HYBRID TO OPTIMISE RESOURCES
The UP model presents a new paradigm of hybrid programming in low resource settings–resources scattered across various sectors are laterally combined on the basis of core competencies to optimise efficacy. This approach is very effective in addressing the challenge that has persisted with service delivery to rural and remote communities. Rural entrepreneurs can use their social relationships to generate demand, counsel clients, procure products & materials, and manage logistics but are unable to deliver the services since formally qualified providers, as legally required, are unavailable within easy access. Personnel in the public sector are the nearest available formally qualified providers who, however, lack empathetic skills particularly necessary for preventive or low-end primary health services. Under the WHP model, public sector quasi-medical personnel called Auxiliary Nurse Midwives (ANMs), who are posted at the first available skills-based facility for rural communities, visit the entrepreneurs’ centres to provide family planning, antenatal and gynaecological services either on their own or in electronic consultation with city doctors. (Refer to ‘Technology’). This is done under a formal arrangement with the public sector, so this additional component is integrated into the ANMs’ work schedule without disturbing their other functions.
A backend call centre (refer to ‘Technology’) provides registration and follow-up care, particularly for ante-natal services. WHP procures good quality IUDs and injectable contraceptives in large volumes, and sells to the entrepreneurs and neighbourhood pharmacies. The clients pay a fee which meets the cost of the service, including earning of the entrepreneurs. Clients from poor families who could not afford the prices were earlier subsidised with donor funds, and currently efforts are underway to get the government to absorb the costs.
Project Matrika started as a collaborative venture with Pathfinder International with $3 million support from Merck for Mothers in 2013. In its second phase starting June 2016, WHP is implementing it alone with continued support of Merck for Mothers.
Lessons and results:
WHP’s premise that communities will not travel long distances or incur high expenses to receive preventive or low-end curative services, but will respond well if the services are available close by is strongly validated by this model. The use of an ANM reduces the cost sharply and improves follow-up care so essential for all services, but particularly for those that have side effects, such as injectable contraceptives or IUDs. Project Matrika has so far provided 33,600 family planning and 100,101 antenatal services either on their own or in electronic consultation with city doctors (as on Sept 1, 2017).