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Moving Care: Getting Medicine to your Urban Community - update 12/21

Quality meds get to urban slums with an environmentally and economically sustainable model that responds to new health problems

Photo of Brittany Johnson
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EXPLAIN YOUR IDEA

Urban logistics is a struggle and particularly in Bangladesh. 60% of urban dwellers in Bangladesh live in slums and the effects of unplanned urbanization that slums represent leave the urban poor with inadequate facilities, including healthcare. We would like to improve access to pharmaceuticals in the urban slum communities of Dhaka, Bangladesh in an environmentally conscious manner. Although many cities are plagued with congestion on the roads, Dhaka is particularly bad. Indeed, it is regularly ranked in the top 10 for congestion, and often receives other dubious awards, such as ‘highest air lead poison” and “worst air.’ This, combined with its overall poor healthcare access (bottom 20%, WHO), makes Dhaka an ideal place to develop an environmentally conscious strategy that addresses access to pharmaceuticals. Our idea works by using a franchise-based, mobile-spoke - and- hub model to deliver pharmaceuticals to the urban poor. Entrepreneurial pharmacists would become franchisees of the company and earn money based on an algorithm that takes into account the type and number of products sold. The revenue that remained after the sale of the product would be given to the owner of the company, who would (1) purchase quality-assured products; (2) pay for upkeep of the trucks; and (3) pay their staff/themselves. The entrepreneurs would pay a franchising fee that would provide them with access to (a) a small truck; (b) fuel; and (c) a set inventory of pharmaceuticals.

WHO BENEFITS?

Beneficiaries are threefold: owner of the model, entrepreneurial pharmacist, patient served. The owner can get a higher return on investment on her start-up capital (trucks, inventory) than she could otherwise in the Bangladesh market. The entrepreneurial pharmacist can sell more pharmaceutical products than she could if she were located at a stationary pharmacy. The patient can access quality-assured pharmaceuticals in neighborhoods were these were previously unavailable.

HOW DOES YOUR IDEA TAKE INTO ACCOUNT THE CONTEXT OF URBAN SLUMS AND CLIMATE CHANGE?

This work leverages the latest knowledge in GIS mapping, urban logistic research, and business development, to create a systems approach to increase population health and opportunities for budding entrepreneurs in-country with a win-win solution to building resilient communities: Plan for ordinary: This solution provides patients with regular access to medicines and creates responsive mechanism to changing health needs as non-communicable disease burden increases and climate change leads to a rise in health issues Consider the system: This is a systems approach. We will be looking into the feasibility of this model and offering this response to current breakdowns in availability of medicines Build in flexibility: This model is based on identifying changing trends in health demands and responding to them Maximize limited resources: In a congested city, easy access implies savings in time and money. This solution offers itself to those that have reduced mobility Design for gender equality: Local access to pharmaceuticals means that women, who generally cannot travel by themselves in Bangladesh, will now have direct access to pharmaceutical services Design with, not for: This is a client centered solution as it provides options to be a stakeholder in the success of the venture by being a small business owner. Pharmacists will have the opportunity to rent a truck for the days they are interested in and choose the areas to cover. This involvement will provide them the opportunity to input thoughts on design and service.

IN-COUNTRY EXPERIENCE

  • Yes, between one and two years

EXPERTISE

  • I’ve worked in a sector related to my idea for at least two years

GEOGRAPHIC FOCUS

  • Yes

TELL US A BIT ABOUT YOURSELF

Stephen founded OpenDroneMap and has 16 years experience using geospatial data. Brittany is a recognized expert in public health logistics. Pascale is an MBA/Phd and works on improving the patient-health provider interface and is affiliated with the William Davidson Institute (WDI) at UMichigan.

IS THIS A NEW OR RECENT IDEA FOR YOU OR YOUR ORGANIZATION? HOW DOES IT DIFFER FROM WHAT YOU ARE ALREADY DOING?

WDI focuses on solving problems in emerging markets using a business lens. This means that our interest is not just in ‘doing good’, but doing good in ways that are long-term sustainable. By long term sustainable, we mean we are only interested in projects where financial, social and environmental benefits outweigh the costs of running the organization. From a practical perspective, this means looking at the strategy, operations and financials of the organization from the perspective of an investor AND the perspective of a citizen of this planet. Stephen Mather provides near scale remote sensing and geographic information systems decision support in solving difficult problems. The proposed project comes with its similarities and differing challenges. In order to support a franchise application, information on infrastructure, population, routing, and logistics needs to be quickly gathered, curated, and augmented. Drone flights will serve as an augmentation to existing information.

HOW IS YOUR IDEA DIFFERENT FROM OTHER SIMILAR INITIATIVES? WHAT ARE YOU DOING DIFFERENTLY? WHAT UNIQUE ADVANTAGES DO YOU HAVE?

While financially sustainable is a fashionable phrase in global development, we really, really mean it. Our experience on projects like these is that once the financial support has been pulled, the project falls into disarray because the project was structured for short-term, not long-term, success. We’re going to try our best to avoid this route by being truthful with ourselves about the viability of the project. We’re going to treat this project like we treat all of our other projects: like a business. Good and good-enough current data is an asset to any urban logistics problem. Core to the approach we take with the project is recognizing that improving access to pharmaceuticals is going to require an adaptable and localized approach first leveraging best available geospatial data. Best available data however may not be good enough, or may have inconsistencies. Given our team’s experience in geospatial analysis, we can rapidly assess existing geospatial data, find gaps in the data, and determine rapid approaches to closing those gaps using a full range of traditional and novel tools, including primary imagery collection with drones.

WHAT ARE SOME OF YOUR UNANSWERED QUESTIONS ABOUT YOUR IDEA?

1. Which neighborhoods have low access to quality-assured pharmaceuticals but adequate capital to purchase the pharmaceuticals? We know where the very poorest and richest neighborhoods are located. We need to talk to communities regarding the areas best served by this venture and better understand willingness-to-pay. 2. What is the return on investment for individual investors? Particularly to attract investors of middle/middle-high means - as opposed to the wealthy who may invest in a garment factory 3. How we can promise quality assured pharmaceuticals? We have thought of incentive structures, but this keeps us up at night 4. How good are existing geospatial datasets?

WHY DO YOU THINK THE PROBLEM YOUR IDEA SOLVES FOR HASN'T BEEN SOLVED YET?

The people that we are trying to serve is neither economically or politically strong. Although our venture is not aimed solely at the poorest of the poor, even customers of moderate means in Bangladesh do not have much bargaining power.

HOW HAS YOUR IDEA CHANGED BASED ON FEEDBACK FROM YOUR COMMUNITY?

We reached out to colleagues in Bangladesh that work in public health and development industries to get their feedback on this idea. The video attached was shared to provide a view of the roads that access one of our target service areas. Currently the Ministry of Health has done substantial work on identifying inventory flows in public health clinics. This has had successful implementation in family planning but not essential medicines which generally have low availability. As a result, we may include the location of public clinics in the model and consider the feasibility and ethical implications of having a private pharmacy in the area on a regular basis - filling a need for pharmaceutical products. From another of our colleagues, we learned that pharmacies are often a source of healthcare advice as well as pharmaceuticals. While we don't necessarily condone this, we recognize this as a reality and would consider a model that could support some supplementary education to pharmacists on general health diagnosis and provide pharmacists with the contact information for local clinics that could provide legitimate care. Additionally, pharmacies are often social places - staffed by one male pharmacist with other staff or friends providing conversation over the day. To make our moving pharmacy more welcoming to women we would encourage women pharmacists to apply and have a gender balance that would further support income equity efforts started by BRAC and Grameen in the area.

WHAT WOULD YOU ULTIMATELY LIKE TO ACHIEVE WITH THIS IDEA? WHAT IS YOUR NEXT STEP TO GET THERE?

Our dream would be that all urban communities within Bangladesh would have access to quality-assured pharmaceuticals via a financially and environmentally sustainable delivery mechanism. The people purchasing the products would benefit from improved health, while those delivering the products would benefit from increased financial independence for themselves and their families, and the knowledge that they were doing something to improve the health and well-being of those in their community. Our next step to get there is to be on the ground developing the tech and business model to entice local investors.

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Answer... we love this work and will give our all to work with the community and for the community. The last thing we want to do is take resources away from something that has an even better chance of succeeding. However, we think this idea has a very good chance of succeeding, enough so that we’re investing our time to think through a solution well matched to the problems at hand.

How does your idea connect to the broader system of the city where you plan to implement?

According to World Bank, the health system in general faces challenges such as shortage of trained health workforce, inadequate governance and regulatory functions and high out-of-pocket expenditure on health by households. This work fits into initiatives across the country working to address these health needs. Whatever work we embark on to enhance existing geospatial data for Dhaka using drones will also augment existing efforts in mapping vulnerable communities. We will develop datasets in line with the MissingMaps project so that international and local NGOs can better respond to crises affecting those areas, making our mapping products a separate, important deliverable. Additionally, this work learns from initiatives across Bangladesh to leverage entrepreneurship for development and improved services. As we develop the business case for this initiative in-country, we would be reaching out to these initiatives to learn from them and be part of the larger business community.

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Photo of Tara
Team

This sounds like a great project! Similarly to Michael's question, I'm wondering about the technologies involved in sharing the maps and other information with the pharmacists?

Photo of Brittany Johnson
Team

Hi Tara, Thanks for your question!

Stephen Mather responded to some of the technology questions below Michael's comment. The maps will be made available to the general public on open sourced web-based platforms, such as the Missing Maps project.

The pharmacists themselves will be provided with directions to their service area. However, the mapping will serve another purpose which will be to design the particular service areas based on an algorithm to determine potential for profit and suggestions on types of pharmaceuticals to carry. This data would influence the 'exclusive territory contract' described by Pascale Leroueil response to Paul Clyde in an earlier thread (Jan 7).

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