Over the last few decades, we have examined health care in remote rural and dense urban settings across a variety of low- and middle-income countries in Africa, Asia, and Latin America. We have examined health care from a variety of perspectives, and we always reach the same conclusion: Millions of people are dying of diseases we can easily and inexpensively prevent, diagnose, and treat.
But crises stimulate action. In dire straits, people become innovative and entrepreneurial, which is what happened in the case of two Nepalese men, Dawa and Pemba.
Dawa and Pemba were running low on medicine because a bandh, or strike, was making it impossible to get to the pharmacy. In Nepal, during a bandh, it is dangerous to go out. The bandh was in its second week, and the men had nowhere to turn once their medications ran out. Their doctors told them to never stop taking their medications because the HIV virus could quickly develop resistance, and then the drugs would no longer work.
If all we had to worry about was the occasional strike, we could solve most global health problems. But this particular bandh, which lasted thirty-two days, exacerbated existing problems related to deep poverty and populations living in hard-to-reach areas. Such problems are found in many developing countries, and regardless of whether they are caused by instability, conflict, geography, or cost, they make it difficult to bridge the “final mile” in global health.
In the end, a community health worker saved their lives and others: Suraj, who also lived with HIV, loaded the needed medication into his satchel, hopped on his bicycle, and delivered it before the two men even missed a dose. Later, the Saath-Saath Project, a local HIV program, partnered with a hospital and some community health workers to create a pharmacy-on-a-bicycle brigade. If the patients couldn’t go to the pharmacy, then the pharmacy would go to them.
Our new book, Pharmacy on a Bicycle, is a bold yet practical approach to saving lives by using innovative and entrepreneurial solutions that increase access, use, and quality of care, while reducing costs. We show how to save lives while saving money through a seven-point approach we call IMPACTS. Here are the main components:
I Stimulating innovation and entrepreneurship to develop new solutions and reach populations in need in sustainable ways.
M Maximizing efficiency and effectiveness to deliver quality products and services at reduced costs.
P Partner coordination to stimulate cross-sector collaboration and coordinate complementary roles.
A Accountability that encompasses defining goals and targets and monitoring success.
C Creating demand for products and services.
T Task shifting to lower-level providers and new settings to reach and serve more people at lower cost.
S Scaling up programs to save even more lives.
Implementing this approach will bring care to those who need it most—no matter whether that care is delivered by a doctor via telemedicine, nurse via mobile phone, community health worker on foot, or pharmacy on a bicycle.