to anyone who is willing to get out of his or her comfort zone and keep an open mind, especially if they’re able to travel with friends.

LifeSpring Hospitals to provide 82,000 women with affordable healthcare through Business Call to Action initiative

Hyderabad, India ― The Business Call to Action (BCtA) today announced that LifeSpring Hospitals ― a chain of small hospitals providing low-income clients in India with access to maternal and child healthcare services ― has committed to provide an estimated 82,000 Indian women and their families with access to quality healthcare. In the next five years, LifeSpring will increase the number of hospitals serving mothers and children throughout India from 9 to 200, which will improve overall standards of care and reduce rates of maternal and childhood deaths.

LifeSpring Hospitals is the first healthcare chain to join the BCtA ―a global leadership platform for companies that leverage core business expertise to meet the Millennium Development Goals (MDGs) ― a set of eight goals designed to reduce poverty, hunger, disease, and maternal and child deaths by 2015. Specifically, this initiative will contribute to MDG 5 which seeks to reduce the maternal death ratio by three-quarters.

“Meeting the health needs of women and children is especially important as the MDG to improve maternal health has made the least progress so far,” said Natalie Africa, the Programme Manager for the Business Call to Action. “Innovative business models such as LifeSpring Hospitals are helping to make real, sustainable progress by providing women with quality, low-cost healthcare.”

She added that while such measures were not cost free, the evidence suggested that they can have results which go beyond the temporary alleviation of suffering. “Well designed, they can help make societies more crisis-resilient over the longer term, and contribute to more stable and equitable growth.”

Women in India often face devastating risks during pregnancy due to poor health, unsafe home births, and inadequate access to quality healthcare. More than 100,000 pregnancy-related deaths occur each year. Another 100,000 women suffer from infections due to pregnancy. Most of these deaths and complications could be averted by providing a standardized level of care. Unfortunately, in much of India, quality healthcare is associated with high prices and is out of reach for many of the country’s poorer citizens.

“The opportunity to provide women a safe, dignified and affordable birth is at the heart of LifeSpring,” said Mr. M. Ayyappan, Chairman of the Board of LifeSpring Hospitals. “LifeSpring is revolutionizing maternal care by offering affordable and superior services to the increasing population of lower middle class Indians seeking high quality healthcare.”

LifeSpring Hospitals, which accommodate 20-25 beds each, provide lower income mothers with high-quality, healthcare and delivery services at 30-50 percent of market rates. LifeSpring Hospitals also provide paediatric care, including immunizations, as well as diagnostic services, a pharmacy and healthcare education to the communities in which they are located.

About LifeSpring: Created in response to the dearth of opportunities available for low-income women to access both affordable and high quality healthcare, LifeSpring is an expanding chain of small maternity hospitals specializing in core maternal health services. With a dual goal of fulfilling its social mission while achieving financial sustainability, LifeSpring aims to serve as a model for providing high quality health services to the poor in India and worldwide.

The Business Call to Action is a global initiative that seeks to challenge companies to develop inclusive business models that offer the potential for development impact along with commercial success. The initiative is the result of a partnership between the United Nations Development Programme (UNDP), the UN Global Compact, the Government of the United Kingdom, the Government of Australia, the Clinton Global Initiative and the International Business Leaders Forum to meet the Millennium Development Goals by 2015. The BCtA tracks commitments companies make and lessons-learned on what works well for both businesses and poor communities that can be replicated globally.

To see release, go to: http://bcta-initiative.org/2010/04/07/indian-hospital-chain-commits-to-fight-maternal-mortality-with-bcta-initiative/

LifeSpring is a network of Maternity and Child Healthcare hospitals that provide vital reproductive and pediatric healthcare to low and lower-middle income people in urban and peri-urban areas, with a focus on delivering high quality, low-cost services to women and children in slum areas. This is a joint venture between Acumen Fund and Hindustan Latex Limited, a public sector company in India. Its model rests on building a chain of 30 small hospitals (20-25 beds) across India. The rates charged by LifeSpring Hospitals for general ward patients are less than one-third the market rate for normal deliveries and half the rate for caesarian deliveries. Each hospital has the capacity to serve nearly 10,000 low-income patients every year. LifeSpring also expects to provide outpatient services to more than a million people over five years. By improving patient outreach and the quality of care available, LifeSpring’s goal is to significantly increase hospital-supervised deliveries and to reduce maternal and child mortality and morbidity rates in the communities that it serves.

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