Problem: High maternal mortality due to a lack of prenatal care in rural Bangladesh.
Solution: Grameen Intel's Laptop-based software for identifying high-risk pregnancies, tracking patients, allocating resources and training community health workers.
Impact: Increased coverage of pregnant women with prenatal care; half of assessed women to date have high-risk pregnancies.
Sustainability: Technology-based packages for pregnancy care may become a “business in a bag” for Grameen Kalyan's community health workers and women entrepreneurs; micro-insurance may offer prenatal services.
This is one of many new ideas and tools from the report, Innovating for Every Woman, Every Child, which profiles projects striving to improve health and save the lives of women, infants, and children in low income countries.
The UN Secretary General's Every Woman, Every Child Innovation Working Group (IWG), which Gina Lagomarsino and others working on the Center for Health Market Innovations take part in (see Gina's 2 cents Business about emerging models for non-profits, hybrids, and public-private partnerships here) issued a call for proposals for catalytic support of innovative projects and received 50 in a matter of two weeks; similarly, Saving Lives at Birth: A Grand Challenge for Development, led by the United States Agency for International Development, received close to 600 proposals in just three months.
Indeed, many believe innovation in the guise of portable technological devices is critically needed to combat maternal mortality.
“Innovation is rapidly transforming the way health care is delivered in low income countries, especially for the 350,000 women who die each year from complications of childbirth and pregnancy and the 3 million children who succumb in the first month of life,” says Tore Godal, M.D., PhD, special adviser to the Prime Minister of Norway, and author of this week's Lancet commentary on the need for innovation.
I asked the working group's manager Frederik Kristensen how these emerging business models can go to scale.
Many of the initiatives in the report are pilots. Do you think they will go to scale? Can you give examples?
The initiatives have been chosen based on their promise and potential, as well as their ability to inspire others. 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 be in the latter category is not possible ahead of time, and is part of the risk one has to be willing to take.
You mention that having a business model means an implementer has a long-term plan for viability. Do you find this is the case, with many of the models highlighted?
There is still a way to go for most pilot projects to have a sound plan for self-sustainability. As the report points out, pilot projects in general will need to secure rigorous evaluations and engage in multi-stage planning: One plan for the pilot phase and another for reaching scale, ie growing from a small, founder-centric business to an enterprise of maybe 50-100 people. The project “SMS for life” made the decision 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.
If you had to point to one or two salient findings of this landscape study for mHealth business models in maternal and child health, what would they be?
Important innovations may come in many fields, and we have therefore included more than mHealth models in the report. But for the mHealth models in particular it seems that the two most important findings are that they: a) need to find practical and realistic ways to perform evaluations of their likely effects and costs at scale, and b) develop a hard-nosed plan for long-term financial viability.
You noted that the goals for self-sustainable models have shifted from a focus on getting more donors to the table. What instead are your hopes for the outcomes of this report?
That the innovative projects will be able to fill a need (and for some, also 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.
Why the terminology, business model?
The business-oriented terminology is used to help innovators in the public health arena to maybe 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 maybe even more on the need for a plan for long-term viability as a prerequisite for scaling up.
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.
It is important 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” and to share lessons learnt and find potential partners (or understand earlier that they are being overrun by a nimbler “competitor”….)
What about the importance of fostering collaboration and coordination between innovators. What can this help achieve?
Many programs could benefit from merging their efforts, both to attract necessary investment, become cost-effective, and ultimately and most importantly, have greater impact on the ground: Reducing the mortality and morbidity of all the devastating diseases they are combating.
Given the theme of this year’s UN summit, do any of these business models address chronic diseases? If not do you think this will develop as the next wave of mHealth programs?
Yes, all the models highlighted in the report have the potential for addressing chronic diseases as well. This is examplified through innovative ways of: Informing patients and families directly (Cell-life), identifying and tracking high-risk patients (Grameen-Intel), providing decision support to health workers (D-Tree) providing access to test results earlier (SMS Printers), developing new vaccines (PATH), distributing medical commodities (Cola-life), ensuring better stock management (SMS for life), and using 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.