- Over 90% of Kenya’s population uses wood, charcoal, or kerosene for their daily cooking needs
- Young entrepreneurs are using the country’s lack of access to clean energy as a business opportunity
- On October 28, 2014, World Bank Group President Jim Yong Kim visited Kenya’s Climate Innovation Center to see these innovative energy projects
In Kenya, over 90% of the population uses wood, charcoal, or kerosene for their daily cooking needs. These fuels pollute the environment and pose serious health risks such as respiratory infections or even death.
While the country offers several clean energy sources, such as bio fuels and solar power, their market is still in its infancy. Prices are often not competitive compared to less sustainable but cheaper alternatives, and the lack of adequate infrastructure prevents their adoption in many rural areas.
Mohamed Kadhi saw a business opportunity in Kenya’s lack of access to clean energy when he founded Consumer Choice Ltd (CCL), a clean technology startup that develops clean cookstoves and a bio-ethanol fuel. On October 28, Mohamed had the opportunity to showcase CCL’s product lineup to Dr. Jim Yong Kim, President of the World Bank Group, during his visit to the Kenya Climate Innovation Center, a business incubator supported by infoDev, the World Bank’s global innovation and entrepreneurship program. The bio-ethanol gel is an alternative biofuel made from molasses, a by-product of sugar extraction.
Mohamed Kadhi (left) demonstrates CCL’s ethanol gel and cookstove to Dr. Jim Yong Kim, President of the World Bank Group, during Dr. Kim’s visit to KCIC on October 28, 2014. Photo credit: The World Bank/Kenya Climate Innovation Center
Another exhibitor during Dr. Kim’s visit to the Kenya Climate Innovation Center was the Keekonyokie slaughterhouse. This business has been recycling blood from a community-based Maasai slaughterhouse to create biogas for cooking. The slaughterhouse generates about 10 metric tons of slaughter waste. To manage the waste and turn it into something useful, the abattoir has constructed a biogas digester which channels waste into gas. The firm even stores the fuel in used tires, lessening the environmental impact of the operation.
While bio-ethanol fuel and biowaste-based gases are clean and highly efficient energy alternatives, getting Kenyan kitchens to adopt these alternatives at affordable prices remains a daunting challenge that would require carefully planned sales, marketing and financial strategies.
Since its founding in 2012, the Kenya CIC has been helping CCL and Keekonyokie with identifying potential target market segments and financing mechanisms, developing marketing strategies, and providing policy support through working with local policymakers in order to create greater incentives for the adoption of clean fuels.
The Kenya CIC supports 83 client enterprises – selected from over 330 applicants. With support from the governments of the United Kingdom and Denmark, the Center aims to spark the next wave of clean technology innovation in Kenya, and catalyze new solutions that promote Kenya’s private sector growth while achieving sustainable development objectives. Thanks to the services of Kenyan CIC entrepreneurs, about 8,300 persons have better access to safer, cleaner water, 55,000 people are better able to cope with effects of climate change, and close to 49,000 people are using low carbon energy sources. To learn more about how the World Bank is supporting climate-smart entrepreneurs, please visit www.infodev.org/climate.
By Eliza Villarino, 27 October 2014, DEVEX
A young girl receives medicine from a health worker at a mobile health clinic in Sindh, Pakistan. How do we scale up innovative solutions for global health challenges? Photo by: Vicki Francis / DFID / CC BY
If there’s one positive lesson to learn from the Ebola scourge, it’s that there’s no dearth of solutions to global health challenges. Prior to the current outbreak, the narrative was that there was no known drug for the disease; soon, vaccines and treatments will undergo testing.
Those experimental vaccines and treatments flew under the radar until the Ebola outbreak turned into a humanitarian tragedy and, eventually, captured headlines and the attention of global leaders. Urgency has created a market for Ebola solutions.
The same cannot be said for many other promising ideas in global health. Today, quite a number of medicines, health diagnostics and delivery mechanisms are lagging behind their potential.
“What we have is only a trickle of things transitioning to scale,” said Peter Singer, CEO of the Canadian government-funded Grand Challenges Canada. “So the next great challenge in global health and development is to turn that trickle into a torrent of things to scale.”
Scaling up new ideas in global health is a challenging venture. It requires leadership, funding and buy-in from a variety of stakeholders, from patients to providers, from the public to the private sector. Cross-sector partnerships can facilitate the process, but there’s no silver bullet to sustainably scaling up new ideas in global health.Funding new ideas
More players than ever are engaging in global health, with corporations and philanthropic foundations taking on a particularly growing role. Often, they partner with one another to develop new ideas in global health.
The use of competitive grant-making mechanisms — sometimes called grand challenges — is a favorite among the likes of the Bill & Melinda Gates Foundation and U.S. Agency for International Development, and has been taken up by governments of emerging countries like Brazil, India and South Africa. Winners of these competitions usually end up with tens of thousands of dollars in cash rewards — not quite enough to scale up a promising idea, perhaps, but a good start.
These challenges have resulted in a slew of new solutions, from a mobile phone application that can help deliver health care to the doorsteps of people in remote villages to a cheap medical device that boosts the chance of newborn survival in the developing world. But despite their lifesaving promise following testing over many years, the majority of them risk remaining at the pilot stage.
“A lot of NGOs and funders are set up to try new things, to fund pilots and small-scale efforts and they don’t necessarily follow through with funding when something is ready to scale,” said Pam Bolton, vice president for strategy and innovation at Concern Worldwide U.S.
That’s because scaling up requires huge costs, especially if it entails making the solution, whether a new drug, equipment or service, continuously available to the poorest of the poor who tend to be among the hardest to reach. And official development assistance for global health, which stood at $31.3 billion in 2013, won’t be enough to cover those costs. Fighting tuberculosis alone requires $8 billion per year, according to the World Health Organization.
Private capital may help supplement that. More and more private investors are committing capital to efforts that generate social impact, including better health outcomes. Impact investments, according to one survey, have reached $46 billion and will likely grow this year by 19 percent.Sustaining access to new ideas and effective solutions
Beyond financing new ideas in global health, the private sector has a role in developing new ways to advance health care and making new solutions more available to those who need it.
Pharmaceutical manufacturers, for instance, have launched more than 350 treatments over the last decade and have 3,200 compounds in the development pipeline. One of those could end up being a malaria vaccine.
But developing a drug that is safe and effective comes with an expensive price tag — somewhere between $4 billion and $11 billion. Much like donor agencies seeking partnerships with corporations to stretch aid dollars, pharmaceutical and medical equipment companies are partnering with one another and others to share the risks and reward of launching new global health solutions.
“Innovation is becoming more collaborative and we have moved away from profit-alone models to profit-together models,” said Andrew Jenner, executive director of corporate strategy and legal affairs at the International Federation of Pharmaceutical Manufacturers & Associations.
Members of the federation are working to develop treatments for diseases in the developing world independently or through product development partnerships, a form of public-private collaboration, such as the Drugs for Neglected Diseases Initiative, Medicines for Malaria Venture and TB Alliance. Pledged to donate 14 billion treatments for neglected diseases between 2011 and 2020, they have affirmed the importance of a “holistic fight” against these diseases to include working with the World Health Organization and other partners to strengthen capacity in developing countries.
Like product development partnerships, advanced market commitments are designed to incentivize the pharmaceutical industry to develop solutions that can fight diseases in the developing world. In this case, donors, largely rich governments and foundations, agree to subsidize the price of future vaccines for infectious illnesses and in turn a manufacturer agrees to sell them in developing countries at an affordable price. Gavi, for instance, has this innovative financing scheme in place for pneumococcal disease — the leading cause of vaccine-preventable death among children under 5.
Another scheme somewhat akin to it is the public-private Pledge Guarantee for Health, which uses partial guarantees from U.S. and Swedish governments to enable traditional aid grantees, such as nongovernmental organizations and developing country ministries, to secure short-term, low-cost commercial credit to procure essential health supplies such as bed nets and contraceptives.Adopting new ideas
Apart from accessibility, adoption is critical to scaling up new ideas.
Take the case of magnesium sulfate, which is proven to effectively treat pre-eclampsia, a disorder that kills 40,000 pregnant women each year, mainly in low- and middle-income countries. Yet despite its low cost — about $1 per dose — and being designated as essential medicine by the WHO the use of magnesium sulphate has been low. Studies suggest that the low price discourages mass production of the drug and policymakers are not moving to change the situation.
Read more #HealthyMeans articles:
A number of reasons may explain why decision-makers aren’t keen on scaling up effective solutions. For some, it’s the lack of money; for others, the fear of being accountable for allocating resources to what may be perceived as a risky activity.
“As long we don’t put in place governance systems, no innovation will help us reach the most vulnerable people,” Gabriel Pictet, unit manager for community health and innovation at the International Federation of Red Cross and Red Crescent Societies, told Devex.
Rwanda, for instance, actively pursues new and effective ideas from its development partners as it wants to become more like Singapore, a city-state esteemed for its efficient public service.
Strong support from local communities can help to promote new ideas, as well. Development initiatives tend to find the most success if implementers live and listen to locals and involve them in the design and implementation of solutions.
More importantly, the new idea should strengthen health systems. And that part isn’t going to be easy.
“I think it comes down to the question of how do we build a really strong health system?” said Jessie Cronan, executive director of Gardens for Health, which partners with government-run health centers in Rwanda to help families in rural regions with the highest rates of chronic malnutrition have a diverse diet by cultivating a home garden. “How do we reframe that role that NGOs play so that we’re playing a supporting role to government institutions in these countries so that it isn’t creating parallel systems but instead how are we working to strengthen what is already there so that there is true meaningful capacity building happening which is hard. It’s a lot easier to set up your own thing than to work with any government.”
Over the next month, Devex, along with leading players in global health, will explore how we can address that dilemma, as well as other emerging opportunities and challenges in saving lives and living longer.
Healthy Means is an online conversation hosted by Devex in partnership with Concern Worldwide, Gavi, GlaxoSmithKline, International Federation of Pharmaceutical Manufacturers & Associations, International Federation of Red Cross and Red Crescent Societies, Johnson & Johnson and the United Nations Population Fund to showcase new ideas and ways we can work together to expand health care and live better lives.
From human-centered design to the lean startup approach, methods to develop innovative products and services emphasize the importance of understanding what customers really need. Here are some lessons in innovation that social entrepreneurs have learned from empathizing with their customers:
Don’t let technology take the wheel: “I used to think that the problem lies in technology. What we realized eventually was that the problem does not merely lie in the technology, but the psychology,” says Ashoka Fellow Swapnil Chaturvedi in a recent video on his work.
Swapnil, founder of Samagra, is talking about providing adequate sanitation in India, where over 50 percent of the population defecates in the open. His statement could be true anywhere else in the world; toilets installed in low-income areas often fall into disuse or end up being used for other purposes such as vegetable peeling bins. To mitigate this, when designing community toilets in Pune slums, Swapnil introduced a LooRewards system. Based on a mapping of the community’s needs, this system linked toilet use with discounts on washing and sanitation products, water purification systems or fortified, nutritional snacks sold by local producers. This helped Samagra engage over100 first-time users of toilets.
Michael Murphy, co-founder of the MASS Design Group also realized that sophisticated technology wasn’t essential, while designing the 140-bed Butaro Hospital in Rwanda. He reveals, “A common misconception is that design interventions that combat the health worsening effects of hospitals are more expensive or require advanced equipment and machinery, but we’ve seen that’s not the case. Hospitals all over the world can be harsh environments for patients—which is shocking to consider, as we think of hospitals as places people go to get better. But labyrinthine corridors, harsh lighting, and stale air can in fact jeopardize a patient’s capacity to heal. Beyond that, hospitals are actually making people sicker. According to the CDC, about 1 in 20 patients gets a hospital-acquired infection (something they did not arrive with) per year in the U.S. (CDC, 2013). In Butaro, we designed the building without hallways, instead creating open-air, comfortable waiting spaces that would reduce the transmission of infection, but still provide opportunity for check-in and interaction. MASS also incorporated ample landscaped areas for patients to have quiet space outside, or visit with their families.”
Build the solution for the most under-served customers: Your most engaged customers often come from the edges of the market. Swapnil admits, “When I started working on community toilets, I didn’t know women would become our biggest customers. However, we have observed that in urban areas, where everyone is stretched for land and privacy, men find a solution to the lack of toilets, but women can’t. They hold their urine and bowel movements, resulting in urinary tract infections.” Thus, women are keen users of Samagra’s community toilets and as its most vocal customers, they help get their friends and families to sign up. Samagra, in turn, pays special attention to their needs, by providing dustbins in each toilet stall for disposing sanitary napkins and prioritizing water supply in the women’s toilets.For Michael, it was important to design hospitals that served patients as well as doctors better. For instance, hospital wards usually have patient beds facing each other, with a hallway in the centre for doctors to check on patients conveniently. Instead, the Butaro hospital in Rwanda has all beds facing the window, allowing patients to view the landscape. Michael explains, “There are myriad studies that demonstrate patients with a view to nature recover faster. Moreover, patients should not have to look at other sick patients when they are recovering; this represents a ‘factory-like’ setting of health care.”
Shift how the community sees you: “Hospitals should be, first and foremost, a public resource. This includes making the hospital an approachable space, where people can come to maintain their quality of life as well as receive acute care. That is why a lot of the spaces are landscaped,” asserts Michael. While building the hospital, he sought to expand its benefit beyond healthcare. “Health infrastructure requires massive investment and construction. This mobilization of resources should be transferred to the local community, by using local labor and materials, as well as providing on-the-job training. Butaro employed over 4,000 people, and transferred a few million dollars into the local economy as well. Beyond that, several masons trained at Butaro have gone on to other skilled jobs,” he states.
Focusing on positive outcomes for the community has prompted Swapnil to transform his rewards program from what he calls “transaction-based rewards” to “value-based rewards,” such as discounts on private tuition classes for schoolchildren. Samagra’s toilets also have bank kiosks that allow customers to deposit small amounts in their bank accounts regularly. This shift has resulted in increased revenue for Samagra, as “learning what customers care about through empathetic market research has allowed us to capture value and monetize it.” Transforming toilets into community connectors that allow slum-dwellers to access a broader range of services is powerful. Swapnil shares, “Since we installed a banking kiosk in the community toilets, rather than a place to relieve themselves, the toilet becomes a place to bank. People will never vandalise their bank; we’ve seen vandalism reduction by 85%. The toilet has become a place of business and a community centre of sorts.” Regular savings also allow customers to budget for the fees for using the toilet, and their payments have become more regular.
Innovations driven by empathy are now enabling Swapnil and Michael to expand the scope of their work. Michael’s MASS Design Group is currently completing construction on both a tuberculosis hospital and a diarrheal disease treatment center in Port-au-Prince, Haiti, as well as designing maternity waiting homes in Malawi and a Center for Global Health at Mbarara University in Uganda. Swapnil’s Samagra is evaluating options for adding more value-based rewards such as day-care centers for mothers who work in the informal sector and can’t afford to quit their jobs to take care of their children.