Country Work

The Banking on Health project has designed an intervention to address this bottleneck by providing technical assistance to midwives, the franchise and the local banking sector. We are working with the midwives to improve their ability to identify bankable projects, apply for loans, and manage credit. We are building the capacity of the franchise management to offer on-going advisory services to member midwife clinics to assist them in applying for loans. Finally, we are working with local banks in the Philippines to promote lending to midwife clinics and private health care providers in general. We provide training to lenders in understanding the private clinic business model and we bolster the bank’s loan origination, loan structuring and monitoring skills. We complement this training with on-the-job technical assistance. Another important component of our bank strategy in the Philippines is supporting USAID’s Development Credit Authority (DCA) guarantee. USAID structured a DCA loan portfolio guarantee to Opportunity Microfinance Bank, a local thrift bank, to provide a partial guarantee of loans to the midwife clinics. We are providing training and advisory services to Opportunity Microfinance Bank to support the use of the DCA guarantee.

Combined these interventions promote financing for the growth of the individual midwife clinics and the WPFI franchise, increasing positive family planning and maternal and child health outcomes in the Philippines.

Resources and Tools for Private Practice Midwives in the Philippines:

• Banking on Health Directory of Financial Institutions in the Philippines
• Tax Form 2551m for Midwives in Private Practice in the Philippines
• List of Suppliers to Midwives in the Philippines
• Birthing Home Requirements in the Philippines
• How Birthing Homes are Assessed in the Philippines
• Tax Form 1601C for Midwives in Private Practice in the Philippines
• Midwife PhilHealth Accreditation Application
• Midwife Registration and License Application
• Private Midwife Business Requirements in the Philippines

Nicaragua

Supporting Contracting Out in the Private Sector

In Nicaragua the Banking on Health Project is supporting the National Social Security Institute’s (INSS) efforts to contract out a basic package of primary health care services in the private sector. This package covers approximately 16% of the population, including formal sector workers and their dependents. Contracting out is an important mechanism that can increase access to high quality reproductive health and other services. Under the contracting out program in Nicaragua, private providers must improve their infrastructure and invest in quality of care. There has been some pressure on small providers to consolidate in order to scale-up services. This process of improvements and investments has been constrained by a lack of access to commercial financing. In order to address this barrier, USAID/Nicaragua structured a Development Credit Authority (DCA) loan portfolio guarantee with two commercial banks in Nicaragua to promote health sector lending. The Banking on Health Project is supporting this effort with a three pronged package of technical assistance:

• Training to the banks in understanding the health care market in Nicaragua and health sector lending.
• Training to private providers in financial management, identifying bankable projects and preparing business plans.
• Working with the social security institute in revise its certification process as a way to encourage EMPs to improve their financial management and quality of service delivery.

In addition to supporting improvements to financial management and access to financing, the Banking on Health Project is also seeking to improve reproductive health outcomes within the contracting out system. This system in Nicaragua is a capitated plan, which covers both family planning services and more expensive deliveries. Despite the significant cost savings of promoting more inexpensive preventive services, such as family planning, most providers are unaware of the financial incentives and are not actively promoting reproductive health services. The Banking on Health Project will train providers in cost containment strategies within the capitated system, with a focus on promoting preventive services, such as family planning. We will also train the Social Security Institute and Ministry of Health in the importance of family planning and reproductive health as part of the contracting out package.