Healthcare for the bottom of the pyramid

Healthcare for the bottom of the pyramid

Article Type: Guest editorial From: International Journal of Pharmaceutical and Healthcare Marketing, Volume 9, Issue 3

It gives both of us immense pleasure to introduce to the readers of International Journal of Pharmaceutical and Healthcare Marketing, the special issue on “Healthcare for the Bottom of the Pyramid”. There are four insightful research articles related to different aspects of healthcare management at the bottom of the pyramid (BOP). Two papers are based on BOP consumers in India: one is based on BOP in Mexico and the fourth is based on a social enterprise in Argentina.

The first article, titled “Business model innovation: learning from a high-tech-low-fee medical healthcare model for the BOP” by Jaqueline Pels and Thomas Kidd, develops a framework by including the environmental characteristics present in most emerging markets, while adopting a bottom-up perspective. Using a single case study on SER-CEGIN, an Argentine social business offering high-quality medical healthcare at the BOP, the authors present a new conceptualization on business model innovation that includes: firm-, environment- and customer-centric dimensions. The framework incorporates the social profit equation, the general and task environment and the end-user, as well as the dynamics between them. Thus, the paper contributes to literature on business model innovation as well as the healthcare management literature at the BOP. The article highlights that to achieve economic and social goals at the BOP, firms need to adopt a bottom-up approach to understand the components of their business model which need to be modified.

In the second article, titled, “The effect of media exposure on contraceptive adoption across poverty line” by Manoj Motiani, Kapil Khandeparkar and Pinaki Roy, the authors explore the effect of mass media exposure on contraceptive adoption by women to determine how factors such as education and standards of living differentially affect the contraceptive use across the poverty line. The authors use logistic regression to test the effect of exposure of various mass media on contraceptive adoption, using a large dataset from the Indian Human Development Survey (2005). Exposure to television was found to have a significant impact on the likelihood of contraceptive use by families. Newspaper readership was also found to have significant effect in the above poverty line sample but not in the below poverty line sample. The results from the study have a huge impact on how healthcare marketers and policymakers can design effective media mix strategies for increasing the contraceptive use in below poverty line consumers in India.

In the third article titled, “Socioecological determinants of mammography screening in Mexican rural areas”, by Ana Paola Sanchez-Lezama, Judith Cavazos-Arroyo, Cidronio Albavera-Hernández, Aarón Salinas-Rodríguez, Mario Lagunes-Pérez, and Beatriz Perez-Armendariz, the authors, in the context of Mexican female healthcare consumers in the age group of 40-49 years, determine the socioecological factors that encourage them to participate in mammographies rather than avoiding taking the test. This study uses data from the 2007 Rural Households Evaluation Survey (ENCEL-2007), and analyzes it using the framework proposed in the Spatial-Interaction Model of Mammography Use (SIMMU), through a three-level logistic regression model to examine the likelihood that a woman will choose to participate in a mammography. The authors find that at the woman-household level, the completion of the Pap smear and the asset index are the strongest determinants of mammography participation. Obtaining preventive medicine services or being enrolled in the Popular Insurance System prevent women from undergoing screening. At the individual level, the BOP consumer is less likely to go for screening with lower social coverage. At the intermediate level, availability of health centers was also found to be negatively related to the use of screening. The article throws light for policymakers, health planners and social marketers to approach social change and promote the cancer screening health behavior through appropriately designed marketing mix strategies in their programs.

In the fourth and final article by Prabhat Dwivedi, titled, “Improvised Model for BOP Healthcare in India: Lessons from NRHM”, the author develops an improvised sustainable healthcare model by integrating best practices, innovations and new dimensions on the basis of India’s largest rural healthcare program-National Rural Health Mission (NRHM) for improving the health status of the bottom of pyramid (BOP) population in India. Some unique proven models of excellent healthcare services and innovations have also been considered in designing an improvised healthcare model. The empirical context includes the use of case study research methodology. Data have been extracted from various relevant papers, reports and Web sites. The author reports that, despite substantial augmentation in health infrastructure and human resources, increased local engagement and technology integration, the progress in health indicators during the NRHM has not been significantly better than that before. The improvised model presented in the article attempts to integrate all important stakeholders such as government, private healthcare service providers, pharmaceutical and insurance companies, as well as the BOP community itself to ensuring 5As rather than 4As in rural healthcare.

All in all the four papers complement each other very well and form a comprehensive package on healthcare delivery and policy-making for poor healthcare consumers in developing and under-developed markets in the world. We hope the special issue would add value to policymakers and healthcare marketers, as well as those in the social marketing space.

Avinandan Mukherjee, College of Business, Clayton State University, Morrow, Georgia, USA

Ramendra Singh, Department of Marketing, IIM Calcutta, Kolkata, India