World Health Partners Sky (social franchising + telemedicine, Bihar)
World Health Partners' Sky program in Bihar (launched in November 2010 in 13 districts, ~43.4M population; funding of more than USD 23 million from the Bill & Melinda Gates Foundation and other donors).
illustrative atlas image · Bermix Studio / Unsplash01 The context
It created a network of health franchises (SkyCare/SkyHealth, up to ~10,663 health entrepreneurs) recruiting rural informal providers and connecting them via telemedicine with urban doctors, targeting childhood diarrhea and pneumonia. The independent evaluation (Duke/Stanford, with standardized patients) found null impact: Sky providers saw a minimal fraction of the target cases and did not improve knowledge or quality of treatment. The program won the Skoll Award 2013 before any evidence of results existed; the Sky program ended around June 2018.
02 How it works
03 What it stands on
The evidence 2 ›
04 Lessons learned
1) The business model was built on untested demand assumptions: neither did providers want to pay to join the network nor did patients switch to franchised providers (only a minimal fraction of diarrhea and pneumonia cases reached Sky providers). 2) The awards (Skoll 2013, Schwab) arrived before the evidence: recognizing innovative concepts without measured results distorts the field. 3) Scaling fast with large funding is no substitute for pilots that validate willingness to pay and to switch providers. 4) The value of the case lies in the fact that it was rigorously evaluated and the failure was published (Health Affairs 2016, WHO Bulletin 2017), something rare in the sector.