Ditto to that!
The Health promoters do refer for complicated cases of pneumonia, malaria, and diarrhoea - they also encourage pregnant mothers to deliver in public and private health facilities. We think this continuum of service at the home allows not just for treatment at the time of need, but also to ensure that better habits and preventative measures are taken going forward.
We need to continue working to ensure people in the communities get to the facility when they need it most and transport is often a major barrier. We have come across Riders for Health and Zambikes' ambulances - potentially interesting models to explore for patient transport for referrals.
Simon - Do you have any advice for building those public sector partnerships? One thing we continue to focus on in country is ensuring that our agents are not only highly trained, but that they also have the blessing of the Ministry of Health.
Yes, and this is where the issues of building trust between public and private secotrs become so important.
Yes, I totally agree. But if are to reach people outside of the big cities who are currently underserved, we need to find a new delivery mechanism for them. The issue is creating a shared value proposition where for example, a bank can reach more customers through micro insurance and a mobile phone company can work with a healthcare provider to ensure products are available in a clinic. It's all additional/incremental demand but we need to work together to generate it. For us, we are driven by a goal of being able to reach 80% of the population of Africa. When you have this as your goal, you start to think of alternative models of distribution and partnership.
Good question. The WHO and other global institutions are certainly doing a lot...but it comes down to national governments to create the right conditions for business to step in a play a bigger role that makes sense for the business commercially -- it has to do with developing systems that enable the private sector to thrive. Some governments are trying to do that through new policies and innovative financing mechanisms.
It can't just be a matter of better products - the conversation around the first topic made clear that trained human resources are a critical bottleneck, as are supply chains, financing options and a million other issues. While not perfected elsewhere around the world, those are the supports/inputs that allow products to succeed in effecting better health outcomes.
With respect to products, however, I think there are a number of factors:
1) Design matters. We (Gradian) - and it sounds like many of the other panelists - began the design of our product (the Universal Anaesthesia Machine or UAM) in the environment it needed to function in. THat meant our design process started from addressing the challenges inherent in operating theaters in low-resource facilities. It had to function without compressed oxygen or electricity, which are unavailable frequently and (importantly) irregularly and yet critical to the provision of conventional anaesthesia. Companies making machines designed to work in hospitals here in New York similarly began their design process with their end site in mind - they could just take for granted certain inputs we couldn't, and therefore end up with a different product.
2) Products not gadgets. There is no shortage of very smart people looking at challenging problems and finding technical or commercial ways to address them. If we think of that as the umbrella, those could be called gadgets. The key to actually achieving scale/viability (and, therefore, better health outcomes) is figuring out which products go beyond being a nifty idea and are actually safe and reliable. With the UAM we have relentlessly pursued the safety standards required for any medical device used in Europe (CE mark, ISO certification, etc) as a way of confirming that what we have developed is a quality product, and not just a funky way to think about improving on a health challenge.
Julia - we found with just one product - that the key was community-based marketing ie creating demand for the product in the community. We found that if we did this the product got there 'by itself'. The demand in the community PULLED the product into the community shops because community shop keepers could make a profit meeting that demand.
We have a tweet-sized hypothesis on this which goes like this:
<<You can get any commodity/service to anywhere in the world by creating and sustaining a demand for it and making it profitable to fulfil that demand>>
4 billion people are "in it". If they can make a dollar from each of them, and improve their health, everyone wins. It shoudl not be an occasional basis but part of their business (mobile, banks, etc are a terrific example, as mentioned by Ramil). A hyper-simplified response, but sustainable can (and should) also mean profit in some cases...
Completely agree, Julia. Health systems need to function more effectively and efficiently to drive better health outcomes for the poor. Products are certainly important – and we are seeing many product innovations profiled in CHMI – but how they get deployed for those who need to benefit from them is just as critical. Educating patients and communities about their needs and health-seeking behaviors is also hugely important. Who pays for care and how is another issue..and on and on.
Carey - I think all the normal rules apply. Involve everyone from the beginning. Don’t go in with ‘a solution’ start with 'a suggestion' and invite commitment and challenge. Come to the solution together.
A technique we used in ColaLife to great effect was to bring all the stakeholders together. Present a ‘suggestion’ and ask everyone to put RED post-it notes (other brands of sticky notes are available!) up stating why it wouldn’t work. Then ask the same group to review all red post-it notes and put up green ones with the solutions . . . then deal collectively with the remaining reds (there usually aren’t many - if any). Great for developing consensus and commitment. If reds remain then you have to modify or throw out the suggestion.
Time for our third question:
Q3: How can private sector products and distribution systems better connect with government systems?
Wow! Love the red/green post-it note idea. It sounds like a very effective way to silence the naysayers by clearly identifying potential roadblocks up front, and creatively/collaboratively showing that every problem has a solution. Thanks for sharing!
We absolutely agree, there are a lot of innovators making products to improve health and livelihoods. The payment issue is one that we struggle with every day - we find that often the cost of going to a health facility is very high and that 'free drugs' from government facilities may not be available. By bringing these products directly to the patients and delivering messaging, we can help improve knowledge and access.
We offer some consignment and other credit products to help limit the upfront barrier to care, but this is likely not enough for the poorest. A major barrier remains for those who just absolutely cannot afford care at any level - systems strengthening work is key to help improve this situation.
Zahid, it's all of these things. We do need to continue to develop better products and make them affordable. But crucially, we need to have better distribution and supply chains in place. In many places, this is very challenging so we have to work with others - NGOs, governments - to reach populations. One area that we need to develop further is getting people and organisations who work at the base of the pyramid to connect their innovative ideas with large companies who may have the ability to industrialise these innovations, of course ensuring the originator shares in its success. This could potentially generate sustainable solutions which others could adapt to their own challenges.
Carey - I have to credit my partner (in life and ColaLife) Jane for that technique! It's scary to do but she's brave!
As with most problems, the best solution will come from identifying and capitalizing on synergies between the public and private sectors. In our case, we are a complement to government systems, helping them fill gaps to achieve their Millennium Development Goals. The more frontline health workers we can deploy, the greater health coverage we can achieve – and the more lives we can save together.
Some of the ways we work in complement include referring complicated cases to public and private clinics and encouraging pregnant mothers to deliver in a facility.
In ColaLife, we found that it MUST be a partnership between the public and private sectors and as you get closer to the customer these partnerships get more and more crucial.
The key partnership in ColaLife was the one between: the retailers (private sector); the health centres (public sector) and its associated Community Health Workers (outreach volunteers associated with the health centres).
All these partners worked together to: raise awareness, promote the product, bring the product to the communities.
Global-level PPPs weren't operationally important when you got down to community level.
In terms of HOW to build these partnerships, as I've already said, I think all the normal rules apply. Involve everyone from the beginning. Don’t go in with ‘a solution’ start with a suggestion and invite commitment and challenge. Come to the solution together.
A technique we used in ColaLife to great effect was to bring all the stakeholders together. Present a ‘suggestion’ and ask everyone to put RED post-it notes up stating why it wouldn’t work. Then as the same group to review all red post-it notes and put up green ones with the solutions . . . then deal collectively with the remain reds (there usually aren’t many – if any). Great for developing consensus and commitment. If reds remain then you have to modify or throw out the suggestion.
We also see frequent challenges in the public sector around supply chain management, which results in frequent stock-outs of essential life-saving products. We are trying to address life-or-death challenges of availability by ensuring our branches and agents are always in stock when it comes to critical life-saving products like ACTs for malaria, ORS/Zinc for diarrhea, and amoxicillin for pneumonia (but amoxicillin only after passing a rigorous certification test!). Leveraging private sector expertise to improve public sector supply chains on a broader scale has tremendous implications for improving availability, access, quality and therefore outcomes in health.