Healthcare Models for LGBTI

The Lesbian, Gay, Bisexual, Transgender, and Intersex communities face unique challenges in accessing healthcare services. These challenges can be worse especially in developing countries that have deeply-rooted cultures and prejudice against LGBTI. This article explores the various approaches and Healthcare Models that may enhance health service provision to the LGBTI community.

Institution-Wide Training Model

Assuming that LGBTI persons live around major urban centers, this model proposes the

training of health care workers in selected facilities favored by the LGBTI community. In the coastal region of Kenya, for example, three out of 54 health care facilities offering ARVs could be selected, in consultation with the local LGBTI community, and facility-wide sensitivity and competence training provided on a periodic basis. The main challenges of this model are the high costs of facility-wide training sessions and the need to offer continuous re-training due to high staff turnover.

Syndromic Reference Model

In this model, which replicates the Comprehensive Care Centre (CCC) model used in government facilities, only a few clinicians and counselors in selected health facilities are sensitized and

trained in the health needs of LGBTI persons. Through the use of syndromic algorithms, other health workers can then transfer patients displaying certain symptoms such as genital sores or anal infection, to competent health workers. At the same time, it can be assumed that knowledge and awareness is passed on informally among peers in selected health facilities, creating a spill-over effect. While this model has the advantage of being less costly as it does not require institution-wide training, institutional and external transfers of LGBTI-competent health workers remains a challenge. It is also dependent on the dissemination of information about the procedure among the LGBTI community. 

Referral Stand-Alone Facility

This model proposes the establishment of health care desks within LGBTI community facilities where, on selected days, locum clinical officers examine, diagnose and refer patients to government health facilities for laboratory, pharmacy and other services. To reduce costs, clinic officers will be drawn from government facilities. Over time, this approach will also contribute to attitudinal change and the build-up of competence within such facilities. With the increased integration of LGBTI health services in public health facilities, stand-alone centers will eventually become abundant.

Insurance Model

This insurance-driven model aims to create incentives for private health care facilities to train their staff in LGBTI health needs in order to be considered as referral health centers for LGBTI insurance holders. While promoting sustainability and on-going innovations, this private-sector-driven model also requires profitability. Such systems could be explored through a public private partnership (PPP) pilot scheme.

Best-Practice Clinic Model

Under this model, which is used by the Fenway Institute, independent clinics are established to serve the particular health needs of LGBTI persons. These clinics can either be completely stand-alone, or they can function as specialized clinics within private hospitals, thus saving costs for shared services, such as laboratories and pharmacies. While such clinics are a good way to build much needed local competence in the area of LGBTI health services, there is also a risk that they may become stigmatized and therefore avoided by their target group. They are also cost intensive and highly localized. In order to extend their reach they must be replicated in various parts of the country. This has substantial implications in terms of cost. 

Responsibility Sharing Model

In this model, responsibility for diagnosing LGBTI-specific health problems is shared between health service providers and the LGBTI community. For this to be feasible, the government must

first carry out legal and policy reforms, so that LGBTI persons are protected from discrimination in health care settings and have mechanisms for redress. Under this proviso, it becomes the responsibility of the service provider to treat LGBTI patients without stigma or discrimination. The patient, for their part, must support the health worker by speaking openly about their sexual

history and providing, where possible, additional information that can assist the clinician’s diagnosis. For example, IEC material might include a brochure or card with simple algorithms. This

could be distributed among members of the LGBTI community, who could then present it to their doctor to assist their diagnosis.

Internet Referral Model

In this model, an internet portal is set up through which LGBTI patients can consult doctors anonymously. These doctors can then issue referral notes as needed for physical examination in

selected health facilities with LGBTI-sensitized and competent health workers. A major benefit of this model is that it is simple and cost-effective to set up in the short term and could serve as

an interim solution. It could be rolled out in collaboration with one of the medical schools and consequently also provide a learning opportunity for medical students.

Ethical Implications on Business Success

Healthcare is a business. Some organizations have developed successful business empires based on unethical practices, while others have had significant business milestones in relation to their ethical corporate culture. The way an organization aligns itself on ethical matters is likely to have an influence on the success or failure of the business. This post attempts to capture various cases for business success in relation to ethical and unethical practices by organizations .

Customers

Ethical organizations tend to treat their customers in a fair manner in terms of pricing and product quality. Ethical businesses offer the customer the right quality of product and at the right price in order to satisfy the needs of their customers. The satisfied customers develop a good attitude of the organization and its products.  This good perception of the company in terms of quality and pricing of items encourages the customers to build their loyalty to the organization and widens the market of the organization leading to a strategic success in business.

Unethical organizations sell low quality products at exorbitant prices in order to maximize revenues. In the short-run, these unethical organizations manage to exploit the markets and gain high revenues from deceiving the public about the quality of its products. However, there are dire long-term implications of this deception on the business success. The customers will reject the organization’s products and even sue the organization for compromising on their safety.

Cost of ethics

Maintenance of ethics in business comes with its own costs. These costs may include costs of auditing, supervision, training, intelligence systems, hiring the right people among other related costs. These costs may form a significant part of the organization’s expenditure and minimize the profits of ethical organizations. However, the strategic implication of spending on ethical behaviors is positive and facilitates success of the business.

An unethical business may be unwilling to spend on improving its ethical practices and instead, maximize its current profits. In the long-term, an unethical organization, spend more on saving its diminishing corporate image, defending itself in lawsuits, and ultimately losing its customers to other organizations. The overall effect is reduced success in business.

Averting competition

In this era of increasing competition in business, many organizations devise strategies that will enable them to overcome business rivalry. Ethical businesses engage in morally acceptable practices in order to beat competition. These ethical organizations believe that the use of fair means to beat competition is essential to maintain the market share and the good reputation among the customers. These fair practices may lead to failure in competition especially where there is stiff competition. In situations of failure, the organization can restructure its strategy and gain back its market share.

Unethical organizations engage in unfair practices in order to win over market segments. The unethical organizations may tarnish the brands of the competitors, and engage in corruption to use the authorities in frustrating the businesses of the competitors. The organizations are likely to gain a significant market share and succeed in business as compared to ethical businesses. However, when these secret adverse tactics become public, the unethical organization is likely to lose its customers’ trust and ultimately lose the customers themselves.

State support

Organizations that engage in ethical practices are likely to receive state recognition in their activities, which is a plus in improving customer confidence in the organization. The state may invest in such ethical organizations and offer the organization privileges based on its contribution to societal welfare. This support by the state is fundamental to facilitate the success of the business.

Organizations that carry out unethical practices are subject to frequent government interference and investigations. These businesses are likely to fail since the government interruptions affect business operations and send an adverse message of trust to customers.

In conclusion, ethical businesses tend to have better chances of success in comparison to unethical businesses.