This post is the third in a five part series on a radical new approach to scaling BoP business models, what we call a transformative sector strategy. In this segment, I describe how this strategy could transform the health sector in emerging economies.

Last Mile Health Care Delivery

Talk to people in the rural communities of southern Mexico, in the new urban communities on the southern edge of Bogota, or in almost any village in rural Africa about getting decent access to healthcare, and their answer is the same: it usually costs more to get to a clinic, a doctor's office, even a pharmacy, than the cost of the service itself. In Bogota, most of the government-supported health services are in the north of the city, such that it can cost people in these new refugee communities a day's work plus bus fare across town and back to get help. Lack of access defines part of the last mile health care dilemma, and that means distributional business models, such as franchising, can be important.

Talk to Health Stores in Kenya, an enterprise trying to staff small pharmacies with nurses, and another part of the problem becomes clear: the sheer lack of doctors, nurses, and pharmacists in emerging markets. There are not anywhere close to the number of skilled professionals needed to cover rural areas, and these health workers overwhelmingly refuse to live either in rural areas or in urban slums. So technologies, organizational models, and legal changes that enable local diagnosis and remote practice by doctors and pharmacists could play a critical role.

Still a third factor leaps out from the data in The Next 4 Billion report that shows clearly that low-income households spend between a third and a half of their out-of-pocket health care expenditures on drugs. They typically don't go to doctors or clinics or hospitals, but rather to pharmacies or some other source of medicines and seek to self-medicate. That means they often get a guess as to what's wrong with them instead of a diagnosis.

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As Ana first reported back in February, Ashoka's Changemakers and the Global Water Challenge have partnered to open a worldwide search for ideas and projects with the potential to transform the provision of sanitation and water worldwide.  The search, entitled Unclogging the Water and Sanitation Crisis, began with a call for projects and culminates this Sunday, when voting closes.

This is a competition through collaboration, meaning that the Changemakers community gets to nominate projects, vet them and vote for the winner.  (If you've never heard of Changemakers, check out Leslie Berger's concise profile of their work in the Stanford Social Innovation Review.) 

The water and sanitation competition is coming to a close; 9 finalists have been selected by the community, and voting is open.  If you haven't already, drop by the Changemakers site and vote - it only takes a few minutes, and your voice actually counts (the winner gets $5,000 cash and is eligible for up to $1 million worth of Global Water Challenge grants). 

In an era when most decisions - political, business - are made in back rooms away from our inquiring eyes, Changemakers represents real change.  By opening up the decision making process to anyone with a web connection, they are democratizing (and crowdsourcing) at the base of the pyramid.  Happy voting...

Though I'm no longer on WRI and NextBillion's staff, I'm glad to announce the release of WRI's latest What Works business case study, CareShop Ghana: Improving access to essential drugs through conversion franchising. This study is authored by Joel Segre (Harvard Business School, '08) and myself, and was made possible through the generous support of the Horace W. Goldsmith Foundation.

NextBillion has discussed pharmacy microfranchises in the health sector on numerous occasions, but CareShop is unique among them as a conversion franchise that recruits existing drug store owners, rather than a "green field" franchise model that establishes new outlets. A conversion franchising strategy has great potential especially in Ghana, where an extensive network of 8,000 individually run retail drug stores, known in Ghana as "licensed chemical sellers," already reaches every corner of the country.

CareShop's founders interpreted the prevalence of easily treatable infectious diseases in Ghana as significant unmet demand for better access to more affordable drugs, and endeavored to meet this demand by working with chemical sellers in a franchising arrangement. CareShop, as the frachisor, runs on a for-profit basis and generates revenue from product sales to chemical sellers as its franchisees. CareShop provides franchisees with valuable business and healthcare training, branded materials, and the convenience of having products delivered directly to their doorstep. CareShop is a program run by Ghana Social Marketing Foundation Enterprises Limited, which itself is a for-profit subsidiary of Ghana Social Marketing Foundation (GSMF), a non-profit organization.

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Today's main headline in the online version of El Tiempo, Colombia's largest newspaper, reads as follows: "Government abandonment and malnutrition ramble in Chocó, where 17 children starved to death"

In a couple of hours, another headline will replace Chocó's tragedy and few will remember these events and, more importantly, acknowledge the pressing challenge that they represent. I can't let these news go by without at least sharing my thoughts with a community that discusses precisely what is needed in such remote and often forgotten areas: active involvement of the private sector to build creative and sustainable solutions to the urgent needs of the poor.

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Guest blogger Mallika Ahluwalia works for ACCESS Development Services, an Indian firm providing inclusive and innovative livelihood solutions enabling the poor to ovecome poverty and live with dignity.

By Mallika Ahluwalia

Yakalakshmi lives in Nekkunda village, part of the Telengana region of Andhra Pradesh, with her husband and two children. Though she has water piped to her house by the village panchayat, her entire family fell ill for a month last monsoon season by drinking water directly from the tap. "We all got high fever and severe diarrhea," and as a result, "we had to spend around Rs. 4000 ($100) on health care, which was very difficult for us." So, when Yakalakshmi got the opportunity this past January to buy an effective water purifier through her Self Help Group (SHG) on an installment basis, she was one of the first to sign up.

Yakalakshmi is just one of the beneficiaries of a unique tie-up between ACCESS Development Services, an Indian microfinance technical services non-profit organization, and Hindustan Unilever Limited, one of the country's largest producers of fast-moving consumer goods, to provide safe drinking water to rural poor. "Most of these villages have piped water or boreholes," according to Padma, Project Coordinator at a local NGO; "the problem is that tests by UNICEF in this district show that up to 70 percent of these sources are contaminated." The contamination gets even worse during the rainy season, especially due to poor sanitation and waste-management practices.

Though local bodies have been working to raise community awareness on the importance of safe drinking water, the major penalties of affordability and access remained. Enter the innovative partnership between ACCESS and HUL. HUL has designed a household water-purifier, PureIt, which uses a four-stage filtration process to remove all bacteria, viruses, dirt, and pesticides resulting in water that is 'as safe as boiled water.' It does not require electricity or running water. ACCESS facilitates loans for rural women to be able to afford these water purifiers through its partner microfinance institutions (MFIs).

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Back in December, we wrote about the new Piramal Prize for healthcare innovations.  Now, the deadline is just twelve days away...but there is still time to submit a winning entry.  See below for the details.

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Anand Shah, CEO of the Piramal Foundation and a NextBillion reader, alerted me to the recently-announced $25,000//10 lakh rupees Piramal Prize for Innovations that Democratize Healthcare. In his e-mail, he notes that prize was created

...to encourage and support bold entrepreneurial ideas which have a profound impact on access to higher standards of health for India’s rural and marginalized urban communities. The award recognizes high-impact, scalable business models that propose innovative solutions which directly or indirectly address India’s healthcare crisis. Entries may include, but are not limited to, innovations in service delivery, technology applications, health-related products, or mechanisms to address public health necessities such as potable water.

Initial entries for the prize are due no later than April 1, 2008; the winner will be announced at the end of May.

The Piramal Prize is a joint project of the Ajay G. Piramal Foundation and the Centre for Innovation Incubation and Entrepreneurship at the Indian Institute of Management - Ahmedabad. It is interesting to note that the Piramal Foundation gets most of its support from Piramal Enterprises, a major player in the Indian pharmaceutical industry. This prize is an excellent example of how corporate social investment aligns with financial returns. But that's the subject of another post.

Thanks, Anand, for the alert. I encourage NextBillion readers to learn more about the Piramal Prize and submit their applications soon. Even if you are not a BoP health enterprise, consider bookmarking the Piramal Prize web site, as the entries will be available for public viewing as they are submitted.

(Via story suggestion - yes, we really do read them!)

Guest blogger Brian Trelstad is the Chief Investment Officer of Acumen Fund, a non-profit global venture fund serving the 4 billion people living on less than $4 a day. Before joining Acumen Fund, Brian Trelstad spent four years at McKinsey & Company as a consultant in the healthcare and non-profit practices and as an editor of the McKinsey Quarterly. Prior to McKinsey, he worked as a case writer at Stanford University's Center for Entrepreneurial Studies and advised a number of early-stage technology companies.

By Brian Trelstad

(This article first appeared on the Acumen Fund blog.)

Yesterday's visit by President Bush to the A to Z Textile Mills factory in Arusha, Tanzania, was a tremendous boost for Africa's fight against malaria and for African economic development. A to Z is now the only manufacturer of long-lasting insecticide nets in Africa, supplying nearly 8% of the continent’s demand for these life-saving products and employing over 5,000 people.

ABE, another local company that we have supported, has a long-term supply agreement to produce Artemisia, and by the end of the year should be producing about 15% of the world's supply. ABE also employs thousands of farmers in cultivating a valuable cash crop.

As we reflect on our experience with these two malaria ventures, we think that the President’s Malaria Initiative could go further in spurring economic development in Africa with a few policy changes in the allocation of funding for malaria prevention and treatment commodities.

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Position: Chief Operating Officer

Location: Hyderabad, India with frequent international travel to the US, China, Africa and Latin America (30%)

Organization: Scojo Foundation is a global social enterprise, currently operating in 13 countries, which creates jobs and sustains livelihoods through the sale of affordable reading glasses to the 700 million people who require clear, up-close vision to read and work.

Scojo Foundation trains low-income men and women as "Scojo Vision Entrepreneurs" to start microfranchises that conduct vision screenings within local communities, sell affordable reading glasses, and refer those who require advanced eye care to reputable clinics.

Position Description: The COO is responsible for the leadership and management of Scojo Foundation’s global operations team and the achievement of Scojo Foundation’s operational and sales objectives. The position is a key member of the senior management team and is actively involved in shaping the future direction of the organization.

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Today, Bill Gates' speech at Davos has thrown the spotlight on "creative capitalism" and an emerging groundswell of interest in market-based solutions and business models that can drive positive social and environmental change. The excitement around these ideas to create self-sustaining, scalable options for development at the bottom of the economic pyramid (BoP) is encouraging, and the potential for a snowball effect of increased action is huge.

Yet all of the grand words and fanfare remind me that what is most riveting - what really seems to capture attention and combat ingrained suspicions (about "development aid" and about "capitalism") - are the actual stories of the models themselves.

So, today I'd like to provide a brief vignette of pieces that NextBillion has posted over the last few years that give direct windows onto how "creative capitalism" works, and what it looks like in action:

Large companies serving the BoP:
Casas Bahia
Codensa
Cemex
ITC's e-Choupal
ICICI Bank
Intel's World Ahead
MicroPlace
Smart Communications
Vodafone's M-PESA

Small entrepreneurs serving the BoP:
DESI Power
Drishtee
Gram Mooligai
Healthstore (SHEF/CFW)
Landwasher
Mi Farmacita
Scojo Foundation
Solar Electric Light Fund
Water Health International

Non-profits using market-based models:
Envirofit
International Development Enterprises (IDE)
Kiva

Patient Capita/Venture Philanthropy:
Acumen Fund
Aavishkaar

Design and Technology for the BoP:
MIT's D-Lab
Mobile Phones
One Laptop Per Child
RIOS Institute

For more organizations, case-studies, and current information related to the BoP space, search our resource library, follow the latest news, and subscribe to our RSS to keep up-to-date on our latest blogs!