Boutik Sante (Community Health Store)

Boutik Sante is a social franchise that will bring nutrition-related products, services, and education to 2 million rural Haitians by 2021.

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I confirm that I am fully aware of the eligibility criteria, and based on its description, I am eligible to apply to the CSV Prize 2017.

  • Yes, I'm eligible

Preferred language

  • English

Organization name

Fonkoze

Year founded

1994

Initiative stage

  • Growth (the pilot has already launched and is starting to expand)

Annual budget in 2017 (USD)

  • $500k - $1m

Number of beneficiaries impacted so far

  • More than 100,000

Organization type

  • Nonprofit, NGO, or citizen sector

Secondary Focus Area

  • Rural development

Headquarters location: Country

  • Haiti

Headquarters location: City

Port-au-Prince

Location(s) of impact

Haiti:Milo,Lenbe,Twoudino,Ganize,Kabare,Gantye,Lavale,Okay,Okoto,Fonveret,Miragwoan,Jakmel,Bomon,BoukanKare,Lagonav,Senrafael,PonSonde,Aken,Sodo,Mibal

Website

http://fonkoze.org

Facebook URL

https://www.facebook.com/Fonkoze/

Twitter URL

https://twitter.com/fonkoze

Problem: What problem is this initiative trying to address?

In rural Haiti, the mortality rate for children under 5 is 81/1000 births, and the stunting rate is 24%. The causes of malnutrition are linked to poverty, and its perpetuation is linked to poor health infrastructure and education in rural communities. Education and screening services are often too far away to address and prevent cases of malnutrition. Boutik Sante is uniquely positioned to target malnutrition through Fonkoze’s nationwide network of microfinance clients, reaching the most isolated communities in Haiti.

Solution Summary: What is the proposed solution? What do you see as its most promising aspects for creating shared value?

Boutik Sante is a social franchising enterprise bringing health products, services, and education to rural Haiti. At scale (anticipated 2021), the program will reach 2 million Haitians; all proceeds from the sale of health products will cover operating costs, enabling the program to be self sustaining--no longer requiring external funding. By then, we will have engaged 1,800 franchisees nationwide; these are Fonkoze microfinance client leaders who are trained by our registered nurses to become “Community Health Entrepreneurs” (CHEs). These women learn to screen children under 5 as well as pregnant/lactating women for malnutrition, and they are linked with nearby health facilities for referral and follow-up. CHEs also train community members, especially households with cases of malnutrition, on good child nutrition practices. When operating at scale they will refer them to nutrition-sensitive gardening and animal husbandry activities as a means of supporting food security and nutrition.

Impact: What is the impact of the work to date? Specify both the social and the environmental impact of your work

In 2016, a Columbia University-led study sampled 1,000 households with children under 5 to assess the impact of Boutik Sante, yielding the following results, relative to a control group:

*6.1% fewer cases of diarrhea in the previous 6 months
*9.9% more households sought treatment for diarrhea
*12.7% more households procured water purification products
*12.8% more households procured infant hygiene products
*7% more households procured contraceptives
*Households demonstrated a 5.9% stronger knowledge of WASH practices
*25.1% more households practiced exclusive breastfeeding for six months

In addition, Fonkoze leverages the Boutik Sante social enterprise to conduct other nutrition-related programming. A five-year grant from USAID—“AKSYON”—deepens CHEs ability to identify and refer cases of malnutrition. Through AKSYON, CHEs have screened 29,048 children under 5 and 6,764 pregnant/lactating women for malnutrition. Of these, 1,383 cases were identified as malnourished (MAM/SAM)

Financial sustainability plan: How is this initiative financially supported? How will you ensure its financial sustainability long-term?

Fonkoze procures health products, sells them to boutik sante franchise owners (CHEs) at a 20% markup, and CHEs resell the products to their community members with another markup of 20%. Fonkoze also charges a nominal franchising fee for all Boutik Sante owners. Fonkoze's proceeds are funneled back into the operations costs of the program. By 2021, we anticipate that proceeds (earned income) will cover all costs of the program. That said, Boutik Sante is not yet a sustainable enterprise, and currently relies on grants to cover operations. The following is the percentage of the annual budget that comes from the aforementioned sources:

1. Individual donations or gifts - 0%
2. Grants - 70%
3. Corporate contributions - 0%
4. Earned income - 30%
5. Other - 0%

Unique value proposition: What makes your initiative innovative? How does your project differ from other organizations working in the same field?

Health social franchising has been attempted (examples: Living Goods/Kenya, Mercy Corps/Guatemala), but successful, scaleable provision of community-based preventive care in a financially sustainable manner has not been achieved. (DKT and others have had success at the clinical level.) Boutik Sante is on a trajectory to prove that it is possible to achieve BOTH high health impact AND financial sustainability. One key to Boutik Sante's success is its connection to Fonkoze's microfinance network.

Founding story: Share a story about the "Aha!" moment that sparked the beginning of this initiative.

In 1994, when Fonkoze’s founder set out to create a “bank for the poor,” he said that we could not “just give a woman a loan and walk away.” We had to accompany her in her journey out of poverty by providing access to other services, like education and healthcare. In Fonkoze’s annual General Assembly, 100 elected client representatives provide feedback to the senior leadership of Fonkoze, and they consistently requested that Fonkoze address two issues: limited health services and challenges with consistent supply of the products they sell.

We listened and responded through our health programming.

In 2012, 16% of clients who dropped out of Fonkoze Financial Services’ loan programs did so due to health issues. By 2016, that figure was cut nearly in half—to 9%. We believe that Boutik Sante, together with our other health initiatives, is making a positive impact in this regard.

Where did you hear about the Nestlé Creating Shared Value Prize?

  • Other

Program Design Clarity: We are hungry to know more about what exactly your model consists of. Succinctly list a) what main activities are you doing with your beneficiaries, b) where you carry out the activities? c) how often? d) for how many hours? e) who delivers the services? and f) any other brief details

a) Registered nurses train CHEs how to conduct basic health screenings (malnutrition, blood pressure, etc.); to understand and explain specifications of the products they sell; manage their small businesses; liaise with local health clinics; and other skills. While CHEs are trained to be on the front lines of basic preventive healthcare in their communities, they have a special mandate to focus on malnutrition. They identify children under five and pregnant/lactating women suffering from malnutrition; refer and accompany cases to local health facilities; and conduct follow-up monitoring visits to homes with cases of malnutrition.

b) CHEs are based in rural communities throughout Haiti. Once a month, they convene for their trainings and to procure inventory at the nearest Fonkoze microfinance branch office, of which there are 44 nationwide. Then, they return to their "boutik" in their communities to carry out the activities.

c) CHEs sell products, and train other women in their community. On an annual basis, they each conduct a malnutrition screening campaign to identify MAM/SAM cases in their communities.

d) CHEs are entrepreneurs, and Boutik Sante is a source of income. They set their own hours.

e) CHEs conduct screenings and liaise with established health facilities to ensure treatment and follow-up.

Focus area

  • Nutrition

We are interested in learning more about your initiative's broad impact on sustainable development. Please reply ONLY to the question(s) related to your above focus area.

The Boutik Sante Program improves access to basic health products, services and education in rural Haiti. In the areas we serve, households often travel long distances to access products/services that might be of questionable quality or availability. This unreliability, coupled with the prospect of losing a day's income in the farm fields or at the market, often dissuades impoverished households from taking measures to protect the health of family members. Fonkoze Foundation (a Haitian non-profit) partners with its sister microfinance institution, Fonkoze Financial Services (with 70,000+ clients throughout Haiti) to implement Boutik Sante. Through a sustainable, market-based approach, we provide nearby access to reliable, preventive healthcare.

Boutik Sante's innovation is twofold:
1-It transforms the "community health worker" approach that is used by devaelopment agencies worldwide. Instead of "workers" whose contract often ends when an aid budget dries up, Boutik Sante has "entrepreneurs," enhancing sustainability of health impacts while also providing economic opportunity to women.

2-It relies on Fonkoze Financial Services’ existing microfinance network and therefore does not establish new, program-specific infrastructure. Microfinance institutions reach 200 million households worldwide and Boutik Sante is evidence that a microfinance network can be leveraged to achieve health outcomes, in addition to economic outcomes (See Health Affairs article attached).

Creating shared value: How does your initiative create value for different stakeholders?

In the spirit of "Creating Shared Value," the Boutik Sante social franchise is benefiting business owners as well as the communities they serve when it comes to improving nutrition in Haiti.

BUSINESS - Fonkoze's initial pilot showed that CHEs had 20% profit margins from the sale of pharmaceutical products within six months of opening their franchise. Quantitative metrics are amplified when we consider that CHEs are impoverished Haitian women. Not only does Boutik Sante provide them with an income source; it also builds their business skills, leadership abilities, and their social capital.

SOCIETY - Distance, cost, and unreliable quality limit access to preventive health care in Haiti. Boutik Sante clients are community members who benefit from the products CHEs sell and from the education and screening services they provide locally. CHEs are linked with health facilities for referrals, and Fonkoze uses the network to provide systems support to the broader health network in Haiti

How is your initiative funded, now and over the next 5 years?

Boutik Sante's current cost-recovery level is 30%, and it relies on grant funding for the remaining 70%. We anticipate that by the time we have scaled the initiative throughout Haiti (by 2021), the program will be fully sustainable, with product sales and franchising fees covering operational costs.

We are in the process of finalizing a revised business plan, which will be ready in the coming weeks. Unfortunately, it is not ready to submit with this application. We would love to attach it to our application when it becomes available, if that is a possibility.

How do you plan to influence your field of work if you are a winner of this edition of the CSV Prize?

The CSV platform has already fostered exciting visibility, particularly for a Haitian organization with a limited budget for communications and outreach. We anticipate that being one of the CSV Prize winners will only enhance this visibility, and by extension, our ability to share our approach and lessons with others who have the capacity to implement similar initiatives worldwide. The rigorous review process and corresponding Ashoka/Nestle endorsement adds to our credibility, which we can leverage for funding and for influence in policy circles--within and outside of Haiti. Significantly, it gives deserved recognition to the ability of impoverished, uneducated Haitian women (CHEs) to impact the health of their community members.

How will you leverage an investment from Nestle to expand the impact of your work?

We anticipate that Boutik Sante will become a sustainable social enterprise by 2021, at which point, the sale of over-the-counter health products and basic health services will cover operational costs. Until then, Boutik Sante will rely on grants to cover costs. As such, a Nestle investment will bring us one step closer to sustainability by helping us to cover costs.

Furthermore, we anticipate that (as noted above), the Ashoka/Nestle endorsement will enhance our visibility and credibility, thereby inspiring confidence in other prospective donors. Perhaps more importantly, it will encourage others who have the capacity to implement similar initiatives worldwide to expand our social franchising for health approach outside of Haiti.

Spread Strategies: Moving forward, what are the main strategies for scaling impact? What’s the projected impact for the coming years? Are you planning to expand your programme into new locations? On what assumptions do you build your scale-up plans?

One of the innovative aspects of Boutik Sante is that it is tapping into Fonkoze's existing microfinance network and branch infrastructure. This means that we are already established in all the areas in which we are currently working and to which we will be scaling. Furthermore, Boutik Sante franchisees (CHEs) are existing microfinance clients with demonstrated leadership ability and a commitment to the health of their community members.

Fonkoze's microfinance institution has 44 branch offices nationwide. Boutik Sante is now reaching populations served by 20 of them. We have taken a rolling approach to scaling the initiative for several reasons, but most importantly, so that we can incorporate lessons learned into subsequent rollout phases. Branch selection and rollout has been primarily influenced by public health data in the various regions.

By 2021, we anticipate that Boutik Sante will reach all 44 branch offices, with 1,800 CHEs, serving over 2 million people in rural Haiti.

Team: What is the current composition of your team (types of roles, number of full-time vs. part-time staff, board members, etc.)? How will this team evolve as your initiative grows?

A 100% Haitian team with medical and business backgrounds leads Boutik Sante:

Team Leader - Dr. Florence Jean-Louis Vorbe, MD (15+ years experience working in the Haitian health system, with an emphasis on women’s health; 7 years with Fonkoze)
Deputy Team Leader - Dr. Wesly Elize, MD (10 years experience practicing medicine as Haitian MD; 6 years with Fonkoze)
1 Business Specialist
1 Administrator
2 Field Supervisors (Registered Nurses)
1 Registered Nurse in each of Fonkoze's microfinance branch offices
30 CHEs (approx.) in each branch office

Fonkoze's microfinance institution has 44 branch offices nationwide. Boutik Sante is now in 20 of them. As we scale throughout Haiti, we will hire additional nurses for each branch and engage additional CHEs (approx. 30 CHEs per branch).

Awards: What awards or honors has the initiative received?

2016 Classy Award Finalist
2016 University of Pennsylvania Lipman Family Prize finalist
2016 USAID/AKSYON grant
2016 & 2017 Innovations in Healthcare finalist

Organizational leadership: How are you influencing your field of work in the present?

Boutik Sante is still in the scaling phase. And for some of Boutik Sante's specific activities, we are still in the pilot/testing phase. (These activities include the use of tablet computers for CHEs as well as the incorporation of ayzh's clean birth kits--another CSV semifinalist!--into our basket of products.) We believe that one of the best ways to influence our field of work in the future is to rigorously document, monitor, and evaluate our current activities. We are, therefore, proud of our research partnerships with Columbia University (past) and the Icahn School of Medicine at Mt. Sinai (current). They have already produced compelling studies (see attached Health Affairs article) that we have shared with counterparts.

Should you be successful, please confirm your availability to attend the Ashoka Impact Boot camp and Creating Shared Value Prize Live Pitch Event at the World Water Forum 13-16 March 2018

  • Yes, I am available to attend the events on 13-16 March 2018
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Attachments (3)

171210 Health Affairs article.pdf

Using Fonkoze's microfinance network as a case study, this article discusses the effectivenss of microfinance institutions--which reach 200 million households worldwide--in delivering health products. This is the founding premise for our Boutik Sante program. The results of this randomized control trial are very promising. As Fonkoze seeks to influence the broader fields of microfinance and community health work, we will point to the success outlined in this article.

#1 AKSYON success story-twins in Fond Verettes.pdf

This is a "success story" that Fonkoze provided to USAID, one of our donors. It tells the story of Jergens and Jerson Sainriste, who were diagnosed with Severe Acute Malnutrition early this year. Olga Dumeus, a CHE, was the key to connecting them with the life-saving help they needed through a nearby health clinic. After just two months of treatment, the boys were on a path to recovery. She continues to follow-up and ensure that they maintain their health.

AR2016_Single Pages_Reduced Size.pdf

This is the 2016 Annual Report for the Fonkoze Family of institutions, which includes Fonkoze Foundation (the implementer of Boutik Sante), Fonkoze Financial Services (a microfinance institution), and Fonkoze USA (the 501c3 partner in the U.S.). Information on Boutik Sante can be found on page 4, and a story of a CHE can be found on page 8.

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Photo of Rachael

Hi NAtalie! I love love love the work you are doing!!! I would really love to hear more as our social and environmental enterprise hopes to launch a similar franchise health model for rural women and communities in Guatemala to have access to health, especially reproductive health care options, when it is otherwise unavailable.

I am curious if over time you hope to phase from donors to more and more earned income or if you project it to be heavily dependent on grants in the long term as well (mostly for financial planning purposes I am curious - not because there is a right answer) - thanks for your help and honesty!!!!

Photo of Natalie

Hi Rachael Cox ! Thank you for your thoughtful comment--lovely to connect. We anticipate that Boutik Sante will be self-sustaining (with all revenue generated from earned income) by 2021. It's a tricky balance to walk, and as far as we know, no other social franchising for health initiative has ever been able to be financially sustainable while simultaneously achieving strong health outcomes. (i.e. they opt to sell health products that have a high profit margin but low health impact in order to be self-sustaining OR they need to generate revenue elsewhere--grants--in order to sell high health impact products that often have a low profit margin). Part of what makes our model successful--and another innovative aspect--is that we're leveraging the existing infrastructure and network of our microfinance institution, rather than trying to establish something new. Anyway, we are eager to connect with and learn from others doing similar work, so it would be wonderful to hear more about your plans! Thanks again for your message!