9

Busting Barriers: Heeding the Call

Millions of men, women, and children are dying of diseases we can inexpensively prevent and treat. Now is the time to create impacts in global health and save more lives. Significant technological and business model innovations have been developed that increase access, use, and quality while reducing the cost of health services. For these solutions to save more lives, they must be adapted to new populations and conditions, continually refined, and scaled to reach more people in more regions.

In Pharmacy on a Bicycle we have described many innovative and entrepreneurial solutions that have been developed in many countries by governments, NGOs, businesses, and donors to save lives. Fortunately, a confluence of circumstances makes scaling these solutions all the more feasible now. These circumstances include growing economies in many low- and middle-income countries, economic interdependencies among developed countries, investments by developing countries in health, and significant investments by businesses.

We are now at a tipping point to make lasting global health impacts.

Building with More Than BRICS

As the economies of developed countries have struggled, the economies of low- and middle-income countries have soared. Over the past thirty years, the growing economic strength and importance of middle-income countries such as Brazil, Russia, India, China, and South Africa (the BRICS) has been clear.

However, many lower-income countries are also experiencing economic booms. In fact, during the first decade of this century, all of the ten fastest-growing economies were low- and middle-income countries. Between 2011 and 2015 that trend is expected to continue, with the majority being in Africa and the remainder in Asia, and their annual growth is expected to be from 6 percent to 9.5 percent. Together these countries represent over 40 percent of the world population.¹ With economic growth and the development of a middle class, there is more demand for health care and need for health investments, creating the opportunity to build and strengthen the health system.

Economic Interdependencies

The growth of low- and middle-income countries is also fostering economic and political partnerships that expand opportunities for health-related partnerships. We saw in chapter 7 the connections that Narayana Hrudayalaya (NH) has created through telemedicine to train and support doctors in Africa. Relationships like this transfer medical skills and knowledge across national and regional boundaries, enhancing the quality of care for all. These investments by NH benefit everyone as the African health providers receive consultations and training from more experienced doctors at NH, benefitting both the African doctors and their patients. NH then receives referrals of patients from Africa who can afford to pay for care.

In addition, these links promote the flow of ideas and solutions from one place to another, allowing solutions from Honduras to be replicated in Malawi or programs in Pakistan to be modified and implemented in Laos. As innovative and entrepreneurial solutions develop, cross-border relationships can help accelerate global health improvements.

Business Is Good for Health. Health Is Good for Business

Drawn by the growth of these countries and a desire to develop new markets for their products, multinationals are increasingly setting up shop in low- and middle-income countries. IBM, Google, PricewaterhouseCoopers, Nokia/Siemens, Procter & Gamble, and many other companies have recently created regional hubs in Africa. New corporate partners may not only help strengthen the economies of these countries, but may improve health as well.

For example, the IBM Foundation, through the Pink Ribbon Red Ribbon initiative, provided pro bono Corporate Service Corps consultants to develop and recommend a way for the government of Kenya to enhance its data-tracking and screening outreach for cervical cancer. This program helps IBM build closer ties within Kenya, developing important knowledge in the health and infrastructure sectors while gaining a better understanding of the region’s business culture. Kenya’s health system and its patients may benefit from an enhanced system of care.

But that’s not all. IBM invests more than $6 billion in research and development each year, and in 2012 the company opened its first research lab on the African continent in collaboration with the Kenyan government. The investment is intended to advance research in a number of areas, including technologies that can help governments deliver services more effectively and efficiently to citizens.² Such investments help to support and stimulate innovators relevant to developing countries. Business is good for health, and health is good for business.

Emerging Leaders

As we’ve seen through the innovative and entrepreneurial examples presented in Pharmacy on a Bicycle, many of the successful solutions that are creating impacts in developing countries are emerging within developing countries themselves, fueled by an emerging group of global health and development leaders. Investments by companies like IBM and others will create additional opportunities for them. Another innovative program, Global Health Corps, was developed to help stimulate and support new cadres of global health leaders in developing countries. Led by Barbara P. Bush, Global Health Corps pairs young leaders from over fifteen countries to work for a year in public and private health-related organizations in Rwanda, Uganda, Malawi, Burundi, and Zambia, as well as in organizations that serve very poor communities in the United States. Due to the high demand for this type of leadership training, they are able to accept less than 2 percent of all the qualified people who apply, making acceptance into Global Health Corps even more competitive than top Ivy League universities.³

Another global NGO, Ashoka, seeks to create sustainable change by linking, training, and supporting over 3,000 fellows who work in over sixty countries on innovative and entrepreneurial projects that create social good. Many of these projects focus on health. Organizations such as the Bill and Melinda Gates Foundation and the Skoll Foundation are also encouraging emerging leaders in global health with generous grants to support their innovative and entrepreneurial ideas.

These new emerging leaders and the global health programs they create, from Aravind Eye Centers to the Narayana Hrudayalaya Heart Centers, are important pieces of the puzzle that may not only help us solve health problems in developing countries, but in countries throughout the world.

Putting the Pieces Together

Innovative and entrepreneurial solutions that help make health in many developing countries financially sustainable, along with greater investments in health in low- and middle-income countries, can help put the pieces together to improve access, use, and quality while decreasing cost.

Spheres of Influence

While it has been large corporations and NGOs that have helped influence the global health agenda, all organizations, large and small, can play a role. Each organization, regardless of size or location, has a different sphere of influence. It is important for each to be aware of and appreciate the scope of its actions and operate in a manner that can make the most of its reach. A small organization working within a community has the ability to influence individuals and promote healthy living habits. On the other hand, large multinationals can influence major flows of funding or draw attention to specific health issues.

Although organizations may have a limited sphere of influence, they are able to influence those operating at higher levels to help mold better working environments. For example, an organization operating a network of franchised clinics can nudge government officials to minimize regulatory barriers to allow for task shifting to take place. Governments can reach out to large aid organizations to help spotlight a specific health problem in their country and increase global awareness.

An organization’s sphere of influence also includes its internal environment, which determines how it works and functions to accomplish its mission. This internal environment includes an organization’s culture, leadership, structure, systems, and resources it has at its disposal. It is important for organizations to build an internal environment that promotes innovative thinking and embraces the entrepreneurial spirit of its workforce.

Leveraging Culture

Health care occurs in a social and cultural context, and to be successful organizations must be consistent with that context, using it to their advantage. To be consistent with social and cultural contexts, we must work with communities and leaders to understand issues, create appropriate programs, and, through a process of mutual respect, instill trust. Cultural differences need not be viewed as an obstacle to achieving success, but rather as providing an opportunity to create something new and possibly better. Operating in different environments and cultures forces innovative and entrepreneurial thinking and stimulates the creation of appropriate solutions. For example, programs distributing white bed nets were unsuccessful in many regions of Africa because they resembled white funeral shrouds. It wasn’t until the nets were dyed a different color that use dramatically increased. Cultural diversity should be leveraged to stimulate innovative global health solutions.

Table 14 Key IMPACTS Actions

Actions for Impact

The IMPACTS approach describes the activities that all organizations can use to significantly improve global health (Table 14). These can lead to improved access, quality, and use while simultaneously reducing cost.

Conclusion

Millions of people around the world from East Timor to South Sudan are dying of diseases we know how to prevent, diagnose, and treat easily and inexpensively. It is not that the science or medical knowledge is lacking. We must do a better job of bringing quality care to those who need it most, in a place that is accessible, in a way that is acceptable, and at a cost that is affordable.

Many organizations are already doing this, in different ways, with different populations, and in different settings. What they have in common is that they are all using innovative and entrepreneurial solutions to solve these problems. In fact, many are disseminating health products and services quite successfully and may not only meet needs in developing countries but may be helpful in all countries, regardless of income.

To be successful they need to be financially sustainable and scaled up. Many can often be easily adapted or adopted to other geographies, settings, diseases, and organizations. This can be done by governments, NGOs, businesses, or partnerships between them.

The IMPACTS approach describes the activities that all organizations can use to significantly improve global health. These can lead to improved access, quality, and use while simultaneously reducing cost. Sometimes this is relatively easy—and sometimes much more difficult because of resource constraints and organizational barriers. But often constraints and barriers can serve to stimulate new solutions that can save lives. The many examples that we have provided here, and the countless more that are in the field, demonstrate the variety of ways that this can be done. The seven-point IMPACTS approach provides a guide.

In Pharmacy on a Bicycle we have presented an approach to reach those goals. This is not only something that can be done in the future. It is already being done by smart innovators and entrepreneurs in government, NGOs, businesses, and donor groups, large and small. We have discussed how to plan for it, act on it, and monitor your progress toward your goals. We can bring care to people and save lives, regardless of whether it is delivered by a community health worker on foot, by a nurse on a mobile phone, by a medical doctor via telemedicine, or from a pharmacy on a bicycle.