Delivering Public Health From Poverty

Harvard Business School and the Harvard School of Public Health have merged their brainpowers to mold a new equation that could be the envy of Albert Einstein. 

Professors involved in the project say they have identified a solution that can cure the ails of public health worldwide and alleviate the scourge of poverty.

S2 + E2 (scalability, sustainability plus efficacy and efficiency) is the formula driving Harvard’s Project Antares, an initiative that has had success in 11 countries in the past five years, and aims to bring in certain areas of expertise from the private sector as one of the possible avenues for improving delivery of public health. 

Since World War II, more efforts and investments have been made to fight poverty than any other time in history, but the results are discouraging, Harvard Professor David Bloom told an audience of Harvard and Dartmouth alumni at the on Sand Hill Road in Menlo Park.

The event, which was sponsored by the featured a panel that included Bloom, who is a professor of economics at Harvard School of Public Health’s Department of Global Health, and his colleague, Senior Lecturer Michael Chu of Harvard Business School’s Initiative on Social Enterprise.  As representatives of Project Antares, the academicians presented a new model for improving public health for low income populations through sustainable and scalable enterprise. 

“Our major warriors for fighting disease and poverty are the NGOs and philanthropists, but these organizations rely on governments to scale their programs,” Bloom said.  “NGOs have been very effective with vertical programs used to reach a single health end point such as eradicating small pox or delivering low cost drugs to treat patients with HIV/AIDs."

He went on to say that government and bloated bureaucracies as deliverers of goods and services are not efficient or effective enough to address public health at the horizontal level.  In India, for example, the poor spend 76 cents on the dollar for inadequate public health services. 

From a business perspective, there is an opportunity to provide much better health care services at the same rate and improve patient outcomes, he said.  For the public health sector, which is a mature market, it takes a lot of money to make marginal gains.  Private enterprise is in a better position to sustainably provide services to the densest populations enduring the world’s most serious diseases. 

Project Antares has developed a matrix that scores global regions (identified by the World Health Organization) based the presence of one or more of the top 30 health conditions affecting the populations in those areas.  It focuses on the most severe health conditions that impact economic development.

According to Antares' data, nine million children die every year before the age of five, and more than 60 percent of them die from preventable diseases.

“The most robust predictor of a country’s failure is its infant mortality rate,” Bloom said.

Infectious diseases in developing countries are giving rise to non-communicable, chronic diseases like heart disease, diabetes and cancer.  Poor health accounts for increasing populations; lost productivity, income and education; and plunges people into poverty. 

Bloom said they have looked to the public sector to come up with the solutions to help the poor, but the programs are fraught with inefficiencies, lack of scalability and corruption.

Another component of Project Antares is dispatching students from both Harvard schools to work with NGOs and create new models of improved health care delivery.

Students worked with Pro Mujer, a women’s development and microfinance organization that helps Latin America’s poor women build livelihoods through microfinance, business training and healthcare support. 

They had to figure out how Pro Mujer could create a sustainable, independent entity to meet clients’ health care needs without having to subsidize these services with its microfinance business.  The students came up with a health care model, bundling low-cost primary health care services with a non-critical dermatology treatment for whic clients were willing to pay, because it satisfied their needs.  A physician was also hired to head Pro Mujer’s separate healthcare operations. 

Pro Mujer is one of Project Antares’s biggest successes in terms of integrating a health care platform as a major part of its microfinance services but without the economic drain.

“Now that we have had a level of success, we have a bigger vision of where this could all go,” said Alix Smullin, Harvard School of Public Health's officer of external affairs. Project Antares is embarking upon an education campaign to attact new partners.

“Looking at it from the business side, there is a lot of money being spent wastefully with meager results and there are many opportunities to provide much better services," Smullin said.  "From the public health point of view, it takes a lot of money to make marginal gains.  The private sector is in a much better position to sustainably provide,” she added.

Chu emphasized fostering competition by reaching out to social entrepreneurs, venture capitalists, as well as non profit organizations and private industries to grow a platform of larger players.

 “What we really need to create an industry—not just a few people—and consider the private sector for one of the possible avenues for delivering public health.”