Post by Maria May, Social Innovation Lab
Last month, I had the opportunity to visit Boston and attend a scientific conference at Harvard. Hosted by the South Asia Initiative, the topic was Health in South Asia: Lessons for and from the World. The conference allowed anyone to submit examples of innovations from their work. BRAC submitted examples from its maternal, neonatal and child health programs. These were particularly appropriate given Bangladesh’s success in reducing maternal mortality, the envy of many other countries in the region.
The conference was an amazing learning experience! Two former Ministers of Health (Dr. Julio Frenk from Mexico and Dr. Sujatha Rao from India) gave presentations along with many other renowned experts. I was also particularly impressed with Dr. Devi Shetty, who is challenging all assumptions about how affordable high quality surgery can be. Within a few years, he asserted, we will see heart surgeries available for $800 (tk 65,000). In a world where currently heart surgery is only affordable to about 10% of the population, this is hugely excited. Already his 14 hospitals in India serve thousands annually with high quality, low-cost tertiary services. His visions are much greater—already Narayana Hrudayalaya Institute of Medical Sciences is involved in establishing a medical education program in the Cayman Islands and advocating for fundamental shifts in how medicine is taught and practiced. “Manpower, not money, is the greatest limitation facing health care delivery today,” Shetty concluded.
One of the major conference themes was to promote South-North learning. That is, how can advanced economies learn from the innovations (many of which are jugaad in nature) that developing countries have developed? Particularly with increasing attention to health care costs in the United States, public and private sector interest in low-cost models has never been higher. Models such as BRAC’s also de-medicalize health and acknowledge social factors, such as clean water and food are huge areas of vulnerability, particularly with increasing populations and hyper-dense slums. Social networks and family ties are also influenced by the changing contexts; new inequities, at the micro and macro levels are emerging.
A popular idea is to build on the boom of mobile phones by creating “snap-on” applications; there are now ways to utilize them to run blood tests and conduct eye exams. One innovator with a product called Embrace, profiled in Professor Jaideep’s book, has created a portable, “inexpensive” device ($ 100, or tk 8,000) that can prevent hypothermia in low birthweight babies (though it will not fulfill the other important functions provided by incubators, such as preventing infections). Product innovators are constantly looking for NGO partners to help them pilot these technologies and find opportunities to scale. However, many times products are more complex to implement than initially described, and not all innovations that sound good on paper are worth pursuing. Important questions for BRAC and others to ask are: How much training is involved? How much better is it than what we are already doing? What level of maintenance is required? What’s the potential impact? Many of the innovators left these questions unanswered. I wondered how BRAC should filter the promising innovations from those that make sense in an engineering lab at MIT, but unable to meet the real needs they will confront in the field. Dr. Shetty’s words about the importance of manpower (or in BRAC’s case, human power)—as the major bottleneck to focus on. Certainly technology can enable more effective and efficient use of resources, but we have to pick our partners and products carefully, because implementing new innovations can be disruptive.
Conclusions
I was shocked at how few people that are “experts” on health in South Asia had heard of BRAC. I imagine that many of the innovators who spoke would be shocked at how low-tech our systems are. Shasthya shebikas use the color of one’s eyes to diagnose anemia, for example, so while prick-free testing machines sound cool, the marginal benefit/costs must be calculated. While there is room to modernize, one reason why so many disruptive technologies are emerging from South Asia is that the challenges of delivering health must be met on a daily basis. BRAC can provide an urgently needed critical voice, calling for the types of innovations that are most desperately needed to provide high-quality care in difficult environments, and demonstrating what truly “low-tech” innovation can look like. Harvard is home to a number of the world’s top thinkers; they need our help in understanding the real requirements for a transformative product.
