New Ideas for Saving the Lives of Women, Children
Problem: Local shortages of anti-malaria medicines at health facilities in sub-Saharan Africa because of poor inventory systems with no visibility of stocks.
Solution: A combination of mobile phones, SMS messages and electronic mapping technology used to track weekly stock levels and the distribution of inventory by district medical managers.
Impact: The SMS for Life system provided visibility of accurate anti-malarial stock levels at the health facilities, and district management reacted with a significant reduction in stock-outs. At the start of the pilot, 26 percent of all health facilities had no malaria medicines of any dose type. By the end of the pilot this stock-out rate had been reduced to just 0.8 percent, almost full availability.
Sustainability: The application is being offered on a commercial basis to support future viability. Because of this approach, country scale-up is fast and affordable, and the application can be easily expanded to collect data on any medicines or health events.
SMS for Life (profiled by Josh Cleveland earlier this year during NB’s Healthcare with the BoP series) is one of many new ideas and tools from the report, Innovating for Every Woman, Every Child, which profiles projects striving to improving health and save the lives of women, infants, and children in low income countries. The report launched with a Lancet commentary from Tore Godal, special advisor on global health to Norwegian Prime Minister Jens Stoltenberg, with Richard Klausner, Managing Partner of The Column Group, of San Francisco, calling for rapid transformation via innovative, technology-equipped business models in the way healthcare is delivered to women and children.
Indeed, many believe mobile ICT platforms are potential game-changers in delivering health information and services to combat maternal and child mortality. Yet this report stresses repeatedly that it’s not just about the technology, it’s about the business model. Many mHealth programs mentioned in the report are quite new. I asked the working group’s manager Frederik Kristensen how these emerging business models can go to scale.
Reis: In a nutshell, what were the key findings from this landscape study for mHealth business models in maternal and child health?
Kristensen: mHealth models a) need to find practical and realistic ways of performing evaluations of their likely effects and costs at scale, and b) develop a hard-nosed plan for long-term financial viability.
Reis: Many of the initiatives in the report are pilots. Do you think they will go to scale?
Kristensen: When supporting new ideas through e.g. a grant or through other means, one has to be prepared to take the same approach as in venture capital: Expect many to fail, but also that a few will have a dramatic positive impact. Predicting which one will succeed is not possible ahead of time, and is part of the risk one has to be willing to take.
Reis: Why use the terminology, business model?
Kristensen: We’ve used the business-oriented terminology to help innovators in the public health arena to formulate more explicitly the components of a business plan as understood in the private sector: A clear definition of their “markets” (with beneficiaries and payors), their value proposition, distribution channel, organization and long-term plan for viability. This is not different from what is already being done in many good health initiatives, but focuses even more on the need for a plan for long-term viability as a prerequisite for scaling up.
Reis: Are the projects you’ve highlighted viable in the long term?
Kristensen: There is still a way to go for most pilot projects to have a sound plan for self-sustainability. Pilot projects will need to secure rigorous evaluations, and engage in multi-stage planning: One plan for the pilot phase and another for reaching scale, i.e., growing from a small, founder-centric business to an enterprise of maybe 50-100 people. The project “SMS for life” opted to plan for scale from the outset, but this may not be possible – nor wise – for all entrepreneurs. It depends on the resources they have available when starting.
Reis: You noted that the goals for self-sustainable models have shifted and it’s no longer about getting more donor funding. What instead are your hopes for the outcomes of this report?
Kristensen: We hope that the projects will fill a need (and a demand) in the local communities where they operate, and in the long run find someone who is willing to pay for their services locally: Be it households, the government, private companies or a mix.
Reis: Why is it important to centralize information on innovative business models operating in the developing world–the report points to the e-portals Health Unbound, the Business Innovation Facility, as well as CHMI.
Kristensen: It is important as to bridge the existing information gaps about innovations and help diffuse promising programs. This will help programs get on the radar screen of old and new “investors,” share lessons learnt and find potential partners-or understand earlier that they are being overrun by a nimbler “competitor”!
Reis: You also stress the importance of fostering collaboration and coordination between innovators. What can this help achieve?
Kristensen: Many programs could benefit from merging their efforts, both to attract necessary investment, become cost-effective and ultimately and most importantly to have greater impact on the ground: Reducing the mortality and morbidity of all the devastating diseases they are combating.
Reis: Given the theme of this week’s UN summit (which includes a focus on communicable diseases), do any of these business models address chronic diseases? If not do you think this will develop as the next wave of mHealth programs?
Kristensen: All the models highlighted in the report have the potential for addressing chronic diseases as well. They’ve designed innovative ways to:
- Inform patients and families directly (Cell-life)
- Identify and tracking high-risk patients (Grameen-Intel)
- Provide decision support to health workers (D-Tree)
- Provide access to test results earlier (SMS Printers)
- Develop new vaccines (PATH)
- Distribute medical commodities (Cola-life)
- Ensure better stock management (SMS for Life), and,
- Use existing social networks for health information (M2M and the HER project)
All these principles are just as relevant in the field of chronic disease as for maternal and child health. However, we need to maintain a focus on avoiding the almost 300,000 deaths among women giving birth and the 8 million children who do not live to be five.