Friday, October 19, 2007
How do you get basic care to the remotest villages in Africa? One clever idea is to borrow tactics from retail chains like McDonald’s and Subway–operate an easy-to-replicate, owner-operated franchise system focusing on health care.
Minnesota lawyer and businessman Scott Hillstrom started HealthStore in 1997 after traveling through Kenya and noticing that one of the big problems there was lack of reliable access to basic generic drugs. Government clinics often ran out of drugs because of supply-chain problems, while roadside shops sold elixirs of dubious quality. “It hit me like a bolt out of the blue,” he recalls: A franchise system would be a way to maintain standards and improve the supply chain.
With a budget of under $1 million a year, HealthStore Foundation subsidizes nurses in rural areas to run 65 for-profit retail clinics in Kenya that provide basic treatments for malaria, respiratory infections and worms.
The 65 clinics run under the name CFW Shops and treated 400,000 patients last year. Many are run by retired nurses lured back to work by the prospect of owning their own business. A charitable foundation in Kenya set up by HealthStore helps train the nurses, delivers drugs and other supplies every few weeks, and checks up on the clinics to make sure they are maintaining quality standards.
Nurses pay about $300 to buy a clinic, and sell medicines for a modest profit at a retail price of $1. About two-thirds of the shops make a good income, and the foundation is flooded with requests for new shops. Hillstrom hopes to expand to 225 outlets by 2011. His next target is Rwanda.
Another solution is relocating nurses from central clinics to rural villages and having them make house calls. Researchers at Ghana’s Navrongo Health Research Center slashed child deaths in one of the poorest parts of Ghana by doing this. In the mid-1990s three official clinics in Ghana’s Northeastern province often saw as few as 10 patients a day from a population of 140,000. Villagers couldn’t get there.
So in 1996 researchers assigned 16 nurses to live in local villages. Each was given a moped (financed by donors), antibiotics and other basic drugs; the villages built houses for the nurses. Nurses treated patients at the house in the morning, and then took to their mopeds in the afternoons to make house calls. On weekends nurses went back to their families.
By 2003 child mortality had declined from 17% to 7% as sick kids got prompt treatment for the first time; immunization rates soared to 80% from 30%. (Deaths declined only slightly in a control region that did not get the nurses.) Total cost: less than $2 per capita annually beyond what Ghana spent already.
Now Ghana is slowly trying to roll out mobile nurse program nationwide.
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