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Innovation from the bottom of the pyramid

11.01.2013
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When CK Prahalad penned The Fortune at the Bottom of the Pyramid he lifted the lid on the vast potential market in serving the billion or so people that exist at the bottom of the global income pyramid.  It’s widely believed that this market is worth comfortably over $1 trillion.  The book provided a clarion call for the kind of frugal innovation that would open up that market, trumpeting some of the work being done in the developing world to service this market whilst also turning a profit.  The book also provided a telling reminder that this shouldn’t be thought of as some imperialist mission to impart our values onto developing populations, but rather that they have many things they can teach us.

A nice example of this that is close to my own heart at the moment is Pesinet.  Pesinet is a social business (in the Yunus sense of the word) originating from the African country Mali.  It aims to reduce child mortality by providing access to advanced healthcare systems via mobile devices.

The issue is a pressing one indeed, with 20% of children in Mali not living past 5 years of age.  Once a week a Pesinet agent visits children, collecting medical data that they enter into their mobile phones, before it is then sent to a central server, where it can be analysed by doctors at regional healthcare centres.  Should they detect a potentially ill child, they can then call the child and their mother in for an examination.

Pesinet is a paying service designed to be financially viable. It costs 500 CFA francs (roughly $1) per child, per month. This fee allows to cover a great part of the operational costs (weighing agents wages, monthly fee reimbursed to the partnering centers, operating expenses, 50 % of the cost of the medication provided) when the project reaches 1,500 subscribers. However, this monthly fee does not exceed one day of salary which make it affordable even for the poor families.It costs the equivalent of a kilo of onions or tomatoes.

The service currently provides access to healthcare for approximately 1,000 children, with initial results in terms of health impact very promising indeed.  Parents are also very happy with the service, with 94% saying they are satisfied and 97% saying it is good value for money.

The service manages to increase significantly resort to care. An independent control-trial evaluation carried out in 2011 showed that Pesinet subscribers seek medical care in case of illness more than twice as much as non-subscribers. This also generate increase in activities and medication sales at the partnering centers.

Doctors involved in the service confirm that Pesinet subscribers tend to come early on to the doctor and that the system manages to avoid complication of diseases.

It is estimated that Pesinet can prevent 80% of mortality causes from benign diseases, hence a reduction of more than half of child mortality in the populations covered by the service. Moreover, because of its focus on prevention, Pesinet contributes to reducing the health spending on benign illnesses.

So how does this relate to healthcare here in the west?  Well, my partner is currently working in infant healthcare, and there appear to be significant lessons that could be learnt from Pesinet.  For instance, it seems health visitors, GPs and midwives all have bespoke information systems, thus making virtual collaboration, or even information sharing, a labour intensive process.  What’s more, the high case load means that many parents see health visitors infrequently, and certainly not on a weekly basis as with Pesinet.  Any notes taken whilst on a visit are done in a paper based way, which then have to be inputted manually into an information system (which isn’t joined up!).

Whilst a World Health Organisation report in 2011 found the UK to be a leader in so called mhealth, most of that leadership was courtesy of the work done with NHS Direct, a service that provides health advice to people without requiring them to visit a doctor.  However, the report finds that integrating mobile technologies in order to create and/or access electronic medical records is “moderate”.

There are a significant number mHealth projects currently being undertaken in the developing world in an attempt to reduce the 21,000 infant deaths per day.  Hopefully healthcare providers from the west will be monitoring these projects keenly to ensure that any lessons learnt can be applied back home.

Find out more about Pesinet in the video below.



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