The Bangladesh Smiling
Sun Franchise Program
Sustainability as Program
Objective
Definition of Sustainability
Sustainability is understood as the systemic capacity of an
organization to consistently respond to societal demands
while generating resources that cover structural needs
and planned development.
Sustainability is understood as the managerial capacity
of an entity to consistently deliver needed and
demanded quality healthcare services while directly or
indirectly generating sufficient revenues to cover overall
operating and management expenses.
The Sustainability Cycle
Understanding
evolving needs
Entrepreneurial
invention
Resources
Distinctive
Competencies
BUSINESS
MODEL
Results
Competitive
advantage
Adapted from Van Der Heijden, Kees; Scenarios: The Art of Strategic Conversations,
John Wiley and Sons , 2005, West Sussex, England
Smiling Sun - the challenge:
Double bottom line
– Expand access to quality affordable health
services
– Increase the number and proportion of poor
people served
– Attain high levels of cost recovery
Enabling Exogenous Factors
• Large populations. High numbers, high density.
• Custom of paying for health services. Majority of
health services in Bangladesh are paid OOP
• Sophisticated market
– GOB contracting out
– Third party payers (Companies, Insurance Schemes)
• Societal changes
– Growing middle class
– Urbanization
– IT use on the rise
• Donor’s interest
Enabling Endogenous Factors
• Sunk investment. USAID had invested for years
in establishing a clinic network
• Diversified service structure. SSFP provides FP,
child and maternal health services, diagnostic
and LCC.
• Installed capacity available
• Brand equity
Sustainability: Areas of Attention
– Invest in relevant market differentiation
– Develop ecosystem
– Redefine relationships with clients
• More service options for existing clients
• Expand client base (regular, corporate, government)
• Develop new products
– Address financials
• Cost management
• Pricing
Conversion Process:
Preparing for Sustainability
Conversion Elements
Sustainability
Determinants
Clinic Physical Enhancement
Higher value
perception
Client Centered
Quality of Care
Methodologies &
Tools
Management
Systems
Improvement &
Development
Brand Equity
Enhancement &
Services
Promotion
Continuous Capacity Building
Client loyalty
developed
Increased client traffic
Increased clinic
income
Lessons Learned
Challenges
– Culture matters
– Business as usual,
– “Donor dependence”
– Clients in the center
– Mind the timeframe
– Align agendas of different stakeholders
– Effort to promote new models
Lessons Learned
What works
– It is important to have a common (well understood) objective
– Clients and providers like good quality
– People pay… really
– If you offer, they will come (integration works, new services and
more)
– Partnership with government