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Overview
Despite the stunning advances in medicine during the last half century, over 25,000 children die each day for want of medicine that costs less than a cup of coffee.
A short list of infectious diseases treatable with inexpensive generic drugs accounts for 70-90% of all childhood illness and death in the developing world. Existing access to essential medicines for much of the poorest is woefully inadequate. A frightening percentage of the most vulnerable populations live hours, if not days from the nearest source of life saving medicines. Moreover, the current limited distribution often suffers from weak supply, a lack of rigorous quality control and unfair or simply inaccessible pricing. To address this yawning healthcare gap Scott Hillstrom and Eva Ombaka, Ph.D. founded The Child and Family Wellness Shops network (CFWshops) in 1997 (now known as The HealthStore Foundation®), adapting a traditional franchising model to the problem of distributing essential medicines in remote communities.
The Micro-Franchising Model - An Effective, Scalable Solution
The HealthStore model is a network of micro pharmacies and clinics whose mission is to provide access to essential medicines to marginalized populations in the developing world. The HealthStore outlets target the most common killer diseases including malaria, respiratory infections, and dysentery among others. They also provide health education and prevention services.
Why a franchise model? On average the 20 poorest developing countries spend less than $33 per person each year on health care compared to over $2,500 in the 20 most developed countries and $4,500 in the US. Even a doubling of public health funding would fall short of meeting the need. While public funding will always be needed, at least part of the full solution to the distribution of medicines must incorporate a sustainable market-based model with effective incentives. The HealthStore model incorporates all the key elements of successful franchising: uniform systems and training; careful selection of locations; and most importantly, strict controls on quality backed up by regular inspections. And importantly HealthStore uses the combined buying power of the full network to obtain quality medicines at the lowest possible cost.
Community health workers who own and operate a HealthStore outlet make a modest living selling the competitively priced drugs. The network operates two types of outlets; basic drug shops operated by community health workers, and clinics operated by nurses who provide a deeper list of essential medicines as well as basic primary care. As the franchisor, HealthStore can revoke a franchisee's right to operate an outlet if the franchisee fails to comply with the franchise rules and standards.
HealthStore targets primarily lower or middle-income women and children subsisting on agriculture, although people of all ages and incomes are treated. HealthStore outlets are located at market centers in agricultural areas of approximately 5,000 people. Approximately one fourth of the patients are treated for malaria.
The essential components of the HealthStore franchise-operating model include:
- A system of franchise rules and strict treatment standards that govern how the outlets are run and what drugs can be sold.
- A thorough training program that ensures every operator knows how to diagnose the target conditions and accurately prescribe the correct medicines. Base training is backed up with continuing education on clinical skills and management practices.
- A centralized procurement operation that drives down drug costs and ensures drug quality by qualifying all the medicines, buying only from reputable suppliers, and maintaining quality standards throughout the supply chain.
- A record keeping regime that compiles patient records and vital health statistics, as well as financial performance statistics for each HealthStore outlet.
- A consistent monitoring program that makes sure every outlet is operating to standard.
Results to Date - The Model is Working
- In 2000, using his own funds, Scott and Eva lead the creation of the first 11 basic drug shops in Central Kenya.
- In 2001, Management Sciences for Health (MSH) and HealthStore formed an alliance under which MSH supplies technical advisory services to The HealthStore Foundation®. MSH is one of the world's leading health development organizations with significant backing from the Gates Foundation.
- Since 2000, the HealthStore network has more than quadrupled to 54 locations comprised of 28 drug outlets and 26 medical clinics. This network treats an average of 40,000 patients per month.
- Since inception, The HealthStore Foundation® has treated over 700,000 patients through its network in central Kenya.
- The Ministry of Health for Kenya has incorporated the HealthStore network in its National Malaria Strategy.
- In 2004, the HealthStore network treated 177,256 patients and in 2005, the number of patients treated nearly tripled, reaching 435,527
The Path Forward - HealthStore's Key Strategic Goals
- Expanding the Network in Kenya: Over the next 3 years HealthStore aims to expand the initial network in Kenya to 200 outlets serving up to 1,500,000 patient visits per year.
- Improving the Model: The HealthStore Foundation® is working to continuously improve its franchise system with an emphasis on increasing utilization of our services in the communities we operate. Going forward, HealthStore is converting shops to clinics, increasing access to registered nurses and a wider array of diagnostic and treatment options.
- Adding Critical Medicines and Services: HealthStore is steadfast in its effort to provide the most effective treatments to the communities served by its network. HealthStore will continue to evaluate which services and products have the greatest impact on childhood health and are best suited to the organization's unique capabilities. Current plans include expansion of reproductive health and prenatal care, vaccination services, family planning, and village-based support for HIV/AIDS patients.
- Expanding Malaria Treatment:In 2006, HealthStore will begin distribution of Coartem, a form of artemisinin combination therapy for treatment of malaria. Combination treatments are now widely recognized as the most effective treatment for malaria. And given the success of insecticide-treated bed nets at reducing malaria death, HealthStore will expand its successful outreach and promotional efforts geared toward increasing use of bed nets.
- Replicating the HealthStore model in Other Countries: The HealthStore Foundation®'s greatest hope is to replicate this innovative model in other countries. While building out the Kenya network will be the primary focus in the near term, HealthStore will be engaging in discussions with major health organizations to export this innovative model.
Just as Grameen bank proved in the 1980's that traditional bank lending can be successfully adapted through a micro-finance model to improve the incomes of the poorest of the poor, the success of The HealthStore Foundation® is demonstrating that 'micro-franchising' can be a key tool in improving their health.
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