NexThought Monday – The Next Billion, the Next Decade
Launching NextBillion’s 10-year anniversary series, what wellness means for enterprises
Editor’s note: This year, NextBillion celebrates its 10th year online. To commemorate our past and look to the future, we’ve asked many leaders in the base of the pyramid and social enterprise movement to offer their thoughts on the past 10 years. Kicking off this series is Al Hammond, social entrepreneur and one of the primary forces behind the creation of NextBillion. Check back on the series, NextBillion’s First 10 Years, for future updates.
Back in early 2005, the BoP movement was gaining momentum. At a conference following the publication of the report The Next Four Billion, major companies, leading NGOs, academics and international development agencies all added their voices to the idea that market-based strategies could help bring people out of poverty. We needed a way to keep the conversation going, to build a communication channel across what were still deep divides. NextBillion was the tool we came up with – feeling our way in the then-novel medium of the blogosphere. Sometimes new ideas really take root and grow – but none of us could have foreseen how big this one has become.
Back then, C.K. Prahalad’s belief that corporations would lead the way in the BoP was still dominant. He was a brilliant, passionate thinker and speaker – and his influence among all of the early stakeholders was profound. But it turned out to be harder for large companies to really focus on how BoP markets were different and – especially for public companies with quarterly profit reports to file – to sustain activities that had little hope of quick profits or high margins. And when hard times came in 2008, most shelved or postponed BoP projects.
Even before then, however, there was growing evidence that the real innovators in the BoP would be social entrepreneurs of both the for-profit and the nonprofit kinds (at least those that aim to be sustainable). And in my view, at least, that’s how it turned out. A thousand flowers and more did bloom, and many of those novel approaches did work, even though relatively few have achieved scale. Nonetheless, coherent strategies began to gel in sectors such as low-income housing, off-grid energy, small-scale agriculture and artisan handicraft support services, health care, water and sanitation. And there are growing indications that education (on the wings of smart mobile devices) will be next.
To give just one example of how many different BoP innovations can come together to enable new strategies, we read almost daily how the costs of aging populations with multiple chronic diseases threaten to bankrupt health care systems. When you look more closely, it turns out that illness care systems designed for acute care (hospitals) are not very good at preventive interventions like getting people to change their behaviors – and that prevention, risk reduction and behavior change are absolutely critical to dealing with chronic disease in an affordable way. Likewise, obesity helps drive many forms of chronic disease, but effective nutrition is mostly not even on the menu of most health care systems. So what is emerging from the social entrepreneur community and its growing allies in the medical community? How about taking care directly to patients where they live, or work, or go to school; seeing them on a regular basis (weekly or monthly) after discharge from hospital or even before they need acute care to reinforce good behaviors; focusing on their total wellness, not just one illness at a time? Such approaches (which I call Doorstep Health, and which can usually be delivered by para-professionals, not doctors) are turning out to be very effective in the BoP, who often don’t have good access to health care systems in the first place. These solutions are potentially very low-cost, both from a patient perspective and particularly from a system perspective. We are finding strong interest in such approaches in rich countries as well as in the BoP.
Interestingly, innovation in another key area – mobile financial services – was corporate-led, as Vodafone’s M-Pesa system took root and quickly went to scale in Kenya. That it has not scaled elsewhere has more to do with the organized resistance of banks and their regulators, who saw that their customer base could disappear. We’ll see if Apple Pay and its imitators fare better.
The lack of scale more generally seems to have a different cause: Social entrepreneurs lack what corporations have, which is access to finance, ability to attract and retain middle management, good accounting systems and the skills appropriate for scale. And now that corporations are again showing more interest in the BoP, it suggests that maybe the real route to success is to marry social entrepreneur innovation skills and ability to operate on the ground with corporations, to create hybrid models and unconventional partnerships, to build new kinds of business ecosystems. Yes, it’s easier said than done. At Ashoka, we are still learning how to facilitate these collaborative approaches, and we find that it only works when there are internal champions, internal changemakers, within big companies. But it’s also true that the pace of innovation is still accelerating, so that companies which choose not to play face author Clayton Christensen’s dilemma and risk irrelevance.
That said, it seems to me that there are plenty of interesting developments to keep NextBillion’s pages full for another decade.
Photo credit: Dorli Photography.
Al Hammond serves as senior entrepreneur at Ashoka.