I think that the franchise model is an important step for putting solutions in the hands of those in the community -- thus solving both health and economic challenges in one fell swoop.

If we look beyond this particular community context, I think there are important ways of scaling this idea to nations/communities where there ARE health clinics, but where important health issues still need to be addressed, specifically with regard to PREVENTATIVE health.

I am interested in holistic preventive medicine as a way of reducing the systemic factors that lead to health problems. One issue that does not get addressed nearly enough is stress and depression. I read recently that soon depression will be among the most prevalent health issues in the world. I was recently involved in a community health center research project in the US, which found that the number one self-assessed health factor in urban communities was the STRESS of living in that community itself (not having enough money to meet family needs, no accessibility to efficient transportation, high rates of crime and violence) -- which leads to chronic health problems such as heart disease to obesity, alcoholism and suicide.

Those with economic means can go on vacation to "get away from it all," can afford yoga classes and massages, and have the time and money to exercise. Those without, don't.

What if we could bring holistic preventative measures to low-income communities, while at the same time creating economic opportunity?

I think the franchise model you have developed would be suitable here -- health clinics may exist in some communities, but community members could still be given the capital and training necessary to open their own PREVENTATIVE health centers that could serve as urban/rural oases, create job opportunities, and increase the overall health of community members without them having to "get away."

  

One way of enriching this process is for the Franchised Health Clinic Network to focus on health promotion and prevention and the treatment of disease.

Most illnesses that are dealt with hospitals are of a preventative nature yet these ailments contribute to a large portion of the disease burden and to the hospital budget. Such diseases include HIV/ Aids, nutrition related diseases in children or ailments related to lifestyle factors in teens and adults (diabetes, hypertension, obesity, alcoholism and drug addictions).

By focusing on prevention and treatment, greater health benefits will be felt in the community in Caldas. The prevention programs can be run by the nurses unlike disease treatment in which complex ailments would require a doctor.

This would also relieve the disease burden on the health centre and free the hospital resources to focus on non- preventable conditions thus providing better service.

Once way in which the health promotion and prevention campaigns could happen is for the Franchised Health Clinic Network to include incentive- based health promoting activities within the Clinics with the collaboration and support of government.

Funding and setting up these units will be done by Franchised Health Clinic Network.

Government could provide a legislative framework that will make possible a partnership with Franchised Health Clinic Network. The enterprise will get rebates or exemptions on taxes as a reward for establishing health promotion units within these centers.

Franchised Health Network could also set up partnerships with private business who will contribute to the health promoting initiative and in turn benefit from increased sales traffic brought about by a loyalty card system issued by Franchised Health Clinic Network.

Individual beneficiaries visiting the health promotion unit will earn points redeemable as cash or discounts on purchase of merchandise or services from participating companies.

Health promotion will be done through creating awareness for current health issues, training, counselling, and distribution of health promoting products and HIV / AIDS prevention campaigns through a loyalty card reward system.

The centre could comprise the following facilities:

• A Mother and Child Facility
• Training zones
• An innovative housing section
• Disease screening and testing
• Health products distribution
• Exhibition areas

This will earn money for users of the centre and increase sales for the participating companies by channelling traffic to the business outlets.

The overall effect would be as follows:

• Better health for mother and child and a reduction in child mortality rates in the community through education, prevention and treatment.
• Better community health through early screening to identify treatable conditions
• Improved nutrition and community health.
• An increase in awareness of lifestyle factors that promote health
• Promotion of innovative, cost effective, safe and sustainable building techniques and products that will promote health and safety in the community.
• An Increase in disposable income of the community through savings and cash rewards offered to those using the centres.
• Publicity to the businesses brought about by the loyalty program and increased traffic to outlets; thus improving sales
• Business expansion and creation of job opportunities for the community through increased profits brought about by the rewards program.

Profits will be reinvested in more Franchised Health Clinic Network clinics, with increasing health benefits to the community.

I love this concept which seeks to address the issue of lack of availability of quality health service providers.

Besides availability and quality, the third issue is affordability which you propose to address by subsidizing the cost of medicines and buying in bulk. After piloting a few to ensure that you have your operating protocols clear, getting one large investment to create many franchise at once will also cut down costs. Affordability can also be addressed by linking to another Grameen social business Bienestar, the health insurance pilot project that It offers patients a card for ca. $5 per year that gives patients access to a network of doctors and healthcare centers offering the patient services and medicine for up to 60% cheaper than standard costs. Bienestar could be effectively linked to the franchise of clinics.

The mobile unit idea that was later added is also very key for two reasons:
a) many people who live in remote areas may not be able to afford the transport to even get to a clinic; and if possible, the mobile unit can provide emergency transport
b) the mobile unit can provide routine surveillance of remote areas for any disease outbreaks, preparing the clinics and larger health networks for better and quicker responses

Your idea really evolve pretty good :)... The Franchise could make oir other ideas possible, because it has one precise skill: quality thru standarization.

This is for me a way of really attend Caldas problems, because it's professional and precise. And that's what people in need depends on, someone taking their problems as serious as paid-doctors do.

I love the empowering of the local!!!

Your idea is great, but MFI is always a big problem in every country they steps in (they are responsible for the crisis in Argentina, Russia and -we expect not to happen- in Greece). If not as a franchise, it could be useful that medical universities have in Caldas a trainee camp for future doctors and nurses.

The medical supplies could be find by sponsors (farmaceutical are the most profitable companies in the whole world).

I love the franchise model of this concept! What about adding a mobile health unit as a franchise option - this would add to the accessibility of basic health care services. And I think the idea of buying medical supplies in bulk as a group is great!

Good thinking here, Eric.
There was an idea form an earlier challenge that could help shape your concept in terms of adapting the clinics to the rural environment: http://bit.ly/iiG8Pc