Primary Healthcare as a Social Business: Lown Community Health Centers (LCHC)
Primary healthcare centers are essential in providing basic health services, and their crucial role has been formalized in the Declaration of Alma-Ata in 1978. Almost 40 years after that declaration was signed by nearly all countries, half of the world’s population do not have access to primary healthcare services (WHO 2017). In 2015, all countries signed the Sustainable Development Goals, which include universal healthcare coverage as a target. However, in many developing countries, governments lack the political will or the resources to achieve this goal. Even where primary healthcare centers cover a large proportion of the population, the public healthcare centers are focusing on maternal and child health and are often ill-equipped to manage the now more common chronic non-communicable diseases such as diabetes and hypertension.
Therefore, in the Lown Scholars Program of the Harvard T.H Chan School of Public Health, we have developed detailed business plans to establish primary healthcare centers as a social business. Social business is a new model of building sustainable enterprises with a social impact (Yunus 2006). Social businesses have been successful in solving public health problems in low-income countries, such as providing access to nutritious food (e.g., Grameen Danone) and clean water (e.g., in schools in Uganda). A few enterprises have also used this model to deliver healthcare services; for example, in remote areas of Liberia.
We have put together a team of public health professionals across four countries in sub-Saharan Africa (Uganda, Kenya, Tanzania and Nigeria-Cross River, Koge, Osun, and Oyo) and two countries in south Asia (Pakistan and India) and have developed business plans with input from experts in community medicine, global health, epidemiology, pharmacology, information technology, and business administration. The model combines a microinsurance scheme with a detailed set of Standard Operating Procedures to ensure high-quality affordable care. A state-of-the-art health and management information system has been developed to monitor quality of care, health outcomes, and finances across all centers. We have also conducted health surveys in the selected communities and revised our business plans to incorporate the health needs of each community and their willingness to pay.
The long-term goal of the project is to set up a global network of Lown Community Health Centers in underserved areas. The Centers will serve as engines of social justice by providing affordable high-quality primary healthcare services and preventing catastrophic healthcare expenditures that drive more than 100 million people to poverty each year. The centers are named after our benefactor and mentor, the renowned physician, activist, and Nobel Laureate Dr. Bernard Lown.
In the next three years, we plan to:
- Establish seven new centers in Africa: We plan to establish seven new centers in Kenya, Nigeria, Tanzania and Uganda. These centers require a start-up investment of US$1.45 million. We expect the centers to break even during the third year of activity and thereafter generate a surplus. Each center operates on a membership model, of $1 to $2 per person per month. This entitles members to unlimited free visits with doctors, nurses, and community health workers and substantial discounts on medicines and laboratory and diagnostic tests.
- Expand current centers in Asia: We plan to expand the services and centers that our partner organizations operate in Mumbai and Karachi.
