When in 1995 entrepreneur Jeff Bezos launched Amazon.com from his garage in Seattle (USA), fewer than 1 in 200 people worldwide had internet access and online shopping was just a year old. Today, Bezos’ innovative website has made Amazon.com the world’s largest online retailer, with $60 billion in annual sales – $170 million a day. Online shoppers see Amazon.com as their primary interface—this is the technology innovation. Amazon.com and its accompanying vast information technology capabilities can predict what we want. It catalogues our searches and purchases, and gives us suggestions of what we want.
A brilliant example of the power of technology innovation – right? Only half right. What we don’t see is actually more profound: it’s the power of partnering technology innovation and systems innovation. If you thought Amazon’s secret sauce was simply the technology innovation, think again. In fact, it’s the systems innovation that makes Amazon work.
The Amazon.com website is the technology hub that links four “sub-systems”: consumer service, product vendors, warehousing, and distribution (see diagram). More than 150 million customers are served by websites and call-in centers in over a dozen countries. Starting first with books, then compact disks, Amazon now handles millions of products from virtually every shippable and downloadable category of consumer goods. Through process improvements in distribution and warehousing, Amazon has made it possible to deliver virtually any product within two days—in some cases, less.
In addition to its 41 “fulfillment centers”, Amazon is pursuing further process improvements that are true game changers. For example, to decrease shipping times and further reduce errors, Amazon bought a company called Kiva Systems that builds “picking robots.” And in major cities, Amazon has begun to build automated lockers in drug stores and convenience stores for same-day ordering and pick-up while shopping or returning home.
In short, what began as a creative technology innovation when the internet was still in its childhood has become a stream of interconnected technology and systems innovations that has led online sales across the globe and an unprecedented 15-fold increase in Amazon’s value from 2001-2011.
As global health practitioners, we might ask: can the Amazon model of partnering technology innovation and systems innovation improve the health of those who are in the most need? The answer is a resounding YES. Dr. Sania Nishtar – founder of Pakistan’s non-profit NGO think tank, Heartfile – was following in Jeff Bezos’ footsteps when she launched Heartfile Health Financing to help the poorest of the poor in Pakistan gain access to essential health services.
Like Amazon, Heartfile Health Financing is much more than a website and app on Dr. Nishtar’s iPad. The Heartfile Health Financing website is “integrated with a custom-made technology platform that enables processing of requests, received through registered service requesters. Heartfile (the clearing house) will then ascertain eligibility, verify requests and subsequently authorize cash transfers to underwrite the cost of healthcare.”
Heartfile Health Financing can be seen as the Amazon of healthcare financing and care provision in Pakistan. The technology platform links together all of the systems components that are necessary for the provision of quality care to the poor. Patients are screened for eligibility through a poverty registry and verified through a system of well-vetted volunteers. Those eligible receive the treatment that they need. Families are protected from medical impoverishment.
Service providers quickly and efficiently receive payment for often costly treatments and surgeries. Funding is targeted to those who fall below the established poverty marker. The system provides funders, initially the Pakistan Poverty Alleviation Fund, with transparency. They can even track the use of their funds to individual services. The potential for corruption and abuse is mitigated by the eligibility verification system. Everyone wins.
In 2012, Dr. Nishtar approached Management Sciences for Health to explore taking the Heartfile model to Africa as part of a Clinton Global Initiative commitment with the Aspen Institute and Parkistan Poverty Alleviation Fund. As we looked together at the potential, we saw that, like Amazon.com, the Heartfile Health Financing model presented an exciting range of potential applications. This is especially true in the context of the accelerating movement for universal health coverage.
Instead of thinking of beneficiaries only as individual patients, we could think of them as families in Rwanda needing payment for their community health insurance. Instead of thinking of providers only as doctors and hospitals, we could also think of providers as the full range of service providers, including licensed drug sellers in countries like Ghana and Tanzania. Instead of thinking of the governance function as just the Heartfile health financing team and the volunteers checking eligibility, we could think of the national or local health services or social health insurance programs. And a wide range of funding sources could be tapped, from a wide range of sources, from national value-added taxes to local employers to international donors to individuals in other countries. Imagine, as part of universal health coverage, families in Tokyo or Paris, paying the healthcare costs of families in Mumbai or Kinshasa.
From polio vaccine to bed nets, new technologies have changed global health. In a tech-driven age, we are attracted to new products and technology. However, a technology innovation won’t fix the problem alone. Heartfile’s website, like Amazon’s, succeeds because of the systems innovations – new ways of organizing people, processes, and resources to achieve greater scale. The end result is a patient who receives the health care that he or she needs without incurring catastrophic debt. Together, technology and systems innovation can lead to stronger health systems generating greater health impact.
Dr. Jonathan Quick
President & CEO
Management Sciences for Health