NextBillion - An Initiative of the William Davidson Institute at the University of Michigan

An ounce of prevention is worth a pound of cure. The old adage is particularly applicable to healthcare in developing countries, where millions of people die or get sick each year from illnesses that are easily preventable. The financial costs of these illnesses far outweigh the minimal costs of prevention, yet even these expenses are currently out of reach for the poorest. Today however, a number of new initiatives are seeking to address this injustice by producing consumer products that prevent diseases and are affordable to the masses.

This post is a continuation in my series about Healthcare Delivery at the BOP. In my previous post, I highlighted examples of enterprises that make use of the franchising business model to provide healthcare to the poor. In this post, I will look at consumer products that help prevent respiratory diseases and malaria. As always, I encourage you to post your comments and questions.

Indoor Air Pollution

More than half of the world’s population relies on biomass (dung, wood, or crop waste) for their cooking needs. Although they are inexpensive, burning such solid fuels indoors without chimneys or proper ventilation produces a range of harmful indoor air pollutants, including small particles that are up to 100 times acceptable levels. This pollution currently results in 1.6 million deaths annually due to pneumonia, chronic respiratory disease and lung cancer. With populations growing and alternatives such as kerosene or liquid petroleum gas becoming more expensive, the numbers of people relying on such fuels–as well as the negative health effects – are set to grow.

To address this problem, the Shell Foundation has committed US$ 10 million to tackle indoor air pollution through a new program called “Breathing Space.” Shell’s approach is to identify, test and diffuse market-based solutions that provide a viable alternative to the high polluting biomass. Under this program supply- and demand-side interventions based on business and market principles are being piloted in eight developing countries.

One such solution that Shell is sponsoring is Project Gaia. The program seeks to create a model by which a household market for locally-produced alcohol-based fuels like ethanol and methanol can be developed on a commercially viable scale throughout developing countries. The initiative is being piloted in Ethiopia, where a thriving sugar cane industry can provide the biomass used to create the fuels. The project is also developing a CleanCook stove powered by the fuels.

Other ventures are also producing cleaner-burning stoves. The Upesi Project, supported by the Intermediate Technology Development Group (ITDG) and Shell, was initiated in 1995 to promote the adoption of more efficient wood-burning stoves in rural areas of western Kenya. More than 16,000 of the fuel-saving stoves were sold during the first 5 years of operation. In neighboring Ethiopia, Mirte Stoves have been specially designed for the production of injera, a household bread that is the country’s staple food. The Mirte Stove reduces energy consumption by 50% and eliminates the smoke emitted inside the house. By late 2000, over 90,000 Mirte stoves had been sold in Addis Ababa and a number of smaller urban and rural areas, leading to wood savings of over 45,000 tons each year, and an estimated cumulative woody biomass savings of over 80,000 tons.

The need to reduce indoor air pollution is not limited to Africa, and neither are the solutions. In Nepal, the Biogas Sector Partnership has developed a cooking stove that operates on the methane produced when cow dung ferments. Over 50 independent companies have installed more than 124,000 of the stoves and biogas production systems in households throughout the country. Although there is a high upfront cost for Nepalese families, microfinancing schemes and savings from ceased daily dependence on wood fuel make it affordable. Subsidies are also provided by the Dutch aid agency DGIS.

What’s interesting about all of the models discussed is that they are affordable solutions that rely on local resources for their manufacturing and use. So in addition to the health benefits, the projects also create a number of sustainable local jobs relating to the production, selling, and servicing of the stoves. Also, with the exception of the Gaia project which is just now deploying its prototype stoves, each model seems to have traction, demonstrating the viability of providing such solutions on a for-profit basis. Finally, beyond the health and economic benefits the stoves bring, there are also the added environmental benefits of creating less pollution and using less biomass, a resource that is becoming increasingly scarce in some areas.

Anti-Malaria Bed Nets

Malaria is another disease responsible for more than one million deaths annually. The social and economic impacts are particularly devastating in Africa where 90% of deaths occur and poor children under the age of five are most at risk. Africa’s GDP is thought to be 32% lower than it would have been if malaria had been effectively controlled 35 years ago. While the race for a vaccine is on–GlaxoSmithKline recently said one could be licensed by 2010–current prevention techniques are inadequate.

Seeing a market opportunity, the Vestergaard Frandsen Group has developed, patented, and is currently marketing an insecticide-treated net called PermaNet. The polyester bednets fully comply with the specifications and requirements of international aid and health organizations, and lasts for three to four years without needing to be re-treated. The company also produces ZeroFly, an insecticide incorporated plastic sheeting used to provide emergency shelter in disaster situations.

Another highly-effective and long-lasting insecticide-treated malaria bednet is being manufactured, produced and sold by for under $5 in east Africa. Tanzania-based A to Z, the largest privately help manufacturer of bednets in Africa, employs approximately 600 workers and currently produces 5 million bednets annually for distribution in Tanzania and other African countries. A to Z is also the lowest cost manufacturer in Africa due to an intense focus on innovation and productivity.

Both bednets are manufactured locally–PermaNet in Asia and A to Z in Africa–creating local jobs. Both products were also developed specifically for cash-poor consumers who require reliable long-term solutions. And like the cooking stove examples above, both companies demonstrate the viability of businesses that produce products for low-income communities, if such goods have a clear and demonstrated value to the consumer.

On Thursday, I will continue to discuss consumer products for disease protection, citing examples designed to improve nutrition and deal with water-borne illnesses.