Corporations and social enterprises partner up to move the needle on improving health in poor communities.
By David Wilcox
“Community health workers: Now that is a profession that must be compensated.”
That is my paraphrase of Jeffrey Sachs’ response to the question I posed at the mHealth Summit about this issue. Investments in technology to support community health workers (CHWs) must be balanced with the need for volunteer CHWs -- which are still the majority in Africa — to be paid in order to have any hope of building a skilled professional corps of these life savers.
Working in the Millennium Villages since 2006, Jeffrey and Sonia Sachs are leading proponents of a program to deploy, train and equip one million CHWs across rural Africa. This effort and its partners are described in Sachs’ article, Breakthrough in Saving Lives in Rural Africa. The scale of the effort is both visionary and challenging to the donor governments who are asked to support it.
These compensation issues are more narrowly focused in the United States. For example, many nurses are not recognized as care providers who can be reimbursed under the Affordable Care Act. We too have underserved populations where innovation and new partnerships are critical to reaching those in need.
Beyond the App: Verizon Models New Ways of Partnering
The innovation needed is not a new app -- there will be plenty of those -- but instead a new way of partnering that merges corporate resources with technology and organizations that are bypassing the many impediments in our care system to directly reach those in need.
Because of ReachScale’s focus on corporate support of social innovation (The New Triple Bottom Line,) we found Verizon Foundation’s new efforts laudable: an innovative step that ensures that technology is actually used for good. In their words, "For the first time at Verizon we are integrating our technology solutions and philanthropy to accelerate change in healthcare and improve patient outcomes."
While four different partners have been chosen to reach children, women and seniors in the $13 million program (roughly one-third cash and two-thirds in kind through technology and services,) most attention at the Summit was on the mobile health clinic parked in the Verizon Foundation display.
Working in six of the 50 underserved communities where Children’s Health Fund operates, Verizon will enhance impact by equipping the three to five person teams in each clinic-on-wheels with smart phones, applications, and support.
The young health worker who conducted the tour said that having Verizon ensure that all their electronic gear could access the network as the clinic arrives at each remote location was one of several significant impact drivers in reaching children at risk due to poverty, homelessness and lack of healthcare access.
Social Entrepreneur, Meet the Health Worker
While the underserved populations in the United States are in the tens of millions, we have adequate economic power to reach them if we choose to. In Africa and Asia, the number of people exceeds one billion and basic components are missing, including a paid profession of local health workers.
While donor government support is probably the only way to accomplish comprehensive CHW coverage, participation in conferences like the mHealth Summit by groups such as ReachScale brings a social enterprise point of view to these issues.
Social entrepreneurs are infamously unwilling to wait on governments, and nearly one-fifth of them focus on healthcare, water and sanitation. The remaining 80 percent innovate with business, technology and finance models. Many options for economic empowerment are available -- as exemplified by leaders like Professor Yunus and by a million or more social entrepreneurs around the globe who are actively exploring new approaches and better solutions.
These social entrepreneurs are supported by a well-developed ecosystem.
And while these players may not be household names, they are well known to university and corporate leaders seeking to train and recruit the millennial generation. Grameen, Ashoka, Skoll and Schwab Foundations are among the leaders as are universities including Babson, Columbia, Oxford, Stanford, Harvard and Santa Clara with their Global Social Benefit Incubator and TECH Awards. (Note: ReachScale tracks over 30 such organizations seeking to surface the most innovative social entrepreneurs, not to mention several hundred competitions with similar goals.)
The questions that must be answered include:
- Are these social entrepreneurs important to expanding primary health systems across Africa and Asia?
- What role should they play in addressing needs around food production and nutrition, education, water and sanitation, technology innovation and entrepreneurship?
- How can philanthropists, non-profits, corporations and local and national governments decide where to invest for most impact?
- And finally, how can we share innovations that create income in communities and enable sustainable payments to CHWs, teachers and other critical social capital developers?
Building Capacity From The Bottom Up
Most social entrepreneurs start with a very personal obsession to improve lives by solving a challenge or inequality. They prefer to spend as little time as possible fundraising, and often they bring innovations to the table that decades of nonprofit work have not uncovered.
Social enterprises typically get off the ground with a small loan, such as the $36 that funded Professor Yunus and his innovation of microfinance. As Yunus points out in every speech he gives, “When I saw a problem, I started a business to solve it.”
Microfinance is the best-known category of business models in social enterprise, and it includes organizations ranging from Citigroup [NYSE: C] to Kiva.org. According to the Microfinance Information Exchange, the global microcredit portfolio in 2010 was estimated at US$65 billion versus US$12 billion in 2004.
Microfinance has demonstrated that the leadership of several global innovators-- combined with support from multiple NGO and private sector players with sustainable and therefore scalable business models -- can aggregate to billions of dollars. As BusinessWeek described the Nobel Peace Prize win of 2005:
“Grameen Bank, a leading advocate for the world's poor that has lent more than $5.1 billion to 5.3 million people. The bank is built on Yunus' conviction that poor people can be both reliable borrowers and avid entrepreneurs.”
Social Enterprise, Local Development & Healthcare Access
Here are five ways that social enterprises can support access to health/healthcare and compensation of CHWs:
- The provision of a health foundation built on safe water, sanitation and health education. Examples: Blue Planet Network and Community Health Clubs
- Enabling job creation that increases income in rural villages, especially for women. Examples: International Lifeline Fund (Cook Stoves) and Katosi Women Development Trust
- Align with locally-led models built on revolving loan funds creating sustainable community development and income. Examples: Nyaka Aids Orphans Grandmother Groups and Hiinga.org
- Utilize and develop the entrepreneurial skills of community members to create profitable local businesses. Examples: Solar Sisters and Living Goods
- Establish portfolios of social businesses enabling communities to choose optimal investments that also maximize education and income to support healthcare access and other social capital.
The last option is an outcome of the first four and others yet to be innovated/created. The drive to organize these portfolios can come from the goal to empower local entrepreneurs to create income or from support for the concept of scaling sectors, as recommended by the Omidyar Network in Priming the Pump.
Leveraging Social Enterprises for Bottom Up Scaling of Essential Services
As Jeff Sachs makes clear, to talk “Africa scale” we need to talk in billions. From Sach’s article, Funding a Global Health Fund:
The annual cost of specific disease control in the next three years is perhaps $6 billion, and another $6 billion per year for health-system expansion. The total, $12 billion per year for an expanded Global Fund, might seem unrealistically large compared to the $3 billion per year spent now. But total annual funding of $12 billion is really very modest, representing around 0.033 percent (three cents per $100) of the donor countries’ GNP. This is a tiny sum, which could be easily mobilized if donor countries were serious.
So how can larger players leverage social enterprises to help in scaling? Here are five suggestions:
1. Build partnerships to scale innovative models that reduce healthcare burdens and risks such as combining water, sanitation and health education or scaling cook stoves with local manufacturing, education and finance.
2. Tie social businesses to the UN's Millenium Development Goal [MDG] investments that promise results that the social business can secure. For example, provision of clean water promises freedom for women and the option for girls to attend school. Meanwhile revolving funds enable women to farm or start self-employment businesses, which in turn fund school fees. Nyaka’s grandmother groups support school fees for 30,000 children in southwestern Uganda.
3. Adopt social innovations that enable CHW’s to become more productive. ChildCount+ is used by Millennium Villages to guide the CHW through malaria treatments, nutrition advice, and danger signs. Switchboard.org working in Liberia, Ghana and Tanzania uses mobile phones to build nationwide networks of health workers. Referring patients to a clinic is critical but so is the provision of clean water that CHWs don’t have to gather such as Grameen Danone.
4. Adopt social innovations from outside each country and use them to become more sustainable. Healthpoint Services in Punjab, India, combines water and health clinics to create a more sustainable model. Punjab state has built around a 100 sites in a year to scale Healthpoint’s sustainable model.
5. Seek social enterprises that are already scaling and become lead strategic scaling partners, attracting other partners with your commitment. The options are extensive, and choosing the ones that leverage investments that need to be made anyway can drive sustainable scale.
Social business has transformed Bangladesh into a country that should achieve six of the eight MDGs. The goal is not to be wildly profitable but to sustain solutions and then scale eventually shifting resources to the next set of challenges.
The opportunity to leverage entrepreneurs whose work determines their and their families’ survival is essential in reaching the billion plus people in extreme poverty today. Social enterprise leverages this essential “human resource” building from the base to meet programs coming from governments and donors.