Module 4: Marketing Strategies for Health Clinics

Viewing clinics as businesses is a critical component of Unite For Sight’s mission and practice.  It is essential that eye clinics have a sustainable business model, as they are private businesses meant to be economically functional.  Instead of simply donating funds as charity, Unite For Sight helps existing eye clinics develop outreach infrastructure so that free care can be provided to patients living in extreme poverty.  The clinic’s private business also continues as an enterprise independent of the Unite for Sight-supported outreach programs.  Having this strong base of independence and sustainability comes from good business practices, which is why Unite for Sight partners exclusively with existing, sustainable eye clinics that also provide care to regular paying patients.(1)

At first glance, the term "marketing" may seem irrelevant to health care employees and volunteers working to deliver healthcare services to local members in need.  However, “good marketing is the cornerstone of effective distribution in business operations,” and the clinics are essentially sustainable businesses.  A common misconception is that social marketing is characterized by a rivalry between different organizations, conflicting with one another and fighting over the same patients. In actuality, social marketing is a method to inspire social change through a shift in behavior and outlooks on health services. This creates awareness and demand for services in populations who need interventions, but have barriers that prevent them from accessing the care.(2)

Organizations such as World Health Organization and Acumen Fund have extensive experience with business models and the creation of sustainable enterprises. Based on their successes and failures, each organization created a set of marketing strategies for future developing businesses.

Strategies From The World Health Organization For Eye Care Delivery

If the ultimate goal is for the target community to enthusiastically agree and pro-actively seek cataract surgeries, thus guaranteeing that hospitals and eye clinics are consistently functioning at maximum volume, then the initial social marketing steps would include:

• Appreciate how cataracts are currently perceived among the population. This will assist in constructing an appropriate education campaign to address these views and increase overall awareness.

• Understand how people view the existing eye health services. This will be helpful in order to refine the current quality of delivery and to dispel any false rumors.

• Research the current challenges and barriers to accessibility of surgeries. This information can be utilized to design an effective delivery system addressing these difficulties, allowing for services to be easily obtainable and affordable.(3)

Social marketing is a critical tool to raise awareness in communities about the importance of eye health and to publicize upcoming services, thereby increasing the effectiveness of intervention programs.  A macro analysis of resource use in India has revealed that there are 200 surgeries provided per ophthalmologist per year, and 13 surgeries per hospital eye bed per year.  This equates to approximately 5-7% % of the blind-due-to-cataract population in India operated on yearly, a shockingly low statistic that is not due to lack of resources, but rather due to inaccessibility of eye care services.  The concerns connected with accessibility begin with the practice of generating awareness, incentive, and finally the delivery of eye health services with required follow-up appointments.  In order to raise sufficient awareness and disseminate the most relevant materials, it is important to carefully assess the patient population based on “health behavior, literacy levels, economic status, barriers to access, and logistics of information transmission.”  Most people who have blinding cataracts are entirely unaware that their condition is the result of a cataract, or that their sight could be restored through surgery.  Even within the population that is conscious of cataracts, persistent barriers to care exist (fear, family attitudes, religion, need for an escort, no desire, no time, etc.).  For social marketing purposes, it is imperative to research all of these challenges that are prevalent in the community, including the locations of service facilities and travel logistics, socio-economic obstacles, lack of information, and harmful health behaviors.  Social marketing can be highly beneficial, as it not only allows services to reach the maximum amount of people with impaired vision in need of intervention, but it also can decrease the cost per cataract surgery, and improve sustainability of eye health institutions.(4) In order to deliver the maximum amount of eye health care services in the most cost-effective way possible, the World Health Organization stresses several key marketing strategies for planners to keep in mind.(5)

• Define priority areas (cataract, zerophthalmia, trachoma, school eye screening, etc.). It is important to be realistic in goal making, focusing on diseases that are most prevalent in the area and have treatment resources available.

• Define priority populations (rural, poor, children, etc.)

• Decisions could be swayed by the tendency of the disease (for example, one that primarily affects children) or by unavailability of current services (resource-poor communities with low access).

• Community involvement: Use campaign methods that are interactive with the population and sensitive to cultural practices.

• Design and implement case finding and clinical service delivery strategies that reflect priorities and takes into account the barriers. Approaches include case-finding services at the local level, joining with the community for outreach efforts, patient education, feeding and transporting individuals to eye clinics, and providing surgeries free of cost.

• Monitor patient satisfaction and visual outcome.

• It is critical to periodically assess the quality of delivery, outcomes, sight restoration frequencies, and overall satisfaction with services.(6)

Strategies From Acumen Fund’s Investments

Acumen Fund’s method of investing in businesses has been extremely instrumental in learning which strategies work and which do not work for business models at the BoP (base of economic pyramid).  In 2007, there were eight primary investments that had been exited, including Project Impact: Affordable Hearing Aids, SATELLIFE: PDAs for disease management, SSI: Immunosensors for low-cost disease testing, Aravind Eye Hospital: Telemedicine for eye disease, A to Z: Anti-malaria bed net production, Mytry: low cost de-fluoridation filters, Heritage: peri-urban water distribution and finance, and IDE India: Low-cost drip irrigation products for small-scale farmers.(7)  From these endeavors, Acumen has repeatedly experienced that the most important part of social business delivery is to sincerely listen to consumers, and that even the poorest buyers have a desire to purchase things that they believe to be of value.  Although each individual investment requires specific attention in terms of economic, functioning, and social impact purposes, there is a set of core principles applicable to all cases and locations.  Tactical management backing is offered by Acumen, which assists investees to achieve goals that usually consist of:

• Creating widespread social change

• Producing projected financial returns (either breaking even or profiting from the business)

• Advancing to more commercial bases of capital (commercial loans or greater equity rounds).(8)

Every investment provides valuable insight to Acumen about how to best market essential products and services to those living in poverty.  The exit process is ongoing, consisting of meetings and interviews with investees and all others involved.  In order to evaluate the success of different strategies, Acumen Fund collects detailed assessments, project evaluations, lessons learned, and summaries of the investment closure from each endeavor. “Despite being product design breakthroughs, these investments taught Acumen Fund that without an effective business model to ensure direct and affordable product distribution, these innovate products would not reach low-income communities.  As a result, Acumen Fund’s due diligence process incorporated explicit emphasis on innovation in marketing, distribution, and pricing for BOP consumers.”(9) As mentioned previously, each investment experience allowed Acumen Fund to rapidly realize that the key to a successful business model is obtaining solid background knowledge of the consumer population.  This understanding must not only include cost and availability, but also cultural partialities, limitations, and opportunity costs.  Many of the principles that allow for accomplishment in mainstream markets also apply to social marketing, and several of Acumen Fund's essential strategies are discussed below.

• Identify social entrepreneurs: Comparable to for-profit businesses, Acumen relies on powerful management to launch their idea and conquer prospective challenges. The goal is to strike the perfect balance between creative visions and practical strategies in order to guarantee that the idea materializes. For example, Dr. Govindappa Venkatawswamy started the Aravind Hospital Network through his dedication to raising the quality of life for those in poverty and his aptitude for applying private-sector techniques to achieve social goals. Nonetheless, Dr. Venkatawswamy’s amazing accomplishments would not have been possible without his forceful management team working alongside him.(10)

• Sourcing: One challenge to accessibility is high upfront expenses. For example, current drip irrigation methods in India are extremely costly, making it difficult for poor farmers to afford the technology. To solve this problem, Amitabha Sadangi created IDE India, combining his knowledge of low-income farmers and his inventive skills to generate a drip irrigation system out of simple, affordable materials that can be built up slowly to evade large up-front costs.(11)

• Product Design: It is essential to keep in mind the different aesthetic preferences and values among the different groups at the BoP (Base of the Pyramid). For example, A to Z and Acumen Fund found that consumers heavily appreciated the artistic appeal of their anti-malarial bed net, and valued the status of the net just as much as they valued its life-saving protection. Designs should be culturally sensitive, considering social factors such as honor, disgrace, and class.(12)

• Marketing: Consumers should appreciate the tremendous value of the merchandise, including its life-saving capacity and potential tradeoffs. For example, “If consumers do not understand the value of safe drinking water – such as the life-saving impact and the tradeoff of water-borne diseases – they simply will not buy the filter. This experience taught the Water Portfolio Team to require marketing strategies for its investees. Another marketing tip is that branding matters. Lower quality “carbon copies” or copycats of the products can serve as potential dangers to the success of the business. Therefore, it is important to powerfully brand items and teach customers to identify the specific product and its value.(13)

• Pricing for the Customer: Methods of pricing can differ tremendously depending on the particular sector and business model. For example, Heritage and Acumen discovered that for low-income households, pay-as-you-go approaches instead of long-term commitments are preferred. Opportunity costs often provide a foundation for appraising products. Also, seasonal changes must be considered. Heritage encountered a fluctuation in willingness to pay as a result of seasonal migration because all men from the slums leave during the pre-monsoon planting season.(14)

• Sales Channels: In order to make sales, it is imperative to understand the target community’s buying habits. Acumen has learned from past experiences that the most effective sales locations are ones where buyers can prepare their money in advance, such as at kiosks or retail sites. When partnering with A to Z, Acumen found difficulties with community sales techniques such as “tupperware parties, church and hospital sales, and door to door sales.” When planning sales channels in a given area, listening to the community members and observing local habits will allow for the greatest success.

Conclusion

These synthesized marketing strategies are extremely useful for clinics and other social businesses to market their goods and services, as they can be applied to a wide range of enterprises.  Along with these core founding principles, it is important to keep in mind the nuanced preferences of different cultures.  The key is to become personally acquainted with the community members, creating a product that caters to the audience’s needs and allows consumers to feel comfortable with open communication.

Footnotes

(1) Unite For Sight, “The Importance of Sustainable Development in Eye Care.”  https://www.uniteforsight.org/what-we-do/sustainable-development.

(2) Thulasiraj, R.D., “Social Marketing for Effective Eye Care Delivery.”  WHO Vision 2020 Action Plan. 

(3) Ibid.

(4) Thulasiraj, R.D., “Social Marketing for Effective Eye Care Delivery.”  WHO Vision 2020 Action Plan. 

(5) Ibid.

(6) Thulasiraj, R.D., “Social Marketing for Effective Eye Care Delivery.”  WHO Vision 2020 Action Plan. 

(7) Hill, K., “Acumen Fund Exited Investments, Lessons Learned.”  Acumen Fund, (2007). 

(8) Ibid.

(9) Ibid.

(10) Hill, K., “Acumen Fund Exited Investments, Lessons Learned.”  Acumen Fund, (2007). 

(11) Ibid.

(12) Ibid.

(13) Ibid.

(14) Hill, K., “Acumen Fund Exited Investments, Lessons Learned.”  Acumen Fund, (2007).