DevExplains: 'Intermediaries' in the health market

The health market is often populated with three players: the government, which heads up overall policy direction; and NGOs and private health care providers that deliver health services where they’re lacking or where there’s weak health infrastructure. In this ecosystem, however, there’s another set of players whose role is less about directly providing health care, and more about ensuring health care services are available, that health care reaches different segments of the population, and that it is provided within a set of quality standards. Who are these players? The Center for Health Market Innovations, a platform providing information and analysis on innovative health programs and policies across the globe for the benefit of different actors such as implementers, funders and researchers, identified these players in a recent report as ‘intermediaries’ or those organizations that, in a nutshell, build and manage relationships between government, health care providers, vendors and patients to create better coordination, savings and continued access to care for the population. How do they operate? Intermediaries currently operating in the health market space are composed of nonprofits and for-profit organizations, and they operate differently depending on the problem they are facing in a given context. Some examples according to the CHMI report include the Christian Health Association of Malawi, which consists of 180 health facilities across the country. The association helps the government tap into its network of small-scale health care providers through a single service contract. This eases the burden on the part of the government in entering in multiple individual contracts with a huge number of primary care clinics, while finding a way to provide health services to a wider set of the population without having to build its own public health facility or infrastructure. To ensure quality services, the association performs facility inspections and clinical trainings among its network of health clinics. A clinic that falls below the standards set by CHAM and the government health ministry loses its membership and, as a consequence, funding from the government. Another example is Health Builders in Rwanda. The nonprofit helps build the management capacity of government-owned clinics, and makes use of a performance evaluation tool to track how facilities are doing in terms of staffing, drug supply, and financial management, to name a few. What other roles do intermediaries play? Apart from ensuring patients have access to continued, quality health care services, intermediaries can also identify gaps and push for the provision of missing or nonexistent health care services, address human resource limitations and lower costs for health providers, which in turn helps maintain lower fees charged to patients. A network of community-based nonprofit organizations in Ontario, Canada, making up the Local Health Integration Networks identify what kinds of health services are not being met in a particular area or community by available health providers through focus group discussions with underserved populations such as immigrants, refugees, the elderly and members of the LGBT community. With funding from the government, these organizations then come out with requests for proposals for these missing health care services. MedicallHome in Mexico makes use of telemedicine — in which patients access doctors or other medical specialists through the use of technology — to reach an estimated 5 million people who rely on the service for their health diagnosis and treatment needs. PurpleSource Healthcare in Nigeria, meanwhile, helps lower costs for drugs and other service and supplies needed by member health facilities by facilitating bulk orders or purchases from partner vendors, which include pharmaceutical companies as well as companies offering cleaning and waste management services.