The CARE/GSK Public Private Partnerships (PPP) health worker program in Bangladesh has been highlighted on Devex in a piece written by Daryl Burnaby, Global Health Programs, GSK (GlaxoSmithKline) and Tom Sessions, lead for Strategic Partnerships and Private Sector Engagement at CARE International UK who is part of the Scale X Design PPP team. The article articulates the shortage of frontline health workers globally and how partnerships between the private, NGO and public sectors can deliver impactful, sustainable solutions to improve access to health. The initiative is now expanding from the original six countries in Asia to Africa, starting with Chad and Cameroon.
Krishi Utsho or KU, the CARE social enterprise initiative focused on improving the accessibility of agriculture inputs and services in rural Bangladesh, recently participated in an optional design challenge as part of the Human-Centered Design (HCD) Accelerator lab. They blended HCD with positive deviance* to look at one of their most successful franchisees, Saiful Islam Sumon, who owns three stores- the most of any franchisee. Continue reading to find out what was learned and then what was done about it!
What does Saiful do differently than other franchisees that makes him so successful?
1. He tailors the format of transaction register books. Krishi Utsho trains all its franchisees to use a general register book format that is uniform for every business size and growth trajectory. But Saiful tailored his register book format to fit the size of his business and growth. He also tracks purchase habits and credit records for each customer, which gives him a deeper knowledge and understanding of them. This change addressed an issue felt by other franchisees who find the traditional register book to be cumbersome and therefore often fail to maintain the credit record
2. Saiful breaks down the bulky 25 kg pack of cattle feed into easier-to-see 1 kg packs. Why? Because he consulted his customers who preferred small-unit packaging in order to keep the quality of the product intact and were even willing to pay a premium to get it. This innovation set Saiful apart from other franchisees who do not repackage but rather supply lower quality product since it slowly deteriorated once the 25 kg pack was open until it was finished.
What else did we learn about the farmers?
In addition to learning about the farmers preference for the items packaged in small quantities, even at a higher price, the KU team learned something about their preferred method for product promotions.
Most of the farmers indicated a preference for miking (promotions using a microphone and loudspeakers) since both the farmers and other household members pay attention to this type of advertisements. TV and radio advertisements can be easily missed and leaflets miss an entire audience segment because of illiteracy. Text and voice message promotions are also not preferred since users tend to ignore most of the commercials transmitted by cell phone companies.
Ok…so what’s the problem?
The miking advertisement strategy only allows for unidirectional communication so KU struggles to learn from farmers about their demand and satisfaction with KU’s products and services. The absence of a formal information channel between farmers, input shops and suppliers leads to asymmetric information between different stakeholders, the outcomes of which include adulteration of inputs and weak credit management.
Wait- why is this so important?
KU views the development of a customer database that will collect, store and maintain consumer-level information on input purchases and consumer feedback to facilitate demand forecasts, appropriate packaging, and in-store credit as an essential component of its business moving forward. This system will capture data from all of the 400 – 600 customers that visit each shop every month.
So what did we do about it? We prototyped!
To address this issue, KU applied the tenets of Human Centered Design (HCD) to prototype a solution and test it at the field level during the optional design challenge. KU prototyped the use of a suggestion box placed in the front of the shop, which allows customers to fill out a feedback form after purchases. The form itself asks simple, pictorial, self-explanatory questions regarding the current purchase as well as the customers’ experience regarding previous purchases. To motivate farmers to fill out the form, KU will randomly select a farmer through a lottery-style prize drawing every month. KU is now testing this prototype in a single store. The response from the customers so far has been very good.
KU’s long-term strategy is to transition to an ICT-based feedback collection system to support rapid expansion. As such, they’ll prototype using a toll-free number where consumers will voluntarily provide feedback and employing two dedicated people who collect data over the phone. This intervention will allow KU to choose customers to provide data according to KU’s needs.
Special thanks to GRID Impact for helping us create the Design Challenge and coaching the Bangladesh team!
*What is positive deviance? It’s an international development approach based on “the observation that in every community there are certain individuals or groups whose uncommon behaviors and strategies enable them to find better solutions to problems than their peers, while having access to the same resources and facing similar or worse challenges.” Learn more at positivedeviance.org!
“An innovative microfranchise model called Krishi Utsho (agro source in Bengali) launched by CARE Bangladesh has developed a network over 110 franchisee agro-dealers who serve over 30,000 farmers providing a wide variety of products (medicine, feed, vitamins, machinery, seeds, etc.) coupled with information and agricultural extension services mean a one-stop solution for farmers input supplies. Since the microfranchise network was launched, average milk production has increase by more than 50 percent and is expected to rise as new strains of more productive cattle begin to produce milk. KU conducted an in house survey on four hundred randomly selected farmers to measure its impact. The survey found that farmers’ income increased by 30%, food spending increased by 10%, distance travelled and cost to access input reduced by 50%.”
Check out the original post here for more on the power of social franchising.
How the Avon Lady Improved Income in Bangladesh by 31% by Emily Janoch
The Avon Lady in rural Bangladesh: it’s actually a more apt metaphor than you think. Avon uses a direct sales model that aims to get products to people who would not normally be able to access them, and that’s exactly what Krishi Utsho is—a way to get products closer to people.
Instead of selling makeup, they’re selling fertilizer, feed, and veterinary services. They may be getting more beautiful cows (IFPRI refers to some of these approaches as the “pampered cow project”), but the real impact is on the farmers. With the support of the Finn Brooks Family Foundation, they’ve been working since 2012 to improve access to goods for the poorest families in Bangladesh.
What did we accomplish?
- Higher Incomes: Farmers in areas covered by Krishi Utsho had a 31% increase in their incomes, and vendors were able to earn $1,394 per month. That’s more than 8 times what the average farmer makes in a month, so being a vendor is an attractive option.
- Cheaper, easier access to products: Because the shops are closer to home, farmers cut the time they spent going to get inputs in half (a 58% reduction), and dropped their cost on items like feed by 92%. So people have more money to spend from income, but also on savings from the goods.
- Stronger businesses: Besides the income, shop owners saw a 25% increase in their sales—and now they’re serving nearly 17,000 people a month.
- Healthier families: Farmers in Krishi Utsho areas increased their spending on protein and vegetables by 15%, so they have better diets. 56% of families increased their spending on health care and education with the new money they had available.
- More empowered women: in Krishi Utsho areas, women were 84% more likely to be able to influence household decisions in 2015 than they were in 2012. They were 250% more likely to be able to make decisions about income generating activities at home.
How did we get there?
- Set up shops with a quality brand standard: Krishi Utsho helped set up 64 branded shops that have a common brand, but are individually owned businesses—the franchise approach. To be a Krishi Utsho approach, they have to stock quality products and provide high quality services.
- Build Better Businesses: Krishi Utsho trained shop owners in business skills, and helped them make connections to providers of quality agricultural products. Once they have the necessary training, CARE can provide certificates and quality of service standards that people trust. CARE also serves as a trusted broker between the big brands and the KU owners.
- Got the extra (last) mile: because the KU shops reach thousands of people that normally would never access products in bigger cities or farther away, they are attractive options for makers of inputs like fertilizer, vet services, and seeds to change their marketing and pricing to reach new customers. It also makes products more accessible for women, who have less mobility, and for people who cannot spare the time or money to travel.
- Build demand: By training poor, rural farmers in improved agricultural techniques and the need for services, and then connecting them to solutions that work, CARE helps the local market strengthen for everyone. CARE’s Monitoring & Evaluation and technology platforms also help track demand and see what needs to change in the future.
In Bangladesh informal village level micro‐entrepreneur input suppliers, the primary source of inputs and advisory services for most smallholder farmers, either don’t exist or crowd out/cannibalize each other’s businesses because they operate within the same limited ranges. Where they do exist these micro‐entrepreneurs often lack access to formal supplies of quality agriculture inputs, market information, technical knowledge, business skills, and access to working capital to serve the smallholders who depend on them. As a result modern technologies, products and services cannot reach farmers, which ultimately limits their livelihood and resilience potential. Additionally, formal input supply companies do not know who their final customers are because their direct connection in their distribution chain does not extend to the last‐mile retailers and farmers. As a result, they cannot ensure product quality at the village level.
Resolving these issues would allow many smallholder farmers to increase their productivity by at least 50% and increase their income by 30% as demonstrated in our current operation areas. For this reason, CARE initiated Krishi Utsho (KU) agro input retailers’ microfranchise1 network in 2012 in rural Bangladesh as a one-stop solution to provide timely access to affordable and quality agriculture inputs and advisory services for rural smallholder farmers, particularly women. KU franchisees sell a variety of quality agricultural inputs at the village level, and provide formal private extension and advisory services to the farmers living in their communities. Through selecting and branding franchisees at the very last mile the network serves over 25,000 smallholder farmers, particularly vulnerable women in Southwestern and Northwestern Bangladesh, contributing to their increased productivity and resilience.
An impact assessment survey conducted by Krishi Utsho in 2015 on a sample of 400 farmers it served demonstrated that 58% farmers increased expenditure in goods, 56% increased their spending on education, 57% increased health spending, 54% increased their agriculture expenditure and 31% increased farmers’ income, from $171 to $225.
Meet the Team
MARUF AZAM | General Manager – Krishi Utsho Microfranchise | CARE Bangladesh
With more than 12 years of professional experience in both the non-profit and for-profit arena, Maruf has an extensive technical and business background. He is an expert in business development and hence, responsible for, the strategic planning, supply chain, management, business development, financial planning and overall leadership of Krishi Utsho. Maruf has his MBA in Marketing from the University of Dhaka.
SABRINA SAHRIN| Project Support Officer (L&D) | CARE Bangladesh
Sabrina is working as the Monitoring and Evaluation expert in the Krishi Utsho team. She is responsible in tracking the progress of the scaling-up efforts of KU and manages records as well as document and analyze evidence on the social-economic impact of KU. She studied Development Studies and Information Communication Technology which puts her in the right place to manage MIS data, track KU activities, and analyze impact.
SCOTT MERRILL | Senior Technical Advisor – Markets & Livelihoods | CARE USA
Scott is a private sector development specialist and has over ten years of experience facilitating value chain and market development programs to address issues in agriculture, food security, climate change resilience, and disaster risk reduction in Bangladesh, Uganda, Zambia, Myanmar, Lebanon, Afghanistan, the Philippines, and Mongolia, among other countries. Scott brings strong systems perspective to Krishi Utsho’s transformation to a self-sustaining agro inputs franchise. Scott holds an MA in International Relations and International Economics from John Hopkins and speaks English, Bengali, and basic knowledge of French.
NURUL SIDDIQUEE | Technical Advisor – Sustainable Agriculture | CARE USA
Siddiquee has been engaged with the Krishi Utsho initiative from the very beginning and contributed to the thought process of the evolution of the model over time. He brings core agriculture and agro ecology expertise to the team and helps connect the idea between sustainable pro poor agro economic transformation and supply of quality agro inputs through standardized franchise business. In his role as Technical Advisor he primarily supports CARE’s women-focused agriculture program, Pathways, which is located in six countries located in South East Asia and Africa.
This innovative solution consists of three key pillars:
- A unique public-private partnership (PPP) between the government, the community and a new cadre of private, community-based, skilled, female, health providers. With funding from GlaxoSmithKline (GSK), this new cadre of providers are selected from the community, trained using WHO/Ministry of Health (MoH) accredited curriculum, and are supervised and monitored by the government in collaboration with the community.
- Community ownership through the establishment of a Community Support System (CmSS), a local government-led community mobilization model that empowers the community to play a key role in addressing demand and supply side barriers through health promotion, referral support and accountability. CmSS actively contributes to identifying appropriate female candidates for health provider training, negotiates and sets fees for service with private providers (which are in line with community needs), builds awareness and promotes the services of the new cadre of private providers, supports timely referral, and monitors coverage, quality and equity of service provision to ensure transparency, accountability and voice of the community.
- Social entrepreneurship and business training from JITA (CARE’s social entrepreneurship initiative) for the new cadre of providers. This training helps them develop business plans and become financially sustainable and independent by selling their health services. They also receive government reimbursement for serving poor and marginalized women through national and local social safety schemes.
Learn more about PPP by watching this video documentary!
Meet the Team
Jahangir Hossain | Program Director-Health | CARE Bangladesh
Jahangir Hoassian is a Health and Development Program development professional with over 23 years of experience in development, implementation, monitoring and evaluation of Primary Health Care (PHC), Reproductive Health (RH), HIV, Nutrition, WASH, Maternal and Newborn Health (MNH) programs in Pakistan, Cambodia and Bangladesh. He has provided leadership and strategic guidance to different Health, Hygiene, Nutrition and Family Planning program with budget about $30 Million in 14 districts in Bangladesh and has a special interest in public Health System Development, health and nutrition in emergency, and Behavior Change Communication (BCC) to address equity and gender issues in accessing the basic health services. Jahangir is a registered physician with Bachelor of Medicine and Bachelor of Surgery (MBBS) degree from Dhaka University, Bangladesh and Master in Science (MSc), Public Health in Developing Countries degree from the London School of Hygiene and Tropical Medicine, University of London, UK.
Rina Rani Paul | Program Manager-Research | CARE Bangladesh
Rina Rani Paul has more than eight years experience in program and research settings that resulted in an in-depth understanding of the contextual issues related to health and nutrition in Bangladesh, especially maternal and child health and nutrition and community health system. She has worked with leading Maternal and Child Health and Nutrition Research Projects in Bangladesh for four years, implementing and monitoring both efficacy and effectiveness studies in the community. In addition, she has worked with reputed study groups conducting large clinical trials and cohort studies and following pregnant women and adult population for health outcomes. Starting as a field worker, she was progressively entrusted and challenged with more complex and supervisory work involving research project management. Rina Rani passed the MBBS from Rajshahi Medical College under Rajshahi University in Bangladesh in 2000 and is currently enrolled in the Masters in Public Health Programme under the Department of Public Health, State University in Bangladesh.
Mariela Rodriguez | Senior Program Officer-SRMH | CARE USA
Mariela Rodriguez is Senior Program Officer for Knowledge Management and Global Coordination for the Sexual, Reproductive and Maternal Health (SRMH) team at CARE. Mariela focuses on finding ways to elevate and share CARE’s global SRMH programming across the CARE world and with external partners and donors. Prior to working at CARE, Mariela worked on rights-based approaches to voluntary family planning, maternal health policy networks, gender inequality and human rights. She has co-authored four peer-reviewed journal articles. She received her master’s in Ethics, Peace and Global Affairs from American University’s School of International Service and her BA in Political Science from Georgia State University.
To be hired | Senior Account Manager-Health | CARE UK