Investments in this strategy aim to supply essential services and products by developing new transport methods to reach previously inaccessible areas, improving supply chains, and establishing novel community-centered service delivery models to ensure rural populations have access to basic services. The sections below include an overview of the strategy for achieving desired goals, supporting evidence, core metrics that help measure performance toward goals, and a curated list of resources to support collecting, reporting on, and using data for decision-making.
Around the world, and especially in emerging markets, people face countless challenges accessing essential medical commodities (e.g., vaccines, blood transfusions) and services (e.g., skilled birth delivery). This strategy seeks to break down barriers to accessing health care through supply-chain innovations (for access to commodities) and innovations in community engagement (for access to services).
Investments in this theme can improve health outcomes through the following means:
The inability to access commodities and services have extensive, diverse implications for global health outcomes.
In maternal health, for instance, there can be many barriers that prevent access to services. Many emerging-market countries feature high maternal mortality rates, attributable largely to lack of skilled attendance at birth (1). Postpartum hemorrhage, frequent in the absence of skilled birth oversight, accounts for 100,000 annual deaths worldwide, or roughly 60% of maternal deaths in developing countries (2). (Strategies that mitigate insufficient access can also address postpartum hemorrhage.)
Vaccinations are a commodity aspect of health care in which obstacles to access, particularly those related to delivery, have immense human consequences. Ten percent of children worldwide did not receive a single vaccination in 2017, leading to countless preventable deaths. Concurrently, 20% of distributed vaccines are spoiled due to high storage temperatures (3), with the resulting shortages and impotent vaccinations leading to unvaccinated children.
Access to essential medical commodities and services affects many different stakeholders. Below are some groups of people who are most critically and directly impacted by innovations in access to such commodities and services.
Pregnant Women: Pregnant women can greatly benefit from improved access to medical commodities and services. Each year, 287,000 women worldwide die giving birth; innovations in both access to services (e.g., skilled birth attendance) and essential commodities (e.g., oxytocin, which can prevent postpartum hemorrhage but is sensitive to temperature and humidity) could prevent many of these deaths (4).
Infants and Children: Innovations in product and product delivery throughout the supply chain could greatly improve rates of vaccination in children. New methods of storing vaccines for and during delivery, innovative temperature- and humidity-resistant vaccines, and generally improved supply chain logistics can increase vaccination coverage, thus averting child deaths and improving cognitive development (5).
People in Rural Areas: Geographic remoteness presents one large, persistent obstacle to universal health coverage (6). Innovative methods to deliver products and services can facilitate access to health care in remote areas.
People in Geographically Inaccessible Areas: Distance is not the only geographic barrier to universal health coverage; untraversable terrain also prohibits access to products and care. Innovations in supply chain and service delivery can help reach populations in these previously inaccessible areas.
People Affected by Stigma: In practice, some populations may be prevented from accessing essential medicines and services because of social stigmas around their particular needs, especially for mental health needs. Innovative outreach or educational models can help those affected overcome the social barriers to receiving care.
Providers: Health care providers who face common shortages of essential supplies, due to any of the conditions described, also stand to greatly benefit from innovative models of product delivery.
Rural populations in poor countries have the most to gain from investments in this strategy. Geographic remoteness prevents access to both essential medical products and services; for instance, vaccination rates in rural areas are consistently lower than those in urban areas across low- and middle-income countries (7).
Populations living in areas of inaccessible terrain also face challenges that this strategy seeks to resolve, whether these challenges result from geographic factors, either natural (e.g., mountain ranges) or man-made (e.g., insufficient infrastructure and roads).
Finally, geographic barriers, especially remoteness, also inhibit access to essential medicines and services in developed-economy contexts, in addition to emerging markets.
In the absence of investment, at least two factors might facilitate greater access to essential medical commodities and services for the populations this strategy seeks to target. First, rapid urbanization in emerging markets will lead to proportionally fewer people living in rural, hard-to-reach areas (8). Second, infrastructure in emerging markets will continue to improve with investment by governments and their foreign partners. However, both these trends are long-term, requiring substantial resources and representing immediate opportunities for investors. Investors might also focus on those areas least experiencing or least likely in the future to experience these trends in urbanization and infrastructure development.
This strategy can most influence the roughly 3.4 billion people worldwide living in rural areas (9). Though not all people in rural areas lack access to essential medical products and services, rural populations worldwide generally face worse health outcomes and greater barriers to access (10).
Moreover, most of the global rural population lives in Africa and Asia, where many of the challenges to providing essential medical commodities and services are often exacerbated by relatively high temperatures (affecting, among other things, the viability of vaccine cold chains) and lower incomes (introducing a financial barrier to access that amplifies geographic barriers) (9).
Different deployment methods for this strategy may benefit from specialization depending on context. For instance, innovative community outreach models to bolster service provision in rural areas may be difficult to adapt across contexts, while supply-chain innovations (e.g., drone delivery) face fewer obstacles to scale.
Access to essential medical products and services is often binary: patients either receive or do not receive a certain treatment, vaccine, or other medical intervention. Treatments, if received, may directly save lives. Consider several examples of impact on both supply-chain efficiency and ultimate outcomes through both product- and service-based models of supply expansion:
Risk factors for this strategy include the following:
All three risks are minimal for most investors. Community outreach models are typically designed to remain engaged with stakeholders and aware of their needs, and rural populations will likely always benefit from improved supply chains and innovative methodologies for supplying products and services.
Risks for this strategy will more likely dilute potential positive impacts than produce negative ones. For instance, improvements in infrastructure may reduce the impact of investments in this strategy over time by naturally counteracting geographic disparities in access to essential products and services, but innovations in the supply of those products and services will probably not yield negative consequences in the present.
Zipline is an early-stage drone delivery service providing hard-to-reach areas with critical access to lifesaving medical products. The model is simple: remote health workers send an SMS text to request essential medicines and supplies. Those supplies, staged at centralized distribution centers, are delivered to the point of care by drone less than thirty minutes after takeoff. Speed is crucial; since launching in October 2016, approximately one-third of Zipline's flights have been in life-threatening situations. The company now supplies 20% of Rwanda's blood supply outside of Kigali, recently expanded to Tanzania, and plans to expand to the United States in 2018 (13).
“Introduction to the Challenges for Maternal Health.” Global Citizen. October 18, 2012. https://www.globalcitizen.org/en/content/introduction-to-the-challenges-for-maternal-health/.
Smith, John R. “Postpartum Hemorrhage.” Medscape. May 31, 2018. https://emedicine.medscape.com/article/275038-overview.
Saul, Isaac. “Bill Gates Wants to Know if You Can Spot These Genius Innovations Hidden in Plain Sight.” aplus. April 13, 2017. https://aplus.com/a/bill-gates-spot-the-innovation-gates-foundation.
“Safeguarding the Quality of Maternal Medicine to Save Mothers’ Lives.” USAID Global Health Supply Chain Program. January 24, 2018. https://www.ghsupplychain.org/node/424.
Bloom, David E., David Canning, and Erica S. Shenoy. "The effect of vaccination on children’s physical and cognitive development in the Philippines." Applied Economics 44, no. 21 (2012): 2777–83. https://dash.harvard.edu/handle/1/33730172.
Wong, Joseph. "Achieving Universal Health Coverage." Bulletin of the World Health Organization 93, no. 9 (2015): 663–64. http://www.who.int/bulletin/volumes/93/9/14-149070/en/.
Restrepo-Méndez, Maria Clara, Aluísio J.D. Barros, Kerry L.M. Wong, Hope L. Johnson, George Pariyo, Giovanny V.A. França, Fernando C. Wehrmeister, and Cesar G. Victora . "Inequalities in Full Immunization Coverage: Trends in Low- and Middle-Income Countries." Bulletin of the World Health Organization 94, no. 11 (2016): 794–805B. http://www.who.int/bulletin/volumes/94/11/15-162172/en/.
“Healthcare Access in Rural Communities.” Rural Health Information Hub. https://www.ruralhealthinfo.org/topics/healthcare-access.
UN DESA Department of Economic and Social Affairs. “World’s Population Increasingly Urban with More than Half Living in Urban Areas.” News release, July 20, 2014. http://www.un.org/en/development/desa/news/population/world-urbanization-prospects-2014.html.
“Rural Health Inequities: Data and Decisions.” Editorial. The Lancet 385 (May 9, 2015): 1803. https://www.thelancet.com/pdfs/journals/lancet/PIIS0140-6736(15)60910-2.pdf.
“Improving Immunization Supply Chains in Mozambique.” VillageReach. http://www.villagereach.org/impact/dedicated-logistics-system/.
“Living Goods Invests in Best in Class Impact Measurement.” Living Goods. https://livinggoods.org/what-we-do/measuring-impact/.
Zipline: Lifesaving Deliveries by Drone. http://www.flyzipline.com/.
This mapped evidence shows what outcomes and impacts this strategy can have, based on academic and field research.
Prina, Silvia. “Banking the poor via savings accounts: Evidence from a field experiment.” 2013
Dupas, Pascaline, and Jonathan Robinson. “Savings constraints and microenterprise development: Evidence from a field experiment in Kenya.” American Economic Journal: Applied Economics 5, no. 1 (2013): 163-92
Jack, William, and Tavneet Suri. “Risk Sharing and Transactions Costs: Evidence from Kenyas Mobile Money Revolution.” American Economic Review 104, no. 1 (2014): 183-223
Karlan, Dean, and and Leigh Linden. “Smoothing the Cost of Education: Micro-Savings in Ugandan Primary Schools”
Karlan, Dean, and Jonathan Zinman.“Expanding credit access: Using randomized supply decisions to estimate the impacts.” The Review of Financial Studies 23, no. 1 (2009): 433-464.
Aker, Jenny C., Rachid Boumnijel, Amanda McClelland, and Niall Tierney. “Payment mechanisms and antipoverty programs: Evidence from a mobile money cash transfer experiment in Niger.” Economic Development and Cultural Change 65, no. 1 (2016): 1-37.
Burgess, Robin, and Rohini Pande. “Do rural banks matter? Evidence from the Indian social banking experiment.” American Economic Review 95, no. 3 (2005): 780-795.
Dupas, Pascaline, Sarah Green, Anthony Keats, and Jonathan Robinson. “Challenges in Banking the Rural Poor: Evidence from Kenyas Western Province.” 2012. doi:10.3386/w17851.
Schaner, Simone. “Interest Rate Subsidies and Savings Behavior in Kenya”, 2009
Suri, Tavneet, and William Jack. “The long-run poverty and gender impacts of mobile money.” Science 354, no. 6317 (2016): 1288-1292.
Each resource is assigned a rating of rigor according to the NESTA Standards of Evidence.
[Client Individuals: Active (PI9327) at the end of the reporting period − Client Individuals: New (PI8732)] / Active Client Individuals at the beginning of the reporting period