3) Description of your products or services: The JANANI program works in Bihar and Jharkhand, poorest states of India (110 million population, per capita annual income $150). Over 55% of the population lives in poverty. The primary clients of Janani are not the poorest but those who can pay part of the current market prices for services. By serving them, Janani reduces the burden on the public sector so it can deliver to the neediest.

Janani focuses on reproductive health and health. Current services include IUDs, sterilizations, safe abortions, injectables, safe deliveries, emergency obstetric care, appendicectomy, hysterectomy, hernia and hydrocoele. The unmet need for family planning in the two states is estimated between 25% and 40%. Janani fills most of this now.

Reduction in fertility and having access to reproductive health care reduce morbidity levels significantly, generate better income and improve the overall quality of life.

Currently, the program delivers 21% of family planning protection in both states at a cost which is about a sixth of the public sector’s. The networks consist of 260 franchised medical clinics, 39,000 rural health centers and 40,000 shops. The innovation of the program is in reconciling the profit motives of the private sector with the clients’ need for services at low prices. Special schemes are on the anvil for the poorest segments who, by using coupons and vouchers available from the government, can access the services free. The providers will be reimbursed for services.

4) Description of the operational model: Janani implements a business plan using social franchising and social marketing techniques to deliver reproductive health services. Economies of scale are used to reduce prices and increase earnings of providers.

Janani procures commodities in bulk. The resultant low prices help the poor. Shops sell the products in urban and semi urban areas. Rural health providers sell at a pre- determined fee. They refer clients to medical clinics to earn a commission.

Janani provides overall advertising support through local and mass media.

The enhanced capacities of doctors enable provision of a wide range of clinical reproductive and health services. The basket of services is constantly expanded to keep the equity levels high. Janani conducts special communication activities in slum areas to promote the services.

The innovation in the model is the integration of networks so they deliver comprehsensive care on a sustainable basis. All the providers deliver services for their own self interest of earning more profits but it addresses large social needs. Janani plays the role of an intermediary to increase caseloads and reduce delivery prices to clients.

Bundling is used as the strategy to create financial viability. Providing communication support, training and commodities at low prices make a viable combination for the providers. This helps Janani enforce the quality of care norms and bring down the prices of services at levels affordable by the vulnerable sections.

5) Description of the financial model: The services are provided at half the market prices. Products are highly subsidized by the government and studies show that they are affordable by almost all segments of Indian society.

Clinical services do not get any subsidies from the government. The prices can be lowered only till a point beyond which the providers’ interest will flag. The poorest of the poor cannot afford these even though they are significantly lower than market prices. Janani has entered into a dialogue with the government to use coupons and insurance to help the poor.

Janani supplies bulk-purchased commodities and conducts a number of marketing and motivational activities to increase caseloads. A coordinator in each clinic ensures that doctors charge the right price. The prices are also widely advertised to empower clients.

Currently the program meets one-third of its cost through revenues and membership fees. Rest of the expenses are met by donors. Attempts earlier to increase revenues by increasing prices led to sharp fall in caseloads.

There is a possibility that in the long-term the model will benefit from output based aid model that is rapidly emerging as a viable option.

      Client fees represent this approximate percentage of operational budget: 7%

6) Key operational partnership: Janani has established strong linkages with the Indian government. The government has recommended that the model be replicated in other parts of India as an effective strategy for public-private partnerships. The programme also works closely with the private providers in the three states and established strong linkages with them. The operation is highly automated and the software was developed in the program area. Trainers too are drawn locally, which has enhanced capacities. Janani has partnered with a government recognized rural university to train in obstetric care. Market research agencies have provided regular inputs in process performance enabling Janani to correct course. Janani is currently partnering with ITC Ltd and Tata Steel, both corporate conglomerates but with an interest in improving health care as their social mission. A clinic each has been set up with both the companies. Janani is collaborating with the Indian Statistical Institute to conduct data analysis using six sigma methodology.

7) Current outreach:

What is the order of magnitude of the potential demand for your products or services? Which
    other low-income groups, countries or regions could benefit from it? Try to quantify (number
    of clients, market size in currency):
The unmet need for reproductive health services is high in most of poor developing countries, specially in Asia and Africa. The Janani model works on scale and sets up systems that can address needs with urgency. This model can benefit perhaps 5 million clients in Africa and perhaps 15 million in Asia every year.

A medical clinic providing reproductive and health services

8) Scale-up strategy: