Business models for primary health care delivery in low- and middle-income countries: a scoping study of nine social entrepreneurs

Abstract

Background Social enterprises are organizations created to address social problems that use business models to sustain themselves financially. Social enterprises can help increase access to primary health care in low resource settings. Research on social enterprises in health care have focused either on high-income countries, or on secondary and tertiary care in low- and middle-income countries, where common business models include differential pricing to cross-subsidize low income populations. This is the first study to examine social enterprises providing primary health care in low- and middle-income countries using primary data. The purpose is to determine whether social enterprise is a viable model in this setting and to identify common patterns and characteristics that could inform the work of social entrepreneurs, funders, and researchers in this area. Methods We identify social entrepreneurs working to deliver primary health care in low- and middle-income countries who have been vetted by international organizations dedicated to supporting social entrepreneurship. Through in-depth interviews, we collect information on medical processes, business processes, social impact, and organizational impact according to the Battacharyya et al. framework. We then conducted qualitative analysis to identify common patterns emerging within these four categories. Results Common characteristics in the business models of primary health care social enterprises include flat rate rather than differential pricing and cross-subsidizing across services rather than patients. Subscription packages and in-house IT systems were utilized to generate revenue and increase reach through telemedicine, franchising, and mobile units. In some cases, alternate revenue streams are employed to help break even. About half of the social enterprises interviewed were for-profit, and about half non-profit. The majority faced challenges in engaging with the public sector. This is still a nascent field, with most organizations being under 10 years old. Conclusions Social enterprise has been demonstrated as a feasible model for providing primary health care in low resource settings, with key characteristics differing from the previously commonly studied social enterprises in tertiary care. There are opportunities to complement existing public health systems, but most organizations face challenges in doing so. More research and attention is needed by researchers, governments and funders to support social entrepreneurs and avoid parallel systems.

Perceived impacts of social enterprises in scaling effective refractive error coverage in Kenya

“…The study findings are similar to those of Henderson et al (2020), who reported that SEs are essential for employment creation, alleviate poverty, strengthen education and facilitate job creation in informal socioeconomic conditions. While SE are cause-driven businesses intended to generate value that benefits the population at the base of the economic pyramid with the aim of enhancing affordability and accessibility of RE services (Lokman and Chahine, 2021; Thompson, 2014), human resources remain a critical aspect that should be prioritized to scale effective eye care coverage. Notwithstanding, with most public health sectors in developing countries such as Kenya having limited human resources to attend to the growing population, embracing and integrating the skills development approach by SE is desirable for scaling human resources to serve all sectors in developing countries such as Kenya.…”

“…Given the significant unmet health-care needs among poor people living in remote areas (Jung, 2021), the adoption of cost-effective and sustainable approaches to supplement the challenges that the government experiences in addressing eye health, such as uncorrected RE (URE) across the economic pyramid, is desirable. In tangent with this, the SE concept, whose mission is to create and sustain social benefits across the economic pyramid (Lokman and Chahine, 2021; Pangriya, 2019), is desirable in resource-constrained countries such as Kenya. SEs have the potential to enhance the health and well-being of vulnerable groups through the provision of affordable health-care products and services, increasing health conditions and capabilities (Jung, 2021).…”

“…In developed countries, the social entrepreneurship concept has been shown as a cause-driven business intended to generate value that will benefit the population at the base of the economic pyramid, including accessibility and affordability of health-care services (Cicinelli et al , 2020). In high-income countries such as Scotland, SEs have been shown to improve health outcomes through the direct delivery of primary health-care and community development programs addressing social vulnerability (Lokman and Chahine, 2021). Notwithstanding, in England, SEs have been shown to increase productivity, innovation and responsiveness to underserved populations (Macassa, 2021).…”

Viability of Point of Care Ultrasound screening in Primary Health Care Setting: A Kenyan Experience

“…Social enterprises have the potential to increase access to health services in Primary Health Care (PHC) settings but little is known on impact metrics and financial sustainability (Lokman and Chahine 2021). The POCUS entrepreneurship social enterprise project explored financial sustainability through differential pricing that involved reduced cost of service in remote areas hoping to benefit from economies of scale (high-volume low-cost work stream).…”

Innovation and Entrepreneurship to Address the UN Sustainable Development Goals

“…Business models for primary health care delivery in LMIC's was presented in a paper by Lokman and Chahine [27]. In this paper, the authors studied nine social enterprises delivering primary health care in LMICs in a sustainable, profitable way.…”