Future of Government | Report | Debates | Case studies
Everyone wants easy access to a competent, available primary care doctor or nurse as a one-stop shop for all our medical needs. But low and middle income countries have struggled to produce enough doctors and nurses who can provide accurate diagnoses and to persuade them to more regularly attend work in government facilities.
Governments and NGOs for the past century have introduced community health worker (CHW) healthcare teams. Community healthcare is a technique to select a shortlist of straightforward and mass-demand tasks for a cadre of less expensive health workers. These people require far less formal education to do their jobs (a nurse takes around seven years to train, while CHWs in Uganda can take about ten days).
CHWs are a market-creating innovation in the sense that their services can be accessed by people – and governments—who cannot obtain a more sophisticated medical service. Also, CHWs are a “disruptive” innovation in the sense that they are low-skilled relative to 'standard' healthcare industry workers, they are cheaper, and adequately meet the needs of the "low demand for performance" of previously unserved users suffering from common illnesses.
Although starting from much lower levels of performance, they can take a path of improvement in order to meet the demands of more and more users. CHWs have been adopted globally to some extent, but few governments have gone ‘all in’ to really disrupt the existing model. Much government money and attention in low- and lower middle-income healthcare remains upstream in prestigious, doctor-provided care, rather than building out better coverage by deploying and rewarding CHWs to achieve their full potential.
Because of a host of interests, incentives, beliefs, and tax financing, government’s existing activities are harder to ‘disrupt’ and displace. But there are other ‘disruptive’ health innovations along the same lines of unbundling the family doctor or general hospital. Single-condition hospitals do thousands of eye surgeries per day in India and clinics provide cut-price diabetes-only care in Mexico. While most users would prefer a general facility nearby, single-condition clinics get economies of scale which result in a better overall service.
Much of this case study is drawn from The Prosperity Paradox.
