Harvard Case - Transforming Maternal and Newborn Healthcare in India Through Midwifery: The Fernandez Foundation Initiative
"Transforming Maternal and Newborn Healthcare in India Through Midwifery: The Fernandez Foundation Initiative" Harvard business case study is written by Swati Sisodia, D.V.R. Seshadri. It deals with the challenges in the field of Strategy. The case study is 19 page(s) long and it was first published on : Sep 23, 2021
At Fern Fort University, we recommend that the Fernandez Foundation (FF) aggressively pursue a multi-pronged strategy to scale its midwifery program across India. This strategy should leverage a combination of disruptive innovation, strategic partnerships, technology integration, and advocacy efforts to create a sustainable and impactful model for improving maternal and newborn healthcare in India.
2. Background
The Fernandez Foundation, a non-profit organization, aims to address the alarming maternal and newborn mortality rates in India. Their approach focuses on training and deploying skilled midwives to underserved communities, promoting a community-based healthcare model. The case study highlights the challenges FF faces in scaling its program, including limited funding, infrastructure constraints, and a lack of awareness and acceptance of midwifery in India.
Main Protagonists:
- Fernandez Foundation: The non-profit organization spearheading the midwifery initiative.
- Dr. Fernandez: The founder and driving force behind the foundation, passionate about improving maternal healthcare.
- Midwives: The trained professionals at the heart of the program, providing essential healthcare services.
- Indian Government: The key stakeholder influencing policy and resource allocation for healthcare.
- Communities: The beneficiaries of the initiative, facing significant challenges in accessing quality healthcare.
3. Analysis of the Case Study
SWOT Analysis:
Strengths:
- Strong Mission: FF's commitment to improving maternal and newborn healthcare aligns with a critical societal need.
- Proven Model: The midwifery program has demonstrated success in pilot projects, proving its effectiveness.
- Dedicated Team: FF boasts a passionate and experienced team committed to the mission.
- Community Focus: The program emphasizes community-based healthcare, fostering trust and accessibility.
Weaknesses:
- Limited Funding: FF faces financial constraints, hindering program expansion.
- Infrastructure Gaps: Lack of adequate healthcare infrastructure in rural areas poses a challenge.
- Limited Awareness: Midwifery is not widely recognized or accepted in India, requiring awareness campaigns.
- Scalability Challenges: Replicating the model across India requires significant logistical and resource management.
Opportunities:
- Growing Demand: The increasing need for accessible and affordable healthcare presents a significant opportunity.
- Government Support: Potential for government funding and policy changes supporting midwifery.
- Technological Advancements: Leveraging technology for training, telehealth, and data collection.
- Strategic Partnerships: Collaborating with NGOs, healthcare providers, and private sector entities.
Threats:
- Competition: Existing healthcare providers may pose competition, requiring differentiation.
- Policy Uncertainties: Changes in government policies could impact program implementation.
- Economic Fluctuations: Financial instability could affect funding and program sustainability.
- Cultural Barriers: Overcoming traditional beliefs and practices regarding childbirth can be challenging.
Porter's Five Forces Analysis:
- Threat of New Entrants: High, as the healthcare sector is attractive to new players, but barriers to entry exist due to regulatory requirements and infrastructure needs.
- Bargaining Power of Buyers: Low, as patients have limited choices in underserved areas, but awareness campaigns can increase bargaining power.
- Bargaining Power of Suppliers: Moderate, as FF relies on skilled midwives and training institutions, requiring competitive compensation and training programs.
- Threat of Substitutes: Moderate, as alternative healthcare providers exist, but FF's focus on midwifery provides a unique service.
- Competitive Rivalry: Moderate, as FF faces competition from existing healthcare providers, requiring differentiation and strategic partnerships.
Value Chain Analysis:
FF's value chain includes:
- Research and Development: Developing training programs and best practices for midwives.
- Training and Education: Providing comprehensive training to midwives, equipping them with essential skills.
- Community Outreach: Engaging with communities, building trust, and promoting awareness of midwifery.
- Healthcare Delivery: Providing essential maternal and newborn healthcare services to underserved communities.
- Data Collection and Analysis: Tracking program impact, identifying areas for improvement, and informing future strategies.
- Fundraising and Advocacy: Securing funding and advocating for policy changes to support midwifery.
Business Model Innovation:
FF can leverage business model innovation by:
- Social Franchising: Partnering with local entrepreneurs to establish midwifery clinics, leveraging their local knowledge and resources.
- Telehealth Integration: Utilizing technology for remote consultations and monitoring, expanding reach to remote areas.
- Data-Driven Approach: Collecting and analyzing data to improve program effectiveness, optimize resource allocation, and inform policy decisions.
- Value-Based Pricing: Developing a pricing model based on outcomes and value delivered, attracting private sector investment.
4. Recommendations
1. Strategic Partnerships:
- Government Collaboration: Engage with the Indian government to secure funding, advocate for policy changes supporting midwifery, and integrate the program into existing healthcare infrastructure.
- Private Sector Partnerships: Collaborate with pharmaceutical companies, insurance providers, and healthcare technology companies to access resources, expertise, and technology.
- NGO Collaborations: Partner with other NGOs working in maternal health to leverage their networks, resources, and expertise.
2. Disruptive Innovation:
- Technology Integration: Leverage technology for training, telehealth, data collection, and communication, improving efficiency and expanding reach.
- Mobile Clinics: Utilize mobile clinics to provide healthcare services to remote and underserved communities, overcoming infrastructure constraints.
- Community Health Workers: Train community health workers to support midwives and provide basic healthcare services, increasing accessibility.
3. Advocacy and Awareness:
- Public Awareness Campaigns: Launch nationwide campaigns to raise awareness about midwifery, its benefits, and the importance of skilled birth attendants.
- Media Engagement: Engage with media outlets to disseminate information, promote the program, and advocate for policy changes.
- Community Engagement: Organize workshops, seminars, and community events to educate and empower communities about maternal healthcare.
4. Financial Sustainability:
- Diversification of Funding Sources: Explore alternative funding sources beyond grants, including social impact investments, corporate sponsorships, and crowdfunding.
- Social Enterprise Model: Develop a social enterprise model that generates revenue through providing healthcare services, contributing to program sustainability.
- Cost Optimization: Implement cost-saving measures in training, logistics, and operations to maximize resource utilization.
5. Program Expansion:
- Phased Rollout: Expand the program gradually, starting with pilot projects in specific regions, demonstrating success and building capacity.
- Regional Focus: Prioritize regions with high maternal and newborn mortality rates, targeting areas with limited access to healthcare.
- Data-Driven Decision Making: Utilize data to identify areas with the greatest need, optimize resource allocation, and track program impact.
5. Basis of Recommendations
These recommendations are based on a thorough analysis of FF's strengths, weaknesses, opportunities, and threats. They address the key challenges the organization faces, such as limited funding, infrastructure constraints, and lack of awareness, while leveraging its existing strengths and tapping into new opportunities. These recommendations also consider the following:
- Core Competencies and Consistency with Mission: The recommendations align with FF's core competencies in midwifery training and community-based healthcare delivery, supporting its mission of improving maternal healthcare.
- External Customers and Internal Clients: The recommendations prioritize the needs of communities, midwives, and healthcare providers, ensuring the program's effectiveness and sustainability.
- Competitors: The recommendations emphasize differentiation through disruptive innovation, strategic partnerships, and a focus on underserved communities, creating a competitive edge.
- Attractiveness: The recommendations are expected to generate positive social impact, attract funding, and contribute to program sustainability.
6. Conclusion
The Fernandez Foundation has a unique opportunity to transform maternal and newborn healthcare in India by scaling its midwifery program. By embracing disruptive innovation, forging strategic partnerships, and leveraging technology, FF can create a sustainable and impactful model that improves access to quality healthcare for millions of women and children.
7. Discussion
Alternatives:
- Focusing solely on training: While important, this approach may not address the broader challenges of infrastructure, access, and awareness.
- Adopting a traditional healthcare model: This approach may not be as effective in reaching underserved communities and may not leverage the unique benefits of midwifery.
Risks and Key Assumptions:
- Government support: The success of the program relies on sustained government support, which may be subject to political changes.
- Community acceptance: Overcoming traditional beliefs and practices regarding childbirth may be challenging, requiring ongoing community engagement.
- Funding availability: Securing sufficient funding for program expansion is crucial, requiring effective fundraising strategies and partnerships.
8. Next Steps
- Develop a comprehensive strategic plan: Outline the program's vision, mission, objectives, and key strategies for implementation.
- Secure funding: Identify and secure funding sources to support program expansion and sustainability.
- Establish strategic partnerships: Form partnerships with government agencies, private sector entities, and NGOs to leverage resources, expertise, and networks.
- Develop a robust technology infrastructure: Invest in technology for training, telehealth, data collection, and communication.
- Pilot the program in selected regions: Implement the program in pilot projects to demonstrate its effectiveness and build capacity.
- Monitor and evaluate program impact: Track program outcomes, identify areas for improvement, and inform future strategies.
By implementing these recommendations, the Fernandez Foundation can position itself as a leader in transforming maternal and newborn healthcare in India, creating a lasting impact on the lives of millions of women and children.
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Case Description
The case explores the promises and challenges of Public-Private Partnerships (PPPs) in the Indian Healthcare system. India has a high maternal mortality rate, poor doctor-to-patient ratio, rising C-section rates, absence of last-mile access to quality maternal healthcare. In this context, Dr. Fernandez, a veteran in maternal healthcare, believes that midwifery is a workable solution to these widespread problems. However, to have an impact both in terms of and financial sustainability, government support is essential. Dr. Fernandez thinks that a PPP may be the best way to create many well-trained and professional midwives in the country. However, given India's complex healthcare structure, it is not easy to get acceptance and commitment from all the states for government schemes. Problems such as frequent changes in the bureaucratic leadership often disrupt the implementation of schemes. Another challenge is the mindset of birthing mothers, the obstetric community, and family members who view the medicalization of birthing as acceptable. Dr. Fernandez has to overcome multiple challenges. She has to address obstetricians' pushback while changing birthing mothers' mindsets and continually motivate the midwives her team had trained. Regarding the PPP, she has to evolve a plan to fast-track the rollout of the PPP model, ensure that the complex PPP involving multiple stakeholders works effectively, she has to address the roadblocks to the implementation of the PPP initiative, and design mechanisms to monitor progress.
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