Case study in Nonprofit Healthcare: Drugs for Neglected Diseases Initiative

nonprofit healthcare accelerates drug development while lowering costs

For social goods like health care, the buyer and the end consumer are often two different parties.  In much of health care, an insurance company or a government agency is the buyer, while the individual patient is the end consumer. At least in the United States, for-profit medicine companies exploit this split. They charge large organizations much higher prices than an individual consumer could afford. At they same time, they obscure the price of urgent treatments from patients. One way to avoid this exploitation is using nonprofit healthcare models.

Global treatment of hepatitis C provides a study in contrasts between for-profit and nonprofit healthcare.

The Cost of Hepatitis C

As described in this Iflscience article, hepatitis C is a viral infection that is transmitted by blood-to-blood contact. The virus can persist in the human body indefinitely. Such persistence leads to a chronic disease marked by fatigue and the potential for liver cancer.

Worldwide, approximately 71 million people are currently infected with hepatitis C. Three-quarters of infected people live in low- to middle-income countries. In 2016, 400,000 patients died and only 2.5 percent of those infected received treatment, despite the availability of drugs to cure the disease.

The problem: the price of treatment.

Before 2014, treatment for hepatitis C required months of daily pills and weekly shots, and still wasn’t very effective. Then, oral antiviral drugs came to market that were highly effective with few side effects. The price for these drugs is $80,000 for a course of treatment, even though they are not costly to manufacture and distribute.

Let’s put that price tag in perspective. It’s more than the average annual household income (find new link) in all but the richest ten countries in the world. And remember, 75 percent of hepatitis C patients live in low- to middle-income countries.

Clearly, the for-profit makers of the current antiviral drugs are exploiting the split between the buyers and the end consumers. The result is that most patients receive no treatment.  Health systems that do provide treatment spend a disproportionate part of their budget on these drugs.

A nonprofit healthcare approach could change the incentives in hepatitis C treatments and lead to more, and more affordable, treatment.

Affordable Drugs for Neglected Diseases

The Drugs for Neglect Disease Initiative (DNDI) is a nonprofit healthcare research and development organization. They currently target seven diseases around the world, including hepatitis C. Seven founding organizations from around the world, including the World Health Organization and Doctors Without Borders, came together 15 years ago to form DNDI.

They have pioneered combining a new antiviral drug with another existing medication to treat hepatitis C. In clinical trials, their combination proved 97 percent effective in wiping out even severe cases of the disease. The best part is their ability to deliver a course of treatment in a middle-income country like Malaysia for just $300. That’s less than one half of one percent of the for-profit price. (Compare this to household income.)

A Marketing Mindset for Nonprofit Healthcare

How does a marketing mindset help DNDI succeed? Here are five ways.

  • They invest in market research to guide their mission, strategy, and tactics. For example, DNDI’s website states, with cited evidenced, that “Neglected diseases continue to cause significant morbidity and mortality in the developing world. Yet, of the 850 new therapeutic products approved between 2000 and 2011, only 4% were indicated for neglected diseases, even though these diseases account for 11% of the global disease burden.” This market shortfall leads them to focus on opportunities to alleviate neglected diseases. Check out their portfolio of projects.
  • They are savvy about business models. For example, their downloadable business plan describes various business models they employ: knowledge sharing, advocacy, advising, platform building, business incubating, and full-fledged research and development. They then match up the business model to the market need, to make the most impact for the efforts.
  • They are driven by the needs of patients. This aligns with the design principle of creating with, not for, your clients and customers.
  • Their policies focus on creating equitable distribution. In any form of marketing, distribution is a core concept and activity.
  • They develop drugs as public goods when possible.

Want to know more about DNDI’s marketing mindset and nonprofit healthcare? Download their ten years of lessons learned in treating neglected diseases.


(Image courtesy of Flickr)


Designing Immigration Solutions

Designing immigration solutions

In the United States, there’s an immigration problem. People are coming to our borders seeking refuge from war, terrorism, gang violence, and climate change. Many more people come than our current immigration system will accommodate. Instead of debating the partisan politics of this issue, let’s look at how a marketing mindset guides us in designing immigration solutions.

Immigration in the US: All Messed Up

It’s hard to miss the dysfunction in the US immigration situation:

  • According to the Pew Center, there are roughly 11 million undocumented people living in the US. You don’t get to 11 million people overnight, so immigration has been a problem for a while.
  • The US workforce is not growing organically. The Pew Center highlights the declining number of US workers born of US parents. We need a functioning immigration system to allow the flow of new labor, both skilled and unskilled.
  • We already have a problem with an aging workforce. According to a US Senate report, more than 35 million US workers are over 55. That number will increase to 42 million by 2026, and equal a quarter of the workforce. To avoid the problems that Japan is experiencing with an aging population not augmented by immigration, we need new immigrants.

So, we need immigration for key economic reasons, but have a messed up immigration system. It’s time to design a new immigration system.

Marketing Research in Immigration

Market research informs system design. Consider these market measures:

Clearly, we have an immigration system that cannot keep up with demand.

What factors are driving demand in immigration? Immigration scholars refer to “push” and “pull” factors. Conditions that push people out of their countries include war, terrorism, gang violence, and climate change. Factors that pull people towards the US include economic opportunity and relatives already residing in the country.

Our question then becomes, do we want to increase immigration capacity to meet demand? Or do we want to decrease demand to match our desired immigration capacity? This is the real split on immigration in the US. We don’t agree on which approach we want. Marketing gives us guidance on both approaches, and which one to take.

Designing Immigration Solutions to Decrease Demand

In marketing the social good, at times you seek to decrease demand. Think of smoking cessation or teen pregnancy. This rarely occurs in the private sector. There, even smoking cessation means pharma companies selling more addiction treatment, not the cigarette companies asking people to smoke less.

What marketing tools do we have to decrease demand?

We know that good marketers design systems, not things. We could design a system to reduce the push factors of immigration. Given the absence of push factors, most people would choose to stay in their communities. Why else would they endure the risk and hardship of immigration? Such a system could include promotion that educates potential immigrants on the realities of immigrating to the US. It could also include programs to reduce the impact of war, terrorism, gang violence, and climate change in other countries.

(To me, this is where the rhetoric  of “building a wall” falls short. A wall is just a thing; it’s not a system.)

Marketing decisions often include pricing: what can and should we spend outside our borders to reduce push factors? How should we pay for it? The US is growing increasingly reluctant to give foreign aid. If we see such spending as funding immigration reduction, we might look at it more favorably.

Designing Immigration Solutions to Increase Capacity

One of our design principles in marketing is designing with, and not for, your customers. From what I’ve seen, immigrants aren’t asked how they think the system could be more efficient. The same goes for border agents, immigration judges, and advocacy and nonprofit groups. Let’s get them all involved in the solution.

Part of being more efficient is making government more digital. If you look at immigration through a digital lens, it comes down to membership and logistics.

Who do you want as a member of your country? At what level of membership? How do you accept, process, and police membership requests and status? Digital companies like Amazon and NetFlix and Facebook handle billions of members. Granted, legal status in a country is much more complicated than registering for NetFlix. Still, government could learn a lot from the experience of digital membership.

The same goes for logistics. Become a lawful resident in a country involves a lot of logistics about moving to a community, acquiring housing and employment, learning language and culture and job skills. All of these tasks have become digitized for easier delivery at scale. That’s what we need for higher immigration capacity.

Another part of efficiency comes from adopting lean methodologies in the social sectors.

Sticking to Brand

I don’t doubt our ability in designing immigration solutions. All the approaches described here are already implemented at large scales in various parts of the public and private sectors.

In my professional and personal life, though, I’ve seen that deciding what to do is often harder than actually doing it. When any organization faces a hard choice, it should look to its brand for guidance.

A core part of the US brand is immigration. The immigrant experience is part of our narrative, from Plymouth Rock to Ellis Island. The world perceives the US is the top destination for immigrants, despite the current environment.

Over centuries, the US has become the country it is today through immigrants. Much of the current US population has an immigrant past; Native Americans comprise just two percent of the population. Yet somehow, we don’t view immigration as something that we can and should excel at.

Once, I worked for a company that used corporate acquisitions to grow from fewer than 1,000 employees to more than 10,000 employees in less than ten years. Yet somehow, they didn’t list acquisition as a core competency for the organization. Just think how they could excel if they treated acquisition as a core skill? I feel like that’s where we are in the US regarding immigration.

Brand values should guide decisions. I think our brand moves us to improve immigration capacity to better meet demand. If we seek to limit our immigration capacity, I think we are essentially betraying our brand. A marketing mindset says that we should stick with our pro-immigration brand. It’s taken us from a few colonies to world leadership.


(Image courtesy of Wikimedia)

Free Download! Service Design Workshop Materials

Host your own free service design workshop

There’s huge opportunity in improving the design and distribution of government and nonprofit services. This is doubly true for making services more digital. How do you get started? Begin with a service design workshop. Read more and download free workshop materials.

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Design Better Mass Transit with Systems Thinking

We need ways of designing better transportation systems.

As U.S. cities grow more gridlocked and Millennials adopt mobility services like Uber out of desperation, transit becomes a crucial social good. Without the ability to easily move people and goods, cities become paralyzed. We need a way of designing better transportation systems.

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Want to Change the World? Use Marketing to Change Local Regulations

“That’s the way we’ve always done it.” More stifling, even deadly, words are hard to find. Changing the way we look after the social good can be hard. It pays to start small. You may not sway an entire country, but you can impact your community. It often starts when you change local regulations.

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Marketers Create Systems Not Things For Improving The Social Good

create systems not things

Plenty of people, including public sector marketers, think design means making things look cool or trendy or pretty. However, looking good is only a by-product. Design is the thought and intention behind creating a product or service that succeeds in filling a need. To ensure success, true marketers create systems not things.

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With, Not For: Nonprofits and Client-Centered Design

nonprofits and client-centered design

If you design goods and services for your clients, instead of with them, you are forced to make assumptions. Inevitably, your assumptions will be wrong. With bad assumptions you risk your goods and services not meeting your clients needs. That means you are wasting your time and money, and your clients’ time and money. With basic needs like health and sanitation, you are also be risking your clients’ lives. At the intersection of nonprofits and client-centered design lies fulfilling your mission for your clients.

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Turning Bright Spots Into Products and Services

Turning Bright Spots Into Products and Services

Look for bright spots of success and hope among your market audience, and you may find your next big idea. Here are lessons from a story about how one underfunded aid worker used turning bright spots into products and services to change a nation.

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Increase Your Public and Social Sector Impact Through Lean Methodologies

Lean production principles can transform public and social sector
We love picking on the DMV, don’t we?

In the US, public debts keep mounting, taxpayers keep insisting on lower taxes, and vital services and infrastructure keep declining. We need to find a new way of designing and paying for government. Cost cutting isn’t enough. We need transformation. Lean production principles can transform public and social sector work.

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Impact Investing: Return on Investment From Marketing Social Goods

Impact Investing

Can you do well while doing good? This is the ultimate question for marketer the social good. Doing well in the public and social sector means more than just money. Earning money leads to sustainability and scale, two qualities that communities desperately need and funders desperately seek.

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