Emerging Voices features regular contributions from scholars and practitioners highlighting new research, thinking, and approaches to development challenges. This article is from Stefanos Zenios, who is the Charles A. Holloway Professor of Operations, Information, and Technology and Professor of Health Care Management at the Stanford Graduate School of Business, and Lyn Denend, Director of the Program in Healthcare Innovation at the Stanford Graduate School of Business. They discuss two attempts to bring cost-effective health technologies to developing countries and the role of diverse stakeholders in facilitating—or hindering—their implementation.
Out of necessity, innovators and health care providers focused on meeting the needs of patients in developing regions have had to devise new health delivery models that improve patient outcomes while keeping costs low. Extreme poverty and severe resource constraints have stimulated news ways of thinking—and working—in the medical field. More often than not, the biggest obstacles to scaling up economical life-saving innovations are linked to stakeholder resistance, as well as the distribution and dissemination of ideas. But global innovators are overcoming these challenges with creative solutions that align the interests of diverse stakeholders.
Admittedly, “doing more with less” is no easy feat. As Rebecca Onie, Paul Farmer, and Heidi Behforouz point out in a recent article in the Stanford Social Innovation Review, there is no shortage of great ideas and cost-reducing technologies from Delhi to Dakar. The challenge, they write, is in implementing these insights effectively and on a large enough scale to reap the synergies they promise. We will examine a couple of examples of health solutions designed to deliver higher quality care at lower cost in developing economies and how they have been helped or hindered by stakeholder alignment on their way to achieving scale.
Consider the case of Diagnostics for the Real World (DRW), a company that was spun-out of the Diagnostics Development Unit at the University of Cambridge to commercialize a low-cost rapid chlamydia test that better addresses the needs of patients in resource-poor settings. Chlamydia is easily treated but it is an asymptomatic and widespread disease, which means it is best addressed through proactive, field-based screening within high-risk populations. Untreated, it can result in serious long term health consequences for men and women, and babies born of infected mothers. Typically, chlamydia diagnostics are technically complex and require processing at a centralized lab, which makes them expensive and inefficient. DRW offered a less expensive point-of-care test that was equally as effective and allowed patients to be tested and treated in the same visit. The company had hoped the test would be widely adopted in Asia, Africa, and South America.
The team initially believed that the superiority of its technology and the magnitude of the need would lead to adoption. However, they underestimated the strength of the resistance mounted by the centralized labs, which sought to maintain the status quo by seeding doubt about the efficacy of the test. Moreover, DRW discovered that the disease wasn’t necessarily a high priority for funders or large-scale NGO customers compared to other illnesses such as HIV.
Although DRW continues to offer its rapid chlamydia test in markets where it’s able to make in-roads, the company was ultimately forced to refocus its efforts to other areas—specifically HIV and hepatitis B—where the demand for solutions is clearly aligned with funder and customer priorities.
One strategy that innovators have used to anticipate and avoid such battles is to proactively align stakeholders around the adoption of a health solution. For example, when the SafePoint Trust sought to bring low-cost auto-disable (AD) syringes to Tanzania to stop the spread of blood-borne diseases caused by syringe reuse, it mounted a comprehensive program to get key players on board. This approach started at the top, with SafePoint convincing the Tanzanian Ministry of Health that it should mandate the production and use of only AD syringes for both immunization and curative injections across the nation. With this endorsement in hand, SafePoint helped the Ministry coordinate with the Tanzania Food and Drug Authority to ensure that it only granted import certificates for AD syringes meeting international quality standards.
Next, the team contacted manufacturers supplying Tanzania with syringes to inform them how to produce and provide the right product. In addition to helping make the international quality standards well known, SafePoint encouraged the manufacturers to include a new “LifeSaver” symbol on their AD syringes that met these requirements.
The same LifeSaver logo was at the center of a health worker training program and public awareness campaign with a clear, simple message—every injection should use a syringe that comes from a sealed package that bears this symbol, is used only once, and then safely discarded. A free text messaging system, developed with the help of Hewlett-Packard, was used to allow patients to provide feedback and to reinforce and reward desired health worker behavior.
To ensure that Tanzania had an adequate supply of syringes as it transitioned from using them four or five times each to only once, SafePoint reached out to donors and other funders to get them on board. They convinced them to underwrite more syringes by showing that for every $1 spent on AD syringes, they could expect to save approximately $280 in additional treatment costs from complications linked to unsafe injections.
Scaling up cost-reducing health solutions from interesting prototypes to widely available products will always be a challenge. But, there are a growing number of organizations that are figuring out how to do this in the developing world. The answers lie, at least in part, in making sure stakeholders are aligned, and that the right distribution networks are in place to support adoption.
At the Stanford Graduate School of Business, we’re studying the many obstacles innovators face in bringing health innovations forward in resource-constrained environments in the developing world, along with the creative solutions they’re devising to overcome them. As we have shown, the problems are not only financial but also linked to entrenched interests that benefit from the status quo. More stories from our research, like the ones above, are available online. Our hope is that by understanding these lessons in detail, we can help overseas innovators continue to increase their effectiveness in cutting health care costs and successfully implementing new ideas.