Clients

A typical client is expected to be an adult male or female, living in poor rural areas or urban slums, distant from or unwilling to use government services, possibly employed, with limited financial means, but access to some money from personal or grouped savings from extended family, and with some family members capable of assisting with direct observation of medication.

Healthspot will target low and middle-income areas (c and d income quintiles) within countries of high population, with HIV prevalence above 5% and TB incidence greater than 0.3%. In some urban areas, such as the slums of Nairobi, it is estimated that TB prevalence may be close to 3% (8). Viability of the model for these populations is based on proven examples of health franchises in Africa and Asia, and in part on DHS (Demographic and Health Surveys) data showing that the poorest quintiles in Africa spend most of their health expenditures on direct purchasing of treatment and/or medicine in the private sector (Marek et al 2004). Healthspot sees this entire group of the poor as at-risk, deserving of subsidized care, underserved by existing government programs, and as potential clients.

Each franchisee will serve a cachement area of an approximate population of 20,000. It is assumed that 10% of those with HIV will seek testing services, of these 50% will go to the private sector, and of these 50% will use the franchise services. Similar assumptions about care-seeking behavior among those seeking or in need of TB tests, and TB and HIV care have been used.

From the available data on health-seeking behavior among the poor in Africa, Healthspot has concluded that information on quality is lacking, and that quality, access, and cost are the three central drivers of the client's selection of provider. Healthspot branding and services are designed to respond to all of these criteria: providing service of predictable and certified quality, in a close-to-client location, and at pre-set costs that are lower or equal to any equivalent in the market. All franchisees will also provide information about alternative free services available from the government. Healthspot's intention is to capture as much of the market for non-government care as possible, but not to compete with the government services.

All prices used in our budgets are based on available evidence of client willingness-to-pay for services, including HIV testing, TB diagnosis, and care for TB and HIV. For TB care, all client costs are front-loaded – that is, clients pay all costs at the start of treatment – to minimize the client incentive to discontinue treatment.

Healthspot pricing of ART will include free ARV medication and necessary testing. Consultation fees will be set to normal rates: approximately $0.40 per consultation, or a maximum of $2 per month during the intensive first six months of ART. Consultation fees will be waived with NFO pre-approval for a maximum of 5 to 10% of ART clients.

End Note:

(8) Private estimates from Kenya NTP.

74 New Montgomery, Suite 508, San Francisco, California 94105-3411, USA