This is part of an entire continuum of need we see in Human Resources for Health where we work. CHWs or Frontline Health Workers are often the first interaction with a healthcare provider and they are instrumental in the referral and communication process to get those who need more specific or medical help. At Gradian we are at the end of that continuum, in the hospital, where we see an unconscionable lack of trained medical providers (we are in the operating theatre, but that is generally the experience across any of the hospitals we work with).
Couldn't agree more Erica. It's clear that mobile phone companies, banks etc could have a role to play in distribution, micro insurance, preventing stock outs, diagnosis and more. But what we need is for companies across different sectors to come together to leverage each other's expertise and develop a shared value model in which all partners achieve their business goals. We believe that this will be critical in reaching the hardest-to-reach populations, particularly outside of the cities.
And at least for basic diarrhoea there aren't big financing issues. As Simon says, the treatment is very cheap. So no complications about needing to get public financing to ensure that poor people can get access to effective treatment.
Hi Jack - do the Living Goods community-based distributors have an ORS/Zinc product in their baskets? If they do which one is it? If not - we should talk!
Hi Donika: can you expand a bit more on what the challenges are in taking innovation/penetration to scale?
We've seen the same with traditional volunteer community health workers. They are certainly overstretched and under compensated for their time. They also often are unable to keep in stock of needed treatments.
We recruit women that are invested in the community's health, but also receive motivation through selling of products like pro poor durables (cook stoves, water filters, solar), consumer goods (soaps, diapers, etc.), preventative measures (bed nets, water purification, clean delivery kits), and treatments (ACTs, ORS+zinc).
The margin on these products paired with routine monthly training refreshers keeps these women motivated over the long term. We essentially see our health promoters as 'retailers on the go'.
We are on the other side of that continuum, running the networks of frontline providers who are trained to assess, diagnose, treat and follow-up on basic cases - and always refer severe cases to a nearby facility. Our frontline Community Health Promoters can promote good behaviors in households in their communities and encourage facility visits in communities where access or awareness has historically been a challenge.
Completely agree Erica. We see many organizations profiled by CHMI that are struggling to make it at scale because the business proposition is not there. Ramil -- what you are suggesting is something that may be happening in certain contexts, but not yet at the level that it should be.
Hi Simon - we do! We currently locally source ORS and Zinc in Uganda to reduce supply chain actors and costs, maximizing our margins and those of our agents. We provide promotions during rainy season to help drive sales, utilizing training from our skilled staff and organisations like CHAI to help drive home the health benefits.
We would certainly be keen to hear more about your innovative delivery methods and products! I actually used to live in Zambia and have seen your products in the field. Great stuff!
Thanks for all the comments so far!
Let's move on to the second question:
Q2: What are the key drivers for achieving better health outcomes at the base of the pyramid - is it just a matter of better products, or are the other factors such as better distribution or better community engagement?
Ramil/Erica This is fine but why should they do more? What's in it for them? One might persuade a private sector business to 'do the right thing' on an occasional basis but we need sustainable solutions don't we?
Exactly - we always end up having conversations with the administration at the hospital or provider level about how important the communication is between those with their "eyes on the communities/villages" and the health facility. Have you seen that communication (and/or referrals) improve in the communities served by your health workers? Have you worked with any ambulance-like services? would love to connect with you over that...
Yes I agree, Donika. We're starting to see some promising pilot partnerships and some organisations like WHO are very engaged in m-health at a strategic level. But we need to get larger, scaleable partnerships that address the healthcare ecosystem as a whole and we're not there yet. I think WHO are really looking at this though.
This gets us into the whole discussion about health systems. The right products are, of course, important. But getting them to the people who need them at the bottom of the pyramid requires much more. Purchasing power, acess in remote rural areas or urban slums (distribution), often behaviour change, often public sector regulation and oversight. And on and on.
To achieve better health outcomes at the base of the pyramid, you need both the right product and the right delivery system to get it to the end customer. We definitely see a plethora of awesome products out there, but a real need for effective, scaled delivery platforms that can take well-designed and impactful products (like ORS/Zinc!) to the doorsteps of those who need them most. Our model is designed to deliver products the last mile through our networks of cost-effective community health promoters - it's no surprise that making it easier to access products does wonders for uptake!
In our experience with a health product – Kit Yamoyo anti-diarrhoea kit http://community.businessfightspoverty.org/profiles/blogs/the-kit-y... - we found that product design was crucial. The product needed to be desirable, aspirational and affordable BUT partnership is also crucial. Down at rural community level, the public sector must be on your side. People go to the rural clinic for everything, not just diarrhoea, so if the health centre tells people the product is not good - or even worse, say if you are using this product then you are not welcome here - then they won’t buy your product no matter how good it is.
Thanks Robert! The challenges are numerous, but some of the specific ones to highlight are the following: 1) an enabling ecosystem that includes government policies and financing mechanisms that enable the health industry to thrive and serve under-served communities; 2) an understanding of the business side of things and how to provide quality care at a low cost at scale; 3) and finally greater understanding of promising practices of what actually works and is producing results.