We live in an age of ubiquitous technology, from cellphones to artificial intelligence and cryptocurrencies — and yet there are still about one billion people across the globe who have no access to basic medical care simply because they live in remote regions.
Imagine you have a two-year-old who wakes up one day with a fever and you realise that she could have malaria. You know that the only way to get her the medicine she needs is to get into a canoe, paddle to the other side of the river and then walk for up to two days through the forest just to reach the nearest clinic.
According to Dr Raj Panjabi, a Harvard Medical School assistant professor, who founded Last Mile Health in Liberia more than a decade ago, this is the reality for far too many people in the world today. “Nobody should die because they live too far away from a doctor,” he says, especially in this age of modern technology where cellphones in particular offer us a solution.
In 2017, 44% of the population in sub-Saharan Africa had cellphones. Their rapid adoption has defied expectations and Last Mile Health is using this fact to Africa’s advantage. In partnership with the Liberian government, it trains community health workers to prevent, diagnose and treat a range of medical conditions and diseases using smartphone technology and apps to help thousands of people in rural areas.
Their interventions have seen the rate of children receiving life-saving treatments increasing by 50% in some areas. Community health workers are able to treat common medical problems such as malaria and pneumonia, and can dispense medication and test for a range of diseases by using innovative medical devices such as rapid diagnostic tests.
Last Mile Health is one of several healthcare innovators in Africa that are using mHealth (or mobile health) technology to reach rural communities. Living Goods in Kenya recruits people to sell goods such as mosquito nets, solar lighting and nappies door-to-door, using a micro-entrepreneurship model. Having gained access to homes, the entrepreneurs are then able to provide contraception, sell medication and carry out health assessments on a cellphone, which then links to the government health system.
VillageReach in Mozambique has developed a proactive model that works to create an enabling context and connect key players — including cellphone service providers — to enable healthcare delivery in that last mile.
Imagine the power and potential if these organisations were able to connect and share best practice to collaborate and scale their success? This is precisely what the Health Systems Entrepreneurship project, a two-year initiative run by the Bertha Centre for Social Innovation and Entrepreneurship at the University of Cape Town Graduate School of Business and funded by Johnson & Johnson, set out to achieve, with startling results.
This project arose from the Social Innovation in Health Initiative (Sihi), hosted at the TDR, the World Bank and United Nations agencies’ special programme for research and training in tropical diseases. It was conceived as an opportunity to better understand how social innovators in health integrate their solutions with governments.
When the government buys in — as it has in Liberia, where Last Mile Health helped to develop curriculum and training modules for all government community health workers — the effect of the innovation is wider and more sustainable.
“Success often depends on an organisation’s ability to support governments as [the latter] assume responsibility for and eventually own a programme’s ongoing operations and management. If it can’t, the solution and its positive impact on the community can disappear or require external funding in perpetuity,” write the VillageReach team in a recent Stanford Social Innovation Review article.
But not all organisations have the time and resources or the knowledge and skills needed to achieve this outcome. The Health Systems Entrepreneurship project set out to change this by connecting six projects identified by Sihi: Last Mile Health, Living Goods, Muso in Mali, the Ihangane Project in Rwanda, VillageReach and mothers2mothers in South Africa to promote collaboration for inter-organisational and government integration.
While all the organisations knew of each other, they mostly did not have the time or the resources to learn from each other. Through the opportunities we created, which included funded visits, scheduling conference calls for peer-to-peer learning, and seminars and workshops — they were able to share best practice, with many reporting that using each other as a peer sounding board was particularly valuable.
One of the tangible outcomes from this collaboration has been the development and publishing of a framework on how to manage the transition from social solutions to government ownership. Piloted by VillageReach, using material gained through our workshops and pressure tested with peers in the cohort, this document lays out a clear pathway for nonprofit and private-sector organisations that want to transfer the implementation of their solutions to government agencies.
The overwhelming lesson from the project is that no single organisation, no matter how innovative, can do this work alone. Creating successful health outcomes is complex and is dependent on building enduring relationships with other actors in the health ecosystem, including local health systems and community members. There are many obstacles around bureaucracy, administration and communication that need to be overcome. This takes time and ongoing effort, but the rewards for persevering are significant.
The potential to empower and upskill many more millions of people on the front lines of healthcare in rural areas is real — and it doesn’t require a radical technological solution, but rather radical collaboration and the commitment to reconfiguring the assets that are already in the system for better outcomes.
As funders and academics, one of the best things we can do is to continue to find ways to connect frontline health initiatives to enable them to collaborate and learn from one another and so create more efficient and effective healthcare systems. The measure of our collective success should be that, in the future, parents don’t have to journey for two days with a sick child to reach help. After all, as Panjabi says: “We are not defined by our conditions, no matter how hopeless they are; we are defined by how we respond to them.”
Katusha de Villiers is the acting senior manager of the Bertha Centre, and the senior project manager for the Bertha Centre’s Health Systems Entrepreneurship project