Market-based solutions for the poorest?

Community outreach to promote the tele-consultation service in Dakar. Photo: Awa Ndiaye

This third week of GHP 547 has probably been the one where I have felt the most rich learning has taken place, both for the social entrepreneurs I am working with, and for myself, which I am very grateful for. Discussing some of the take-aways with my J-term classmates and Professor Langer and Nora has provided further food for thought and very actionable take-aways.

– One of the dilemmas several of the social entrepreneurs have been facing is to what extent they can target exclusively pregnant/post-partum women with their social innovation, in a community that has other – sometimes very pressing – health needs. Their innovation (a mobile-phone-mediated tele-consultation, and a home consultation service via a fleet of motor-cycle equipped doctors in peri-urban Dakar) targets pregnant and post partum women, but the services are non-specific enough that they could, in principle, respond to a diversity of health needs and different profiles of patients. As they have started to promote the services through neighbourhood outreach campaigns (offering free consultations to pregnant/post-partum women) they have been approached by many other people, asking for medical attention, and willing to pay for it. This has resulted in a major dilemma for the social entrepreneurs. Do they ‘relax’ the parameters they had set regarding their target group and attend to others, as part of their effort to become known and earn the good will of the community? Or do they stay the course, focus exclusively on pregnant/post-partum women even if this may mean it takes longer to promote the service and may make broader community buy-in harder? Professor Langer and Nora noted that this is a dilemma faced frequently in the field, and that for the social entrepreneurs, being aware of their bandwidth and staying focused is crucially important.

-Another theme that is emerging is that whereas there is a great deal of need among pregnant women in the lowest income bracket, and that has been the target group of these social enterprises, for practical reasons they have decided to focus the pilot in their immediate neighbourhood in Dakar, “Liberté 6”. They are confident that they will elicit high demand and be able to prove the concept more efficiently and effectively this way. But it does entail a shift upstream regarding the beneficiaries of the services to a middle-income population . In class we discussed that reaching those in the last mile, or  “bottom of the pyramid” remains the enduring challenge in all types of maternal health projects globally. We discussed encouraging the social entrepreneurs to finding ways to really listen to the needs of the community and re-evaluate who is their “archetype user”. Also discussed that often solutions may be inadvertently imposed on communities, and that a relentless focus on the problem and a willingness to iterate and adapt are important.

-It also became more apparent this week that the business model is not yet fully clear. It seems that, on one hand, they assume that the middle-income cohort they are now targeting will be able and willing to pay a fee for these services, and this will guarantee the financial sustainability of the program. At the same time, they are thinking of a hybrid model wherein paying patients could cross-subsidize those who cannot afford the services, We discussed in class that in a small market (such as specific neighbourhoods in Dakar) this hybrid business model  or a sliding fee might be difficult to implement. The social entrepreneurs would probably benefit at this stage from a strategic thinking exercise focusing on their archetype user and audience segmentation.

The first challenges of partnership among the social entrepreneurs have surfaced and we discussed in our weekly debrief that “walking the talk” with any partnership or collaboration is tough. But they seem to be dealing with issues of dissent quite constructively.

I am looking forward to our final presentations soon!

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