Four innovators help to improve healthcare access for the poor
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From the high costs of medical care and drugs, to the lack of safe equipment and advice, there are many problems restricting access to healthcare in Africa and Asia. The FT has identified a series of innovative companies, social enterprises and charities that are trying to provide sustainable ways to meet these challenges. All highlight the need for new approaches where funding and coverage is limited.
In India, pregnant women are encouraged to give birth in clinics rather than at home. Yet poor hygiene at the medical centres means women are still susceptible to infection. ayzh has responded by developing a low-cost “clean birth kit” that it sells to clinics.
“When people promoted births [in clinics], they did so without increasing capacity, and hygiene is the first thing that is compromised,” says Zubaida Bai, the founder of ayzh, which generated nearly $500,000 in sales last year. “Our kit helps with behaviour change. It’s about helping childbirth in the right place at the right price point.”
Ms Bai is planning to expand into east Africa and to increase the range of products to cover menstrual hygiene, birth and beyond. “We are creating a brand that focuses on the entire lifecycle,” she says. That will lead to a shift in ayzh’s model, away from direct sales to instead selling through franchises. It plans to break even within four years.
Africa is home not only to some of the world’s poorest countries but also some of its most expensive medicines. One reason is inefficient supply chains. Each hospital typically buys its own drugs in small and irregular volumes but erratic inventory-management can leave them with products that expire before use.
“Their job is to provide clinical services, so we stepped in to see how we could centralise procurement services,” says Gregory Rockson, co-founder of mPharma, which offers private hospitals and health insurers a chance to save money by buying drug supplies in bulk. Mr Rockson was inspired by the Clinton Health Access Initiative, which developed similar systems to pool procurement and manage stock for clinics in the public sector in poorer countries.
mPharma, which operates in Ghana, Nigeria and Zambia, also offers financing to clinics and collects data on use of the drugs. So far it has concentrated on treatments for diabetes, hypertension and glaucoma. Mr Rockson estimates his organisation has reduced medicine costs for about 10,000 patients by an average of 30 per cent.
Many people in rural Zambia lack access to supplies of over-the-counter medicines, malaria bednets and health products such as soap, condoms and sanitary pads. Live Well is a social enterprise set up by Care International that manages a network of 300 people selling low cost items to about 45,000 customers a month. It drew inspiration from practice elsewhere in Africa and Bangladesh to train a network of local entrepreneurs and supply them with affordable goods.
It has received support from local businesses as well as Barclays, which helps provide basic business training, and GlaxoSmithKline, which offers a range of its products at low prices.
“It’s a new way of delivering our social impact in a more sustainable way to improve health outcomes and livelihoods,” says Tom Sessions, head of strategic partnerships at Care. GSK has the right of first refusal to provide supplies, but Mr Sessions stresses that “if Live Well can find a better product [elsewhere], equal in quality and cheaper, we are happy. If you go in with just one company and sell their own products without diversifying, it is not sustainable.”
Iain Barton was frustrated that, as a doctor in South Africa, he was often required to charge high consultation fees to patients with simple problems. He believed one way of making primary care more accessible was to deploy more affordable skilled nurses to treat simpler health problems among the 40m South Africans without private medical insurance.
He started Unjani, which employs more than 100 people in 31 clinics run by nurses. Qualified dispensing nurses cover a range of conditions and charge R180 ($14), including diagnosis and basic medicines, for each treatment. The network, which takes some of the pressure off free but understaffed public health clinics, has seen 260,000 patients in the past three years.
Lynda Toussaint, Unjani chief executive, says: “Our government believes that primary care should be for free but it is not achieving its objectives because of the resource drain. We’ve just given patients a choice: if they are able to afford to pay, they can use ours and free up capacity for the unemployed. If not, they can continue to use state facilities.”
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Growing and ageing populations around the world are creating stronger demand for healthcare. Yet limited money and out of date infrastructure mean policymakers in rich and poor countries alike are faced with the challenge of making sure their citizens have access to the resources they need