written by Tracy Kim Horn, Community Manager, Forum for Growth & Innovation

A funny thing happened to my vision when I started working in academia a couple of months ago: the world that used to appear confusing, chaotic and sometimes random suddenly began to look more like a planned city — mostly organized, generally predictable, and always navigable. The more exposed I’ve become to causal theory, the backbone of the elective course Building and Sustaining a Successful Enterprise (BSSE) at the Harvard Business School and the research upon which the Forum for Growth and Innovation was founded, the more clear it has become to me that once you figure out how to define the “categories,” actions and behaviors in the world that once seemed unpredictable suddenly become rational and (almost) expected.

That theories developed and furthered at the Harvard Business School can help well-educated executives with their company’s big problems may seem tautological, but as someone who’s had the to work alongside Tom Bartman, a researcher who is deep in the weeds studying why big companies struggle to innovate their business models, I would be remiss if I didn’t acknowledge how incredible it has been to observe Tom ignite meaningful discussion between the nine very different industry-leading companies in his research cohort on how to solve some of their biggest problems around growth.

But what has really been eye-opening to me is the applicability of these very same theories to an entirely different population: the lives of 95% of the 160 million Nigerian people who live on less than 20USD a day. The sheer breadth of this statistic alone ensured that when researcher Efosa Ojomo landed in Lagos last week, there would be no shortage of “nonconsumption,” the absence of product users due to high cost, or opportunity for innovation at the “low end,” two phenomena common to those familiar with disruption theory.

What seemed less guaranteed to me, however, was the potential for other theories we commonly use in BSSE — for example, theories around what a business model is (and isn’t) or about weighing interdependent vs. modular architectures — to be relevant to a society where stores often don’t have four walls, the electricity is siphoned off a line from a nearby well-to-do residence, and, frankly — they look like this:



Efosa reported back to us early on:

Governments and private sector players build huge hospitals but when people get sick, here is what they do:
1. Go to pharmacy for fever drugs. If I get well, I move on with life. If not, I go to a diagnostics center for tests (typically blood tests).
2. Get results from tests and then go to pharmacy to get results read and drugs prescribed.
3. If I take drugs and get well, I move on with life. If I don’t get well then I go to the hospital.

At first, I read this and was disheartened: the developing world is treating the symptom, fever, rather than its cause, I thought. But then I remembered what Clay wrote in The Innovator’s Prescription about the potential for new technology to accelerate the delivery of healthcare from the expensive custom solution shop business model of doctors to the realm of precision medicine administered by nurse or nurse-practitioners — or, as Efosa has seen happening in Nigeria — by pharmacists. And then I began to wonder: with the benefit of healthcare technology being at a more advanced stage today than when the current expensive and inefficient US healthcare system was built, could Nigeria leapfrog the US and build a more economically viable healthcare system?

The huge hospital that helps patients with their complicated, never-seen-before problems certainly has an important role to play in the healthcare system. But what if governments, private sector players, and other organizations desperate to help Nigeria instead concentrated on building hospitals of the “value-adding processes” variety? Or if there was a greater emphasis on providing the requisite education and training to empower more pharmacists to open shop around the country? Or, in the language of disruptive innovation, empower those same pharmacists to move “up-market” and tackle bigger medical problems, and thus continuing the decentralization of health care delivery in an effort to keep it affordable?