June 10, 2013
Eric Bing and Marc Epstein have written in their new book, Pharmacy on a Bicycle, about the lessons they’ve learned from battling diseases around the world. The title captures the innovation they believe is needed to get medicines to people who lack access to them. Points asked Dr. Bing, senior fellow and director of global health at the George W. Bush Institute and an SMU professor in global health, to explain why medicine delivery is the new big challenge.
You write that keeping people from dying from disease in the developing world is not really a scientific problem. Rather, it’s a business challenge. For many of us not involved in public health work, that probably sounds odd. What do you mean?
Getting quality health care to people in ways that they will use it and at a price that they can afford is the main challenge that we are having in global health. Businesses and entrepreneurs get products and services to people, regardless of whether the product is a Coke or a bed net to keep out mosquitoes.
Furthermore, the majority of health problems that people are dying or suffering from in developing countries, we already have the solution for. For example, over a million people die each year from malaria, yet we know how to prevent it and treat it easily and inexpensively. We have 14 million people under the age of 15 who are visually impaired and could benefit from receiving a simple pair of glasses that cost a few dollars. These are cheap solutions that we need entrepreneurs and businesses to get into the hands of people so they will use them and at prices they can afford.
It was interesting reading about so many nongovernmental organizations, private institutions and even individuals using innovative solutions, such as the pharmacy that used bikes to get medicine to needy HIV patients in Nepal. But how do you expand innovative services so they can reach enough people?
Local problems require local solutions. We need to harness what exists in places and build upon what’s already working. This will require collaborative efforts and partnerships. This will also require everyone to be more businesslike and entrepreneurial — regardless of whether they are a large or small entity or from business, government or a nongovernmental organization.
But are these organizations capable of “bringing to scale” their answers? To put it another way, what is the role of governments in developing nations? What must they do to help expand what’s working?
Yes, that is why I say that everyone must operate more businesslike and entrepreneurial — that includes government.
In Rwanda, reducing maternal and infant deaths is a high priority. There, the central government has agreements with the local government. There are also agreements with hospitals, clinics and communities. Part of the agreement involves paying for performance, so everyone is given an incentive to achieve the desired outcomes.
Rwanda is a country where the government functions well and sees the importance of health and the role of government. However, even in a country where the government functions less effectively, businesses and NGOs can help ensure that care gets to people. And in fact, government, business and NGOs’ roles in health and the partnerships amongst them are essential in all countries. They all have a role to play.
Ideally, the government sets sound and effective policies, standards and safeguards that support the health of the nation. Government is needed to fill the gaps that businesses and NGOs don’t address in health care — safety nets for the population. It also plays a key role in facilitating partnerships on a local and international level.
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