Economic Development

Scaling Up by Scaling Down: A New Model for Saving Lives in the Developing World

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On September 25, 2013, world leaders will convene at the United Nations to discuss accelerating progress in meeting the U.N.’s Millennium Development Goals (MDG) by 2015. The MDGs were created to help billions of people around the world leave poverty and live in safety with dignity and respect. While at the U.N., these leaders also will set a development agenda for beyond 2015 to build on lessons learned and tackle the compelling problems that remain.

There have been notable advances since the MDGs were first set. The number of people living on less than $USD1.25 per day has been halved since 1990 – down from 47 percent to 22 percent. Over the same period, the number of people suffering from hunger decreased 36 percent. Likewise, deaths among children younger than five decreased 41 percent and deaths among mothers giving birth was down 47 percent.

Despite these encouraging numbers, progress still has been slow or non-existent for too many in the developing world – where nearly one billion people continue to live in extreme poverty. Twenty-five percent of the world’s children suffer from stunted growth due to malnourishment, with nearly seven million of them dying before their fifth birthdays. And every year, a quarter of a million mothers die unnecessarily while giving birth.

People continue to die from preventable diseases. Even though we have the medical solutions to prevent their deaths, we just can’t get those solutions to the people who need them. The sad fact is that people across the developing world are dying because we are unable to solve health care distribution problems for the medical solutions we already have.

Saving these lives does not need to be costly, and it can be done today without any new research in health or science. All it requires is better use of existing management knowledge, skills and infrastructures, and increasing the effectiveness of programs that are already working. Local entrepreneurs can deliver health products and services in congested and remote places all over the world. And that local entrepreneurship also can generate a better standard of living for millions of the world’s poor by reducing poverty as it improves public health. The good news is that there are many excellent examples of how these sound management and business strategies already are beginning to bring health care to those who need it most.

Child and Family Wellness (CFW), a franchised network of 88 private clinics in Kenya and Rwanda, helps women entrepreneurs start small clinics in local communities to treat the major causes of illness among children. Patients pay only a small amount for quality care. The care providers save lives while making a living and improving their lives. This is not “aid.” These entrepreneurs are using business approaches to improve the lives of themselves and their neighbors.

In Uganda, Living Goods trains women entrepreneurs to sell health care products door-to-door similarly to “Avon Ladies.” With about 1,000 agents, Living Goods reaches more than 400,000 women each year with products to prevent or treat the most common infectious diseases. Additionally, the sales agents track and support pregnant women in their territories, and promote prenatal care and delivery in a skilled care facility.

By shifting health care from expensive hospitals and clinics to local providers, these innovative and entrepreneurial programs have successfully increased access to services while reducing costs. Workers who live in these communities provide care and perform critical services locally – treating “patients” like customers. Localized service from community members helps educate women about health issues in culturally sensitive and appropriate ways, and encourages them to seek necessary and preventative care. These ambitious local caregivers are looking to expand their health care services, and are forming partnerships to help create efficiencies.

New partnerships, such as Pink Ribbon Red Ribbon (PRRR) – a public-private partnership among the George W. Bush Institute, PEPFAR, UNAIDS, Susan G. Komen for the Cure, IBM and others – are designed to combat cervical and breast cancer in sub-Saharan Africa and Latin America. PRRR leverages existing health infrastructures and public and private partners to increase access to care and scale up essential health services for women
in need.

As the U.N. considers how best to reach its development goals, it need look no further than local entrepreneurs and organizations such as Living Goods, VisionSpring, Marie Stopes, CARE, BRAC, Aravind Eye Care System, Narayana Hrudyalaya and others that are using sound business management techniques to help save lives. Efforts by these and other organizations have made it clear that we don’t need new science or health research to save millions of lives and lift people out of poverty. All we need is to apply the good business practices that we already know to reach underserved populations while empowering the communities in which they live.

Eric G. Bing, MD, PhD, MBA is Senior Fellow and Director of Global Health at the George W. Bush Institute and Professor at Southern Methodist University. Dr. Bing is co-author (with Marc J. Epstein, PhD) of Pharmacy on a Bicycle, a new book about using proven business approaches to save lives by delivering medical care to those who need it most.

Follow Dr. Bing on Twitter.

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