Martin Herrndorf

From the ’Last Mile’ to the ’Last Centimeter’

Calls for pharmaceutical companies to make their pills and powders available to the poor at low prices are abundant. But that’s often when the challenges begin – and the solutions, something examined in a soon-to-be-launched Endeva report.

The challenge: The last mile!

Once again, the main challenge can be found in the “last mile” and, even, in the last centimetres:

How do pharmaceuticals reach remote rural areas? And once they do, where are they stored? Where are they cooled, when perishable?

Who controls fraudsters, producing copy-cats of well-known medical products, many of them without effect or even harmful?

And finally, on the last centimetres: Who persuades clients that the medicine will actually work? And who controls “compliance” of patients, taking their medicine regularly at the prescribed intervals, and till the end of the treatment period (sometimes well beyond the last symptoms?)

And, who’s going to pay for that? Even if pharmaceuticals are publicly funded, as is the case with Tubercolusis treatment in India, the distribution remains a logistical, technical and organisational challenge.

The solution(s)

There are too many solutions for a single blog-post. Successful programmes, like Operation Asha, combine a series of elements in its “recipe” for successfully distributing pharmaceutical elements:

– Technology, like fingerprint readers and netbooks, to identify patients (it works like a charm, your author has tried it);

– Incentives, like a bonus for ASHA district staff for zero-defaults among their patients;

– Camouflage, such as hiding treatment centres in “normal” stores to avoid stigmatisation of patients.

– While Asha is certainly impressive, it is not a universal blueprint. But it contains a lot of inspiring small examples on how the big questions above could be tackled.

Which to pick?

If the bits and pieces for solving the “last mile and centimetre” challenge are out there, the task for practitioners is understanding them and finding the right combination that works in their specific context.

One aid in this task can be the upcoming “Bringing Medicines to Low-income Markets” publication. Almost one year after their report on Energize the BoP-Report, Berlin-based consultancy Endeva has teamed up with BMZ, GIZ, Sanofi and Planet Finance Deutschland to take a look at a hundred business models for delivering pharamaceuticals, and summed up approaches that have worked in the convenient “A4s” – Awareness, Availability, Affordability, Acceptance; plus a additional A for Actors. The report has a wealth of information, which it provides in a digestible 72 pages. Probably, the accompanying case study vignettes are most useful for practitioners.

As with energy, the partners have packed up the findings in a report, will run a small workshop on Jan. 23 and 24, 2012 hosted by GIZ for practitioners interested in working on their business models, and have a bigger launch event hosted by BMZ in Berlin on Jan. 23.

As some findings are relevant beyond the medical field, for BoP in general – for example the question on how to to persuade skeptical customers or fight piracy – the report makes a good read even if you’re not a health sector expert.

Disclaimer: I am sometimes working for Endeva, being one of their expert associates.

Health Care