Before HBS, I moved to Kenya so that I could work on critical infrastructure projects and help build the foundation of countries. While contributing to some of the largest energy and transportation projects in the region was rewarding, I realized that none of the projected development would materialize without a healthy population. It became clear that global health was an integral component to development and that an “investment in human capital, partly through global health, is a prerequisite to inclusive economic growth” (Former president of World Bank, Jim Yong Kim). This summer I sought out to test a hypothesis of mine that led me to apply to business school: that the skills developed through an MBA could contribute to solving some of the world’s toughest global health issues.
Going into my MBA program, I was familiar with the World Health Organization’s (WHO) list of the 16 essential services for human life. I knew that half the world does not have access to these essential services: 100MM people are pushed into extreme poverty because of health expenses (living on $1.90/day), and 800MM people spend at least 10% of their household budget on health expenses. What these statistics told me was that this was not so much an R&D problem, given that the required products and services were already developed and created, but rather an access and delivery problem. The bottleneck was a lack of innovative financing, supply chain, delivery, and procurement solutions. These were areas I believed an MBA skillset could be of use and the Social Enterprise Summer Fellows Program has allowed me to prove this.
This summer I have the privilege of working for the Clinton Health Access Initiative, Inc. (CHAI). CHAI was founded in 2002 on the principle that is was morally unacceptable that millions of people were dying each year of AIDS in Africa, Asia and the Caribbean while treatment was readily available in wealthier countries. They did not accept the arguments, often made at that time, that treating people with AIDS in resource-poor settings was too expensive or too complicated to be successful. Consequently, they started with a focus on scaling care and treatment to help save the lives of people infected with HIV/AIDS in low-resource countries.
While CHAI has since expanded its work beyond HIV/AIDS, my summer project is focused primarily on HIV testing in low-resource settings. Specifically, my role has been to design a tool to help key partners, funders, and ministries of health find the optimal mix of testing tools to reach the global 90-90-90 targets. The 90-90-90 targets were launched by the WHO and UNAIDS in July 2014 to accelerate the fight against HIV/AIDS. Their aim is that 90% of all HIV-infected people will know their status, 90% of all HIV-diagnosed people will be on treatment, and 90% of all people receiving treatment will achieve viral suppression.
While access to HIV Testing Services (HTS) has expanded exponentially over the last decade, less than 75% of People Living with HIV (PLHIV) know their status. This large gap in the first 90 target severely limits the progress that can be made by addressing the second and third targets in order to meet the ultimate goal of ending the HIV epidemic. Therefore, continuing testing with a “business as usual” mindset will not be sufficient. There is a need to optimize existing testing approaches but also consider innovative testing approaches and products to accelerate progress towards the First 90.
We hypothesize that the 25% of PLHIV that do not know their status, and are consequently not receiving lifesaving treatment and further spreading the disease, are not testing for one of three reasons:
- Stigma: there is significant stigma around HIV and an association with homosexuality that has life threating consequences in some of the countries where we operate
- Access: people may have limited access to testing facilities and other essential resources
- Education/Awareness: people may be unaware that they need testing
The tool I am creating this summer takes these possible reasons for not testing into account and looks at how new innovative products like self-testing tools can be applied. I am leveraging my accounting knowledge to do a deep dive into the cost of various product mixes. I am using Technology and Operations Management (TOM) skills to assess and quantify the impacts of healthcare workers’ time savings that can be realized under a variety of scenarios that were developed using a human-centric design approach. This information is then fed into an investment case that will be presented to a variety of stakeholders, including the U.S. President’s Emergency Plan for AIDS Relief (PEPFAR), the Bill & Melinda Gates Foundation, and several ministries of health in Sub-Saharan Africa. Once we get buy-in from donors that self-testing products can make a meaningful difference towards the first 90, we hope to secure volume guarantees from ministries of health. These guarantees, in turn, will help bring down the cost of self-tests by increasing manufacturers and suppliers’ appetite to provide volume discounts. It is uncanny how many of these objectives and issues were covered through various cases, albeit often through a different industry or sector.
This summer experience has reinforced my belief that business skills have a large role to play in the global health field. Treating this project like a case, I have felt confident expressing my ideas in front of diverse groups of experts all passionate about finding an optimal solution to an important cause.