Business models in global health: Village Health Works

Delivering care in one the world’s poorest countries 
Student observations on Village Health Works’ participatory care model

In late 2010, a small team of MIT students took a look at the organization from the outside and, as a course assignment, prepared an executive summary aimed at its board of directors. This article presents their overview and assessment of the organization, and their thoughts on challenges and opportunities. Keep in mind that this a class assignment drawing largely on publicly-available materials and in some cases direct, though limited, interaction with the organization. We share the student’s work in the hopes that others will build on it in keeping with the creative commons license.

by Grace Chen, Tracy Han, Terry Hu, Zanyar Golabi

Overview of Organization

Village Health Works was founded by Deogratias Niyizonkiza, a Burundi-American physician whose story is told in Tracy Kidder’s book Strength in What Remains. When Village Health Works was founded in 2006, Burundi was the poorest nation in the world (it is now 5th poorest), and is still recovering from years of violence after genocide and war. Working in this setting, Village Health Works not only provides free healthcare to the community, but aims to address the social determinants of ill health in a dignified manner. Since its founding, its clinic has treated over 40,000 patients and it has built a safe water supply to the area. It has also established projects on food security, education, employment and economic development.

Village Health Works delivers their service through community health workers, physicians, nurses, and a lab technician. Other staff and volunteers support their ancillary services. Community health workers identify patients and families in need of help and visit their homes to provide care, including vaccinations for children, ready-to-eat therapeutic food for the malnourished, and daily care for HIV and TB patients. The community health workers are critical in care delivery because they are the point of care for many patients. They also generate a feedback learning loop by providing information to clinic staff about local social needs and economic conditions. In the clinic, there is one physician, four nurses, and one lab technician, as well as clinical volunteers from abroad who share skills and learn from the Burundian medical staff.

As for ancillary health functions (food, water, education, economic development), agricultural volunteers work with community members on common problems like lack of soil fertility with the ultimate goal of ensuring food security for the community. Village Health Works financially supports children’s tuition, books, and uniform fees so they can attend school. In health and health support activities, Village Health Works places importance upon using local resources and people to deliver care and services. They believe strongly that “the process of delivering health care in a participatory way is an engine for economic security”; providing healthcare and jobs at the same time is a win-win situation.

Accounting for success

VHW is entirely dependent on external funding, as the organization does not generate income for itself. 75% of funds come from private donors, 15% from foundations, and 10% from talks given by the founders. Village Health Works is supported by its impressive list of partners and advisors. They include Partners in Health (donation processing, technical support, advise), the Burundi government (HIV meds and lab supplies), and Solar Electric Light Fund (solar energy). The in-country executive council includes the Minister of Education and the Minister of Health. The Kigutu community itself has been a main driver of success through donating land for the medical clinic and volunteering physical work. By aligning their goals with the needs of the people, the organization has managed to achieve the trust and buy-in from the village necessary to achieve success.

Considering the fact that Village Health Works is only three years old and serving one of the poorest countries in the world, we can conclude that Village Health Works has been performing well given the country’s limited facilities and infrastructure. Indicators include the volume of patients served, the number of services and new opportunities, strong partnerships with the community, the staff’s awareness of values, and alignment between the organizational mission and its activities.

Looking ahead: student thoughts

We identified three main challenges: financial dependence on donors, too broad of a focus, and the difficult local conditions.  For addressing financial stability, we recommend working towards long term funding guarantees from the Burundi government, foundations, and private donors.  As for having a broad focus, Village Health Works is only one organization with limited resources and expertise. Therefore, we recommend that Village Health Works strategically partner with the government and other organizations that have expertise in areas that fit with Village Health Works’s mission.

Furthermore, we recommend that Village Health Works implement a structured method of evaluating its performance and encourage learning. We applied the balanced scorecard framework, which takes Financial, Customer, Internal Business Processes, and Learning and Growth perspectives to link outcome measures with drivers of outcomes.

At this critical point in Village Health Works’s history, we recognize the importance of putting in place a strong management infrastructure that both establishes and secures its long term presence in the community and is flexible enough to learn and adapt.

Download the accompanying student presentation on Village Health Works (pdf).

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