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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.

41 comments

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Spam
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?

Spam
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).

Spam
Photo of Kurt Johnson
Team

Wow Brittany. Great idea and nicely thought out. 

Spam
Photo of Brittany Johnson
Team

Thanks Kurt! The idea has taken shape from the approaches and expertise of Pascale, Stephen and some key people in Bangladesh as well. We look forward to the chance to develop it further in Dhaka.

Spam
Photo of Amy Gillett
Team

This sounds like a great and innovative idea for getting pharmaceuticals into the hands of those who have difficulty accessing them, while at the same time offering a sustainable business opportunity to aspiring entrepreneurs. What would you anticipate your top 2-3 hurdles might be in rolling out this initiative? How easy do you think it would be to roll out this service to other markets?

Spam
Photo of Pascale Leroueil
Team

Dear Amy,

Thanks for the questions!  I think the top hurdles are going to be:
(1) Identifying the initial investor.  We need to fine someone(s) with capital and connections since they are going to be the one that ultimately drives the organization. 
(2) Making the business case to that government, private sector and/or NGOs that they should subsidize the costs of those medicines that are not profitable on their own.  While our personal goal is to provide quality medicines to those who don't currently have access to them, the business model we have proposed only works if the investors / entrepreneurs are able to make a profit.  For that reason, we need the support of groups/organizations that have an inherent interest (whether for social (government/NGOs) or financial (private sector) reasons.  

If this model works, this idea could be rolled out fairly easily in other densely populated markets provided that the big hurdles described above can be cleared.  That said, one could imagine more bumps along the roads in markets that are more highly regulated.

Spam
Photo of Eric Vaughan
Team

I'm very impressed by the amount of research and thought that has went into this concept.  I would also like to know what kind of medicine would the truck carry? If you can grab the attention of local investors this would make a tremendous impact on this community and it would exciting to see how it will transform neighboring communities. 

Spam
Photo of Pascale Leroueil
Team

Eric,

Ideally, the truck would carry all medicines listed on the 'essential medicines list.'  In practice, however, this list may need to be culled.  For example, the demand for some medicines on the essential list may be sufficiently low that it's not financially feasible to keep those medicines in stock.  In those cases, our plan is to work with the government or non-profits in the area and say, "We can provide access to quality forms of these essential medicines to populations that traditionally have not had this type of access.  If you can subsidize some of the cost, we can provide access to X many more essential medicines.  Would this work for you?"  If we can provide medicines to people that the government and NGOs haven't been able to reach yet, the answer should be yes -- it should be a win-win situation.

As an aside, we want to make it very clear that we see this as a for-profit venture for the investors / entrepreneurs.  We care deeply about what we hope will be the end result (better access to live saving medications) but we truly believe that the only way something like this can be sustainable is through the incentive systems that are inherent in a for-profit business model. 

Thanks for the comment and question!  

Spam
Photo of Madhurza
Team

The truck will also carry the recently identified 25 priority MNCH medicines (by MOHFW) which are supposed to be available at all levels as part of improving continuum of care for both mother and child. To be noted, the priority MNCH medicine list considers the UN commissioned 13 Life saving commodities and the essentials medicines available at Community Clinics (the lowest level where the health services being provided) in Bangladesh.

Spam
Photo of Sinia
Team

Given that you're trying to serve a traditionally under-served population, do you think that the government of Bangladesh would be interested in supporting this project?

Spam
Photo of Madhurza
Team

The response to the question with a "YES"-

There also remain gaps in primary healthcare coverage of urban areas where the quality and accessibility of health, family planning and nutrition services are yet to be managed efficiently either in public or in private sectors.

The Mid term review of Bangladesh Sector Program (2011-16) identified this issue too. It reads, "Issues of environmental health were not extensively discussed at the Mid term review. Little engagement is apparent by the MOHFW in general environmental health or climate change issues. In general there appears to be growing concern about environmental pollution (air, water, land). The urban environment of Dhaka is a good example of a highly polluted environment and one that is hazardous to those living in the city and especially slum areas. This can only be expected to get worse with the rapid urbanization if nothing is done to mitigate the situation.

Bangladesh Govt is in the process of designing next sector program and has stressed a lot on urban health and ensuring availability of quality pharmaceuticals at all levels and welcoming any innovative and sustainable model to improve pharmaceutical practice it its sector plan and is budgeting accordingly.

Spam
Photo of Ekta
Team

I am very impressed with the business idea. It shows promise and impact. Some questions - How do you plan on getting people to sign up to be the owner and franchisees (pharmacists)? Is there an outreach/recruitment activity planned or you already know of some people in this space who would be willing to sign up? Curious to know about your targets i.e. if you have thought about how many such mobile pharmacies you plan to open by end of Y1 and % of target population served. Good luck.

Spam
Photo of Pascale Leroueil
Team

Dear Ekta,

These are all very good questions!  We don't have particular people in mind for the owner and franchisees.  Instead, we have profiles of the people that we think would be the effective in these roles.   What we're actually proposing here is to draft a formal business plan based on the research that we complete through this project.  Within that business plan, we'll certainly include estimates on the number of mobile pharmacies, projected number of patients served based on demand studies, etc.  A lot of that information is going to need to come from in-country interviews with people from the Ministry of Health, people in the pharmaceutical industry, potential users, etc.  The goal of this is to be able to then pitch the business idea to one or more potential investors who will then carry the idea forward.  

Thanks again for the question!

pascale

Spam
Photo of Stacy Finkbeiner
Team

I am very impressed with this idea and the thoughtfulness that has clearly been demonstrated in the responses to all of the questions that have been posted. The value of this model is quite clear for populations that have limited access to pharmaceuticals right now. For people who are currently accessing "medicines" from the unregulated shops, there may be different challenges at play. What are your thoughts on competing with the unregulated shops? Is there where you would see potential subsidy models being advantageous?

Spam
Photo of Pascale Leroueil
Team

Stacy,

Thanks for comment and question!  The unregulated shops are going to be a bit of a challenge because it's highly unlikely we'd every be able to beat them on price.  For that reason, we're going to need to convince the payer (whether it's the patient, or some government entity) that the value of quality controlled medicines dispensed by trained pharmacists is sufficiently high that they're willing to pay the difference in cost.   From a practical standpoint, we need to figure out a way to brand our company as trustworthy and competent.  One tried-and-true method of doing this is to recruit organizations that are already perceived as trustworthy to vouch for you.   For that reason, we're very interested in forming partnerships early on with the governments / NGOs / large companies.

Spam
Photo of Connie
Team

Apart from having the capital required to buy the medicines/trucks, what other characteristics are you looking for in the primary investor? (e.g., the hub).

Spam
Photo of Pascale Leroueil
Team

Dear Connie,

Thanks for the question!  Capital is probably the most important characteristic that we're looking for in the primary investor, but we've definitely got a wish list of other characteristics in mind!
1.  General understanding of the pharmaceutical industry in Bangladesh.  One of the primary roles of the 'hub' is going to be purchasing the inventory that will be sold by the trucks.   For this to get off the floor fast, the 'hub' will need to have had some experience in this area.

2.  Relationships with the private sector, particularly large businesses.  As noted earlier in the comments section, we think that quality pharmaceuticals provided by professional pharmacists would be attractive to companies with large workforces (e.g., garment factories).  Ideally, the hub would be able to make the case that helping their employees access these medicines is good for the bottom line.  From the perspective of the 'hub' (and its spokes), it means more customers and more money.

3.  Relationships with the government.  As we mentioned earlier, we think that the government of Bangladesh would be interested in this model because it could provide much-needed medicines to citizens that as of yet aren't being taken care of by the system.  Again, the 'hub' would need to make the case that this model is a way to get there but the language / what is being optimized would need to be tailored away from profit and more towards the government-friendly metrics like Disability Adjusted Life Years (DALYs).

4.  Relationships with NGOs that might be interested in partnering with this organization.  As several people have mentioned in this comment section, there are a number of NGOs that might be interested in 'tagging' along with the trucks because they're trying to serve the same communities.  If our model can make them more efficient at their job both sides could cut down on costs and that would be beneficial to everyone.

**Note that the 'hub' may not be a single person.  For example, we may find someone who has all the capitol needed but none of the relationships required.  In that case, there would need to be some contract between those two individuals laying out the roles and responsibilities of each of the parties.

Spam
Photo of Paul Clyde
Team

This looks like a very interesting idea.  I have one question: in order to make this a profitable venture for the franchisees, it would seem important to include some sort of exclusive territory contract with each of them using the geographic information to determine which areas are financially sustainable and/or have fees that vary depending on the area the franchisee has rights to.  Do you have something like this in mind and if so, can you explain a little bit about how you think that would work?

Spam
Photo of Pascale Leroueil
Team

Dear Paul,
Thanks for the question! The franchisee model that we have in mind is based on an ‘exclusive territory contract.’ The idea is that we would use a combination of drone mapping and other population data that’s available to identify where the areas of need are located within the city. The city would then be segmented into some number of exclusive territories. The size and location of these exclusive territories would dictate the ‘rent’/fee that the franchisee would pay the owner of the company. For example, those territories located in relatively well-off areas would have a larger rent/fee associated with them than those territories located in relatively poor areas. The advantage of this is that it would encourage providing service in poorer areas. We’ve also thought of a number of safeguards to ensure that franchisees are selling in their location (and only their location) but we know that these aren’t bullet proof.

Spam
Photo of Michael Krautmann
Team

Thanks, Brittany, this is a really thought-provoking idea!  Two quick questions:  

1. From the client perspective, the value proposition of this business is clear - much better access to high-quality medications and pharmacy services.  However, I don't know much about urban Dhaka and am curious why the local pharmaceutical market hasn't already responded to capture that value.  Are there any key  factors preventing today's entrepreneurial pharmacists from starting up their own mobile pharmacy businesses, and if so how does this idea either address those factors or take them into account?

2. Could you explain a bit more about the geospatial data, e.g. what information would be included, how you would capture it, and the ways in which that data would link back to the pharmacy franchise model?  

Spam
Photo of Stephen Mather
Team

Hi Michael,

Regarding question 2, we have three basic requirements for the geospatial data:
1) Improve mapping of buildings / structures in densely populated areas with high resolution imagery in order to improve population estimates;
2) Gather adequate imagery to also augment existing transportation data, especially for smaller (e.g. motorbike, foot, bicycle) modes of transport;
3) Augment with focused on-the-ground knowledge to refine the above estimates.

These three pieces then become the starting point for modeling franchise locations and opportunities.

Spam
Photo of Brittany Johnson
Team

Hi Michael, Thanks for the questions and interest! One of the bottlenecks for entrepreneurial pharmacists would be access to start up capital and support services for resupply and general operations. This idea proposes a method to make a business for a sole pharmacist more accessible and provide them with the services and oversight that help ensure quality standards. My intuition into why this was not previously attempted is that this could not be achieved by an individual pharmacist, but requires an organizing body to work out the roles of the various stakeholders (primary investor, pharmacist/entrepreneurs, clients) and also create a platform of mapping tech and urban logistic strategy to incentivize business interest and ensure coverage of neighborhoods.

Spam
Photo of Tamara Goldschmidt
Team

Super interesting way to implement push model pharmaceutical distribution. To what extent do you think market forces will contribute to the entrepreneurial pharmacists finding the neighborhoods most in need. Could this be paired with existing voucher programs for basic pharmaceuticals?

Spam
Photo of Brittany Johnson
Team

Thanks for the questions! In our initial thinking, sectors/neighborhoods would be defined and pharmacists would "rent" a particular area. We would like to develop a program that would adjust rents in a way that pharmacists will be incentivized to select neighborhoods most in need.

We love the idea of joining forces with current efforts, what are some of the voucher programs you have in mind? 

Spam
Photo of James
Team

Traditional advertising doesn't seem like it would work in a city like Dhaka. Have you thought about how you're going to market this idea in country?

Spam
Photo of Brittany Johnson
Team

Thanks for your question! We would want word of mouth to work in our favor; however, more would be needed. I've actually noticed a few contributors on OpenIDEO addressing this particular problem of connecting marginalized people to quality services. This may be a good area for us to collaborate with other innovators.

Spam
Photo of Mary Lowe
Team

Question to add:

Do you have an idea about what types of medicines the truck will be carrying? Is the plan to carry all types or are you going to select them based on some criteria?

Spam
Photo of Ted London
Team

Finding a specific home or location in urban slums in Dhaka would seem to be challenging.  As the locations of many homes/dwellings may be best know through "informal" landmarks (rather than a specific street numbers and address), how can you overcome this challenge to deliver to low income settings in an efficient and timely fashion?

Spam
Photo of Pascale Leroueil
Team

Hi Ted,

Thanks for the question!  You're absolutely right on the use of informal addresses in Dhaka and it certainly does make things a little more complicated than it would be if we were working in a city that was laid out in a grid.  That said, we do not believe that it will pose an insurmountable challenge.  The location of the mobile pharmacies on any given day / time will be based on population information and data collected using the drone technology.   However, we expect each mobile pharmacy to have a predictable schedule as far as its location -- we're not delivering to individual houses or people -- they're coming to us.  For example, every Thursday afternoon one mobile pharmacy might be located outside of the Diarrhea Hospital while every Tuesday morning it might be located outside the main mosque.  Certainly, the marketing / advertising strategy will need to take into account the use informal landmarks, as well as the lower literacy levels of our target populations.

Spam
Photo of Stephen Mather
Team

Hi Ted,

I think Pascale covers this well. Because the trucks will be located and distributed according to where people are, not attempting to directly service addresses, we sidestep the issue of informal addressing.

You bring up an important point to consider with respect to the mapping process in general -- remote information alone is not enough to make population estimates, but at the high resolution available with drones, we seek to augment on-the-ground knowledge in an iterative mapping process.

Spam
Photo of Shanna Shaked
Team

It is great to see a proposed sustainable solution to an increasing problem impacting a community that did virtually nothing to induce that problem! It also seems win-win in that it is addressing a problem while enabling and enhancing the socioeconomic status of the local population.

To better understand the scope of the problem and proposed solution, it would be helpful to quantify the impacts and benefits if at all possible (in such complex systems, it may be difficult). Do you happen to have estimates indicating the current disability-adjusted life years (DALYs) and/or predicted DALYs as climate change increases, and how this proposed solution can reduce those impacts? (Since DALYs may be hard to come by, any indication of disease incidence and reduction would be informative, including population affected and current access to medicines compared with predicated access.)

Thanks for working toward business-based solutions to pressing global problems!

Spam
Photo of Brittany Johnson
Team

Hi Shanna, Thanks for your encouragement and question. 

Admittedly, measuring quality of life and isolating one project's impact to this measure is a major challenge. Bangladesh ranks first as the country most vulnerable to climate change in the next few decades. As a result, within the near future, hundreds of thousands are expected to move from low lying river and sea lands toward cities [1]. In regards to impact of our work, we will be able to say how many people invest in our idea and provide estimates of profitability. We will be able to measure how many people were served. It will be challenging to say what the delta of people served to people that previously did not have access to service would be and some of the positive externalities such as improvements in health. We know there is a huge gap in service, but data is not available to confidently estimate this need.

Additionally, ever increasing, ad hoc urbanization in Dhaka has already affected the urban poor through both exposure to worsening environmental conditions and lack of access to basic services like healthcare [2]. Through the initial phase of this project, mapping service areas, we will be able to estimate coverage by existing health services.
These measures would allow us to gain some insights on the impact we have toward quality of life measures, like DALY. We’d be happy to take suggestions on other recommended measures! 

[1] National Geographic, http://ngm.nationalgeographic.com/2011/05/bangladesh/belt-text

[2] United Nations University, http://ourworld.unu.edu/en/sick-cities-a-scenario-for-dhaka-city

Spam
Photo of Chioma Ume
Team

Hi Brittany,
Below is some feedback from our experts. We look forward to reading your responses!

The idea itself is very impressive, as it breaks down multiple challenges. Can you please describe in a bit more detail what types of financing plans could be put in place for asset acquisition? Also, if you are to start in a pilot phase, how will you prioritize which stakeholders to engage?

Have you considered including an overlay consisting of those citizens who are old and aged by living in the critical area so that you can assign a priority level? Could hospitals should also give subsidies or other incentives to those who will sign up to the program?

What are some of the key barriers to access that your beneficiaries are currently facing?

Spam
Photo of Brittany Johnson
Team

Great questions!! Our efforts in this work result in three components which are each a deliverable: maps of the more vulnerable areas of Dhaka, a logistics model maximizing revenue for nano-entrepreneurs and access to quality medicines for slum-dwellers.
In terms of financing plans, there are three models that we would investigate for asset acquisition:
(1) Pharmacist invests in the truck and a pharmaceutical wholesaler invests in the inventory.
(2) Wealthy organization (e.g. pharmaceutical wholesaler) buys the model and rents out the vehicles.
(3) Coop model with co-ownership on trucks and inventory.

In regards to the stakeholder engagement, we would prioritize those interested in investing in this idea. Other stakeholders should be incentivized by the execution of the work: pharmacists needing jobs, patients needing medicine. We would create estimates of these needs during the pilot phase, but our priority would be establishing investor buy-in.

Distribution routes will consider the composition of the population in the area: age, income level and other determinants in the quantity of certain medicines prescribed. It would be interesting to consider hospital subsidies as a potential revenue stream for this model. This would be an excellent idea in a second iteration of the model development, once we’ve established the reliability of medicine availability.

Key barriers of access faced by our beneficiaries are two-fold: one for the patients requiring quality medicines and two for the pharmacists interested in developing a business. In regards to patients, key barriers include (1) low availability of essential medicines in public clinics, (2) poor quality medicines available in local drug shops, and (3) general low accessibility to women. In regards to pharmacists, key barriers include (1) few investment opportunities for middle income individuals, (2) jobs focused in manufacturing and not with the patients that motivated some to study pharmacy science and (3) the establishment of patient and organizational trust. For the final point, we will need to consider trusted groups that can potentially support this organization in the long term - adding to long-term viability.

Any additional questions, let us know!

Spam
Photo of Chioma Ume
Team

Hi Brittany! Thanks for the detailed response! I do have a few quick follow up questions. It's great that you've had input from colleagues in Dhaka - are any of them planning to partner with you if this idea was to become a reality? If not, who would be responsible for in-country implementation? Second, have you had a chance to speak to any of the potential customers for a business like this? Have you developed any insights about their spending habits, schedules and use of pharmaceuticals that has helped shape your idea? 

Spam
Photo of Pascale Leroueil
Team

Hi Chioma, this is Pascale -- thanks for the comments!



First, we have interested partners in-country who will join publicly once the project is a reality. If for any reason those commitments fall through, our Plan B is to recruit an in-country partner from our network. Whether it’s one way or the other, we are committed to working with an in-country partner from the beginning since that’s the only way that this project has a chance of truly responding to the needs of the community we are trying to serve.

We have not had a chance to speak with potential customers. However, all of our information regarding demand for this type of service comes from people who live or have lived in Dhaka for extended periods of time. From these interviews, we understand that there are behavioral differences in poor vs. middle income women, as well as relative control over family finances in these areas. In addition, we’ve collected data through the World Bank and other international institutions on things like the relative amount of money the average Bangladeshi spends out of pocket on their health care, the top 5 causes of morbidity in this area and average salaries for unskilled labor.

While we recognize the danger of relying on averages, we are confident enough in average customer demand that we think it’s worth evaluating whether our particular segment (the relative poor) can afford the products at a sustainable price. If that relative poor segment alone does not have the disposable cash required to purchase the products, we will look into the feasibility of a cross-subsidization model that uses revenue from sales to the relative rich to cover all or part of the costs of the products given/sold to the relative poor. From a technical perspective, we could build a simple financial model that told us the appropriate prices. From a practical perspective, we recognize that we would need buy-in from key members of the public or private sector.

One cross-subsidization model that we have talked about is providing the garment industry with a semi-permanent pharmacy for its workers. The idea is that we would provide the garment workers with access to quality-assured medicines from trained pharmacists at a convenient location (e.g., near the entrance of the garment factory). The benefit to the garment factory is that their workers and their families will have easier access to the medicines that keep them healthy, thereby reducing the costs associated with training a new employee / not having their labor. If we can build the business case for the garment factory, we can charge them some type of fee for the on-site service that could then be used to subsidize the cost of medicines to those in much poorer areas.

All this to say: We are acutely aware of how important understanding our the needs and behaviors of our customers and / or users is going to be to the success of this project. This will work will be critical to the research phase of the project to determine the financial feasibility of the project.

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Team

This is helpful, thanks Pascale ... interesting to think about other ways these medications could be affordable - like your suggestion of the garment industry. Have a great holiday!
 

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Hi Bittany, interesting post! Any chance you could find an image to go along with it? Images help grab attention and tell a story with higher impact. You should be able to use the Edit Contribution button on the top of your post and follow the instructions to add images from there. Looking forward to seeing more of your inspiring insights on OpenIDEO.

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Team

Thank you for your advice and encouragement! We've added pictures and video. If there is anything else you'd like to see let us know.

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Congrats on making it to the Feedback Phase Brittany! We would love it if you can take some time to answer the new Refinement questions that we've added to your original idea submission form. To answer the new questions, hit the Edit Contribution button at the top of your post. Scroll down to the entry fields of the new Refinement questions. Hit Save when you are done editing.

Also, here's a useful tip: When you update the content of your post, it'd be helpful to indicate this in your idea title by adding an extension. For example, you can add the extension " - Update: Experience Maps 11/16" to you idea title. This will be a good way to keep people informed about how your idea is progressing!

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Thanks so much for the help! This is our first submission to OpenIDEO so advice on the best use of the platform is appreciated.