Josh Cleveland

Advancing Healthcare With the BoP: To Emerging Markets and Back Again

This is part one of two in a set of articles on reaching BoP markets with healthcare innovations. This article addresses the perspective of several multinational corporations while the subsequent piece will present the perspective from a social enterprise start-up.

If your company has a great healthcare innovation that can treat scores of poor people, how do you get it to market?

How can an organization spread the drastic advancements in biological strip tests, online and mobile diagnostics, and “lab on a chip” technologies currently under development in North America and Europe?

There are not enough trained doctors to disseminate the innovations at the BoP. Those with adequate training either can’t buy or don’t want to buy products that can drastically increase ability to cure or prevent disease, or don’t want to live in rural areas where many patients are located. How do you reach the people who need healthcare products and services?

And how (if at all) does innovation move the other way – from the BoP to developed markets?

Over the past month I spoke with leaders in BoP healthcare from global health specialists to global pharmaceutical companies, from huge tech firms to nonprofit start-ups. I’ve aggregated many of the perspectives on channels to market and technology flows that we discussed in those conversations here.

The key takeaways for reaching these markets are as follows:

  1. Partnerships are key for big companies and start-ups alike
  2. Good corporate programs build on internal capacity and deep knowledge of the firm
  3. Companies can benefit from complimentary philanthropic and market-based approaches
  4. Distribution is the biggest nut to crack

*(We only begin to scratch the surface of the distribution paradigm here. To learn more about some innovative strategies in this regard please check out the excellent work from my NextBillion colleagues here and here.)

This article is not meant to be comprehensive – there is far too much activity in BoP healthcare to attempt that in one post. Rather, I’ve presented a couple of the case studies from these conversations below where you’ll find some guidance from leaders in the field on moving innovations from one realm to another.

From New York to Accra and Banjul

What happens when a large U.S.-based multinational company wants to get a product to market in the BoP? For Pfizer and GE, the approach is two-fold: part market-based and part philanthropic but both closely linked to market objectives of the firms.

It’s a long way from Pfizer’s headquarters in New York City to Ghana where the company has targeted anti-malaria efforts as part of the Mobilize Against Malaria philanthropic program. The program trains Licensed Chemical Sellers (LCSs) – small retail outlets for medicine and other goods – throughout Ghana to diagnose and treat malaria with Artemisinin-based Combination Therapy (ACT) or refer patients to hospitals for more severe cases. Atiya Ali, a senior program officer in Pfizer’s Corporate Responsibility department told me that when Pfizer began the program in 2007, LCSs provided correct diagnosis and prescriptions in only 14 percent of cases involving malaria. After their training with Pfizer’s partners, Family Health International and Ghana Social Marketing Foundation, the average skyrocketed to 72 percent, helping Pfizer get its products to those who need them most. Unlike the CareShops Ghana experiment, the LCSs that Pfizer partners with are not obligated to use Pfizer as a sole provider of drugs. Pfizer builds on their core healthcare expertise by relying heavily on their Global Health Fellows program for employee-led field support for the Mobilize Against Malaria program.

Ali manages several of Pfizer’s philanthropic investments, which help build the company’s value by opening long-term opportunities and gives them a foundation for expanding operations in emerging markets. To provide the market-based perspective, I asked Martina Flammer, a business lead from the Global Access Team, a relatively new commercial unit within Pfizer’s Emerging Markets Business Unit, to provide their approach. The purpose of this group is to explore sustainable, commercially viable ways of reaching underserved customers in the low-income sector, with a focus on the BoP. With the relatively unflattering history of upselling customers on brand-name drugs as a backdrop, I was pleasantly surprised by their innovative approaches.

Last year, riding the wave of SMS breakthroughs in international development, Pfizer’s Global Access Team, in partnership with Vodafone, launched a pilot initiative called “SMS for Health” in The Gambia, designed to use text messaging to manage pharmaceutical supply in healthcare facilities, reduce stock-outs, and ultimately improve the availability of medicine to patients. Dispensary assistants, nurses and store managers throughout the supply chain have been trained to use a simple coding system to text the stock levels and expiry dates for 20 medications and the rate of 10 pre-specified diseases to a central database, where the information is then analyzed on a weekly basis and compiled into web-based reports. The disease and medicine spectrum includes high-priority health areas, such as the rate of malaria, pneumonia, maternal death and anti-infective and malaria treatments. By tracking pre-specified health event data, disease rates and treatment types, SMS for Health helps capture trend information that can be used to predict the seasonal variation in the rate of disease, enabling appropriate medicine stocks to be procured and distributed in time so that patients can get those medicines when they visit their local healthcare facility. If store managers and healthcare providers complete their updates within the agreed timeframe, they receive free usage of mobile services. Vodafone’s Health Solutions unit provides the required SMS technology to the partnership. The project is supported heavily by the Gambian Ministry of Health and Social Welfare. And Pfizer and Vodafone are investigating replicating the model elsewhere in Africa.

The partnership spans multiple public, private, and NGO entities. Both philanthropic and profit-driven programs rely heavily on Pfizer’s core competencies. And the outcome so far is a win-win-win situation: healthcare facilities better manage supplies, the ministry of health gathers valuable data on disease trends and is able to more effective treat those diseases, and Pfizer get more product out efficiently to those who need it.

From Fairfield, Connecticut to Phnom Penh

Krista Bauer, Director of Global Programs at GE, outlined a similar two-pronged market-based and philanthropic approach to getting healthcare innovations from GE to the BoP. Krista describes GE’s main development focus as “building infrastructure and upgrading technical capabilities at government hospitals and rural clinics.” Initially, GE’s philanthropic arm identifies a target country and then develops deep partnerships with the Ministry of Health. Thereafter, managers work together to identify the best technology solutions for the target healthcare provider. Through a partnership with Engineering World Health, GE trains local health employees to maintain and repair the technology. Meanwhile, the company reaps benefits in the form of design feedback, brand recognition, and reputational boosts.

Bauer notes that their efforts in developing countries have raised the profile of BoP markets as viable consumer bases throughout the company, an area that the company is actively pursuing. The recently announced partnership with Embrace came about through their new market initiatives unit in part as a result of the success of GE’s philanthropic programs.

Like Pfizer’s approach to global health challenges, GE’s relies on the core capacities of the company in technology provision, uses partnerships with existing networks wherever possible (Engineering World Health, ministries of health, and others), and pursues a separate but complimentary for-profit and philanthropic strategies.

… And back again

Now that we’ve covered a couple of models for moving healthcare innovations to the BoP, what about moving ideas and technologies the other way: upstream to developed markets? A recent McKinsey report notes that the necessity for innovation and fewer constraints faced by entrepreneurs exploring healthcare solutions in developing economies means that: “They can bypass Western models and forge new solutions.” Yet as the Economist reminds us, the actual tech transfer is a bit complicated. Regulations get in the way, consumers in the U.S. have little incentive to lower healthcare costs in the first place, and the organizations that need to adapt the innovations are bureaucratic behemoths. Things thus move quite slowly.

But that doesn’t mean that it’s not happening. “Our work in Cambodia providing technologies to government hospitals and rural clinics has taught us a lot about how products work – or don’t work – in the field,” says GE’s Krista Bauer. Product innovation and insight is often cited as an innovation that moves upstream from developing to developed markets.

But many believe that the real potential lies in the workflow innovations that don’t require the same level of regulatory scrutiny to implement. You’ll hear more about these workflow innovations in this series on NextBillion. And it shouldn’t take a rocket scientist to figure out why it might be good to apply the proven methodologies in developed countries.

A bright future

Overall, healthcare at the BoP provides a fertile ground for optimism. Cross-border, cross-sector, cross-functional partnerships in this sector at the BoP are common. For-profit and nonprofit solutions are becoming more viable. Innovation flows are becoming more substantial in both directions. No, we haven’t eradicated malaria yet and yes, we are still waiting on a cure for polio. Many programs are still “pilots” and start-up solutions have certainly not yet scaled. GE and Pfizer both pursue some forms of BoP engagement as philanthropic activities for a reason. I won’t argue that the attempts presented in this article are anywhere near perfect or complete, but I will suggest that they are boldly pushing ahead. And that is exactly what we need to see in order to confront some of the biggest health issues in both developing and developed countries today.

Health Care, Social Enterprise
philanthropy, social enterprise