John Paul

Healthcare Delivery: World Class Services

This is the final post in my series on financially sustainable models that provide high quality healthcare to the poor. A compilation of all posts will be available to download as a PDF next week.

Healthcare for the poor is typically regarded as substandard, and it sometimes is. But a number of new initiatives are turning this assumption on its head, proving that affordable world class healthcare can be affordable to markets at the base of the pyramid.

Hi-Tech Healthcare Delivery

Hardly a day has gone by recently without a flurry of news stories about the bird flu and the inevitability of a human flu pandemic. If the locations of recent outbreaks are any indication, this pandemic will likely start in a rural developing area where healthcare and infrastructure is limited, and then spread quickly throughout an increasingly connected world.

One company has pioneered an approach to stop such a pandemic before it starts. In Peru, the for-profit Voxiva has developed and implemented a technology platform that enables medical professionals to collect health data in real-time and communicate with one another in order to effectively monitor and respond to disease outbreaks. In such a situation, active surveillance is critical to early detection. The Voxiva platform utilizes phones and the Internet to ensure that appropriate action is taken, enabling local communities to use scarce resources effectively.

The Uganda Health Information Network is also providing practitioners with real-time access to vital information through the use of Personal Digital Assistants (PDAs) connected via the local GSM cellular telephone network. The technology allows for easier consultation, real-time ordering of medicines, and access to medical journals – all of which improves the quality of Uganda’s health care system. Developed by SATELLIFE, the project has successfully transitioned from a grant-funded project to a stand-alone non-profit organization, in part due to its ability to secure support from the Ugandan government.

Even the best healthcare schemes suffer undue costs due to patients who fail to follow their doctor’s orders. It is estimated that no more than 50% of patients with chronic conditions take their medicines properly. In the medium-long term, the costs of this non-compliance are significantly greater than the costs of the medication itself. On-Cue Compliance addresses this dilemma by using text messaging to send patients timely medication reminders via their personal cell phones. The technology used to send out the messages is extremely low-cost and robust: an open source software operating system, Web server, mail transport agent, applications, and a database. Currently, the system is being used in the treatment of tuberculosis patients in Cape Town, South Africa, with almost a 100% success rate.

A number of other examples of initiatives that use information and communication technologies to provide world class health service to low-income individuals can be found in Lessons from the Field: ICTs in Healthcare.

Disease Detection

Recognizing that conventional laboratory diagnosis of diseases can be prohibitively expensive in developing countries, San Francisco-based Sustainable Sciences Institute (SSI) is helping public health workers in poor areas take advantage of the latest advances in molecular and biological technology. The group has demonstrated how – with a basic knowledge of the processes – DNA, blood and urine analysis can be done without expensive equipment for one-hundredth the cost of traditional methods.

With support from the Acumen Fund, SSI is also testing a portable disease detection device capable of diagnosing major illnesses such as dengue fever, HIV, malaria, and measles in the field, for one-third the cost of existing technologies. Other companies are also producing equipment designed to rapidly and accurately make diagnosis in the field. In India, for example, the TeNeT Group at the IIT Madras and Neurosynaptic have developed an affordable telemedicine solution which includes a remote diagnostic kit called ReMeDi. The device incorporates an electronic stethoscope, and can conduct physiology tests including temperature and blood pressure measurements, and ECG.

Freeplay is expanding beyond just wind-up radios and torches. The company has teamed up with a group of doctors at University College London to redesign four pieces of standard neonatal-care medical equipment to better suit developing country environments. The portable hand-powered devices include: a pulse oximeter to measure levels of oxygen in the blood, a syringe driver for delivering small amounts of fluid and drugs in tightly timed doses, a micro-centrifuge, and a hand-held fetal heart monitor. Several prototypes of each apparatus are now being tested in hospitals in South Africa.


In developing countries, where social safety nets are limited or non-existent, being born with or acquiring a disability often relegates a person to a life as a beggar, and prevents them from living up to their full potential. Several initiatives are combating this inevitability by developing low-cost technologies aimed at helping the even the poorest overcome their disabilities and live a productive life.

The Affordable Hearing Aid Project (AHAP) has produced a digitally programmable analog hearing aid named Impact 1. Designed to minimize component cost, the device wholesales for as little as 1/12th the price of comparable models in the US. Through a multi-tiered pricing model, the device retails according to the patient’s ability to pay, where profits from wealthier customers are used to offset losses from poorer ones. The project has further reduced costs and maximized benefits by distributing the Impact 1 through socially franchised partnerships with other non-profit organizations already working in the fields of health care, disability, and hearing impairment.

Comcare International is also producing a hearing aid aimed at the BOP. The solar-powered device has an extremely strong case that seals the internal parts from dirt and moisture, an easy to use rotary volume switch, and larger, more reliable and less expensive components. Distribution is accomplished through onsite clinics.

For amputees, the Jaipur Foot is a cheap, durable prosthetic foot, whose lightness and mobility allows the user to run, climb trees and pedal bicycles. Developed in India, the device costs only $30, compared with several thousand dollars for a similar device in the US. The prosthetics are primarily fabricated and fitted by the NGO BMVSS, which annually provides fittings to 16,000 people and services another 44,000 through seven centers within the country. BMVSS is expanding the reach of Jaipur Foot by organizing mobile camps throughout India and in 19 other countries abroad, where a temporary facility is set up to fit and manufacture the prosthetics on site.

Nearly 1.6 billion people living in the developing world need reading glasses, but less than 5% have access to affordable options. Scojo, a world leader is manufacturing lenses, is addressing this shortfall by providing affordable reading glasses to people in Guatemala, El Salvador, and India. The Scojo Foundation adds additional value by identifying, training and supporting community-based women entrepreneurs as “Vision Advisors”, who are able to double their monthly income by selling the glasses.

Also in India, the Aravind Eye Hospital uses a tiered pricing system to perform low-cost or free cataract surgeries for thousands of poor each year while still remaining profitable. The hospital network has also started a telemedicine initiative. Aurolab, Aravind’s manufacturing division, helps keep costs down by producing high quality ophthalmic consumables at affordable prices. Since its inception in 1992 as a non-profit charitable trust, Aurolab has set up facilities to produce intraocular lenses (IOLs), suture needles, pharmaceuticals, spectacle lenses ($4 vs $150) and hearing aids ($60 vs $1500).