A few weeks ago I visited a Government health clinic in Nakasongola, Uganda. I found two energetic nurses, whose dedication make the place function, together with some less encouraging elements: long queues of mothers and malnourished infants; a dearth of data; and absent staff. But my real interest was drugs.
The clinic has an in-house pharmacy that receives a delivery from the National Medical Stores every three months. They received their last delivery six days previously and were already stocked-out of zinc, ORS, ACTs and amoxicillin – treatments for diarrhoea, malaria and pneumonia – the three biggest killers of children in Uganda.
The pharmacist tells me that they do send stock request lists to the National Medical Stores, but they do not compile the lists based on the previous quarter’s patient needs; and they do not receive what they ask for. So there is limited incentive to compile the drug list with care and attention, resulting in regular stock-outs of essential medicines.
Then I wandered over to a local trading centre, a few hundred yards from the clinic, and found Blessing.
Blessing has a nursing certificate but could not find work in the public sector. So she set up this kiosk. She had every medicine I asked to see, including the three that were stocked out at the clinic’s pharmacy. She tells me that she never has a stock-out:. Why would she – she would lose customers and money!
Blessing keeps simple, paper-based records of what she buys and sells and therefore immediately knows when any product is running low. She has a deal with a local taxi driver who shuttles between Nakasongola and Kampala. Every few days she gives him a drug list, which he takes to a pharmacy in the city. The pharmacy calls her with the total price for the order and she transfers the cash directly to the driver via her mobile. He carries the delivery back with him the same evening, and receives a fee for his service on delivery of the medicines.
This is a case of small being beautiful. Great bottom-up innovation. I like it because it relies on an existing and permanent “supply chain” – people will always need to travel to the capital; it rewards those along the chain for good performance; it uses mobile technology to improve efficiency and reduce wastage (i.e. transporting cash); and it provides essential medicines for a poor community when they are simply not available anywhere else.
Lots of innovations, but also some failures. Blessing’s drugs are expensive – given the profit margins required at each step along the chain – and are therefore unaffordable to many members of her surrounding community. If she could reduce her costs she could increase her profit margins and improve access to life-saving medicines for the people of Nakasongola. How could she acknowledge her failure and iterate her model?
- She could team up with the other vendors in her locality. That way they would share transportation costs and could negotiate better prices with the supplier.
- She could diversify her range to include non-health products – face creams, hair gels – to increase her profits and enabling her to reduce the price of the medicines.
- She could integrate a tech-based system into her kiosk to record what she is selling over a longer period of time . This would be incredibly useful information for her own little business, for any expansion aspirations she has, and for the health system more broadly
- She could build better linkages with the clinic and communities. This could result in referrals to her when the clinic pharmacy is stocked-out; and more consistent health messages delivered to patients.
- She could go mobile and proactively seek out customers – increase her client base, build trust, make more efficient use of her time.
I felt blessed to meet Blessing. She genuinely wants deliver quality healthcare and she genuinely wants to make money – a great combination. She inspired me to consider how we can leverage Blessings at scale. I hope to report back on that soon…