I have the great privilege of being able to do work which makes a difference in the world. I say this from a place of gratitude, not one of smugness. While I certainly enjoyed my former career in the telecom industry (and its concomitant financial benefits), it did not feed my soul the way my work at Linked Foundation does. Having been groomed in the private sector though, I find myself wanting to overlay the metrics and tools of American commerce onto the non-profit world.
Sometimes this is like fitting a square peg into a round hole. For example in 2008, we began a collaboration with Mercy Corps to deliver high quality, low cost medicines to rural Guatemalans using a sustainable business model. It started like many projects start; a colleague introduced me to someone at Mercy Corps with the thought that we could benefit from one another’s expertise. It was determined that Linked Foundation would provide risk capital to kick-off the micro-pharmacy franchise pilot.
But we wanted more than that. We wanted a seat at the table, not unlike a venture capital company wants a voice on the board or management team. We’re not the write a check and please send us a periodic update kind of organization. That’s not why Linked Foundation was established. We want to roll up our sleeves and dive in – not get in the way, mind you – but participate. For some partners, this does not translate to good news, but fortunately, with Mercy Corps, they welcomed our voice.
The project was a complicated one. Pharmacies, hospitals, and doctors are few and far between in rural Guatemala. If you’re an American you might think, big deal, hop in a car or a bus or on a train, and seek help – we aren’t all urban or suburban either. But in rural Guatemala, you likely can’t afford a car and even if you can, the roads are unreliable. Buses and trains are few and far between. And they’re expensive. And all of them take time. If you’re traveling by foot for six hours to acquire medication, you’ve lost a day’s wages…and you still have to travel back home. You can imagine what this does to something as luxurious as preventative care; it renders it nearly non-existent.
Our solution was TISA (Tiendas de las Salud… ‘Health Stores’ in Spanish). The idea was to train a villager in basic health care so that he or she could adequately and accurately dispense medications to those in need. Each store would be run as a profit center, creating a vocation for the owner, and thereby creating a sustainable and scalable model for the program. In our world, sustainable means that the program can live on without the need for continual donor support. Scalable implies that the pilot program may be replicated throughout the region, and possibly adapted for new regions.
It all looked great on paper. Linked Foundation brought in expert support in developing the business model, and Mercy Corps contributed its invaluable expertise in ground operations and medical knowledge.
But paper and the best-laid plans can’t account for the challenges that are blurred through our American lenses. For example, someone recently asked me if we have metrics about how many individuals have been given certain medications. Through American eyes, this would seem like a simple question. If you went into a local Rite-Aid and asked how many doses of Amoxicillin had been dispensed in the last 12 months, they would login into their terminal, create a quick report, and hand you the information.
Not so in rural Guatemala. Let’s start with the computer. There isn’t one. And there isn’t any WiFi either. Transactions are manual, and they’re cash. Nobody’s using a credit card or a digital point-of-sale system. The only potentially reliable data is in the restocking…but that doesn’t yield any information about repeat customers vs. new customers for that particular medication. And it assumes someone is keeping track too.
Now let’s say the owner has a smart phone. Many do because we provided them as part of the program for access to a medical questions hotline. Couldn’t he or she enter data into a cloud-based database? But smart phones require paid-for minutes. These are acquired with calling cards, which incidentally are a major component to the profitability of the TISA. Villagers purchase their calling cards at the TISA. It turns out the calling cards are susceptible to supply-chain problems and are often unavailable.
The nitty-gritty on-the-ground reality makes it difficult to cull the kind of information that we Americans view as fundamental to determining success or failure. So how did it go? Despite challenges, overall we can confidently say it’s gone well. We do know we’ve opened 50 stores introducing healthcare access to 88,000 people. We’ve transferred the reins to Farmacias de la Comunidad (FdeC), a large Guatemalan pharmaceutical concern, who together with Mercy Corps will continue to refine the process. Their goal is to expand to 500 stores, with access to 450,000 people.
We are pleased, but we know we have more work to do. In a country where roughly 50% live in poverty and 60% lack access to basic healthcare, we know we can’t rest. We’re working with a talented group at the University of California at San Francisco (UCSF) to collect valuable data about the program. With it, we hope to improve what we’re currently doing, and use it to inform our future projects. In the meantime, we’ll keep adjusting our focus to more clearly envision both challenges and solutions on the ground.
Read more details about the TISA project here.