Podcast transcript: Investing in women-owned health businesses: a triple win
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Eric Tischler: The shops plus program is USAID's flagship project for improving and sustaining global health outcomes through public-private engagement. The scope is huge, but today we're going to focus on how SHOPS Plus is strengthening health outcomes by empowering women health care providers. I'm Eric Tischler from Abt Associates and today I'm joined by three leaders on that front, they'll shed some light on the project's activities from three different perspectives, each of fielded in its own rate. Private health sector, gender, and access to finance. Caroline Quijada is a principal associate at Abt and the deputy project director for SHOPS Plus. She's an expert in family planning and reproductive health with a particular focus on private sector initiatives. Mary Beth Hastings is the senior associate at Iris Group and the gender liaison for the SHOPS Plus project. She's been working for close to three decades on gender, global health, and human rights. Ignacio Estevez is a principal associate at Banyan Global and the access to finance director on the SHOPS Plus project. He has over 30 years of banking experience, including over 20 years working internationally with a focus on development finance, and 12 years in the US private sector. I know I just said it's a huge project, But Caroline can you start by giving us an overview of SHOPS Plus.
Caroline Quijada: As you mentioned our project is very broad, we cover a number of different health areas, from child health to family planning to HIV and TB. And we apply a number of different technical approaches with the private sector, so things like networking and social franchises, financing quality. Historically our focus has been on markets, so really focused on information product and service delivery and strengthening the quality of care of the services and information that are provided through the private sector. Our project now reflects new priorities that are emerging from USAID, and those include things like stronger engagement with government. So, the private sector engagement strategy comes into play. And gender integration. I think what's exciting about our program is that we can bring together all these different disciplines because we are so broad. And I think a great example is the work that we do with our partners Iris and Banyan Global, which I know our client has been excited about because it focuses on women's economic empowerment and access to credit.
Eric Tischler: Great. Mary Beth you want to tell us a little about Iris Group and then explain how you're contributing to SHOPS Plus?
Mary Beth Hastings: Sure. Well, Iris Group helps clients to understand and address issues of gender and social inclusion. And on SHOPS Plus we are the gender partner on SHOPS Plus. So, we work to ensure that SHOPS Plus strategies and activities promote gender equality. So, we collaborate with the technical and regional staff at Abt to address the obstacles related to gender discrimination. And we build understanding about the role of the private health sector in advancing gender equality.
Caroline Quijada: I think one of the things that Iris has done so well is integrate gender across our project. Not only in the field in the implementation of our activities, but working with our staff both in the headquarters as well as our teams that are located in in the field. And I think what they've done really is help to reorient our lens so that everything we do from a work plan, to an evaluation, to design of a new program has that gender lens in you know front and center.
Mary Beth Hastings: Thanks Caroline and just to add to that, the work we've done on women's economic empowerment I think is really I think fundamental to using this gender lens. Women's economic empowerment is such a hot issue in development circles and, as you said, it's really a priority of the client. But although women are 70 percent of health workers, and many of them are entering into private practice, we don't know very much about women's economic empowerment as owners of those practices. And so as one of our stand-alone activities we hope to shed some light on this. So, we went to Kenya and Uganda and we did extensive interviews with women health providers there. All of them participate in social franchise networks. So these networks are designed to improve access to family planning, but not necessarily to improve women's success as business women who own practices. And so our theory was that that actually even though there's not an intention to improve women's economic empowerment through these social franchises, that by alleviating and taking care of some of these obstacles to credit, to technology, to access to insurance schemes, that by breaking down some of these barriers, that women were actually benefiting from these social franchise networks in ways that maybe the men didn't benefit from because they already had those advantages, they already had those privileges as men in their societies. And so the interviews were extremely interesting and revealed that these women are big on vision, big on how they want to see their practices expand, but we're limited in terms of having access to that business training and to even conceptualizing of themselves as business women.
Eric Tischler: Thanks. Ignacio I know Banyan Global address the fact that many private healthcare providers are women, and they're not just providing services, they're running businesses. You want to talk about the financing and business training?
Ignacio Estevez: Sure, and thanks Eric, and thanks for the opportunity to participate in the podcast, especially with my colleagues Caroline and Mary Beth. Maybe if I can start by providing some context as it relates to our work under SHOPS Plus. As we know globally the reliance on the private sector continues to grow and as a result there's an increased need for investment. Investments they're required to meet demands in terms of capacity, availability of services, and quality. The challenge the private sector faces, in particular small and medium-sized facilities, there's a difficulty in securing access to loans for these investments. Financial institutions, which are the primary source of financing, are hesitant to lend to the sector as they have various concerns. Concerns around lack of market information, risks associated with the sector, such as credit risk, and reputational risk, and just generally the poor quality of loan applications that owners of facilities submit to the banks. As a result available financing for these investments is limited, and the sector faces, and will continue to face, significant challenges in meeting the demands of the population they aim to serve. Banyan Global is leading the access to finance and business strengthening component of SHOPS Plus. Our role within the project is twofold, one is to support private health facilities to strengthen their business skills, and secondly to work with financial institutions to increase availability of loans for the private health sector. Following up on the work that Mary Beth conducted, we conducted a gender analysis in Tanzania. It was an analysis that aimed at identifying barriers and opportunities that women-owned private health facilities face. I think it's important to keep in mind that these tend to be small facilities, but have a very important role in provision of reproductive health services, maternal and child care services. So findings from the analysis were used to develop solutions that we expect will support women owned facilities and their business operations, including the ability to access loans to facilitate work, to facilitate growth. So far we've managed to adapt our training material based on these findings. We've changed the delivery methodology from traditional classroom to WhatsApp platform. We've delivered training recently to a selected group of women owners, that belong to social franchise, and we will continue to adapt our learning based on the learnings.
Eric Tischler: Thanks, and I'm going to point out for those who don't know that WhatsApp is a free global messaging platform and this was a very cool usage of that tool. Caroline, I know Abt has done a lot of work connecting private healthcare providers to financing in order to expand healthcare capacity through the private sector. So how is this different, or you know what are we, how are we expanding that envelope?
Caroline Quijada: So a few things I think. So one, it's not just work that that Ignacio and team, and Iris through gender lens are doing with social franchises. There are many types of providers out there, not all of them involved in a social franchise network, there are lots of small businesses that are stand-alone, there's an emerging group of social enterprises. And I think we're you know we're beginning to explore one of the specific needs of women owned businesses and female entrepreneurs that need to be considered. And I think you know Ignacio mentioned adjusting trainings, perhaps we need new modules, but I think what we are what are we doing currently is really, how do we you know bring together this stronger understanding of the specific needs of women-owned businesses and how do we adjust all of our program. And not just in the area of access to financing, but across the board. I think this is an exciting new step for us as a program, and I think we'll begin to see many many more developments and results as we move this work forward.
Eric Tischler: Ignacio, Mary Beth, you want to talk about maybe some of the things we're hoping to see moving forward? And you to Caroline?
Mary Beth Hastings: Well, I think one of the exciting takeaways for me is, and one of the things that I think can be used by folks in SHOPS Plus or in other programs, is the empowerment framework that we use to analyze our interviews. And it wasn't just an analytical tool, it can be used as a way to look at what your program, what your intervention, is offering to women owned businesses who own health care businesses. So, I think that's one of the exciting takeaways that other projects can use and apply to their own interventions.
Eric Tischler: Great. And now is a good time to point out that the framework is described in the brief, and you can access it on the SHOPS Plus website. So, let's look at the finance side of health care. Ignacio what have you found noteworthy in this work?
Ignacio Estevez: I mean for us what was exciting is that there are tons of studies that look at women, as I mean women owned businesses, and the difference that exists between them and men. I don't think anything's been done in the health sector before, and what we're able to do is really look at how to better reach women both with financing and training. They have different profiles, they have different needs, you know they're different approaches to reaching them that will enhance the value that they get from the approaches. And you know a simple example for me is, on the financing side, and this is really a simple one, many women feel uncomfortable being attended by a male loan officer. And this is something that came out from the analysis. So having a bank simply install female loan officers, to attend the sector, creates a level of comfort for women where they can come in, talk to the bank comfortably, and you know increase the their ability to access financing. I think on the on the training side one of the interesting things was the developing WhatsApp, of the training through WhatsApp, because this reduces the time that the women owners of facilities require to attend training. So rather than traditional training where they have to leave the family and the business, and spend two, three, four, five days locked up in a hotel, we're able to do this through WhatsApp where they can do it remotely from their home or their businesses when they have time, and over a period of, in this case 14 weeks.
Eric Tischler: That's great that WhatsApp gives them a chance to sort of train on their own schedule.
Caroline Quijada: So I just want to add to what Ignacio is saying, because I think he's raising a very good point which is COVID has really forced many of us to move to more digital technology. So he's talking about WhatsApp and a training program that they rolled out and that seemed to really resonate with women involved in the program. But there is a huge digital divide when it comes to male and female ownership, and understanding, and comfort with regards to digital technologies. And I think that's something that we are starting to incorporate and integrate into our programs. I'm excited by what can be done. What does it mean to be a female owner of a business that's exploring telemedicine? We're also beginning to look at management structures. What does it mean for supportive supervision when it's a male provider who's being supervised by a female who's more senior than they are, what's the dynamic? This is some of the work that Iris has also begun to explore. So again that intersect between gender, and everything we're doing, is an area that we as a project are exploring more and more. And we're seeing a lot of exciting results.
Ignacio, is there a better return with regards to lending like on default rates for women than men? Are women a better bet when it comes to lending, are you seeing any of that?
Ignacio Estevez: I mean there's tons of studies out there that show that women tend to be more risk adverse, and as a result they’re better credit risks for banks. We just kicked off this activity in the health space in Tanzania, where we're developing a value proposition targeting women owned health facilities. So, the results are yet to be seen, but generally, globally, in the SME space women tend to be a better risk. I think the big challenge is that banks just don't see this as a market, and especially in the health sector where it's viewed as a social good, they don't see it as a business. And to the extent that they can develop a proposition that targets the specific needs of women in the health space, if they see a business opportunity there's a really strong potential to provide them the investment that they need, the funding that they need in order to make the investments to grow.
Mary Beth Hastings: You know it's important for us to underscore how important this is not just to these women business owners, but how important it is to these communities. They're often serving in these underserved areas where there's not a public facility. And so there was one example of a woman whose clinic we visited, and she had taken the training, and the access to credit, and the supportive supervision that she was getting from the social franchise network, and turning it into this amazing building on a, you know, another story, getting access to equipment that would allow her to do different procedures than she was able to before. And she even created these private maternity suites, because she heard from women in the community. There were some women in the community who said, okay I would like to give birth in your facility, but I would like a private suite. And so she created these suites in response to demand from her community, with access to credit, with access to training and it was a huge hit, she was already building two more suites in her facility to expand her services. And so you know what we're really talking about here is addressing problems in the market that are caused by gender discrimination, and when we take away those barriers we are opening up all kinds of possibilities, not just for these women, but for their communities as well.
Ignacio Estevez: One of the benefits that we've seen from these trainings that is focused on women, and thereby delivered by women, and only attended by women, they feel much more comfortable in a setting, and they open much more about some of the challenges that they face and how they've addressed them, again on the business side and on the investment side. And so it's been a, it's been really interesting to see this sort of win-win associated with it.
Eric Tischler: I was going say it sounds like a three-sided win right? There's the addressing gender discrimination, and expanding health care capacity, and there's a financial opportunity, so it's just a win-win-win. And that seems like a good place to end it. Hopefully we'll have an excuse to get together in the near future to discuss more SHOPS Plus wins. Thank you all for joining me.
Mary Beth Hastings and Caroline Quijada: Thanks Eric.
Ignacio Estevez: Yeah thanks everyone.
Caroline Quijada: And always remember to look at our website www.shopsproject.org.