Fonkoze Health Services Fund | July - Dec. 2012 | Issue 2 THE CASE FOR IMPACT INVESTING BRIEF PARTNER DESCRIPTION: Fonkoze is a microfinance institution in Haiti, which provides Haiti’s poor with the financial and educational services they need to make their way out of poverty. It currently serves more than 50,000 women microentrepreneurs with loans via a group lending methodology, the initial target population of the health services package. This package could expand in the future to also reach Fonkoze’s more than 250,000 savers. INNOVATION: The health services package will leverage Fonkoze’s existing 46 branch A Fonkoze nurse explains test results to a offices which include 1,800 village banks across the most rural and isolated client. Photo c/o Darcy Kiefel/Boulder. communities to deliver monthly preventive education and screening, focused on prevalent conditions particularly anemia, malnutrition, hypertension, and diabetes, and access to primary care consults with existing providers for clients and their families. Fonkoze’s health program is unprecedented in terms of its ambitions for scale and sustainability. Client leaders at each village bank will be strengthened and supported to provide all clients with education at a low marginal cost, while reinforcing Fonkoze’s literacy initiative by providing all clients with printed take away messages. Clients value the pre-paid nature of the package, which enables them to utilize services when they need them without worrying about high out-of-pocket expenses. Furthermore, Fonkoze will augment the reach of existing Ministry of Health programs such as family planning products distribution and child malnutrition screening, by leveraging its rural network. INVESTMENT: Global Partnerships began delivering technical assistance to Fonkoze in the summer of 2011. To date, Global Partnerships has disbursed $116,283 in grant support to underwrite the pilot program. (continued on reverse)
REACH / SCALE
SUSTAINABILITY
A snapshot view of progress
July - Dec. 2012
Education
Basic Screening
Target at scale=60,000 Current=1,275 (2.1%)
Child Malnutrition Screening
Target at scale=90,000 Current=1,464 (1.6%)
Optional Consults
Target at scale=30,000 Current=22 (0.07%)
100
Percent Sustainability
Target at scale= 60,000 Current=1,274 (2.1%)
80
Dashed line indicates 0%
60 40 20 0
Education
Basic Screening
Child Consults Malnutrition
SUSTAINABILITY Revenue generated covers total costs over reporting period
Overall
The pilot program expenses include: start-up costs of hiring staff, conducting market research, developing a comprehensive health education curriculum, and purchasing screening equipment and supplies in two branch offices. Future investment depends on the development of expansion plans beyond the two branch locations of education and screening, including a mechanism to ensure compliance with fee payments, and on the feasibility of the optional medical consults package which will be assessed in mid 2013.
RESULTS • Two nurses have been hired, trained, and are currently working in the two pilot sites to support health education and provide screenings for anemia, high blood pressure, malnutrition and diabetes. • A comprehensive health education curriculum and methodology has been developed in Creole and is being implemented in the pilot sites by client leaders. • A consults package was negotiated at one pilot site, and launched in December 2012.
INSIGHTS • Volunteer client leadership (in this case, for education) is effective and necessary to achieve reach with reasonable cost, due to the scale and dispersed nature of Fonkoze’s client base. • Health care providers are not aware of their costs, making negotiation of the consults package challenging. • Some components of the health package scale faster than others, for example, in Haiti education and screening will probably scale faster than the consults package.
HEALTH CARE SERVICES EDUCATION
BASIC SCREENING
OPTIONAL CONSULTS
Who’s covered: Clients
Who’s covered: Clients and children
Who’s covered: Clients and children
What’s covered: Nutrition, family planning, hypertension, diabetes, STDs, respiratory and diarrheal disease
What’s covered: Glucose, BMI, blood pressure, anemia, malnutrition (children)
What’s covered: Up to three consults annually, basic list of medicines, basic list of diagnostic tests
Delivery channel: Village bank client leaders, with one page take-home handouts
Delivery channel: Fonkoze branch-level nurses
Delivery channel: Allied third-party providers
Nurses and screening equipment
Services provision
BUSINESS MODEL COSTS Curriculum development, training of trainers, supervision
REVENUE Clients pay a mandatory monthly fee of $1.00/month
Clients pay an optional monthly fee of $1.50