Healthcare innovation in rural Nicaragua
In late 2015, I took a sabbatical from my day role as a strategy consultant in order to support the development of micro-enterprises in rural Nicaragua. During this time, I worked with two sisters who wanted to develop a pharmacy to improve their community’s access to medicines and, eventually, health care services.
Sustainable development and healthcare access are particularly important in Nicaragua, a country where:
· 76% of the population live under less than $2 a day[i]
· 31% of the country’s population work in agriculture[ii], an occupation which has become increasingly unstable: Nicaragua was identified as the fourth most affected country in the world by climate change[iii]
· 33% of the rural population live more than 2 hours walking distance from the nearest basic health services and even farther from hospitals that offer specialized care [iv]
· 81% of total spend on healthcare is on medicine for the poorest quintile of the population; for the richest quintile this is almost halved, at 41% [v]
During our project we recruited ‘entrepreneurs’ across two rural communities: anyone who wanted an opportunity to make a change in their community or to have a new way of developing income. We worked around their schedules, developing practical ways to teach core business skills and coaching entrepreneurs to think around their ideas using the Business Model Canvas.
Ivania and Delila, two sisters studying nursing, joined the group of entrepreneurs in order to start a pharmacy. There were no doctors or health facilities in the community, and access to drugs was limited to a limited set of over-the-counter items available in small, local all-purpose stores which sold everything from bottles of Pepsi to clothes washing soap. Anything else required paying for the 30 minute bus to the nearby towns of Ocotal or Somoto.
The sisters had a clear vision and mission for their pharmacy. It would provide a wider variety of medicines than the pulperias so that community members would not spend excessive time and money of purchasing medicines in a nearby town. In the future, they hoped to expand their services, including giving injections and providing basic nursing services. Additionally, with the presence of a pharmacist, they could also provide prescription-only products and expand to other locations. In what we might term a minimum viable product, they had already cleared a small stall near their home and advertised a list of medicines to sell in order to test demand.
To develop the idea further, the girls surveyed community members to understand how much they were willing to spend, demand for a wider selection of medicines, and any desired additional services. The responses of their friends and family members revealed a number of opportunities to innovate:
· Out of hours: community members expressed that they sometimes needed to access medicines at different hours, and could not rely on buses or the pulperias at this time. The sisters decided that their unique selling proposition would be extended opening hours, including an out-of-hours text service that they could take shifts to fulfil
· Delivery: for members outside the community, or those unable to get to the pharmacy, it was suggested that a delivery service would be essential. The sisters agreed that they could receive orders by text, and operate a free daily delivery route. Customers who needed urgent deliveries could be charged a delivery fee
With an idea of the medicines they could sell, the next step was to develop supplier partnerships and understand the economics of their future business. Armed with a pen and paper, we visited pharmacies in nearby towns to understand their pricing and gathered opinions on the benefits of procuring directly from laboratories in the capital city of Managua. During the process, we found a number of mentors who agreed to support the sisters with the administrative elements of setting up a pharmacy.
This month, Ivania and Delila will be pitching for seed capital, alongside the other community entrepreneurs, for the funds to bulk-buy medicines at a lower price and kick-start their pharmacy. During the course of the project, they have successfully balanced family duties, their university education and working on their business plan. If successful, they will create the first community pharmacy in their local area. I wish them the best of luck.
[i] https://www.wfp.org/countries/nicaragua
[ii] http://www.nationmaster.com/country-info/profiles/Nicaragua/Labor
[iii] https://germanwatch.org/en/download/10333.pdf
[iv] http://www.amoshealth.org/needs-we-address/
[v] http://siteresources.worldbank.org/HEALTHNUTRITIONANDPOPULATION/Resources/281627-1095698140167/CortezNicaraguaHealth.pdf
