Are companies reaching into low-income markets?
Inclusive business models explicitly aim to be inclusive of underserved populations. These business models can also meet the access needs of vulnerable populations including, but not limited to, children, girls and women, LGBTQI+, people living with HIV and people living with mental health conditions.
Inclusive business models show ways in which companies can directly address barriers to access for specific communities. These models introduce a tailored approach to current business models so that they are better directed towards the base of the pyramid for the long term.
They can complement pricing, licensing, donations and capacity building initiatives, recognising that conditions in low-and middle-income country markets can be vastly different from higher income markets. Generally, companies tend to start on a small scale to identify and overcome hurdles before expanding to further low-income countries or more underserved populations within one country.
- Long-term models to continue growth;
- Financially sustainable to scale up and deliver value;
- Integrated with a national health system to secure a sustainable future.
How many business models are aimed at the base of the pyramid and/or vulnerable populations?
In 2021, a total of 21 inclusive business models were identified out of 77 initiatives submitted or assessed through publicly available sources. Six inclusive business models have scaled up.
By expanding their activities to more diseases, regions and healthcare systems, these models are reaching more patients at the base of the pyramid, including specific populations facing access barriers. Five companies, GSK, Merck, Novo Nordisk, Novartis and Roche, stand out for measuring the outcomes of their models, e.g. by continuously tracking the number of patients reached, helping to assess the inclusivity of their models and the progress made.
Examples of scaled-up business models
Aim: Health camps focused on disease prevention, awareness and treatment, tailored to local health priorities and customs, including a wide range of essential medicines.
Scale up: One additional country in scope, Uganda. Model is divided in two parts: a commercial section and social activities (including e.g., awareness raising). Revenues generated in the commercial section are intended to compensate for the costs of social activities. Continuous scale up to more regions since 2007. Outcomes: the company tracks the number of health camps’ participants, number of patients diagnosed, prescriptions filled.
Novo Nordisk, 2010
The Base of the Pyramid programme
Aim: To improve diabetes care for the working poor by providing training to healthcare professionals, patient education to improve self-management and ensuring a stable, affordable supply of insulin.
Scale up: From five to six countries, including one additional country in scope, Morocco; and with new facilities in countries (e.g. opening of a ninth diabetes support centre in Ghana in 2019). Model generating long-term revenue for the company with more people getting the right treatment and reporting adherence to treatment, thus increasing sales of insulin. A third party, Dalberg, is expected to perform evaluations of the model in Ghana, Nigeria and Senegal for 2020.
Examples of companies trialling inclusive business models in low- and middle-income countries
Partnership with Access Afya (AA) on COVID-19 response
Target: Local communities; Kenya
Partner: Access Afya (AA)
Aim: To improve access to primary healthcare services in Kenya during the COVID-19 pandemic. The initiative aims at incorporating COVID-19 risk assessments into AA’s digital medical portal, training local entrepreneurs on telemedicine and strengthening the service for severe cases.
New model ongoing since 2020. AA, the implementing partner, has developed a social model of clinics that it plans to bring to scale. Outcomes are yet to be measured by Bayer’s partner and results to be shared in the company’s sustainability reports.
Partnership with Yako Medical
Target: Out-of-pocket patients; Lagos, Nigeria
Partner: Yako Medical, a social venture
Aim: To provide primary healthcare facilities with access to NCD screening technology and support a digital patient data management platform for underequipped hospitals or clinics receiving mostly uninsured patients; works by creating a pay-per-use model taking into account affordability and adherence.
Boehringer Ingelheim is newly involved with a goal to make the model profitable.
Outcomes: The company reports 860 people screened at primary care facilities with Yako Medical equipment during the 2019 pilot phase.
Partnership with Jacaranda Maternity
Target: Pregnant women; Kenya
Partner: Jacaranda Maternity
Aim: To deliver NCD care to pregnant women with NCD-related complications, through the development of a specific independent business unit within the maternity.
New since 2019; the company states it is a social initiative with a goal to generate profit. The company reports 2,200 people, including pregnant women, screened for NCDs during the pilot phase.
Partnership with Southlake Medical Centre
Target: Low-income workers and communities in Kenya
Partners: Ingo Investments; Sumerian Partners
Aim: Healthcare model for low-income workers to address access to primary and secondary healthcare by setting consultations at a low, affordable price. Revenue is generated through fees and paid walk-in consultations at the Medical Centre. The company will measure outcomes through impact indicators such as number of patients receiving HIV care. Johnson & Johnson Impact Ventures, supported by the Johnson & Johnson Foundation, reports a goal to maintain an average out-of-pocket cost of USD 2 per patient visit.
What is the key driver behind inclusive business models?
What sets the companies apart in this analysis from the companies without inclusive business models is a clear access-to-medicine strategy that is rooted within the company’s business model. An access-to-medicine strategy is intended to improve access to medicine in all countries, including low-income countries and is integrated in the overall corporate strategy (see page 38 for more information). This indicates that not only can such a strategy provide better access, but it can also create opportunities for the company that may otherwise not be realised. An inclusive business model is a concrete product of a wider access-to-medicine strategy.
Scale-up and replication to more countries and diseases is needed.
It should be pointed out that inclusive business models are only one of the many important pieces of the access puzzle and companies are key partners in advancing UHC. Inclusive business models help ensure that different socioeconomic groups have access to healthcare, but currently they are mostly limited to intra-country settings. To make inclusive business models truly successful, scale-up and replication in more countries and for more diseases is needed.
*Based on the definition used by: Business Call to Action. Implementing Inclusive Business Models. How Business Can Work With Low-Income Communities.; 2015. https://www.unglobalcompact.org/library/3161. Accessed December 18, 2020.