“Disruptive innovation” in health
The Anglo American Chairman’s Fund has traditionally viewed healthcare strengthening as a major contribution made by NGOs to the healthcare sector in South Africa.
Within this pool of NGOs, there are some remarkable organisations acting as change catalysts or market disruptors in healthcare.
Disruptive innovation is a term used in business and technology literature to describe innovations that improve a product or service in ways that the market does not expect, typically first by designing for a different set of consumers in a new market and later by lowering prices in the existing market. In public health, the impact on the market is not typically an economic disruption in the way that it would be in, for example, the technology space. But some NGOs are able to disrupt the usual approach by thinking boldly and creatively around service delivery and its particular challenges. Simply put, it is this kind of innovative thinking that gives people access to better services and therefore improved overall health.
When this happens at the bottom of the income pyramid, it’s often called “breakthrough innovation”. India is a country experiencing dramatic changes in healthcare as a result of this.
In India, a few healthcare providers have embraced typical business constraints such as patient inability to pay and limited access to healthcare services, to establish new global standards for cost, quality and delivery. Examples are the Narayana Hrudayalaya cardiac care center in Bangalore that uses telemedicine to reach patients in remote locations that are difficult to access. Other examples are the Aravind Eyecare System, which aims to “wipe out needless blindness” and BMVSS which provides free prosthetics to those in need and survives on donations from satisfied patients and philanthropists.
What is particularly exciting about these Indian examples for South Africans is that these healthcare innovators have been around long enough to show evidence that such efforts represent sustainable businesses.
Not bound by institutional requirements, red tape and organisational politics, NGOs have the freedom to create and experiment with different approaches to service delivery. Through their flexibility, and often quite perseverant approaches, a number of NGOs working in the healthcare space in South Africa are able to try out new, innovative and more efficient or effective approaches. Their significance in healthcare system strengthening is that they are able to work with, support and ultimately influence government.
Some innovative South African NGOs that are supported by the Fund include:
Umthombu Youth Development Fund (UYDF), which uses an innovative and self-sustaining approach to addressing youth unemployment and the shortage of rural healthcare professionals. Based on evidence that youth from rural areas are more likely to return to work there, UYDF identifies rural youth with potential to become healthcare professionals in the community. Academic, financial and social support is provided to the youth at university in their chosen healthcare professions with the proviso that they return to work in their communities after graduation. UYDF started with four youths in 1999, and grew to 189 qualified graduates in 2014. They boast an exceptional pass rate of 92% (compared to the national pass rate of 35% for rural students) and today they work closely with government in funding and placing students.
Ndlovu Medical Trust – Ndlovu Wits Audiology Clinic – implemented the first universal newborn hearing screening programme at primary healthcare level in Limpopo province to facilitate the early detection and identification of hearing loss in infants and young children. This has involved placing screeners at government clinics to refer serious cases to the programme, so complementing the services provided at clinic level, and contributing to the general body of knowledge.
Mosamaria is successfully implementing adherence clubs at a number of government clinics in the Free State. Adherence clubs, providing patient-friendly access to antiretroviral (ARV) treatment, were developed by the Médecins Sans Frontières in Khayelitsha. Mosamaria runs clubs which meet monthly, where members are provided with treatment, screened for any complications and provided with health education in the form of talks and presentations. These clubs have dramatically reduced the workload of nurses, have decreased waiting time for patients and improved adherence.
Desmond Tutu HIV Foundation – the Tutu Tester is a clinic caravan that takes screening services right to peoples’ doorstep. They provide health screening and educational services, using testing kits provided by the provincial Department of Health and referring patients to the local government health facilities. In this way, they are detecting diseases early on so that they can be treated before complications develop.
These organisations share some common traits:
- Strong leadership and strategic vision;
- Solution-oriented thinking;
- An understanding how to develop an effective working relationship with government health service providers, making their work scalable and sustainable;
- Real understanding of the communities that they serve and an empathetic approach to service delivery; and
- Valuing human resource.
The freedom of the NGO environment provides fertile ground for these organisations to incubate new approaches. Donors provide them with the space to continue to be both innovative and relevant.