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Pharmacy on a Bicycle: Innovative Solutions for Global Health and Poverty, by Eric Bing, Marc J. Epstein
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Every four minutes, over 50 children under the age of five die. In the same four minutes, 2 mothers lose their lives in childbirth. Every year, malaria kills nearly 1.2 million people, despite the fact that it can be prevented with a mosquito net and treated for less than $1.50.
Sadly, this list goes on and on. Millions are dying from diseases that we can easily and inexpensively prevent, diagnose, and treat. Why? Because even though we know exactly what people need, we just can’t get it to them. They are dying not because we can’t solve a medical problem but because we can’t solve a logistics problem.
In this profoundly important book, Eric G. Bing and Marc J. Epstein lay out a solution: a new kind of bottom-up health care that is delivered at the source. We need microclinics, micropharmacies, and microentrepreneurs located in the remote, hard-to-reach communities they serve. By building a new model that “scales down” to train and incentivize all kinds of health-care providers in their own villages and towns, we can create an army of on-site professionals who can prevent tragedy at a fraction of the cost of top-down bureaucratic programs.
Bing and Epstein have seen the model work, and they provide example after example of the extraordinary results it has achieved in Africa, Asia, and Latin America. This is a book about taking health care the last mile—sometimes literally—to prevent widespread, unnecessary, and easily avoided death and suffering. Pharmacy on a Bicycle shows how the same forces of innovation and entrepreneurship that work in first-world business cultures can be unleashed to save the lives of millions.
- Sales Rank: #1162900 in eBooks
- Published on: 2013-05-06
- Released on: 2013-04-05
- Format: Kindle eBook
Review
“In this compelling, practical, and very human book, Bing and Epstein offer real-life solutions to ending millions of preventable deaths around the world. By integrating tools from public health, medicine, and business, they have created an approach—IMPACTS—that has potential for saving millions of lives, not only in low- and middle-income countries, but in resource-poor, hard-to-reach settings within wealthier nations.”
—Helene D. Gayle, MD, MPH, President and CEO, CARE USA
“Powerful medicine for a world that is ailing from growing health disparities and a must-read for anyone providing care for—or caring about—the world’s most vulnerable people. Short on abstraction and long on practical solutions, this is an inspiring call to action that awakens the entrepreneur in all of us.”
—Julie Gerberding, MD, MPH, President, Merck Vaccines, and former Director, Centers for Disease Control and Prevention
“This is what needs to be done in order to save lives! The creativity and originality of this book provide the impetus to bridge the final mile in global health. Bing and Epstein exemplify cost-effective and successful innovative solutions—a must-have for all working in global health.”
—Christine Kaseba-Sata, obstetrician and gynecologist and First Lady of the Republic of Zambia
“Pharmacy on a Bicycle demonstrates how, even in the most dire circumstances, entrepreneurs can develop cost-effective, sustainable, innovative solutions that have the potential for replication and scale. Not only are the examples inspiring and instructive, but the IMPACTS framework has applications that extend well beyond global health.”
—Professor J. Gregory Dees, cofounder, Center for the Advancement of Social Entrepreneurship, Duke University
“This book provides workable answers for applying tested entrepreneurial techniques to the unique challenges of the very poor. Among the fertile minds of its readers, it will inspire new solutions from many successful examples. This book will save lives!”
—Marc J. Shapiro, Chair of the Board of Trustees, Baylor College of Medicine, and former Vice Chair, JPMorgan Chase & Co.
“By engaging emerging leaders with diverse skills and backgrounds, Bing and Epstein recognize how we can solve the problems we face in global health now. They demonstrate how partnership is fundamental to improving health access for all—an essential read for tomorrow’s leaders in global health!”
—Barbara Bush, CEO and cofounder, Global Health Corps
About the Author
Eric G. Bing, MD, PhD, MBA, is a Harvard-educated physician who has created and managed innovative health programs throughout Africa, the Caribbean, and Latin America for over two decades. He is a senior fellow and the director for global health at the George W. Bush Institute and professor of global health at Southern Methodist University in Dallas, Texas.
Marc J. Epstein is distinguished research professor of management at Jones Graduate School of Business at Rice University. Previously a professor at Harvard and Stanford, Dr. Epstein is the author of many books and articles on innovative approaches to improving businesses and nonprofit organizations. He works in Asia, Latin America, and Africa and trains students in entrepreneurial solutions to global health and poverty.
Excerpt. © Reprinted by permission. All rights reserved.
Introduction
Why Pharmacy on a Bicycle
Dawa paced in front of Pemba’s door, trying to hide his concern.1 He had run out of his medication, and Pemba had been kind enough to share his. Both men had been told to never stop taking their medications because HIV was a virus that could quickly develop resistance, and then the drugs would no longer work. Now Pemba was beginning to run out of his supply as well.
Dawa and Pemba were running low on medicine because a bandh, or strike, was making it impossible to get to the pharmacy. In Nepal, during a bandh, it was wise to avoid going out in a car, because if you did, you could get your tires slashed, your windows broken, or your vehicle set on fire. The bandh was in its second week, and the men had nowhere to turn once their medications ran out.
Crises stimulate action. In dire straits, we become innovative and entrepreneurial. Which is what happened in this case. The Saath-Saath Project, a local HIV program, partnered with a hospital and some community health workers to create a pharmacy-on-a-bicycle brigade. If the patients couldn’t go to the pharmacy, then the pharmacy would go to them.
It was a risky proposition. Would the bandh enforcers respect the riders’ mission? Nobody knew. But lives were at stake. That is why Suraj, a community health worker and person living with HIV himself, was one of the first to volunteer. Suraj set out early in the morning after loading his satchel with medications. By midday his pharmacy on a bicycle reached Dawa and Pemba—right before their pills ran out. Because of quick thinking, a partnership, and a bicycle, Dawa and Pemba didn’t miss a single dose. This simple solution may have saved their lives.
If all we had to worry about was the occasional strike, most of our problems in global health would be solved. But a bandh that lasted thirty-two days only exacerbated Nepal’s problems of deep poverty and a population living in hard-to-reach areas. Such problems are found in many developing countries, and regardless of whether they are caused by instability, conflict, geography or cost, they make it difficult to bridge the “final mile” in global health.
Over the last few decades the authors have examined health care in remote rural and dense urban settings across a variety of low- and middle-income countries in Africa, Asia, and Latin America. Some countries were stable, others were in civil war. We have spoken with presidents and health ministers, tribal leaders and CEOs, and patients and their families. We have worked alongside dedicated and compassionate clinicians—doctors, nurses, community workers, and traditional healers—and we have consulted with governments, businesses, NGOs, and donors. We have examined health care from a variety of perspectives, and we always reach the same conclusion:
Millions are dying of diseases we can easily and inexpensively prevent, diagnose, and treat.
Pharmacy on a Bicycle is a bold yet practical approach to alleviating problems in global health and poverty. Fortunately, we are not starting from scratch. There are many examples of successful programs that are already saving lives. We need to leverage these innovative and entrepreneurial solutions and create even more to save lives by increasing access, use, and quality of care, while reducing costs.
In Pharmacy on a Bicycle, we show how we can save lives while saving money through a seven-point approach we call IMPACTS (Figure 1). Here are the key components:
Figure 1 The IMPACTS Approach
Implementing the IMPACTS approach will help bring care to those who need it most.
How to Use This Book
This is a book about taking health care the last mile—sometimes quite literally—to a place that’s accessible, in a way that’s acceptable, and at a cost that’s affordable.
In other words, this book is about solutions.
There are people and organizations already doing many things that work. Now we need to scale those models to reach the masses of people who deserve quality health care. What works may come from governments, NGOs, businesses, or donors. All are part of the solution to the problems we face, and all have a role to play.
• Government. Governments can help create an environment, supported by sound policies, regulations, and resources, where basic, high-quality health care is expected. Ministries of health are the backbones of strong national health systems upon which services are built. Local and national government leadership and commitment are essential for success and financial sustainability.
• Nongovernmental Organizations. NGOs, including faith-based organizations, have long provided essential health care, social services, and advocacy in developing countries throughout the world. They are critical to providing quality care in diverse and hard-to-reach communities.
• Businesses. For-profit businesses offer not just resources but models of efficiency, innovation, entrepreneurship, and distribution: ways to create demand and reduce costs. In addition, local businesses, along with microenterprises, are often created and based within communities, and owners understand the local culture and needs. Microenterprises in health care, which include small clinics and pharmacies, can help distribute services and products to those in need. So too can traditional healers and traditional birth attendants, particularly in rural areas. For a variety of reasons, these smaller providers and traditional sectors may not be integrated into formal health care systems. But when given appropriate training, support, and oversight, they can help us complete the final mile.
• Donors. International agencies, foreign governments, and foundations provide essential financial and technical support to country-led health programs. Such donors are essential to enable governments and local implementers to provide needed services.
Innovative partnerships that bring these sectors together can help save more lives. In addition, the approaches used by these sectors overlap and complement each other as they grow and evolve. For example:
• Effective governments in many developing countries are now adopting sound internal business strategies and practices to manage public resources to deliver health services.
• Many NGOs in low- and middle-income countries operate like businesses to ensure that their resources are effectively used and have real impact. Some NGOs are even creating for-profit spinoffs to enhance their chances of creating financially sustainable programs.
• Businesses, large and small, seek not only to be financially profitable, but also to create social good in the countries where they work. This approach goes beyond corporate social responsibility—it is part of their business model.
• Donors are increasingly requiring recipients to reduce costs, demonstrate impact, and achieve greater financial sustainability once support ends.
These new, blended approaches are also helping to change the perceptions of target populations from beneficiaries to customers. This change in orientation recognizes that a patient is a customer and that the customer is in charge. All people, regardless of income, are customers of health products and services. When customers perceive little value in or encounter barriers to using a health product or service, it is likely that they won’t use it—even if it’s free and potentially lifesaving. Our job, therefore, is to find innovative and entrepreneurial ways to motivate customers to use health products and services that can save their lives.
Pharmacy on a Bicycle is filled with practical examples of innovative and entrepreneurial solutions to health care delivery in a wide variety of settings in developing countries. While this book focuses on low- and middle-income countries, many elements are readily applicable to populations in higher-income countries as well.2 Innovation is much more than discovery; entrepreneurship is much more than maximizing profits. The innovator creates solutions. And the entrepreneur finds efficient, effective, and economical ways to get solutions to customers.
We encourage those readers who develop or manage health programs to read Pharmacy on a Bicycle with an entrepreneurial lens and find ways you and others can take some of these ideas to the next level to deliver health services. Regardless of your specialty, population, or setting, you may see a solution to a problem you’re working on, even if it was developed to combat a different disease, for a different population, under different circumstances, or in a different country.
If you see a model that might work for you, try it. If you see a model that, with some modifications, might serve your needs, then change it. If you see several models you think could work well together, then combine them. And as with any other model, new or old, monitor it regularly and evaluate it periodically to ensure that it’s producing the intended impact.
Regardless of your reason for reading this book, in presenting the IMPACTS approach and spotlighting successful real-world applications of its core points, we hope to activate your inner innovator and entrepreneur so that you can see existing solutions or create new solutions to the challenges you face.
We have divided the book into three sections:
Part 1: The Prescription includes four chapters that deal with the basics—the essential ingredients, the model, and the core elements of our approach.
• Chapter 1 provides an overview of the issues, the IMPACTS approach, and the model that describes how to save millions of lives and billions of dollars in global health care.
• Chapter 2 describes the roles innovation and entrepreneur-ship play in improving global health.
• Chapter 3 describes how task shifting, maximizing efficiency and effectiveness, creating demand, and focusing on accountability can better deliver health services and products and improve outcomes.
• Chapte...
Most helpful customer reviews
1 of 1 people found the following review helpful.
A Pragmatic Approach to Global Health
By Troy Camplin
The tendency for most authors of books recommending how to help people in developing countries is to propose a one-size-fits-all approach. The history of failures of that approach does not even seem to affect those making the proposals. It seems that ideology matters more than success.
The authors of this book, however, are more concerned about doing what works to get health care to those who need it most. They recognize the fact that culture matters, that what works in one place may not work in another. This means that taking a historically popular top-down approach is out of the question. This means that, although government programs and working in partnership with government are not off the table, the primary approach must be bottom-up, entrepreneurial, making use of local people's local and tacit knowledge to deliver health care goods and services. Indeed, this is what makes this book unique among books making policy proposals for improving health in developing countries: the authors' recommendation that businesses, NGOs, and government all take an entrepreneurial approach to solving the problems of getting health care goods and services to those who need them most.
The authors' pragmatic approach means the reader needs to read this book with an open mind. It is likely the examples of successful government programs in the book are going to turn off those who think markets are the only way to efficiently deliver goods and services. Equally, it is likely the examples of successful entrepreneurs, and the very recommendation that people become more entrepreneurial in spirit, is going to turn off those who think top-down government solutions are the only valid solutions. Yet I hope that both sides will put aside ideology and pay close attention to the examples and suggestions in the book. What works in one time and place may not work in another. Culture matters, and so does overall development. In one country, businesses will be better able to deliver what is needed; in another country, government will be better positioned; in yet another, the situation may be so dire, only NGOs can help. We can argue about the best form of political economy once everyone in the country is healthy enough to participate. In the meantime, we need to get to work with what works now. This book lays out a reasonable way to get people in even the remotest regions the health care they need.
If you want to be inspired, read this book. If you want to learn about successful health programs in developing countries, read this book. If you want to learn new ways to do things so you can apply them to your country, to your culture, to your local circumstances, read this book. And more, be open to the possibilities that present themselves. That is the real message of this wonderful book. Be open to the possibilities -- as that, itself, is the soul of entrepreneurship.
1 of 1 people found the following review helpful.
Engaging Solutions
By Nia Parson, PhD, Author of Traumatic States: Gendered Violence, Suffering and Care in Chile
With vivid examples of innovative programs such as Narayana Hrudayalaya, a for-profit hospital network in Bangalore, India, where care is provided effectively to both those who are able and those who are not able to pay, Bing and Epstein convey their message that effective solutions to caring for the world's poorest members lie in employing business tools. Private and/public partnerships are crucial in this model, as are innovation and creativity. This is a broad vision about how to work with and not against the larger processes of economic globalization and the role of publics, privates and states in the reconfigurations of human life and well-being globalization entails. Bing and Epstein attend to crucial issues in global health today: diseases of lack of access to the basic necessities of life, infections and seemingly intractable problems like endemic malaria, and propose practical pathways to shift health outcomes and improve people's lives, which they posit will enable more people to both benefit from and contribute to the positive aspects of global human society. Importantly, they include the global health problem of non-communicable diseases, including mental illnesses and heart disease. In the grandest sense, this book is an argument for thinking in terms that will enable human survival and well-being for all people, as we inhabit and share an increasingly smaller planet.
1 of 1 people found the following review helpful.
A Refreshing Ground-Up Approach to Social Enterprise
By Jonathan Huggett
Bing and Epstein give a fresh, ground-up view of enterprising ways to help improve health of the poor. We can all learn from their hands-on guide based upon what works in Africa and Asia. They break the mold of the top-down view of social enterprise through the eyes of "heroic entrepreneurs" who want to "save" the poor. Instead, they show how empowered communities acting as customers and in partnership with others can drive change that works and lasts. They show how the developed world can learn from developing countries, instead of the other way round. It's social enterprise that's more social and more enterprising.
Jon Huggett, Chair, Social Innovation Exchange
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