Getting Down to Business in Global Health OR The Brain in Spain Works Mainly on Supply Chains (I think we’ve got it!)

October 26, 2009
When business expertise combines with an opportunity to contribute to a social mission, the results can be remarkable. Let me share one powerful example. In mid-2006, as the Global Health Forecasting Working Group was underway, my co-chair Neelam Sekhri and I were feeling stuck. With working group members from a range of global health organizations, who brought perspectives from industry and international public health, we had been able to describe the magnitude of the challenge of forecasting the demand for global health products, particularly new ones like the rotavirus vaccine and artimesenin-based anti-malarials. We’d also developed a good understanding of how inadequate information about effective demand – how much money would be available to buy what, and at what pace countries would be likely to introduce – constrained the ability of firms to make the business case for investment in manufacturing capacity, let alone new R&D. What we were missing, though, was the deeper understanding about why the demand forecasting problem persisted, despite reasonably wide recognition that it caused shortfalls in supply, wasted of products, time and money. It’s often in answering the question, “So why hasn’t someone solved that yet?” that you discover the most interesting new ways to approach a problem. Looking for information on demand forecasting for health care and other products in industrialized markets, Jessica Pickett, then a Program Coordinator at CGD, came across a fascinating article about difficulties in forecasting demand for seasonal flu vaccine. Intrigued, we called the author, Prashant Yadav, and had the first of what was to be many, many conversations. Prashant, a faculty member at the MIT Center for Transportation and Logistics in Zaragoza, Spain, not only had a special way of analyzing the way the different actors along the supply chain relate to one another, and can be incentived to work more efficiently, he also brought a passion for using business expertise and creativity to contribute to a better world. Although we didn’t have the budget to pay anything close to corporate rates for his consulting services, Prashant cheerfully devoted an uncountable number of hours to analyzing incentives along the supply chain for global health products, and ultimately sowing the seeds of the recommendations that the group adopted. By that time, Prashant had been seriously bitten by the “global health” bug, and many individuals who were struggling with supply chain issues had seen the contribution he and his colleagues at Zaragoza could make. So for the past couple of years, Prashant has been spending a very large portion of his time responding to requests to working on that dimension of the “access to medicines” problem. But, as he told me in a recent e-mail, the story doesn’t stop there. He writes:
Ruth and Neelam, Since you were the ones who created the motivation for this, I wanted to send you an update.
  1. We have started a work-study program for African pharmacists who work on supply chain and logistics in Ministries of Health. We bring them in for two years to our regular Masters in Supply Chain Management Program, we give them a tuition waiver and a small stipend and they work on small projects in return. We wanted to select a good group of 2-3 for our first crop, so we interviewed many during my travels and carefully picked the highly motivated and those who had the potential to become change agents when they go back.This year the students we have in our Masters program include: the distribution manager of the Central Medical Stores of Ghana; the Logistics and Pharmaceutical advisor for USAID in Sudan; the distribution manager of Mission and Essential Drug Supplies unit in Kenya; and the pharmacist consultant for MoH, East Timor.
  2. The ‘MIT-Zaragoza Africa Health and Humanitarian Supply Chain Scholarship’ is in its third year now. One of the two past recipients has obtained a position as a deputy minister in his home country. The other African recipient went to work for a private company. But if I believe a recent paper by Michael Clemens at CGD on skilled migration, even if they work for a for-profit company, the incentives will lead to more people train in supply chain management in Africa and then some of them will stay to work at MOHs due to social, family and other factors.
  3. Our graduates have shown keen interest in working for global health organizations over our typical recruiters, i.e. US /EU based large corporations. We have two students who have picked to work for small NGOs in Mozambique, Malawi, and Tanzania over very well paying jobs from pharma companies and others. We have one student who has gone to work for Medicines Sans Frontiers as their supply chain champion and has a great story to tell (a 24-year-old woman from Ohio who goes to a different war zone in the world every day to help create more efficient drug supply systems). Another former student has moved to Tanzania to work on an innovative pilot project we are doing there.
  4. Our graduates who go and work for big pharma are acting as change agents within big pharma about the developing world. A student from last year who works for big pharma has convinced his emerging markets group to spend more time understanding their supply chains in Africa instead of the product hand-off model they currently use. The company is starting a small project to look at this. Another student in big pharma is showing keen interest in his emerging markets supply division instead of North American and European market supply chains.
Does this remarkable cascade of social value – the goodness multiplier – always happen when those in business are brought into the conversation about development challenges? No. But my recent experience – with Prashant, with the incredible dedication of Covington & Burling’s John Hurvitz to development of the Advance Market Commitment, with the commitment of Eli Lilly’s Gail Casell around drug resistance – has convinced me of the value of meaningful involvement of the business sector in advancing global health. Thanks for the update, Prashant. Looking forward to seeing what you (and your students) do next!


CGD blog posts reflect the views of the authors, drawing on prior research and experience in their areas of expertise. CGD is a nonpartisan, independent organization and does not take institutional positions.