Pharmacy on a Bicycle demonstrates how, even in the most of dire circumstances, entrepreneurs can develop cost-effective, sustainable, innovative solutions that have the potential for replication and scale. Not only are the examples inspiring and instructive, but the IMPACTS framework (Bing and Epstein’s framework) has applications that extend well beyond global health.  —Professor J. Gregory Dees, cofounder, Center for the Advancement of Social Entrepreneurship, Duke University

Millions of people are dying from diseases that we can easily and inexpensively prevent, diagnose, and treat. Why? Because even though we know exactly what people need, we just can’t get it to them. They are dying not because we can’t solve a medical problem but because we can’t solve a business logistics problem.

Pharmacy on a Bicycle introduces a unique model for better global health. It saves more lives while saving money by using innovation, entrepreneurship and building on existing infrastructures.  Authors Eric G. Bing and Marc Epstein come at the global health care crisis from two very different backgrounds—Epstein is a business school professor, Bing is a physician with an MBA. Combining Eric’s extensive work in global health with Marc’s work in designing and implementing solutions to challenges faced by business and nonprofit organizations has produced a powerful guide to action grounded in the best academic research and managerial practices.

The authors provide over 100 examples from organizations that are already using innovative business solutions to deliver and scale health care to the poor in more than 35 countries throughout Africa, Asia, and Latin America. Some of these best practices include: 

• Improving access to health services in rural communities by using an army of micro-entrepreneurial health workers based in and trusted by these communities.  The health workers make a small profit to support their families while providing needed health products and services
• Dramatically lowering costs of complex procedures, including open heart surgery and cataract surgery, by using factory-like processes to increase efficiency
• Increasing the use of simple, yet life-saving solutions, such as insecticide treated bed nets, by making them culturally appropriate and acceptable
• Improving the quality of health services through the use of simple checklists to ensure consistency and completion of all tasks

Mark Kramer, Senior Fellow Harvard University, says about the book, “…governments, companies, and NGOs must embrace a new paradigm to convert medical discoveries into real-world solutions. Bing and Epstein’s elegant framework for action provides clear guidance and a multitude of compelling examples to demonstrate that the power to save lives is already in our hands.”

Co-published by the Bush Institute and Berrett-Koehler Publishers, Pharmacy on a Bicycle brings life-saving innovation to health care through the increased use of business and entrepreneurial practices and supports the institute’s global health initiative, which is built on the belief that every life is precious.

About the Authors

Eric G. Bing, MD, PhD, MBA, is a senior fellow and director for global health at the George W. Bush Institute and a professor at Southern Methodist University. He has developed health programs throughout Africa and the Caribbean for more than two decades..

Marc J. Epstein is distinguished research professor of management at Jones Graduate School of Business at Rice University. He has been a professor at Stanford, Harvard, and INSEAD. He leads a yearly trip to Africa to train students in poverty work.

Publication date: May 2013, $29.95, hardcover, 240 pages, 6â…›" x 9¼", ISBN 978-1-60994-789-7

More Praise for Pharmacy on a Bicycle

“In this compelling, practical, and very human book, Bing and Epstein offer real-life solutions to ending millions of preventable deaths around the world. By integrating tools from public health, medicine, and business, they have created an approach—IMPACTS—that has potential for saving millions of lives, not only in low- and middle-income countries, but in resource-poor, hard-to-reach settings within wealthier nations.”

—Helene D. Gayle, MD, MPH, President and CEO, CARE USA

“Powerful medicine for a world that is ailing from growing health disparities and a must-read for anyone providing care for—or caring about—the world’s most vulnerable people. Short on abstraction and long on practical solutions, this is an inspiring call to action that awakens the entrepreneur in all of us.”

—Julie Gerberding, MD, MPH, President, Merck Vaccines, and former Director, Centers for Disease Control and Prevention

“This is what needs to be done in order to save lives! The creativity and originality of this book provide the impetus to bridge the final mile in global health. Bing and Epstein exemplify cost-effective and successful innovative solutions—a must-have for all working in global health.”

—Christine Kaseba-Sata, obstetrician and gynecologist and First Lady of the Republic of Zambia

“Pharmacy on a Bicycle demonstrates how, even in the most dire circumstances, entrepreneurs can develop cost-effective, sustainable, innovative solutions that have the potential for replication and scale. Not only are the examples inspiring and instructive, but the IMPACTS framework has applications that extend well beyond global health.”

—Professor J. Gregory Dees, cofounder, Center for the Advancement of Social Entrepreneurship, Duke University

“This book provides workable answers for applying tested entrepreneurial techniques to the unique challenges of the very poor. Among the fertile minds of its readers, it will inspire new solutions from many successful examples. This book will save lives!”

—Marc J. Shapiro, Chair of the Board of Trustees, Baylor College of Medicine, and former Vice Chair, JPMorgan Chase & Co.

“By engaging emerging leaders with diverse skills and backgrounds, Bing and Epstein recognize how we can solve the problems we face in global health now. They demonstrate how partnership is fundamental to improving health access for all—an essential read for tomorrow’s leaders in global health!”

—Barbara Bush, CEO and cofounder, Global Health Corps

“So many of the solutions to the world’s most tragic health-care problems are simple and inexpensive—if we can get them to the people who need them most. Bing and Epstein show how that can be done by unleashing the entrepreneurial spirit of the world’s poor.”

—Sir Fazle Hasan Abed, KCMG, founder and Chairperson, BRAC

“Bing and Epstein show how people from around the world are creating successful innovative, ‘outside the box’ solutions to take health services the last mile. Stakeholders across the public, private, and nonprofit sectors will find the lessons shared in this book highly useful.”

—Dr. Agnes Binagwaho, Minister of Health, Republic of Rwanda

“Bing and Epstein tackle the most important problem vexing global development: how do we spread what we know works to places and people who need it? This book offers powerful frameworks and examples that spark practical insights into what it will take to truly solve many of our most challenging problems.”

—Jeff Bradach, cofounder and Managing Partner, The Bridgespan Group

“Drs. Bing and Epstein remind us that many of the deaths and much of the disease among mothers and children can be halted through simple and low-cost solutions. They combine their medical knowledge with cutting-edge business school methodologies to identify and summarize the opportunity for innovative solutions to combat disease and poverty. It’s a must-read for people who care deeply about the world’s poorest people.”

—Peter Hotez, MD, PhD, Dean, National School of Tropical Medicine, Baylor College of Medicine, and President, Sabin Vaccine Institute

“If you ever wondered why easily preventable and curable diseases cripple human potential across the developing world, this book has answers. Bing and Epstein are on a mission to make sure that access to basic health care is never a barrier for anyone to reach his or her full potential. This book will leave you with the hope that seemingly insurmountable development challenges can be transformed into solvable problems when creative partnerships are formed across sectors and mutual accountability is established.”

—Ambassador Sally Cowal, Senior Vice President and Chief Liaison Officer, PSI

“Pharmacy on a Bicycle is about saving lives—simply, effectively, and inexpensively. Through their focus on innovative and entrepreneurial solutions, Bing and Epstein show how to take health care the last mile—to a place that’s accessible, in a way that’s acceptable, and at a cost that’s affordable. Chock full of successful examples of ways this is already happening, it will leave you inspired and filled with hope!”

—Rich Stearns, President, World Vision USA

“While so much of the focus on health is a debate about the science, Pharmacy on a Bicycle is a timely reminder that simple, cost-effective solutions exist and can be scaled to provide access to quality care. A practical guide to successful program delivery—showing how millions of lives can be saved globally.”

—Paul Bernstein, CEO, Pershing Square Foundation

“This is the first book I know of that goes beyond inspiring stories of social entrepreneurs to provide a comprehensive and practical guide to the entrepreneurial process itself. Every policy maker and aspiring social entrepreneur will benefit from the practical steps to successful entrepreneurship articulated in this book.”

—Kirk O. Hanson, University Professor and Executive Director, Markkula Center for Applied Ethics, Santa Clara University

“We firmly believe that the world can dissociate health care from affluence. Change in policies is all we need to turn this dream into reality. Pharmacy on a Bicycle has many valuable propositions to make it happen.”

—Dr. Devi Shetty, Chairman, Narayana Hrudayalaya Group of Hospitals, Bangalore, India

“Bing and Epstein have written an eminently readable and absorbing book that will be essential for any organization interested in empowering underserved populations to improve their health and well-being. Bravo!”

—Stanley S. Litow, Vice President of Corporate Citizenship and Corporate Affairs, IBM, and President, IBM International Foundation

Suggested questions for: Pharmacy on a Bicycle

 By Eric G. Bing and Marc J. Epstein

What is Pharmacy on a Bicycle about?
Pharmacy on a bicycle is about how to save lives by bringing quality care to patients in ways that are acceptable and at prices that are affordable.  If patient can’t reach the pharmacy, then bring the pharmacy to patient.  Put the Pharmacy on a Bicycle. 

Why aren’t people getting the care they need?
Millions of people are dying of diseases we know how to easily prevent, diagnose and treat.  We haven’t solved the challenge of increasing access, quality, and use while simultaneously reducing cost.  This is a not a medical challenge, it’s a business challenge.  In Pharmacy on a Bicycle, we show innovative and entrepreneurial individuals, organizations and governments can be more effective solving these business challenges and outline the steps to solve these challenges.   This will not only help people in developing countries in Africa, Asia and Latin America, but right here at home in the US. 

Are you saying this is all about business to solve these problems?
It is important to continue to make advances in medicine to find better treatment and cures for diseases.   But, most people are dying from diseases that we already know how to prevent and easily treat – from malaria and diarrhea to even cervical cancer.  In fact, we can diagnose early stages of cervical cancer with just a few drops of vinegar.  And if they have it, move them on for simple treatment before it progresses to cancer.  Nearly half a million women each year are diagnosed with cervical cancer and nearly all of them are in developing countries.  

Isn’t it impossible to simultaneously increase health care access, quality and use while reducing costs?
Actually it is not. It is quite possible to increase health care access, quality and use while reducing costs per patient.  And there are many great organizations that are already doing it.  They are using innovative approaches to enable entrepreneurs to deliver health products and services that help the entrepreneur make a small profit while saving lives. Most of these entrepreneurs are women so this has the added benefit of improving the lives of those who are often most in need.

Can you give me some examples?
Sure.  There are lots of them.  The Rwandan government partners with communities, NGOs and international agencies to distribute low costs but effective health services in the villages and towns where people live.  They have 45,000 volunteer community health workers that are linked to health facilities.  Maternal and child deaths have both dropped about 60% over the past decades.  Many other countries from Ethiopia to Nepal are seeing similar progress.  

Living Goods, an NGO based in Uganda uses micro-entrepreneurs that go door to door like Avon ladies, selling health care products to prevent or treat the most common infectious disease and provide other supplies that people need for cough and cold, wound care as well as other things that people want and need like phone chargers, water filters, solar lamps and clean burning cooking stoves.  Vision Springs uses a similar model to distribute glasses.

What are the biggest challenges in global health today?
The biggest challenges in global health are not medical, they are business challenges.  For most of the diseases people face, we know how to prevent and treat them.  What we fail to do is to get simple basic care to people, where they need it, in a way that they will use it and at a price that is affordable.  In Pharmacy on a Bicycle, we show innovative and entrepreneurial individuals, organizations and governments can be more effective solving these business challenges and outline the steps to solve these challenges.  

So, how can we solve these challenges in global health?
The solutions requires innovation and entrepreneurship, building upon existing infrastructure, being more efficient and effective, partnering, creating demand and education, tasks shifting, having clear targets and accountability, and scaling what works.  And when it’s done, it works. 

Why are so many children dying in developing nations?
Actually, childhood deaths have decreased by 40% in the world in the past 20 years.   Much of this success is due to more business-like approaches towards preventing child deaths.  However we need to scale up what works and do even more.  

What about AIDS?  Why are so many people still dying of AIDS? 
The approach that has been taken to combat AIDS has very much followed the pattern that we present in the book to increase care quality, access and use while decreasing costs.  This started with PEPFAR, the President’s Emergency Program for AIDS Relief a decade ago under George W. Bush and the Global Fund to Fight AIDS, Tuberculosis and Malaria.  In the past decade there has been a 23-fold increase in the number of people on antiretroviral medications and the costs of these medications have decreased by 96%.  New infections are down 15%.  We are beginning to win at this battle, but to succeed, we must continue to use this process that works, that we describe in Pharmacy on a Bicycle.

In Pharmacy on a Bicycle, you talk about heart surgery that is 95% cheaper, but 100% as effective as what we can get in the US.  How is that possible? 
The hospital, Narayana Hrudayalaya, is in a poor area of Bangalore India.  It  has increased access and use of quality cardiac care, while dramatically reducing costs by following the key elements discussed in Pharmacy on a Bicycle.  In about the past decade it has performed 50,000 cardiac surgeries.  It is able to charge prices that are up to 95% cheaper than in the US and even up to 70% cheaper than other places in India. It supports over 100 other center in India and 50 more in Africa – all for free.  And it makes a profit!  It does this by being innovative and entrepreneurial, efficient and effective, conducting outreach and creating demand for services, stimulating mutually beneficial partnership, shifting tasks to lower skilled and priced providers and settings, creating clear targets and scaling up services.  It’s in the process of building a hospital in the Cayman Islands, just a 50 minute plane ride from Miami.  

How are mobile phones changing health care?
Almost 90% of the world’s population, even in developing countries, has access to mobile phones.  Mobile phones may help us create leap frog advances in health in developing countries.   We can do simple things like send text message reminders to patients.  You can shift care to lower skilled community providers because more experienced back up support is just a phone call or text message away.   The phones make it easier for data collection to evaluate system improvements in real time. 

What are you doing to change global health care as the Bush Institute’s Director for Global Health?
The Bush Institute believes there is no higher priority than saving lives.  The Bush Institute believes in moving thought into action.  This book, Pharmacy on A Bicycle, outlines the key ways that we can increase access, use and reduce costs of quality care.  We also have an initiative called the Pink Ribbon Red Ribbon, a public private partnership where many of these key elements are now being applied to cervical and breast cancer. 

We are currently dealing with heated health care debates here in the US.   Can the solutions that you cover in the book be applied here at home?
Absolutely.  The key elements presented in Pharmacy on a Bicycle to improve access and use of quality care, while reducing cost can be applied right here at home.  We merely present it in the context of developing countries because many more lives are needlessly lost there and many good examples of its application already exist there. 

Why did you write this book?
Quite simply, we wrote this book to save lives.  We believe that by following the elements in the book we can get good care to those who need it more in ways that they will use it and at a price that they can afford. 

We are one world.  Their health is our health.  That’s global health. 

Berrett-Koehler Publishers

Berrett-Koehler Publishers

Berrett-Koehler Publishers is a mission-based, independent publishing company located in Oakland, CA. Berrett-Koehler’s (BK) mission is - Connecting People and Ideas to Create a World that Works for All. BK publishes books in the areas of sustainable business, corporate social responsbility, leadership, social justice, politics, economics, and personal development. BK is both a B-Corp and a Benefit Corporation.

More from Berrett-Koehler Publishers